Muscle Pain vs. Nerve Compression: A Patient's Journey

Q: Muscle Pain vs. Nerve Compression: A Patient's Journey

Hello： Based on the symptoms you described, it is more likely to be a cervical spine issue. <br>Since the MRI of the cervical spine has confirmed nerve compression, and the symptoms are consistent, as a neurosurgeon, I would also recommend surgery. <br>It is possible that your fa

Is the alternating soreness throughout the body due to a muscle disorder or nerve compression?

Hello, doctor.
I would like to consult about my father, who is 64 years old.
Symptoms:
1.
Areas of soreness: upper back, outer upper arms, lower back, knee and thigh junction, inner calves; (the soreness is not consistent, sometimes it’s here, sometimes there, with the upper back or knees being the most painful).
2.
Areas of soreness and numbness: palms and soles of the feet.
3.
He has experienced severe fluctuations in temperature for several days.
4.
He feels depressed.
Medical consultations:
1.
Neurosurgery 1 (Hospital): MRI showed C4-5 bone spurs.
Surgery is required, with a success rate of about 70%.
No further tests needed.
(The doctor listened to the patient's account, reviewed the images, and did not perform a physical examination.)
2.
Neurosurgery 2 (Hospital): MRI showed bone spurs.
Surgery is required, no further tests needed.
(The doctor listened to the patient's account, reviewed the images, and did not perform a physical examination.)
3.
Rehabilitation 1 (Hospital): X-ray showed bone spurs, which are not significant.
Likely myofascial pain syndrome; recommended rehabilitation and maintaining a positive mood.
(The doctor listened to the patient's account, reviewed the images, and did not perform a physical examination.)
4.
Rehabilitation 2 (Clinic): Based on symptoms, it seems to be nerve compression; recommended rehabilitation and more bed rest.
(The doctor listened to the patient's account, did not review images, and did not perform a physical examination.)
5.
Traditional Chinese Medicine (Hospital): Based on symptoms and physical examination, muscle stiffness and multiple tender points were found, indicating a muscle-related condition; recommended treatment and more exercise.
(No images reviewed, physical examination performed.)
6.
Orthopedics (Clinic): Based on symptoms, it seems to be nerve compression.
(The doctor listened to the patient's account, did not review images, and did not perform a physical examination.)
7.
Surgery 1 (Hospital): Based on symptoms, it is not a bone spur.
(The doctor listened to the patient's account, did not review images, and did not perform a physical examination.)
8.
Surgery 2 (Clinic): Based on symptoms, it is not a bone spur; it seems to be a meridian issue.
(The doctor listened to the patient's account, did not review images, and did not perform a physical examination.)
Current condition: He is not working.
Due to soreness or depression, he has been lying on the sofa or bed all day for about 2 years.
Two years ago, pain medication was effective; however, after 3 PM, he would start to feel sore.
Sometimes he would feel normal for a few days, but changes in weather would trigger soreness.
After six months, the medication gradually became ineffective.
Now, he experiences continuous soreness throughout the day, especially in the knees and upper back.
He underwent a small needle knife treatment in traditional Chinese medicine once, which provided slight relief (the doctor noted mild muscle fibrosis during treatment), but the pain returned the next day.
Three days later, he had acupuncture (the doctor noted that the muscles were less stiff, and it is not a bone spur).
After treatment, he felt slightly better, but the pain returned the next day.
He was initially planning to ask a third rehabilitation doctor for an electromyography (EMG) test and cervical traction, but the patient is now in severe pain and insists on immediate surgical treatment.
Questions:
1.
Does this patient not fit the symptoms of cervical spondylosis (neurological type), could it be cervical spondylosis (myelopathic type)?
2.
Why do most doctors not perform neurological examinations and only review images to determine the need for surgery?
3.
How can this patient accurately determine if it is a muscle disease or nerve compression?
4.
Can electromyography effectively determine if it is a muscle disease or nerve compression?
5.
Is there no pain medication that can effectively relieve pain before undergoing treatment or rehabilitation?
6.
Are there other methods to resolve this? He is nearing a breaking point! I appreciate your great kindness! Thank you!

Lu Dan, 30~39 year old female. Ask Date: 2011/08/07

Dr. Zhang Junwei reply Neurosurgery

Hello: Based on the symptoms you described, it is more likely to be a cervical spine issue.
Since the MRI of the cervical spine has confirmed nerve compression, and the symptoms are consistent, as a neurosurgeon, I would also recommend surgery.
It is possible that your father has multiple issues contributing to the problem.
However, since you have consulted many doctors and none have provided a definitive diagnosis or solution, the best approach is to identify each issue one by one and address them individually.
I hope this helps resolve your problem!

Reply Date: 2011/08/07

More Info

Understanding the distinction between muscle pain and nerve compression is crucial for effective diagnosis and treatment, especially in a patient like your father, who has been experiencing a complex array of symptoms for an extended period. Given the details you've provided, let's delve into the various aspects of his condition, the diagnostic process, and potential treatment options.

Symptoms and Diagnostic Challenges
Your father's symptoms, including widespread muscle soreness, numbness, and fluctuating temperatures, suggest a multifaceted issue. The presence of cervical spine osteophytes (bone spurs) at the C4-5 level raises the possibility of cervical radiculopathy, where nerve roots are compressed, leading to pain and neurological symptoms. However, the variability in symptoms and the lack of consistent findings across multiple consultations indicate that a comprehensive approach is necessary.

1. Cervical Spondylosis vs. Other Conditions: While cervical spondylosis (degenerative changes in the cervical spine) can lead to nerve compression, it is essential to differentiate between cervical radiculopathy (nerve root compression) and myelopathy (spinal cord compression). The symptoms of myelopathy can include weakness, coordination issues, and changes in bowel or bladder function, which may not be present in your father's case. A thorough neurological examination, including reflex testing and sensory evaluation, is crucial to determine the nature of the compression.

2. Inconsistent Diagnostic Approaches: The variability in diagnostic approaches among different specialists is concerning. Ideally, a thorough clinical evaluation should accompany imaging studies. The reliance on imaging alone without a comprehensive physical examination may lead to misdiagnosis or inappropriate treatment recommendations.

Diagnostic Tests and Their Role
- Electromyography (EMG) and Nerve Conduction Studies (NCS): These tests are valuable in assessing nerve function and can help differentiate between muscle disorders and nerve compression. EMG can identify muscle electrical activity and detect abnormalities that suggest muscle disease or nerve damage. If nerve conduction is impaired, it may indicate nerve compression or injury.

- Imaging Studies: MRI is the gold standard for visualizing soft tissue structures, including nerves and discs. However, the interpretation of these images must be correlated with clinical findings.

Treatment Options
1. Pain Management: It is concerning that your father has not found effective relief from pain medications. While opioids like tramadol and morphine can provide temporary relief, they are not ideal for long-term management due to potential side effects and dependency issues. Non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and adjunctive therapies such as gabapentin or pregabalin may offer better control of neuropathic pain.

2. Physical Therapy: Engaging in a structured physical therapy program can help improve mobility, strengthen muscles, and alleviate pain. Techniques such as manual therapy, stretching, and strengthening exercises can be beneficial.

3. Alternative Therapies: Acupuncture, chiropractic care, and massage therapy may provide symptomatic relief and improve overall function. However, these should be pursued in conjunction with conventional medical treatments.

4. Surgical Options: If conservative measures fail and significant nerve compression is confirmed, surgical intervention may be warranted. However, this decision should be made after careful consideration of the risks and benefits, ideally in consultation with a neurosurgeon or orthopedic spine specialist.

Conclusion
Your father's situation is undoubtedly complex, and it is essential to approach it with a multidisciplinary perspective. A thorough evaluation by a neurologist, possibly followed by a pain management specialist, may provide clarity on the underlying issues and guide appropriate treatment. It is crucial to advocate for comprehensive assessments, including EMG/NCS, to ensure that the diagnosis is accurate and that the treatment plan is tailored to his specific needs.
Encourage your father to maintain open communication with his healthcare providers and to seek a second opinion if he feels his concerns are not being adequately addressed. Pain management is a journey, and finding the right combination of therapies can take time.

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