Cervical pain for 5 years in a 24 year old male.

Patient

Q: I am a 24 year old male who has had chronic neck pain since 7th grade and chronic pain in my entire upper back and left shoulder blade for the last 5 years or so. After a 2nd MRI 2 years ago, I was told that I had a herniated disc in c5-c6 with c6 left nerve root impingement and spinal stenosis in c5-c6 area. There is also a reversal of the lordotic curve. Until recently, I had sharp pains down my left arm to my fingers. Although I'm not certain, I believe the pain is cause more with the 'what feels like painstaking steel ball' muscle knots all over my upper back and more painful primarily in the Trapezius muscle area.

I have been to so many doctors, chiropractors, physical therapists, etc. for so long and it has only became exponentially worse.

Please help!

Doctor

A:   The pain in your left shoulder and arm as you described it is due a cervical nerve compression (C5-C6), but it would be also important to rule out inflammation of the peripheral nerves at the level of the arm and hand. In the younger patients, as yourself, cervical radiculopathy may be a result of a disc herniation or an acute injury causing impingement of an exiting nerve. In the older patient, cervical radiculopathy is often a result of spinal canal narrowing from bone (osteophyte) formation, decreased disc height and degenerative changes due to aging process. The same described before for the cervical spine applies to the lower back in terms of cause of pain and numbness in the legs, same causes, different spinal level. The treatment strategy usually includes: physical therapy program aimed to reduce pain and inflammation, and the use of anti-inflammatory drugs (as ibuprofen), also a re-education of habits and posture of the patients to improve quality of life. Patients should be independent in a stretching and strengthening program and continue with these exercises under the periodic supervision of a physical therapist initially and then completely on their own. Patients whose condition fails to improve with a comprehensive rehabilitation program and selective injections should be presented with a surgical evaluation. Often, patients should show progressive improvement over the first 6-8 weeks with conservative treatment. If there is no significant improvement in this time frame, consider a surgical evaluation.

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