Where do I go from here ? NEED RELIEF

[keephurting]

Hi everyone ,

History...

I am in my 40s , and when I was 18 years old xrays showed I had fused ribs , some scoliosis , and some fusion of the upper spine in 3 discs ? Gave me some heat treatment and that was that.

Then 8 years ago I got alot of shoulder pain and dizziness ,
had some massage done at the chinese place and felt a bit better but still dizzy.

Then 4 months ago both my arms went numb , collar bone hurts, rib pain , neck pain and shoulder pain. Had mri and it shows I have degenerative changes at c5/c6/c7.

Still in pain , very very dizzy with head movements , stay home all the time cos its so bad. Doctor said it will go away one day , may take a year , pain killers dont help.

any help pleaseeeeeeeee .

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[keephurting]

forgot to say , I also have electric shock shooting pains coming out from my Thoracic area , right between my shoulder blades that is severe , sometimes it itches and burns like stingling nettle pain. If you press on my cervical and thoracic area it feels very bruised.

thanks for reading.

[Roselyn Longares]

Hi keephurting,
I suggest that you see a neurlogist to understand more where your dizziness is coming from. Although I have a feeling that it is a case of vertebral basilar insufficiency where head movements can aggravate it due to kinking / compression or stretching of the arteries, especially complicated by spinal musculoskeletal issues, however, you can also experience it with just simply narrowing of your blood vessels from plaques. Until you see a neurologist I suggest that you avoid head movements that exacerbates your dizziness at this time by wearing a soft collar to protect your neck. If massage is helping, I encourage you to obtain it regularly. I would also visit a physiotherapy clinic so they can screen you teach you stretching and strengtehing exercises that are appropriate for you.

[bhalla.ravneet]

Hi There
Reduced joint spaces, scoliosis and spine fusion cause pain and shock like sensations radiating down from neck to arm/chest/Back/Fingers...
also with the condition you are suffering from might be compressing your blood vessels causing dizziness. Do you have any vision disturbances ?
avoid overhead activities, use a soft cervical collar-sponge and maintain a pain diary..
use it well to pin down the times- activities that increases your pain.. AVOID THEM AT ALL COSTS..

Ultrasound and Tens Should give you relief..
God Bless

[Denver Chiropractor]

Just wondering if there is any eye twitching along with your dizziness or is it just light headedness? What's your blood pressure like? I'm interested in the BP when laying on your back and then right after you stand up. A drop in the BP when standing up may indicate a problem with your adrenal glands. If this is the case I would clean up the diet: cut out sugar, coffee (actually any caffeine), get more sleep, and take an adrenal supplement. The shoulder pain, is it always there or only with movement? Does it hurt when you first started raising your arm, is it the mid way point (90 degrees) or at the very top of elevation? I understand you have some degenerative discs at C5/C6/C7. This could also be part of your problem as the nerves do run to the shoulder. Since the pain killers are not working anyway, my suggestion is to go see a Chiropractor where you live who does Applied Kinesiology and find out what's what. Best Wishes Denver Chiropractor on Google

[keephurting]

Thank you for the replys , I feel overwhelmed that people are trying to help me. I really appreciate it.

Denver Chiropractor , "YES" I always have eye twitching with the dizziness episodee,
but its not nystagmus , its my eye lid that twitches. Any ideas what this could mean ? Sometimes its so bad I fall over.
I did see a neurolgist who said I have blood pressure problems called orthostatic hypotention. I was put on salt tablets and my blood pressure is now normal.I already eat a sugar/what free diet for weight control , but it doesnt make much difference.
It hurts when I lift my arms only slightly.

bhalla.ravneet , I do have alot of fuzzy vision that comes and goes, I cant explain it but its not nice , it comes and goes on dizzy days, yet my eye tests are normal.

Roselyn Longares , I do not know what vertebral basilar insufficiency is but it sounds a possibility that no one has mentioned before. I will try to look into that.

Today the pain went from my collar bone , into my neck and ear , I am awaiting a appointment with the hospital "orthopedic".

Thanks x

[keephurting]

just remembered they did give me a scan on my neck
to look at my cartoid ( spell check ?)
Would this be to look for vertebral basilar insufficiency ?

[Dr Damien]

i have to agree that a VBI is the more likely explanation...sometimes radiological studies may not give a picture of the problem simply because the issue is mechanical and the actual movement is needed to show the possiblity of a kink. Arteriography may be the way to go investigation wise...with regards treatment, its best you consult both a neurologist as well as an orthopeadic surgeon to know what way to go...this is not something that a physio/manual therapist/chiropractor can handle safely without the proper investigation, I personally dont think...the risks are way too high...any loss of muscle power, funny gait, unsteadiness? etc?

[alophysio]

Hi keephurting...

All the above responses are good.

I was personally thinking of your C2/3 joint. Often when you get get headaches which affect the eye, it is this level that is responsible. Sometimes it feels like a pressure or knife in your eye.

As for the arms going numb, they are supplied by nerves which come from the nerve roots of C5-T1 but we also know from research that there are connections between the different levels of the neck discs so that even up to 3 or 4 levels away can be affected! So a C2/3 disc issue can be affecting the nerve roots of C5 and C6 and C7...which will affect your arm.

I suffer from neck pain and headaches with occasional shoulder and arm symptoms. Believe me, the best thing you can do is to seek treatment and get a good physio to check your joints, muscles, nerves and coordination (motor control) of the upper neck and back...

...this is assuming you don't have some sort of vascular problem of course Personally it doesn't sound like it to me because it is with you all the time. Sudden head movements tend to be neck or inner ear related. Sustained head positions (more than 5 seconds or more in the one position) tend to be neck or vascular issues.

Good luck and let us know how it all goes

[keephurting]

Dr Damien, yes lots of gait problems for the past 8 years , cos when I walk I vere to one side and its difficult to stay straight,
the hospital physio noted I have a very poor gait and I am unsteady all of the time ...
its something I struggle with so much, every hour of the day,
and I cry about it alot - because I dont understand myself and get frustrated.

When I turn my head to the left or right , all of a sudden I feel like I have been shot in the head and I feel stunned ,
My world goes very strange , a strong woozy feeling comes over me - through my head, and my vision alters to a blurred state ,
and at exactly the same time I feel the life drain out of me and I feel extreamly weak and struggle to stay upright.

But one thing I am certain of is ...
It is ALWAYS the head movement that makes this happen.

I have been checked for Bppv over and over again - which is always negative .

I am waiting for my orthopeadic appointment to come through , and wonder will they know about VBI ?

Could someone pls explain what this VBI is in simple terms, cos I tried to look it up and couldnt understand it.

Thank you for listening , I cant tell you how gateful I am.



I went to a chiropractor 6 weeks ago , they said that my pupils were very slow reacting to light
and this was when I was having a bad time.

I sometimes feel a tremor in my head , but it does not show.

A few days ago I laughed and lifted my head up at the same time, and straight away fell to the floor with another episode.

[keephurting]

Alophysio , thanks for that info. My husband got me a intrasound unit that I use everyday and it helps with the pain a bit.

When I turn my head -the feeling hits me in one second.

I just want to say , I dont get hit with every head movement,
its intermitant. But usually once a day or more.

[alophysio]

Hi keephurting...

Thanks for the replies.

1. I don't think it is VBI - too quick in symptoms for me...
2. I don't think it is necessarily BPPV either but it could be inner ear related...
3. Try this test - keep your head still and turn your body underneath you. For example, imagine you were standing on a clockface with feet and head facing 12. Keep your head facing 12 and turn your whole body (not the head) to 3 o clock or whatever you can manage. Then do the same to 9 o clock. You can even have your husband hold your head still (a physio would in the clinic). If you get the same symptoms, i am almost certain it is your neck. Otherwise no symptoms could mean ear disturbances (although not every head movement gives you symptoms...).

My money is still on a musculoskeletal problem with the neck being the primary suspect All the symptoms you have described are symptoms i help with headaches from the neck...

Good luck!

[Dr Damien]

Dear Keephurting

I have to agree with some of the reasoning of alophysio. I will speak with respect to clients i have seen that have reported similar symptoms. I saw a lady approximately 8 months ago with a similar problem. She would fall to the ground with certain head movements. Alophysio is right in thinking that a VBI would need more sustained rotatory movements to cause dizziness/loss of balance/blackouts.However, this is usually what we see on assessment when things are controlled and in reality quick head rotations that are very rapid can totally obstruct an artery supplying the brain especially if the artery itself is already compromised.I say this because i have seen many patients who have had all the investigations in the world for inner ear problems all coming to not but still having drop attacks. A feeling of fuzziness and blurred vision makes me think the posterior part of the brain where vision is generally controlled is experiencing some compromise...which is why i still think a VBI is strongly the issue...most patients with inner ear problems do not describe a blurry vision, what they describe is a feeling of the room spinning, a feeling of the objects bouncing and they say if they do things a lot slower then they are fine...so the question is if you turn your head slowly do you feel alright?

VBI or verterbrobasilar insufficiency is a condition that occurs when the arteries that come from your neck to part of the arterial network that supply your brain are compromised. This can be as a result of a clot, vascular diseases or mechanical in origin. By mecahnical we mean movement causes it. because these arteries pass through the bones in your neck especially and at the upper part of the neck they change course in somewhat a turn, degenerative changes in the neck would mean they are vulnerable to blockage when the head is turned as the path they go through is smaller. So if you rotate and/or extend (look up) your neck the bones clip down on them and shut the blood supply to the brain...causing a feeling of wooziness, heaviness or tendency to black out...as soon as the pressure is taken off, everything back to normal, you fall because that is your bodies way of telling you "hey we cant pump blood up again to your brain, lie down and let gravity help us"

what you seem to be reporting is a "drop attack". certain conditions based on what clients have reported to me have this symptom, one is menneires disease, the other is cerebellar dysfunction/ataxia or posterior fossa lesions, veterbrobasilar insufficiency...

You report a feeling of fuzziness in your head and generally feeling weak after certain head movements. also your gait is unsteady, this still rules in either a cerebellar issue or a vascular problem. Musculoskeletal problems with the neck may cause a cord compression at the level of the brain stem...

you say you have been tested for BPPV and all tests prove negative...this means that positional effects do not influence your problem, do you get a feeling of fullness in your ear? do you have periods when you feel like you are fine and periods when you feel like the condition is just worse? i mean do your symptoms present at certain times during the year? when you lose balance due you feel nauseated like you want to vomit?

Do you experience vertigo? a feeling of the world spinning around you or oscillopsia, a feeling of objects bouncing up and down when you walk? these symptoms will mean you are unable to focus your eye on objects with head/body movements suggesting possibly an inner ear problem or CNS problem...slow pupil dilation really is not the test for a vestibular problem however it could mean a CNS problem sometimes originating from obstructions in the neck...

As alophysio said , testing you for BPPV only does not rule out an inner ear problem completely.

Are you able to keep your balance with your eyes closed? if you seriously lose balance, then you probably are looking at a central nervous system issue...this can happen when your with obstructions in the brain stem...

you need the following tests to help you make a suggestion for a diagnosis: Do them sitting down for safety,

NOTE:take care when doing these tests cause they can provoke neck pain and if you are unsure of what pain you would have or what effects they woul cause i strongly advise against doing them unless you are with a trained clinician!!!!

test one: can you focus on a stationary object in front of you? as your husband to watch you eyes, try to keep them still, if you eyes are bouncing up and down or side to side, and you start to feel dizzy...then your gaze stability is flawed...this points to a CNS problem...

test two: can you keep you eye steady on a stationary object while you move your head slowly left to right? these movements are just small rotations not extreme ones, again your husband can watch your eyes...do they bounce up and down or left to right? try to do this faster, again small rotations, if you eyes are not staying in focus...then your vestibuloocular reflex (VOR) cancellation is flawed...this means you may have a CNS problem or an inner ear problem...to be more precise would be looking for the gain of bounce, by gain we mean by how much the eye is bouncing out of focus and returning... this is a sign of nystagmus...

Do a similar test looking up and down, slowly then quickly...again small movements is all your need not extreme ones, if there is a bounce watch for the direction of bounce away from the ears if there is any, a horizontal bounce would mean a an inner ear problem...i.e your eyes keep bouncing away from the left ear towards the right..means the problem is problem is with the left ear...a bounce mainly in the vertical direction strongly suggests a CNS problem rather than an inner ear problem

test three: can you track an object moving in front of you smoothly with your head still? your husband can float a pen in front of you in different directions, try to follow the pen with your eyes... if you are having difficulty doing this... then the problem is likely to be CNS...it means you are unable to smoothly pursue an object, the vestibular issue is central

test four: can you follow an object moving your head and eyes smoothly...having trouble with this means your VOR, again this can be ponting towards an inner ear problem or CNS problem...

test five: can you stand still with your eyes closed? extreme sway or loss of balance strongly indicates a CNS problem...

test six: can you switch vision between two objects easily? put your hands about six inches away from the side your head but in front of you...keep your head still and switch vision between your two hands...do this for about a minute or two...if you are getting dizzy spells or are having trouble coordinating these movement then it is likely that you have a vestibular problem...maybe inner ear or CNS related...

No need to do BPPV tests as you have been through these before...

Now For what i really think is the problem...It is unusual to have pure inner ear troubles with headaches unless you have both problems...cervicogenic headeaches usually come from neck movements and as alophysio pointed out you would feel heaviness or a stabbing sensation in your eyes, however not all the time...you may experience pain at the top of your head or jaws..and these area in addition with your eyelids may feel tender...if your head ache is constant...then a cervicogenic headache is unlikely and CNS issues should be considered...

I think the problem is coming from your neck, and the degeneration you are having is probably causing some cord compression, i think you are displaying some symptoms of VBI, if you are not having a feeling of the room spinning and objects bouncing and your gait is just unsteady i would consider a cord compression/brainstem compression...you shouldnt have an unsteady gait with VBI alone...
In these case, i would consider looking at your coordination, sensation and muscle power in your arms and legs....

I would not attempt manipulating your neck until a good knowledge of how bad the degeneration is first, I may want to start of with exercises first to see what happens...

[Dr Damien]

Just to add, whenever you are seeing signs that are bilateral, that should be suspect of something more sinister...both your arms getting numb is a sign that something huge is compressing something that connects both arms to give bilateral signs...i.e a huge prolapsed disc or a cord compression...either that or you have multilevel disc prolapses...this not uncommon but it really is rare within your age group...your neck has to be pretty bad for this to be happening, usually traumatic events are the main causes...you can find them in the elderly though cause they can have pretty bad degenerative cervical spines...it is rare to have multilevel disc prolapses to the same degree is what I mean...so my bet is on either a huge prolapsed disc or a cord compression...this would go in hand with the suspicious gait...

I apologize for my lengthy post

[alophysio]

hi keephurting...Dr Damien is right - if you already have some arterial insufficency, then the neck movement can just top it off.

Seems you have some tests to do.

A good physio should be able to do them...or at least follow them as described on this thread.

Thanks Dr Damien for your input - good to have your opinions on here

[keephurting]

Thank you again for your replies
Dr Damien, pls do not appologise for the lengthy post because you have been so helpful and have given me many leads.

In answer to your questions ,
I have no fullness in the ears.
I never have nausea.
With the "head turning" symptoms , I have good days and bad (but mostly bad) ,
Sometimes I have milder attacks , where I turn my head and feel woozy but do not fall.
But most attacks are horrific and floor me.

yesturday I had a good day with no attacks yet felt unbalanced all day
(which I am used to) , today I have had it twice.

In the past 8 years I have had ....

mri of the head = normal.
ct scan of the inner ears= normal.
mri of the cervical neck and thoracic area = degenerative changes.
inner ear tests = normal.
orthostatic testing = abnormal - but now controlled very well with fluids and salt.

I think the numb arms I get must be cord compression from my degenrative problem, because they didnt mention any prolapses on my mri,
Right now using my computor I have stabbing pains in my cervical area, I feel I cant use my arms too much or I will regret it.

I will go and do the tests now and I even have a swizzle chair to use alophysio ,lol.
Thank you so much.

[alophysio]

hi Keephurting, we are going to change your username one day to painisgone!

Keep going with things. I am fairly confident it is your neck or thoracic spine.

Don't be fooled by looking for prolapses in a cervical disc - a common assumption is that the disc in the neck is like a lumbar disc...in fact, anatomical studies have shown that it ISN'T and that it has a split in the disc from about your 20's and that is likely due ot how your uncovertebral joints work...the disc is mainly fibrocartilage, not fluid like a lumbar disc...very different in morphology.

If you email these people with a request for people in the UK near you who have done their courses, i think you will find someone who can help you. I do not have any vested interests with this group other than i take their courses and i love their work! [email protected] is the email.They can direct you to someone who can help you find someone as geographically convenient as possible to you. Because you are a head/neck/thorax patient, the physio will need to have completed "The DP Series" or "The Thorax" courses.

Your treatment, i am guessing, should be functionally based around your movements and postures and retraining you on how to control your ribs/thoracic spine/neck/head to coordinate all that - and your shoulders and arms too by the sounds of it...so please note down exactly what actions and when and how consistently you get the symptoms to help the physio help you the most.

Please keep us up to date with the progress of your tests and treatment

Cheers!

[keephurting]

lol alophysio , that would be wonderful.
I will take a note of that email and maybe look into it after my hospital appointment.

If it is a VBI , do you know how do they make it stop ?

I will let you know how I get on,

god bless.

[alophysio]

cool - no worries See what happens and let us know.

[keephurting]

I didnt expect to be back here so soon , but have had a terrible day so far and dont understand whats going on,
I got a numbing pain in the side of my neck that then went down under my collar bone , down my arm and hand, then spread up to my ear and cheek bone (all on my left),
it hurt so much and then started tingling every where. I thought I needed to go to emergancy cos it was so bad but it passed in 25 mins with pain killers and rest.
It felt like a heavy feeling and I have had it before in the past. I dont know if this is this my neck or something else.

On another note , yesturday I felt woozy and unbalanced walking and then did that neck
exersize - where you push your chin back into you neck and the woozy feeling went away 85% , so it does sound like its my neck.
As soon as I put my chin in normal position the woozyness came back.

[alophysio]

Hi,

To me, it sounds like a neck or thorax (thoracic spine, ribs, sternum) issue. The fact that doing the neck retractions helped is a good sign. The wooziness etc is common from neck problems.

I still reckon it is your neck or thorax but get it all checked out.

Thanks Let us know how you get on. You have the email to ask the people at discoverphysio.ca for a physio near you Cheers

[keephurting]

Hi again, just a update from me !

I went to see the orthopedic specialist yesturday, he had my mri pictures on his computor screen and said not only do I have degenerative changes in my neck , I also have 2 prolapsed discs in my neck.
Then he asked all my symptoms and gave me lots of tests and said
I also have thoracic outlet syndrome.
He said all this could be the cause of my dizzy/drop attacks.
So he is now referring me to a vascular surgeon (but did'nt say what for ? ) and he is sending me to a physio.

when I looked at my mri picture , there were 2 black lumps pressing into my spinal cord , so I pressume that was the prolapsed discs. It looked like it went almost half way into my spinal cord.

I am a little worried but also relieved because it confirmed every thing I have been feeling.

And it is also what you guys thought might be going on !!!!
Any info would be much appreciated.

[alophysio]

hey keephurting...won't be long until you are "feelingbetter"!

Thanks for the update.

I think you have summed it up nicely. It is hard to comment specifically but it would seem that the disc material (which at your age is NOT fluid) is causing some physical irritation or compression of the spinal cord.

Whilst this seems serious (and it can be), it might help you to know that lots of people have these problems and don't have symptoms.

In my opinion, it would seem to me that chemical irritation tends to produce more pain than physical compression. Having said that, you have had this problem a long time. Therefore your brain might be sensitizing your neural system - it is a fancy way of saying that your nerves are in a state of high alert all the time. This can cause issues as well.

The vascular surgeon is to check the blood flow out of your thoracic outlet = there are tests you can look up and do from Dr Google to test for thoracic outlet syndrome.

Physio is to take care of the symptoms, get your nerves and joints and muscles moving and help you get better.

Worry is only because you don't have a definitive plan of action outlined for you yet but it would seem that even from thousands of miles away, your story is a familiar one to us physios! So please remain positive and keep us informed of how you are going

Glad to have helped Hope the extra info helps. Post any specific questions you have here too if you like...

Cheers!

[keephurting]

hi Alophysio , thanks alot for the reply.
There are a few things that have popped into my mind today.

I read that throacic outlet syndrome can cause dizziness,
and so can prolapsed disc. Which would be more likely
to be the culprit in your experiance ?

Also , what do you mean by my
Disc material would not be fluid at my age ?

The specialist used a pin to stab me all down my right arm and
left arm , but on my left I had hardly any feeling ,where as on the right it really hurt. When I raise my arms , I get numb down my left arm but sometimes when its acute I get numb down both arms. Does this sound like the discs causing this or
is it compression in the shoulder area ( where I also get pain) ?

I understand you can not say for certain,
but would like to hear your opinion anyway.

Thanks.

[alophysio]

hi keephurting,

I read that throacic outlet syndrome can cause dizziness, and so can prolapsed disc. Which would be more likely to be the culprit in your experiance ?

Hard to say without examining you as they present differently and i usually use my examination of you to tell which is which. Bascially you would try to stress one without stressing the other to differentiate between the 2 and try to reproduce the symptoms. I would love to give you something to try but it simply would be fair on me or you to try do so as I wouldn't / couldn't be sure of the results.

Also , what do you mean by my Disc material would not be fluid at my age ?

Exactly what i said. Some people might tell you that the disc has "leaked out" but it isn't fluid so people think that the disc material breaks away...just some more info so you are better educated about your conditions...

The specialist used a pin to stab me all down my right arm and left arm , but on my left I had hardly any feeling ,where as on the right it really hurt. When I raise my arms , I get numb down my left arm but sometimes when its acute I get numb down both arms. Does this sound like the discs causing this or is it compression in the shoulder area ( where I also get pain) ?

Whilst at rest, i would hazard a guess and say disc > TOS (thoracic outlet syndrome). As for both arms raised, if it depends on how bad the pain is (how acute it is), then it might mean more the disc than TOS.

I understand you can not say for certain, but would like to hear your opinion anyway.

Please remember this very important point that i cannot say these things for certain

To be honest, I lean towards a cervical disc than TOS in your case but don't have enough information to decide - of course, a full examination would be preferable. I also think you have a possible dysfunction in the thorax (not TOS) but will need to reread your posts to confirm and have an examination.

Hope this has helped!