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Suggest treatment for acute pain in neck and shoudler

Answered by
Dr.
Dr. Praveen Tayal

Orthopaedic Surgeon

Practicing since :1994

Answered : 12004 Questions

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Posted on Thu, 19 Feb 2015 in Bones, Muscles and Joints
Question: My sister-in-law, Mrs XXXXXXX XXXXXXX in Belgium has developed an acute pain in the neck, left shoulder and in left arm due to hernia between upper vertebras. As per the CT scans doctors are suggesting the disc is slipping out between two vertebras which is pressurizing the nerve and causing a serious pain. The pain was so severe that they had to call emergency service last week. She had this pain in last week of December as well.

From past 2 days, she is feeling severe sensation and pain under shoulder and in hand above wrist. Even the pain killers are not helping.

There is no history of accident or serious trauma etc.

Currently she is on rest as much as possible. The neurosurgeon is suggesting to do surgery OR to take the injection (it is called Epidurale Infiltration cervical, ERA). We took the appointment for the injection for 18th February. Meantime we would like to have some other opinions whether this can be treated with any other alternatives, is there any harm in taking the injection, can yoga help or is there any medicine to cure etc.

The CT scan report (which is in Dutch but the nearest possible English translation) is attached as well. CT Scan can be viewed by :

1. Click on weblink :

https://beelden.zna.be/Pacsportal/loginaccesscode.aspx

2. Log in (in capital letters) : EHQL64YVY
3. Password : 05608

All the details of the CT scan and reports are available on this portal.

I have also mentioned below the English translation for the same:

"Clinical information: herniated disc?

CT volume centered at the levels of C4 to C7. findings:

Normal bone structure.

Saved vertebral heights.
Good wervelalignatie.

Normal discusaflijning level at C2-C3. Light uncartrose C2 C3 right with slight narrowing of the neuroforamen.

Light median discbulging C3-C4. Light uncartrosetekens with slight narrowing of the foramina.

Normal discusaflijning at level C4-C5. The foramina C4-C5 seem still preserved.

Light C5-C6 disc osteoarthritis. There is a degenerative disco osteofytaire bulging especially para median left with asymmetrical impression on durazak.

Light uncartrose C5-C6 right with slight narrowing of the neuroforamen.

Moderate osteoarthritis disc C6-C7. There is a definite localized disco osteofytaire bulging median - para median left with significant impression on the durazak.

Lichtgradige uncarthrosis C6-C7 with slight narrowing of the foramina.

Limited degenerative bone changes interfacettair on the investigated"
doctor
Answered by Dr. Praveen Tayal 34 minutes later
Brief Answer:
She is getting right treatment.

Detailed Answer:
Hello,
Thanks for posting your query.
Your sister in law is having a disc prolapse that is causing these symptoms.
Treatment includes
1. Use of cervical collar helps in immobilisation and brings relief.
2. Medical drugs like pain killers - acetaminophen/ibuprofen and muscle relaxants might be helpful.
3. Methylcobalamin supplements are also recommended for nerve compression symptoms.
4. Cervical isometric exercises are beneficial to maintain the strength of the neck muscles. Neck and upper back stretching exercises, as well as light aerobic activities, also are recommended under the guidance of a physical therapist.
5. Hot fomentation helps in relieving acute symptoms.
6. She can avoid using a pillow.
Epidural steroid injections are used if the medical treatment is not helpful. Yoga can help in maintaining the spine flexibility once the disc prolapse is cured with surgery. Surgical treatment can correct the prolapsed disc and then regular exercise is needed to stop any further progression or relapse of the problem.
Cervical traction can help her in relieving the acute pain for now.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen Tayal 20 minutes later
Thanks. Currently she is having acute pain which she is not able to bear. What should we do now? Is this a normal condition in this situation? If so, how many days it takes to get the pain reduced?
Regards, XXXXXX
doctor
Answered by Dr. Praveen Tayal 11 minutes later
Brief Answer:
Needs cervical traction.

Detailed Answer:
Hello.
Thanks for writing again.
To get relief from the acute pain cervical traction and potent pain killers - opioids with muscle relaxants are needed. These will give pain relief for a while but will not reverse the prolapsed disc. The response to medicines varies from person to person and depends on the severity of the problem. In case the pain is not relived with these then surgical treatment is needed.
Such acute pain can happen in prolapsed disc.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen Tayal 13 minutes later
Is this level of pain, normal in this situation? How long will this be there? How many days she has to be on pain killers? Thanks
doctor
Answered by Dr. Praveen Tayal 7 hours later
Brief Answer:
Yes it is normal.

Detailed Answer:
Severe pain can happen due to disc prolapse. It is normal. The duration of pain cannot be predicted. If she takes the proper treatment like cervical traction then it may reduce for few weeks. But the pain can happen again if she does not do regular physiotherapy exercises.
She may need pain killers life long as this is an age related degenerative change of spine that cannot be completely reversed.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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