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Cervical & Lumbar Radiculopathy

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    Posted: Sep 03 2011 at 1:30pm
Hello,

In early June I was diagnosed with cervical sprain post MVA end of May and was prescribed an NSAID, muscle relaxant and PT.  I seemed to be recovering until....Confused

About a month later I was experiencing numbness, tingling and pin and needles thru-out my upper extremities plus headaches (progressive neurological symptoms)Ouch.  My ortho ordered an MRI with showed 3 cervical herniations with stenosis Shocked.  I f/u with the ortho when the results were ready.  He recommended an EMG, neuro consult for the headaches and to f/u with the spine specialist.  The latter freaked me out b/c I feared the spinal surgeon would automatically recommend surgery.  My ortho doc also said to continue PT.  

In the end of July I felt pins and needles at my lower extremities.  In early August, I finally got an appt to see the neurologist who ordered an MRI of the lumbar spine which showed disc herniation in two locations with impingement.  He performed the EMG and NCV both were positive and indicative of carpal tunnel syndrome and pinch nerves in the upper and lower extremeties.  The ENG confirmed vestibular neuronitis and BPPV.  The neuro said to continue to PT.  

In third week of august the headaches which I thought were improving with traction and PT, were becoming chronic and all day with no breaks and no relief from the NSAIDs.  And I was experiencing shoulder and upper arm flares (burning pain and pins and needles)which lasted longer than a few minutes  Ouch.  

The neuro gave me a stronger oral NSAIDs to take daily and an NSAID cream which has helped tremendously.  I still feel heaviness and pressure in my head.  Pins and needles do come and go but I have not experienced a flare.  The neuro guy said to continue PT.  

The following week I saw the spine specialist, who said 80% of patients improve with conservative treatment but are not necessarily 100% better or back to "normal"  He said 20% of patient get progressively worse.  He said to continue PT and to f/u in two weeks.  Practically the following day I experience lip numbness.  

I believe PT has helped with my neck ROM.  I am not as stiff.  Since I've been going I wonder if PT has maintained neck ROM or have I already recovered.  However, depending on my neck positioning, I feel discomfort, pin and needles.  Regarding my lower back I feel pins and needles and a constant dulling and heaviness.  The pins and needles concern me more than the lower back dulling ache.  

So thats my history up until now.  My question is based on my history is PT futile or is it worth it to continue. The spine specialist said that NSAIDs and PT will only provide temporary relief.  And only time will tell whether how significant is my recovery.  

What is your professional experience with patients with similar history?  I may consider ESI so I don't have to take NSAIDs on a daily basis, but I am freaked out .   I look forward to all comments and or advice.  
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Ask a PT Quote  Post ReplyReply Direct Link To This Post Posted: Sep 06 2011 at 8:45am
Sorry to hear about all the things that are going wrong. Physical therapy should be able to help with the BPPV in a few sessions at the most, if it truly is positional vertigo related: http://www.cyberpt.com/CyberPTBPPV.asp. As far as continuing PT for your other issues, I think it is probably a good idea especially since the medical professionals that know you best continue to recommend it. Besides ROM, PT can help with strengthening, stabilization, posture, pain management, etc which can help manage your condition. McKenzie based exercises can also help with the disc herniations. You mentioned the MRI of the lumbar spine, did you get a MRI of your cervical spine as well and are there disc issues? 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote dusting Quote  Post ReplyReply Direct Link To This Post Posted: Sep 07 2011 at 2:17pm
Yes, I did have an MRI of the cervical spine.  Disc herniations at C3-C4, C5-C6, and C6-C7.  Moderate stenosis at C5-C6 and mild stenosis a C6-C7. 

Thank you very much for your response.  I sometimes feel that I am wasting the DPT and PTAs  time because I feel I should have recovered already.  And bc I am a clinician myself and have seen the worse conditions/disease like cancer and COPD, why should I be complaining. With regards to the BPPV, since the neurologist made the diagnosis, shouldn't he create a special prescription for that kind of tx? 

So far the ortho and spine specialist docs have focused on tx of my cervical radiculopathy, which has been giving me the most angst.  The lumbar issues, I just feel a steady heaviness and numbness down my right leg.  However, a script was not created to focus on my back.  So I wonder if the lumbar disc issues are not as serious.  I will better prepared when I f/u with the spine doctor in a few weeks. 

Thank you again for feedback.  Any additional comments or recommendations I'd love to hear. 
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