Persistent Pain: Seeking Answers for Neck and Nerve Injuries

Injury can feel very helpless?

Hello, doctor.
I sustained an injury in mid-August while undergoing chiropractic treatment (pulling my neck while lying in bed, with one person pulling my legs and another pulling my neck).
Initially, I visited an orthopedic specialist and had X-rays taken, which showed that my neck appeared overly straight (the bones seemed undamaged).
My initial symptoms included severe dizziness, difficulty focusing on nearby objects, eye pain when moving my eyes, a sensation of things appearing blurry, swelling in the jaw muscles, and muscle injuries in my neck.
I would feel weak after standing for 10 to 20 minutes, and I experienced some ear pain.
After three months of orthopedic treatment, I have not recovered; my eyes still feel uncomfortable (I believe this is due to tight neck muscles).
My neck has improved compared to before, but I still frequently experience weakness and soreness (sometimes feeling completely weak during class).
Occasionally, my hands feel numb.
Recently, for two to three days, I experienced noticeable numbness on the entire right side of my hand and face, which gradually subsided after taking pain and anti-inflammatory medication.
I have recently consulted with neurosurgery and rehabilitation specialists, but they did not conduct further examinations.
The neurosurgeon prescribed medication and mentioned that since it has been a long time without improvement, surgery might be necessary.
The rehabilitation doctor said no further examination was needed, stating that if there is nerve compression, I would still need to continue rehabilitation.
After three months of seeing doctors and continuously taking anti-inflammatory medication, I am truly exhausted both physically and mentally.
I would like to ask you, doctor, what areas I might have injured (muscles? brain? nerves?) and whether I should consider switching hospitals for more in-depth examinations (so far, I have only had X-rays).
Could you also recommend a doctor in Hsinchu? Thank you very much.

Amin, 20~29 year old female. Ask Date: 2006/11/16

Dr. Chen Xianchang reply Rehabilitation

1.
Further magnetic resonance imaging (MRI) should be performed to visualize the cartilage and spinal cord, as well as nerve conduction studies and electromyography (EMG) to assess for nerve compression.

2.
There may be a possibility of a herniated disc compressing the cervical nerve or a facet joint subluxation causing nerve compression.

3.
You may ask your original physician for a referral to a larger hospital.
I am not familiar with the Hsinchu area, but I apologize for that.
If you come to Nantou Hospital, I will refer you to a medical center for further examination.

Reply Date: 2006/11/16

More Info

Persistent pain following an injury, especially in the neck and associated with nerve symptoms, can be quite complex and frustrating. Based on your description, it seems you have been experiencing a range of symptoms including dizziness, visual disturbances, muscle swelling, and sensations of weakness and numbness. Let’s break down your situation and explore potential causes, diagnostic approaches, and treatment options.

Understanding Your Symptoms
1. Neck and Nerve Injuries: The mechanism of your injury, involving manipulation of the neck, raises concerns about potential strain or injury to the cervical spine and surrounding soft tissues, including muscles and nerves. The symptoms you describe—dizziness, visual disturbances, and muscle weakness—could be indicative of cervical radiculopathy or even cervical myelopathy, where nerve roots or the spinal cord itself may be affected.

2. Dizziness and Visual Disturbances: These symptoms can be associated with cervical spine issues. The neck houses important structures that can influence balance and vision. For instance, the vertebrobasilar system, which supplies blood to the brain, can be compromised by cervical spine injuries, leading to dizziness and visual problems.

3. Muscle Weakness and Numbness: The sensations of weakness and numbness, particularly in the arms and face, suggest possible nerve involvement. This could be due to nerve compression from muscle spasms or structural changes in the cervical spine.

Diagnostic Approach
Given that you have only undergone X-ray imaging, it may be beneficial to pursue further diagnostic evaluations. Here are some recommended steps:
1. MRI of the Cervical Spine: An MRI can provide detailed images of the soft tissues, including intervertebral discs, spinal cord, and nerve roots. This can help identify any herniated discs, spinal stenosis, or other structural abnormalities that may be compressing nerves.

2. Neurological Evaluation: A thorough neurological examination by a specialist can help assess the extent of nerve involvement. This may include tests for reflexes, muscle strength, and sensory function.

3. Electromyography (EMG) and Nerve Conduction Studies: These tests can evaluate the electrical activity of muscles and the speed of nerve conduction, helping to identify any nerve damage or dysfunction.

Treatment Options
1. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can provide exercises to strengthen neck muscles, improve flexibility, and reduce pain. They can also teach you proper posture and body mechanics to prevent further injury.

2. Pain Management: If inflammation is a significant factor, medications such as non-steroidal anti-inflammatory drugs (NSAIDs) may help. In some cases, corticosteroid injections may be considered to reduce inflammation around the nerves.

3. Alternative Therapies: Techniques such as acupuncture, chiropractic care, or massage therapy may provide relief for some individuals. However, it’s essential to consult with your healthcare provider before pursuing these options.

4. Surgical Consultation: If conservative treatments fail and there is evidence of significant nerve compression or structural issues, a surgical consultation may be warranted. Surgery may be necessary to relieve pressure on nerves or stabilize the spine.

Seeking Further Care
If you feel that your current treatment plan is not yielding results, it may be wise to seek a second opinion or consult with a specialist in a different facility. A multidisciplinary approach involving neurologists, orthopedic surgeons, and rehabilitation specialists can provide a comprehensive evaluation and tailored treatment plan.

Conclusion
Persistent pain and neurological symptoms following a neck injury can stem from various underlying issues. A thorough diagnostic workup, including advanced imaging and neurological assessments, is crucial to identify the root cause of your symptoms. From there, a combination of physical therapy, pain management, and possibly surgical intervention can be explored to help you regain function and alleviate discomfort. Don’t hesitate to advocate for your health and seek out the care you need to improve your quality of life.

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