Well, Im a mess!

[RoadRaven]

Well, I'm not so funny as the other gals here...
but just wanted to say it is great to hear you have a diagnosis, because when you know the nature of the beast you battle, you can develop a plan of attack... and that gives you control over the situation

All the best in your way forward
awhi-awhi

[Duck on Wheels]

Hmmm. Sounds like Latin for pinched nerves to me. Which I guess makes sense with symptoms like tingling fingers ...? And the glimpse I got of you at Day 0 of ALC you definitely looked human, not degenerate at all But whadda I know. I never studied medicine; I only studied doctors at work.

[Xrayted]

Wow Snap. Just wow. Ok, I'm not a doc and never will be one but I do a lot of cervical xrays and work shoulder to shoulder with the spine docs during procedures. I've seen them do a wide range of things for people in your spot. So, here goes...

Osteophytes are bone spurs. We all get them, just a matter of when and how much. Think of it as arthrits in your neck. Repeated stress on the neck and shoulders (hate to tell you that biking is a big contributor to this), genetic predisposition, whiplash injuries and the like increase our risk of getting them worse. We can see them very well on xrays and then they do an MRI or CT to check out the soft tissue and nerve openings to see if they are possibly being impinged in any way. Since yours is affecting the C5,6,7 areas, I suspect that is where your arm pain has been coming from since that is where those nerves run to. They create problems in your forearms, elbows, down into your hands, sometimes making it hard to grip things. It says your right side is impinged more than the left (narrowing of neural foramen - holes where your nerves run through) which, if I remember correctly, is the side you are having difficulty with. There is a positive in all of this, I didn't see any mention of possible herniated discs. That is a very good sign. That usually means no surgery needed.
The absence of the lamina of C1 is not likely related to any of your symptoms, just one of those things that happen on rare occasions. If it makes you feel any better, you probably made some young med resident's day by having that show up.

So, where does that leave you? Well, there are many degrees of good and bad when it comes to the spine and each person really is very different in what their body can handle. It also depends on how far along it has progressed before being correctly diagnosed. (Did the previous people even bother to do neck xrays. That should have been one of the first things to look at.)
They sometimes try to start with therapy and NSAIDS to relieve the inflammation without using steroids. For a more advanced degeneration, they also can go in with a very thin spinal needle and inject steroids right where you hurt (this is where I come in, I show them the way) that will dull the pain and relieve your radiating symptoms. These usually last for 3-6 months and then you return for more. Some people do this for years and are very happy with it because it's an outpt thing and they walk out feeling like brand new in many cases with just a few needle holes to show for it. They can also do denervations which, in easy terms, is placement of a needle near the offending nerve (not your spinal cord), then they stimulate it to make sure that it's the correct one and then burn it off. (Just the sensory part, not the motor part. That's why they stim it first, to make sure they have it perfectly placed.) The only thing that people typically feel for either of these procedures is the pressure of the needle through the Lidocaine numbness. You could also have surgery to try to remove some of the spurring depending on where/how bad it is.
There are other, more invasive treatments and some easier ones that I haven't mentioned here due to my fingers starting to cramp , but you get the idea of the broad range of treatments out there. It all depends on your very specific circumstances and what you and your docs are willing to do to get relief. I've seen incredible results with the steroid and denervations stuff and wouldn't hesitate to do it if I needed it. Just make sure you pick a good doc that is an expert on them.

I'm including some pics that point out a bunch of parts that are in your CT report in case you wanted to get a better idea of where/how. The 1st one is AP (looking straight forward), the 2nd one is lateral (standing sideways), and the last one is an oblique (turned at a 45 deg angle).

Good luck on getting things to feeling right again. I'm anxious to see what you end up doing and how it all works out for you. I think you will be amazed how quickly you can get relief and get back your old routine.

(((Snap)))

[Wahine]

Hey Snap,

Congratulations on getting a reasonable diagnosis......finally. The C1 thinng is likely irrelevant. The degenerative changes are the cause of your arm pain (as X said), and are treatable. Depending on the degree, many times with conservative measures.

I'd assume you've been on anti-inflams for awhile since you were diagnosed with tendonitis before. So it's unlikely that NSAIDS will do the trick for you. They may try to put you on a stronger anti-inflammatory but those have some significant side effects you need to discuss thoroughly with the Doc or PA before taking them.

Other options include more PT but this time for your neck, not your arms. Mechanical traction is a very good option for a lot of people. At our clinic we loan out traction units on trial and patients buy them if they work well to manage the symptoms. Here's a link to check out:

http://www.medicalproductsonline.org/sacehode.html

I have many clients with the same diagnosis that do very well with a home traction unit, exercises and a little caution to aviod activities that irritate the neck.

As for the injections and denervations. The steroid injections do help and sometimes they can be effective long term. Denervations are helpful in cases where a lot of the pain is coming from the facet joints themselves. This is less likely to be the case for you. Also, they tend to be less effective in the cervical spine than they are in the lumbar spine.

The pain Docs that I work with would normally send you out for traction, preferrably a home unit, on trial and PT. Then if that didn't work they would do a steroid injection, trying different sites until they found the most effective location - this also gives them a far more specific diagnosis. If the primary area causing the pain is/are the degenerated facets, they would then do a radio frequency cauterization to allow for longer term pain relief. If the pain is predominently coming from the nerve roots, they would then consult with a neurosurgeon on other, more aggressive options.

Good luck and keep us posted. Rest assured that this is not an uncommon problem and there are effective treatments available to you now that you have an accurate diagnosis.