I had a 36 year old male present with a Cervical herniated disc today. He presented with neck pain rated an 8 on the 0-10 scale and radiating pain into his left arm and hand of one month duration. He felt that his wrist was beginning to get weak. He had been to his primary doctor who sent him for an MRI of the cervical spine. His medical doctor had given him a medrol dose pack and pain meds. His MRI demonstrated two herniated disc, one at C5-6 and one at C6-7. His primary then referred him to a local orthopedist who wanted to do surgery immediately. The surgeon wanted to do a two level fusion. The patient wanted another opinion.
I did a complete history and physical. After examination I concluded that he had NO neurological deficits. He had numerous positive orthopedic and neurological test but non indicated a true neurological deficit. I needed further NCV testing to differentially diagnose between radiculopathy (radiating pain from the neck) vs Carpal Tunnel Syndrome (an entrapment of the Median nerve at the wrist) both of which could produce a pain in the hand. I ordered an NCV the next day. Dr Gary Cohen our Physical Medicine doctor at Millar MultiMedical preformed the test. The test concluded that yes there was a mild radiculopathy (radiating pain) coming from the neck but also there was carpal tunnel syndrome.
I started the patient on daily CMT, Chiropractic Manipulative Therapy with the Activator and DTS - Decompression Traction of the cervical spine at 22lbs at 15 degrees for 20 min a day. I also included in his care e-stim and ultrasound treatment. I told him he would get worse before he got better and indeed he did. But after only a few pulls his pain started going down. We also started treating the carpal tunnel syndrome with e-stim, ultra sound and manipulation. He is now nearly pain free.
I think this case demonstrates always get a second and even a third opinion if surgery is the option and it's not an emergency.
Dr Greg
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