Expert: Dr. J. Shawn Leatherman - 10/9/2006

Question
About three months ago, I leaned back into a shampoo bowl at the hair dresser.  Pretty much as soon as I got laid down in the bowl, and when I went to get up, a pain shot through my neck.  Shortly thereafter, I had little sharp pains in my neck and down my left arm.  Then came numbness, tingling and burning.  I have gone to my chiropractor three times.  He said I do have a pinched nerve and it is not uncommon.  I had this happen once before and after about 4 weeks it cleared up.  I am in a lot of pain with no improvement.  We've used ice and the chiropractor has done his normal treatments in the office.  Adjustments of my spine and neck.  He is very good.  I am getting worried though now.  This pain is just going on and on.  
For years, I have been diagnosed with fibromylgia and degeneration in my spine, carpel tunnel syndrone and I have lupus with chronic arthritis.  I deal with all of that okay, but this pain and burning in my left arm is becoming very hurtful and annoying.  I'm ready for it to end!!  Any help you can give me would be greatly appreciated!!  Thanks in advance for your help.  Bless you.  

Answer
Dear Stephanie,

I first have to ask you, do you have recent x-rays of the neck?  By recent I mean within the last year.  The reason I ask is because of your extensive history of inflammatory conditions, and you had mentioned chronic arthritis and degeneration of the spine.

If you have arthritis in the neck and it is progressing, it may be that you have progressed to an increased state of spinal degeneration which can easily cause the problems you have described. It is definite that you are experiencing nerve root symptoms. I would highly suggest that you have a four view series of x-rays taken in the neck.  The views should be an antero-posterior view, a neutral lateral view, and right & left oblique views.  These views will be able to identify the amount of degeneration you presently have and if there is spur formation (osteoarthritis) into the neuroforamen (holes) of the vertebra where the spinal nerves exit the cord and vertebral column. Spurs can easily cause "pinched" nerve symptoms, but may have progressed beyond chiropractic care for resolution.

I have seen these types of cases in my office, and when the degeneration is severe, you need to be refered to a neurosurgeon for a consultation. In addition you may need a CT to better visualize the degeneration...as a matter of fact, the neurosurgeon will want this for consideration. I have had to do this on occassion with a few of my patients.  The neurosurgeon I refer to removed the spurs and patients felt 100% better immediately following the surgery ... with only a few days of recouperation time.  Afterward, (six to eight weeks to allow proper healing of the tissues), continuing chiropractic care is advisable for the biomechanical integrity of the spine, as well as post surgical rehab concerning range of motion and muscular funtion.

Stephanie, I don't bring this up to scare your, but it is very important to document the current state of degeneration in your neck before continuing with adjustments.  Now if your chiropractic physician has already taken these x-rays and has ruled out extensive degeneration and neuroforaminal encroachment (blocking of the holes in which the nerves exit), then continued adjustments are fine.  

I would also recommend that you start a traction protocol to reduce the amount of gravitational pressure that is exerted on the spine daily. Axial traction (pulling upward) on the head and neck is the best to initiate relief due to any compressive forces in the neck resulting in pain into the arm.  This is because it also pulls on the nerve root and alleviates the "pinching" that may be present.  In fact, your chiropractic physician should have examined you for this latest episode, and he should have performed an orthopedic test in which he pulled up on your head to see if it relieved your symptoms or made them worse.  This is an axial decompressive move. Please talk to your doctor about this, and make sure it has been performed.  Axial traction should be performed in the office for the first few visits.  Once you are comforatable with application and the proceedure, a home unit should be prescribed.

Lastly, the pain you are experiencing is most likely not due to the fact that the nerve is truley "pinched", but rather it is crowded by the surrounding tissues which are causing irritation and inflammation.  Let me explain, a true pinched nerve will result in motor disruption of the nerve.  In other word you will have a loss of strength and function to the muscles in which the nerve supplies.  Irritation/inflammation of a nerve causes pain, tingling, numbness, burning etc... This is because the actual arrangement of the nerve fibers. The motor portion is more central, while the sensory portion is more to the periphery.  Your body is designed for preservation, if you irritate a nerve it will hurt so you will reduce activity, therfore reducing the likelyhood of further injury which would damage the motor portion an affect mobility, movement and your ability to interact with your environment.

Bottom line Stephanie, 1. make sure that you get the x-rays if not already taken, 2. document the level of arthritic change, 3. make sure this is still a chiropractic case or find out if it has progressed to warrant a neurosurgical consultation and evaluation, and 4. determine the correct treatment protocol needed to correct the problem, whether it is chiropractic, medical, surgical, or a combination of the above.

I hope this answers your question and gives you a higher level of understanding.  Feel free to follow-up if needed.

Respectfully,
Dr. J. Shawn Leatherman