Degenerative bone changes in cervical spine in a young man
Patient : So cutting straight to the chase; my arms (mostly my hands) and legs (mostly calves) have been numb as well as weak for three weeks now. There's no pain, but I've been having difficulty walking (especially long distances) as well as keeping my balance. On top of that, I've developed a bit of clumsiness in the use of my limbs. When it all first started, I was having a pretty stressful week while I continued going to the gym for my usual weight training routine. I felt that my body wasn't in the mood for training... Especially since I've been having a pain in my left bicep (at the point where the bicep meets the inside of my elbow) and a pain within my right tricep. So I decided to go light to moderate with the weights and stuck to compound exercises such as squats while avoiding working out arms. I completed my training and I definitely didn't feel any pain in my back, so as usual the workout went well. The next day my legs were sore as normally they normally would get, so I took the day off to rest. The following day, I returned to the gym to workout my chest with the use of dumbbells. It was at that moment that for some odd reason I couldn't lift the weight I would normally work with. I was still stressed out and a bit tired from the week, but I even then, I normally could always be able to lift weights. So just to be safe, I went lighter. But still my arms would give out. Finally, I decided to go home just to avoid any further possibility of injury seeing as how my body was acting. The next day I could tell the soreness in my legs was going away. But as they recovered, they began to feel a bit numb, while my arms began to do the same thing. Other sensations were a tightness in my midback and lumbar area. At this point, I decided to go to the emergency room and get myself checked out. I met with a doctor who diagnosed me with a pinched nerve (Cervical Radiculopathy) and perscribed me with Steroids (prednisone 10mg) that I had to take once a day for five days(SIDE NOTE: I noticed that the numbness and loss of balance increased a bit after taking the steroids. I was numb before, but it wasn't as much and I still had my balance.). She also gave me a perscription for an MRI. I took the MRI and the following are the results:
MRI CERVICAL SPINE WITHOUT IV CONTRAST
CLINICAL INDICATION: NECK PAIN WITH WEAKNESS TO THE ARMS.
TECHNIQUE: MRI cervical spine using a standard protocol without intervaneous contrast.
FINDINGS: There is normal anatomic alignment of the cervical spine. The vertebral bodies are of normal height. Mild disc desiccation is seen at C5-6. No significant marrow signal abnormality is seen. The visualized cervicomedullary junction and cord demonstrate normal signal. No paraspinal mass is identified.
C2-3: No significant disc herniation, central canal or formanial stenosis is seen.
C3-4: There is a minimal disc bulge. No significant central canal or foraminal stenosis is seen.
C4-5: No significant disc herniation. Central canal or formanial stenosis is seen.
C5-6: There is a minimal disc bulge with associated osteophytic ridging that does not cause significant central canal or foraminal stenosis.
C6-7: No significant disc herniation, central canal or formanial stenosis is seen.
C7-T1: No significant disc herniation, central canal or formanial stenosis is identified.
IMPRESSION: MINIMAL SPONDYLOTIC CHANGES ARE SEEN IN THE CERVICAL SPINE. MOST NOTABLY, A MILD C5-6 DISC BULGE WITH ASSOCIATED OSTEOPHYTIC RIDGING DOES NOT CAUSE SIGNIFICANT CENTRAL CANAL NOR FORMINAL STENOSIS. MILD DISC DESICCATION IS SEEN AT C5-6. NO ABNORMAL SIGNAL IS SEEN WITHIN THE CORD.
So buttom line is, what do I do now? I'm really worried and I feel the longer I stay like the worse it'll be, even though the numbness hasn't increased anymore than what it is now. I don't have insurance due to being let go from my former job, so I'm currently using this Primary Care Card that I got through The Memorial Regional Hospital's Primary Care Center Services. I will highly appreciate any detailed information you can give me. Thank you very much!
The pain in your arms as you described may be due to a cervical nerve compression , 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 you, 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 medication (“Motrin”, “Aleve”), also a re-education of your habits and posture to improve quality of life. You 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 your 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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