Neck Pain: Seeking Effective Treatment for Neurological Issues

Neck pain

Hello, doctor! A year ago, I have been experiencing a heavy sensation in the back of my neck and occiput, along with fatigue.
Sometimes, I also feel pain and swelling in my jaw, as well as partial numbness in my face.
My left ear feels stuffy, and I have tinnitus, which worsens when I clench my jaw, causing dizziness.
My vision can be blurry, and when I lie on my back, it feels uncomfortable as if I'm lying on a rock.
After sleeping, the top left side of my head feels numb, my back is very stiff, and my lower back is sore.
I underwent a brain MRI, which showed no issues, and a brainwave test that also came back normal.
I had X-rays taken, and they said my cervical spine is fine but slightly straightened.
I have tried neck traction, heat therapy, and electrical rehabilitation, but there has been no improvement.
I also underwent manual therapy, which did not help either.
Now, a year later, I have developed new symptoms, including numbness and tingling in my left hand, along with weakness.
The rehabilitation clinic suggested that my nerves might be compressed and recommended more neck traction.
However, since my original issues have not improved after a year, I would like to know which specialist I should consult for effective treatment for these conditions.

Mr. Kuan, 30~39 year old female. Ask Date: 2022/10/09

Dr. Jiang Junyi reply Neurology

Hello Mr.
Kuan,
You mentioned that your left hand experiences numbness, tingling, soreness, and weakness, and that the rehabilitation clinic indicated it might be due to nerve compression.
I'm curious about the specific area where you feel the numbness and tingling.
Based on your description of neck pulling, we may need to consider the possibility of cervical nerve root compression.
Typical symptoms of peripheral nerve compression include:
1.
Pain characterized by burning or electric sensations.
2.
Symptoms that have a specific dermatomal distribution, which can be triggered by touch or pressure.
3.
Accompanied by muscle soreness and weakness.
Examinations for peripheral nerve issues typically involve electrophysiological tests to assist in diagnosis.
Nerve conduction studies assess the conduction velocity and waveform of large fiber nerves, while electromyography evaluates the muscle response in the affected nerve distribution area.
I recommend consulting with a neurologist specializing in peripheral nerve disorders, as they have more experience with electromyography diagnostics.
Thank you for your inquiry.
If you have any further questions, feel free to discuss them.
Wishing you good health, peace, and joy.
Dr.
Jiang Junyi, Neurologist, Taoyuan Hospital

Reply Date: 2022/10/09

More Info

Your symptoms suggest a complex interplay of neurological and musculoskeletal issues, particularly involving the cervical spine and possibly the nerves that originate from it. The heaviness in your neck and back, along with facial numbness, ear fullness, and tinnitus, can be indicative of cervical radiculopathy or other forms of nerve compression. Given that you have undergone various imaging studies (MRI, X-rays) that have not shown significant abnormalities, it is essential to consider other potential causes for your symptoms.

Firstly, the cervical spine can sometimes exhibit subtle changes that may not be easily visible on standard imaging. Conditions such as cervical spondylosis, which involves age-related wear and tear of the cervical spine, can lead to nerve root compression even if the imaging appears normal. Additionally, muscle tension and spasms in the neck and upper back can contribute to the sensation of heaviness and discomfort, as well as radiating symptoms into the arms and head.

The presence of ear symptoms (tinnitus and fullness) and facial numbness may also suggest involvement of the cranial nerves, particularly the trigeminal nerve, which can be affected by cervical spine issues. The fact that your symptoms worsen with certain movements, such as tucking your chin, further supports the possibility of nerve irritation or compression.

Given the persistence of your symptoms despite various treatments, it may be beneficial to consult with a neurologist who specializes in pain management or a neurosurgeon. They can provide a more in-depth evaluation of your neurological function and may recommend additional diagnostic tests, such as a cervical spine MRI with contrast, to assess for any subtle abnormalities that may have been missed previously.

In addition to medical evaluation, consider exploring physical therapy with a focus on manual therapy techniques. A skilled physical therapist can assess your posture, movement patterns, and muscle imbalances, which may contribute to your symptoms. They can also provide targeted exercises to strengthen the neck and upper back muscles, improve flexibility, and reduce tension.

If nerve compression is confirmed, treatment options may include corticosteroid injections to reduce inflammation and pain, or in some cases, surgical intervention may be necessary to relieve pressure on the affected nerves.

Moreover, addressing any underlying anxiety or stress that may exacerbate your symptoms is crucial. Chronic pain can lead to increased anxiety, which in turn can amplify the perception of pain. Cognitive-behavioral therapy (CBT) or mindfulness-based stress reduction techniques may be beneficial in managing the psychological aspects of chronic pain.

In summary, your symptoms warrant a comprehensive evaluation by a neurologist or a pain specialist, along with a multidisciplinary approach that includes physical therapy and possibly psychological support. This holistic approach can help you achieve better management of your symptoms and improve your overall quality of life.

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