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    Suggest a non-evasive course of action for brachial plexus neuralgia

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Posted on Wed, 27 Aug 2014 in Back Pain
Question: Hi, 1 month ago, due to illness and subsequent dehydration, I passed-out in the shower. Doing so, I hit my head/neck on the shower inclosure seat. Since then, I've experienced consistant Brachial Plexus Neuralgia (right arm and shoulder). A CT scan then MRI was performed. The results follow. QUESTION: What would you recommend and is there a non-evasive course of action.

Narrative
INDICATION: 55-year-old male with right upper extremity radiculopathy.

EXAM: MRI CERVICAL SPINE WITHOUT CONTRAST. Sagittal T1, T2, and STIR
sequences were obtained in addition to axial T2-weighted images.

EXAM DATE: 8/5/2014 3:29 PM

COMPARISON: CT cervical spine July 11, 2014

FINDINGS: No evidence of altered osseous signal intensity or
vertebral body loss of height. Multilevel degenerative disc disease
greatest at C4-C5 and C5-C6.

Cerebellar tonsils are normally located. Cervical cord caliber and
signal intensity is within normal limits.

C2-C3: Unremarkable.

C3-C4: Prominent uncovertebral hypertrophy on the right with
associated right lateral recess effacement and probable mild to
moderate exiting nerve root impingement. Correlate with exam.

C4-C5: Bulging disc osteophyte complex with bilateral uncovertebral
hypertrophy and left greater than right neuroforaminal stenosis.
Severe left and moderately severe right neuroforaminal stenosis upon
comparison with recent CT. Mild superimposed acquired central canal
stenosis.

C5-C6: Bulging disc osteophyte complex with bilateral uncovertebral
hypertrophy and bilateral neuroforaminal stenosis, left greater than
right.

C6-C7: Minimally bulging disc osteophyte complex with mild right
neuroforaminal narrowing.

C7-T1: Unremarkable.
Impression
IMPRESSION: Multilevel degenerative disc disease.

Multilevel uncovertebral hypertrophy and neuroforaminal stenosis
worse at the left C4-C5 level.

Focal uncovertebral hypertrophy at the right C3-C4 level with right
lateral recess effacement. Correlate with exam.
doctor
Answered by Dr. Mukesh Chugh 41 minutes later
Brief Answer:
Clinical findings is of more value than MRI

Detailed Answer:
Hello
Thanks for posting
I have gone through your query and understand your concern. The MRI and CT finding are suggestive of age related degenerative changes they may occur somewhat early in some people. Clinical examination and symptoms are of more importance than MRI/CT report. As you can see in the MRI report which is suggestive of changes in left side while you do not have any complain in the left limb?
Please tell me-1.How is your grip strength in right hand as compare to left hand?
2. Is there any numbness in right limb along with weakness?
For now my suggestion would be-Avoid heavy weight lifting, gentle neck and shoulder exercises, pain killer drugs (Ibuprofen) along with muscle relaxant (thiocolchicoside) and for radiating pain you may have drug pregablin.Except Ibuprofen other drugs are prescription only so you may have to contact your local doctor.

Hope this answers your query and I shall be glad to answer any further query.
Take care

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Mukesh Chugh 1 hour later
Hi, RE: Please tell me-1.How is your grip strength in right hand as compare to left hand? I think you may have guessed, I am a body builder. (Right hand) grip strength is unaffected, however any direct right tricep pressure (flexion) causes nerve pain. When extending right arm for any lift, the muscles "short circuit" at about 1/2 to 3/4 motion. Right arm strength has weakened considerably. My bench press has gone from 375lbs to 135lbs, with inability to push to full extension. A right hand triceps push is 15 lbs (right) vs 55 lbs (left).
2. Is there any numbness in right limb along with weakness? Not so much numbness, more a consistent nerve pain. Not so much in my back and neck, but generally feels like a nail in my right tricep and forearm, sometimes throbbing. Relative intensity varies from 5 to 8. It was at a 10 level, until I started receiving decompression treatments from my chiropractor. I noticed a marked improvement (10 to 8) after my first visit, no changes with subsequent visits.
doctor
Answered by Dr. Mukesh Chugh 7 hours later
Brief Answer:
Drug pregablin will help along with rest to arm

Detailed Answer:
Hello
It's good to see you.
I have gone through your reply carefully and have following suggestion for you-
1. Rest to arm, Ice fomentation and avoid lifting weights/bench press.
2.May have few days course of drug's as discussed earlier especially my favourite drug Pregablin(prescription only) to take care of brachialgia for few weeks (2-3).
3. Cervical traction under physiotherapist guidance may help.
I hope you will get over in 2-3 week time.

Hope this helps.
Take care

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Mukesh Chugh 11 hours later
Hi- My doctor has me on combination of Gabapentin and hydrocodone. What, if any, is the advantage of pregablin (Lyrica)?
doctor
Answered by Dr. Mukesh Chugh 35 minutes later
Brief Answer:
As follows

Detailed Answer:
Hello
I have gone through your reply carefully and though I use both of them,I prefer Pregabalin for neuropathic pain because-
1. It is more effective (potent) at a same dose level as of Gabapentin.
Because of the higher potency of pregabalin, a patient would need a lesser amount of this medicine to reach the same level of potency as a larger dosage of gabapentin. Another difference is that usually pregabalin can be absorbed by the body much faster than gabapentin. Because of the fast rate of absorption of pregabalin, it guarantees a more firm and stable ingestion of this medication.
2. Pregablin has lesser side effect and has higher patient acceptance rate as compare to gabapentin.I prefer Gabapentin for those who are diagnosed with Restless Legs Syndrome or RLS, and Post herpetic Neuralgia.

I have a lot of respect for your treating doctor. So, you may discuss this and follow his advice.
Wishing you good health.
Take care

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Mukesh Chugh

Orthopaedic Surgeon, Joint Replacement

Practicing since :1997

Answered : 1619 Questions

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