Neck and Shoulder Pain: When to Consider MRI After Previous Disc Issues

Neck and shoulder pain

Four years ago, I experienced numbness in my left fingers and pain in my arm.
After an MRI examination, it was found that there was a herniated disc at the levels of C3-C4, C4-C5, C5-C6, and C6-C7, with the C5-C6 level being more severe.
I did not undergo surgery and after six months of rehabilitation, the numbness and pain resolved.
However, I occasionally felt discomfort and continued rehabilitation until this year.
Recently, about three weeks ago, I woke up with pain in the left side of my neck, especially when turning left or looking down to the left.
Other movements did not cause significant symptoms.
I resumed rehabilitation for about two weeks and noticed that the symptoms fluctuate; sometimes they improve, but often I feel particularly uncomfortable in the morning after sleeping, especially when lying on my left side, which increases the pain.
During the day, I feel relatively fine unless I turn left or look down to the left.
Additionally, I have pain on the outer side of my left upper arm, and if I accidentally bump my shoulder, causing my head to jolt, it can also be painful.
Two days ago, I visited an orthopedic doctor who took X-rays and indicated that the imaging showed a similar condition of cervical disc protrusion as four years ago.
I would like to ask if I need to get another MRI?

Zhe, 30~39 year old female. Ask Date: 2019/07/04

Dr. Wang Zhaomin reply Rehabilitation

Nerve root lesions caused by herniated discs typically improve with rehabilitation treatment, but they often cannot be completely cured, leading to the possibility of recurrence and discomfort.
Whether to arrange for imaging studies such as MRI should be determined by the treating physician based on a comprehensive assessment of clinical symptoms, physical examination findings, and treatment outcomes.
It is advisable to discuss this further with your physician.

Reply Date: 2019/07/04

More Info

When considering whether to undergo an MRI after experiencing neck and shoulder pain, especially in the context of previous disc issues, several factors must be taken into account. Given your history of cervical disc herniation affecting the C5-C6 levels, which was previously diagnosed through MRI, and your recent symptoms, it is crucial to evaluate the necessity of further imaging.

Understanding Your Symptoms
Your current symptoms include neck pain that worsens with certain movements, particularly when turning your head to the left or sleeping on that side. Additionally, you report discomfort in your left upper arm, which could indicate nerve involvement. The intermittent nature of your symptoms, along with the exacerbation upon specific movements or positions, suggests that there may be ongoing issues related to your cervical spine.

When to Consider MRI
1. Persistent or Worsening Symptoms: If your symptoms have persisted for more than a few weeks and are not improving with conservative treatment such as physical therapy, it may be time to consider further imaging. MRI is particularly useful in assessing soft tissue structures, including discs and nerves, which can provide insight into whether there is a new or worsening herniation or other pathology.

2. Neurological Symptoms: The presence of neurological symptoms, such as numbness or tingling in your fingers or arm, can indicate nerve root compression. If these symptoms are returning or worsening, an MRI can help determine if there is a new disc herniation or other issues that may require intervention.

3. Comparison with Previous Imaging: Since your previous MRI showed significant disc herniation, comparing new imaging with past results can help assess any changes. If the X-ray findings are similar to your previous MRI, it may suggest that the underlying issue has not changed significantly. However, MRI provides more detailed information about soft tissue than X-rays.

4. Impact on Daily Life: If your symptoms are affecting your daily activities, work, or quality of life, this is a strong indicator that further investigation is warranted. MRI can help guide treatment decisions, whether that involves continued conservative management or surgical options.

Conclusion and Recommendations
Given your history and current symptoms, it would be prudent to discuss the possibility of an MRI with your healthcare provider. They can evaluate your symptoms in the context of your previous imaging and clinical findings. If there is a suspicion of recurrent or new disc herniation, or if your symptoms suggest nerve root involvement, an MRI would be beneficial.

In the meantime, continue with your physical therapy and consider discussing pain management options with your physician. They may recommend anti-inflammatory medications or other therapies to help alleviate your symptoms while you await further evaluation.

Ultimately, the decision to proceed with an MRI should be made collaboratively with your healthcare provider, taking into account your clinical history, current symptoms, and the potential benefits of obtaining updated imaging.

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