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Bi-Lateral Neck/Arm Burning-Clean MRI

Exit forum ID Forum Discussion Bi-Lateral Neck/Arm Burning-Clean MRI

This topic contains 4 replies, has 3 voices, and was last updated by   Jamie Hansen July 1, 2019 at 3:17 pm.

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    Jamie Hansen

      Hi Everyone,
      I am a stumped with this case and was hoping that maybe I missed something that someone can spot out.

      1st Order HX
      Age: 24 Male
      SX Location: Posterior Neck into Bilateral triceps/medial forearm (medial and lateral aspects), pinky and ring fingers. Occasional bilateral index finger and dorsal aspect of hand.
      SX Qual: P&N/Burning
      SX Intensity: AVG, 7/10,,, worse 10+/10….. pain is never a 0/10 absolute best is 2-3/10
      Provocative: All movements, worse with felxion & rotation, any and all exercise.
      Pallative: Rest, thera-gun, adjustments (all short term)

      2nd order:
      Onset: MVA all re-ended accidents 8/2017, 11/2017, 1/2018.
      -After 11/2017 accident neck pain started along with L and R arm sx (left first) much worse after 1/2018 accident.
      -MRI after 3rd accident, came back clean.
      Occupation- student
      currently seeing Dr Stepien for Lower back issues steaming from 8/2017 MVA

      Exam Findings:
      UCF- 16/25 able to get him to 26/25 but still has sever pressure left arm burning, along with L Levator scap area burning.
      CF 66/60,,, re-exam 66/60 no change in SX same as above
      CTF-80/90 rexam 90/90 with same sx
      ROT L-60/90 R79/90 (still working on these tests last treatment L 76/90, R 77/90 (same SX severe with burning into hands)

      Lateral Flexion: L 30 degrees with burning to hands and R levator scap area (same as CC) R 30 degrees, burning into hands and significant burning into L Levator scap area.

      Shoulder AB 1.5 Fingers bilaterally with burning into LS.

      BC SX were not improving and it has been ~8 months since his last Cervical MRI, he got another one and this again was clean (this was last week).

      Past treatment of L shoulders (performed by): L Infra- mod adhesion created burning into Left dorsum of hand, brachial cords are sub scap mild/moderate, Post JT Capsule -mild/clean.

      I am finding mild/moderate adhesion on L Levator scap, L NR at scalenes,
      Only real sustained relief I have been able to get him was decrease the number of HAs from 4x/wk to once a week/10days.

      Am i missing something here?
      Open to any and all help

      THANK YOU!!


      Andrew Wengert

        I lived in the auto accident world before ID saved my career and sanity.
        One test we did order in that world was a digital motion X-ray or even just plain flexion extension films with a note to the radiologist to check for ligament instability. Having had 3 MVAs his ligaments likely had some degree of damage which could explain his symptoms.


        Jamie Hansen

          Thank you Andrew for this. I will look into this some more.


          Tyler Vorst

            Did you look at the images yourself, or only the report. I’ve had radiologist not include disc pathologies in the past on the radiology reports.


            Jamie Hansen

              We looked at the images our selves, and we have Dr Nina in office has a diplomat in reading images.

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