C5 Nerve Root Case Summary

She still had some loss in her sensory neurons, but they showed some slight improvement from the initial evaluation. A follow-up MRI also showed a “…decrease in the brachial plexus thickening and hyperintensity.” (Gazioglu) The patient in this case study experienced rare symptoms. Patients who are usually diagnosed with brachial neuritis have severe pain in the shoulder and some even have localized pain. Only a small number of patients have pain that subsides to the fingers of the affected side. This case study supports the signs and symptoms along with the treatment that our team doctor prescribed.

The patient wants to also update me as far as the arm pain he mentioned last time. He says his left arm is feeling better now. He is noticing that his right shoulder is hurting at times, especially in certain positons such as while he is sleeping and if he has his arm raised over his head while he is lying down. He had no specific injury or trauma. He is not aware of anything that makes it better or worse. He is not using any medication for it thus far. He would be interested in having

IW was diagnosed with sprain of the ligaments of the cervical spine. Patient has received chiropractic care. Response has been good and IW is encouraged with gains being made. Improved function and functional restoration are expected with additional treatments. Plan is for chiropractic treatment, 2 times a week for 3 weeks.

DOI: 06/04/2008. The patient is a 61-year-old female dispatcher who sustained a work-related injury to her right hand and arm due to repetitive duties. As per OMNI entry, she is status post right proximal median nerve decompression on 05/12/11 and right carpal tunnel release on 09/26/11.

On examination of the right shoulder, there is pain on range of motion. Abduction was 160 degrees. Forward flexion was 165 degrees.

cervical discectomy and fusion performed on 04/14/15. The latest progress report noted that the patient has neck pain, upper back pain, and shooting pain down the arms. The exam revealed that the DTRs were mildly diminished in the left upper extremity. The strength and sensation were mildly diminished in the left upper extremity as well. Spurling sign was also weakly positive on the left. It is noted that the patient has tried and failed conservative treatment, including medications and PT. However, review of the records revealed that the postop PT was put on hold due to his increased pain. In addition, the MRI Report showed that the disc space was normal and there was no significant disc herniation at the requested level i.e. C7-T1. The spinal canal and neural foramen are patent. In addition, EMG Report revealed that there was no evidence of peripheral nerve entrapment or underlying peripheral neuropathy on nerve conduction studies. Considering the minimal/mild physical examination findings and normal imaging and EDS testing; the medical necessity of C7-T1 cervical ESI has not been established. Recommend

Per the medical report dated 08/12/16 by Dr. Gunderson, the patient had neck pain, as well as headaches, dizziness and blurred vision. The neck pain radiated into both shoulders, but more so on the right, and occasionally she had tingling in her upper extremities. She described the neck pain as severe and intermittent, and not related to any specific activity, and relieved with massage. The pain in her lower back was in the beltline and radiated into both lower extremities, more so on the left. She described the pain as moderately severe and constant, and not related to any activity, and only relieved with nerve medicines. On examination, the patient had tenderness in the lower cervical region about C5 to C7. Range of motion of her neck was 75% of normal. Motor, sensory, and reflex examinations in the upper extremities were normal. On examination of the lumbar spine, the patient could dress and undress without difficulty. She had a bent forward posture and gait. She had reduced lumbar motion and with maximum forward flexion, her fingertips were 12 inches from the floor. Lateral flexion was 50% of normal, and she had no active extension in the lumbar spine. Motor, sensory, and reflex examinations in the lower extremities were normal. There was paravertebral tenderness about L4-5 bilaterally, as well as in both sacroiliac and sciatic notch regions. Straight leg caused hip and thigh pain at 50 degrees bilaterally. Of note, X-rays of the cervical spine demonstrated disc degeneration at C5-6. X-rays of the lumbar spine were normal. Patient sustained

Based on the latest medical report dated 02/10/16, the patient has undergone extensive PT. She was diagnosed with sprain/strain derangement of the cervical spine, cervical subluxation complex, and cervical brachial radiculopathy, sprain/strain derangement of the lumbar spine, lumbar subluxation complex and lumbar radiculopathy.

In case of a pinched nerve condition the signal is by some means interrupted along the way and is consequently not capable to transmit the message. The significant areas of the body that are more susceptible to nerve compression include the neck or lower back caused by a herniated disc, arthritis, bone spurs, or spinal stenoisis. The main causes of pinched nerve include nerve pressure; injury, poor posture, osteoarthritis, sports activities, and obesity. Due to these conditions the tissue are compressed resulting in

The symptoms of pain, numbness, tingling or weakness are the result of the inflammatory process within the carpal tunnel that leads to compression of the median nerve. The compression and resulting impingement of the median nerve results in ischemia. The ischemia leads to the symptoms of numbness, tingling, pain and weakness of the hand and/or forearm. The FNP should inspect the wrist and hands of the patient with symptoms of CTS, looking for skin color and temperature changes, deformities and muscle wasting. The active and passive range of motion (ROM) of the neck, shoulders, elbows, wrists and fingers should be accessed. Muscle strength should be assessed at the shoulder, elbow, wrist and fingers. Spurling’s test for cervical radiculopathy should be performed. A plain x-ray can be ordered by the FNP if ROM of the wrist is limited. The FNP should also assess capillary refill of the fingers (Dunphy, Winland-Brown, Porter, & Thomas,

Per PT daily therapy notes dated 05/26/15, the patient has completed 6 sessions for both hands.

Examination revealed restricted range of motion with flexion and extension in the neck, upper back and upper trapezius area followed by pain. Tenderness in the paraspinous muculature and discomfort with right lateral flexion was noted. Muscle spasms were noted in the following areas upon palpitation: cervical paraspinals, suboccipitals, upper trapezius, levator scapulae, medial scapular, thoracic parasinals, lumbar paraspinals and gluteus. He was tender to palpation of the right dorsal wrist at

The ROM was restricted, 50% of normal. The paraspinal muscle strength and tone was normal. The SLR was negative bilaterally. The exam of the left lower extremity was normal. The exam of the right lower extremity was normal except mild decreased strength in the right hip flexors. A reported MRI Lumbar Imaging on 07/01/15 showed multilevel degenerative changes; Previous L4 to sacrum fusion, evidence of herniated disc or significant central stenosis or foraminal stenosis. A reported MRI L Spine on 11/05/15 revealed herniated disc L2-3 with inferior extrusion impinging on the right L3 nerve root. Assessment: The patient has continuing symptoms of pain in the right lower extremity radiating down along the anterior thigh. This is consistent with the herniated disc at the L2-3 level on the right. He had previous surgery at the L2-3 level 3 years ago for his work-related

Per progress report dated 02/26/2016, the patient had good response to corticosteroid injection; however, her symptoms have worsened now that she is working more. Examination reveals positive Tinel’s sign over the median nerve at the wrist. Carpometacarpal joint is also tender to palpation and has a positive passive flexion. Sensation testing to light touch reveals dysesthesias in the median nerve distribution. As per office notes dated 6/3/16, the patient

The cervical and lumbar regions of the vertebral column are most likely to experience a herniated disc. This is so, because these regions have the least structural support, while having to endure the most strain. Since the nerves that supply the upper limb are found in the cervical region of the spinal cord, cervical herniated discs may cause pain here. Muscle weakness in the upper limb and neck pain may also occur as a result of injury to the cervical discs. Injury to the lumbar region typically causes lower back pain. If the herniated disc affects nerve fibers, pain that radiates through the leg and down to the foot may occur. This condition is known as sciatica