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Dr. Andrew Rynne

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MRI showed moderate C6-C7 foraminal stenosis. Experiencing weakness and shoulder pain. What's wrong?

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Dr. Rahul D Chaudhari

Spine Surgeon

Practicing since :2002

Answered : 322 Questions

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Posted on Fri, 8 Feb 2013 in Osteoporosis
Question: My MRI report show moderate left C6-C7 foraminal stenosis and mild flattening of the ventral cord surface. The right neural foremen is adequate. I am experiencing tricep weakness and shoulder pain primarily in my right side. Is this explained by the flattened ventral cord surface?
The full description related to C6-7 is as follows: there is moderate disc narrowing and desiccation. There is mild anterior spurring. There is also mild posterior spurring and disc bulging measuring approximately 2 to 3 mm in AP extent. This is abutting the ventral cord surface which appears slightly flattened. Cord signal is normal. The central canal is mildly narrowed, measuring in 9 to 10 mm in AP dimension in the midline. The right foramen appears adequate. There is moderate left foramen stenosis due to unfit uncinate hypertrophy.
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Answered by Dr. Rahul D Chaudhari 11 hours later
Hi,

Thanks for the query. You are having a C 6-7 disc prolapse. In cervical spine, if you get symptoms such as feeling of tightness in legs, feeling of imbalance while walking, tingling and numbness in both hands all the time. If you have one sided arm pain with specific muscle weakness as you suggested, then it indicates the nerve root compression (C7 nerve root in your case). From the description it looks like you have compression of the nerve root and not the spinal cord. Initially, we always try to treat it conservatively with medicine and physiotherapy. However, if you have significant weakness, then you may need decompression surgery.

Hope I have answered your query. Let me know if I can assist you further.

Regards
Above answer was peer-reviewed by : Dr. Mohammed Kappan
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Follow up: Dr. Rahul D Chaudhari 4 hours later
I am aware of the general information you provided. My question is related to the fact that the symptoms are primarily on the right side, while the MRI indicates foraminal narrowing on the left but adequate foraminal opening on the right. Do you see anything in the MRI results that would explain the weakness on the right?
doctor
Answered by Dr. Rahul D Chaudhari 15 hours later
Hi,

Thanks for the clarification.

I understand your concern. In regards to your first question, I don't think that the ventral flattening can cause a weakness in your right side. The symptoms as explained earlier. But, right side weakness points towards a nerve root compression.

To explain the right sided weakness, it is important to co-relate your clinical findings with the MRI. The given details do not explain the weakness on your right. A proper clinical examination can help in understanding the pathology behind.

I would like to know few more things as this would help me in suggesting you better.

- How significant is the weakness?
- Have you been examined by the spine specialist?
Sometimes pain may contribute to weakness.
- How about the other levels in the spine? Are they normal?

If possible please upload your MRI images and examination findings. Please let me know if I need to simplify or clarify any part of my answer.

Thanks.
Above answer was peer-reviewed by : Dr. Mohammed Kappan
doctor
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Follow up: Dr. Rahul D Chaudhari 12 hours later
I tried to upload MRI images, but was unsuccessful.

In answer to your questions:

- I have had issues with my right shoulder and arm for many years. I first noticed the tricep weakness in October when doing some yoga. Since then it has become much more pronounced. I would say it is at least "moderate". I am fairly certain the C7 nerve root is compressed somewhere, because it feels like a string is being pulled tight through my shoulder, down the back of my arm to the elbow and then around the front of the arm to the center of my wrist. When using the arm, I feel fatigue along this path. I also have some weakness on the outside portion of my hand leading to the thumb.
- I have had one appointment with the neurosurgeon who did my original fusion 12 years ago. He prescribed Relafen, gave me exercises and ordered the MRI. My follow-up visit with him is on 3/5. I was just doing some research in advance of the appointment.
- the radiologist report notes minor findings at other levels but nothing of real significance.

My MRI findings always seem to suggest issues on the left side, but my symptoms have always been on the right. I know that I broke my collar bone as a child and am now wondering whether the nerve could be compressed as it runs past my collarbone. Could that cause pain in the shoulder radiating up toward the neck as well as the nerve issues in the arm?
doctor
Answered by Dr. Rahul D Chaudhari 37 hours later
Hi,

If the clinical judgement says you have pain and weakness on right side then we need to investigate further.

Without an opportunity to look at the MRI reports or examining you clinically, I would not be able to relate the exact location. However if the MRI report is inconclusive we may have to do EMG and NCV test which can give us more idea about the location of nerve pinching - whether in spine or along the course of the nerve.

If we suspect anything towards brachial plexus then we may have to do MRI of the shoulder and brachial plexus. Shoulder and Brachial plexus MRI scan will surely tell us if the problem is located at this region.

I would encourage you talking with your current orthopedic and consider the aforementioned tests.

Regards

Above answer was peer-reviewed by : Dr. Prasad
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