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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for persistent neck pain that radiates to the shoulder

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Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3242 Questions

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Posted on Thu, 2 Mar 2017 in Brain and Spine
Question: I have neck pain that occasionally goes into the right shoulder. It is very severe when it goes to the right shoulder...No tingling or numbness. I had an MRI recently (1 week ago) that said:
There is severe disc space narrowing C5-6 C6-7 C7-T1....
C 4-5 A broadbased disc osteophyte indents the ventral thecal sac at this level.The ventral cord is contacted. There is mild canal narrowing. Moderate right and moderate to severe left foraminal narrowing are present secondary to facet and uncovertebral joint hypertrophy.
C5-6--A broad based disc calcified indents the ventral thecal sac at this level. The ventral cord is contacted. There is mild canal narrowing. The ventral thecal sac is flattened. Uncovertable joint hypertrophy and facet hypertrophy contribute to severe right and moderate to severe left sided foraminal narrowing. "
Id like to know what I could do to keep it from getting worse and to avoid surgery if possible. I take care of my mom who is 92 and I have to stay healthy. What is the best pain med to take? I take Advil now
doctor
Answered by Dr. Erion Spaho 1 hour later
Brief Answer:
Conservative treatment includes other possibilities besides drugs.

Detailed Answer:
Hello again and thanks for being on HCM.

I have read your question and understand your concerns.

It is obvious from MRI results that you suffer from degerative cervical spine and discs disease.

Conservative treatment is a feasible first course of action to treat the clinical manifestations of first-onset degenerative spine disease.

The most commonly accepted modalities range from anti-inflammatory therapy to exercises designed to increase muscle strength and relieve joint loading.

So, ibuprofen is an antiinflammatory drug, you can use also painkillers such tramadol in addition to it.

Warm procedures on neck and exercises designed to stretch the muscles and neck (McKenzie exercises for example) may be of benefit in your case.

If these treatment ways fail to improve your condition after one or two months, decompressesive and stabilization surgery may be considered.

Discuss with your Doctor about these issues.

Hope you found the answer helpful.

Kind regards.
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Erion Spaho 1 hour later
Dr....
1. what do you think of diclofenac as a prescribed anti-inflammatory?
2. what is your opinion generally about accupuncture for the pain I have?
3. what type of injections might be used for the situation I have?
doctor
Answered by Dr. Erion Spaho 11 hours later
Brief Answer:
Diclofenac may be a good alternative.

Detailed Answer:
Welcome back.

Diclofenac is one of the potent antiinflammatory drugs, in my opinion, you can use it to relieve your symptoms, however, it could result in adverse effects such stomach upset, increased blood pressure etc.

Acupuncture also is found to relieve neuralgic pain, so, it could be of benefit besides exercises and physical therapy.

If these measures fail to improve your condition, epidural injections may be tried.

Hope I helped you.

Take care.
Above answer was peer-reviewed by : Dr. Yogesh D
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Recent questions on  Broadbased disc osteophyte

doctor1 MD

MRI results - language. I have right side weakness for years and recently had a severe case of adhesive capsulitis . after that time I was receiving physical therapy and the weakness in the right arm became greater and numbness in lower three fingers as well as arm. MRI was suggested. Shoulder is doing better but still have right side weakness. To complicate this I have POEMS disease but I don't know how much of the symptoms are related to the disease - or not at all. So frustrated. I deal with chronic pain and muscle problems all the time. Now I am having problems in the lower left rib area with extreme pain. Ultrasound didn't reveal much - I have had an enlarged spleen for years but it showed no changes.
Anyway. Here are the results of the MRI of neck as related to the shoulder/arm problems.
Thank You,
Stephania
AGE: 52 years DOB: 7/23/1960 GENDER: Female      

PROCEDURE: MRI CERVICAL SPINE WO CONTRAST, 3/20/2013 6:45 PM      
ACCESSION NUMBER(S): RIM0000      
LOCATION: SSPLDIMA      

COMPARISON: MRI from 11/4/2010      

CLINICAL INDICATION: neck pain with radicular symtoms on the      
right arm..      

TECHNIQUE: Sagittal T1-weighted, sagittal T2-weighted, sagittal      
STIR, axial T2-weighted, axial gradient echo.      

FINDINGS:      

Mild degenerative changes are present at C1-2.      

Vertebral bodies are normal in height, signal, and alignment.      

There is diffuse desiccation of the cervical discs.      

Ligaments are within normal limits.      

The spinal cord is normal in signal and size. Contour the spinal      
cord is abnormal at C5-6 and C6-7 due to central spinal stenosis      
from disc osteophyte complexes. These will be further described      
on the axial images.      

Axial images:      

C2-3: No significant abnormality      

C3-4: Broad-based disc osteophyte complex with resultant mild      
central spinal stenosis. There is right uncovertebral hypertrophy      
producing moderate right neural foraminal stenosis. There is left      
uncovertebral hypertrophy producing mild left neural foraminal      
stenosis.      

C4-5: Broad-based disc osteophyte complex with resultant mild      
central spinal stenosis. There is mild left neural foraminal      
stenosis. Right neural foramen is normal.      

C5-6: Broad-based disc osteophyte complex with resultant severe      
central spinal stenosis and flattening of the spinal cord. There      
is severe bilateral neural foraminal stenosis due to      
uncovertebral hypertrophy. No definite cord signal abnormality.      

C6-7: Broad-based disc osteophyte complex. In addition, there is      
a small superimposed left paracentral protrusion that contacts      
the left hemicord but does not significantly efface it. There is      
resultant severe left neural foraminal stenosis as the lesser      
paracentral protrusion extends into the proximal aspect of the      
left neural foramen. There is moderate left hemi-canal stenosis.      
Right neural foramen is normal.      

C7-T1: No significant abnormality      

Paraspinal soft tissues are within normal limits.      

Flow-voids are present within the imaged aspects of the vertebral      
arteries, common carotid arteries, and internal carotid arteries.      



Impression:

Impression:      
1. Multilevel degenerative changes as detailed above. No      
significant interval change from previous exam on 11/4/2010.      
2. At C5-6, there is a broad-based disc osteophyte complex      
producing severe central spinal stenosis and cord effacement.      
There is severe bilateral neural foraminal stenosis. There are no      
abnormal cord signal changes.      
3. At C6-7, there is a broad-based disc osteophyte complex and a      
small superimposed left paracentral protrusion extends into the      
proximal aspect of the left neural foramen. There is moderate      
left hemi-canal stenosis and severe left neural foraminal      
stenosis.      
     
Electronically Signed by Arun Krishnan, MD, Sutter Medical Group      
3/20/2013 8: 13 PM      

doctor1 MD

Can you please explain these MRI results:
1. C5-C6: Broad based disc osteophyte complex most prominent in the right subarticular with slight compression of the cervical spinal cord. Bilateral uncovertebral joint hypertrophy. Bilateral facet joint hpyertrophy. Mild central stenosis. Severe right and moderate left neural foraminal stenosis.
2. Multilevel cervical spondylosis.

Thank you!

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