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Dr. Mark
Dr. Mark, Doctor (MD)
Category: Health
Satisfied Customers: 11946
Experience:  U.S. Physician/Surgeon in Neurosurgery
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On a recent MRI the Findings describe Mild degeneration of

Customer Question

On a recent MRI the Findings describe: Mild degeneration of the C3-4 intervertebral disk and mild uncinate degeneration. There is some hyperttrophy on the right, which impinge slightly upon the axilla of the right C4 nerve root.

At C4-5 there is mild narrowing of the intravertebral disk and bulging of the annulus. There is minimal impingement upon the ventral surface of the thecal sac.

At C5-6 level there is degenerative narrowing of the intravertebral disk with bulging of the annulus and bilateral uncovertebral hypertrophy. Axial images suggest some mild spinal canal stenosis although this is not strongly suggested on sagittal images. There is also narrowing of the right neural foramen.

At the C6-7 level there is degenerative narrowing of the intervertebral disk and uncovertebral degeneration. There is minimal impingement upon the ventral surface of the thecal sac. There is also mild degeneration of the T1-2 and T2-2 intervertebral disks with mild bulging of the disks at these levels. There is also some anterior osteophytic hypertrophy at the ventral margins of the disks between C3and C7. Note is made of what appears to be some subchondral cysts or sclerosis on the left near the inferior endplate of C4 and C5.

Impression: Disk and uncovertebral degeneration as described above with no significan facet degeneration. At the C3-4 level there is mild disk degeneration and uncinate degeneration and hypertrophy greater on the right. Degenerative changes at C4-5 are minimal. At C5-6 there is a narrowing of the disk with bulging of the annulus and uncinate hyperrophy, which appeats to result in some mild spinal stenosis and narrowing of the right foramen. At C6-7 there is also degenerative narrowing of the spinal canal although on axial images this appears less pronounced.

The reason for the MRI is bilateral arm pain

I would appreciate your overall analysis of each of the issues and explanation of some of the descriptions such as bilateral uncovertebral hypertrophy. Also your opinion of likely treatment options,with consideration for such as C4 nerve root impingement, stenosis, bulging disks, subchondral cysts and all the hypertrophy.
Submitted: 5 years ago.
Category: Health
Expert:  Dr. Mark replied 5 years ago.
Where exactly in your arms are you having pains?

Does the pain involve the fingers, and if so which ones?
Customer: replied 5 years ago.

 

 

The pain is in the back of the upper arms in the area of the triceps and sometimes down the top of the forearms, but normally not in the fingers.

Expert:  Dr. Mark replied 5 years ago.
OK. This is a long an involved question.

Mild degeneration of the C3-4 intervertebral disk and mild uncinate degeneration. There is some hyperttrophy on the right, which impinge slightly upon the axilla of the right C4 nerve root.

There is a slight degeneration of the disc which may be irritating the right C4 nerve root (this would not cause arm pain).

At C4-5 there is mild narrowing of the intravertebral disk and bulging of the annulus. There is minimal impingement upon the ventral surface of the thecal sac.

There is mild degeneration at this level, but not clinically significant.

At C5-6 level there is degenerative narrowing of the intravertebral disk with bulging of the annulus and bilateral uncovertebral hypertrophy. Axial images suggest some mild spinal canal stenosis although this is not strongly suggested on sagittal images. There is also narrowing of the right neural foramen.

There is a bulging disc here at this level that could be causing narrowing of the spinal canal, though on the side-view images, it does not appear narrow. The right nerve canal appears smaller.

At the C6-7 level there is degenerative narrowing of the intervertebral disk and uncovertebral degeneration. There is minimal impingement upon the ventral surface of the thecal sac. There is also mild degeneration of the T1-2 and T2-2 intervertebral disks with mild bulging of the disks at these levels. There is also some anterior osteophytic hypertrophy at the ventral margins of the disks between C3and C7. Note is made of what appears to be some subchondral cysts or sclerosis on the left near the inferior endplate of C4 and C5.

At C6-7 (this is the level where it would cause pain in the triceps down the forearms) -- there is degeneration, but only minimal compression of the front of the spinal cord. Unfortunately, the report doesn't mention anything about the foramen at this level. The subchondral cysts (probably sclerosis) are not really important - just small changes in the bone from degeneration.

bilateral uncovertebral hypertrophy.

This means there is slight growth of the joints at the side of the spine, due to arthritic degenerative changes. If these grow too much, they can press on the nerves in the foramen, and cause pain.

Overall, this MRI should be interpreted by a neurosurgeon with an exam to see if there are surgical issues in the spine. However, the pain you describe seems to come from C7 nerve root irritation (not C4) and the level which would cause this is C6-7, which does not appear to be that bad on the MRI report.
Customer: replied 5 years ago.

 

 

Thank you for the report. I do have a couple more questions

 

I have recently started physical therapy for rotator cuff tendinopathy issues in both shoulders but discontinued because of pain in the cervical spine area and the pain in the arms thus the MRI

 

Is it likely that physical therapy for the shoulders would aggrevate the cervical spine issues and would physical therapy for the cervical spine first be appropriate

 

Your thoughts ?

 

Thank you very much

Expert:  Dr. Mark replied 5 years ago.
Physical therapy probably would not aggravate the neck issues, given your MRI report, which really isn't all that bad.

But of course, if physical therapy is making you feel more uncomfortable, then stopping it is best. Your body will tell you what is right.
Customer: replied 5 years ago.

 

 

Dr Mark

 

Do you think physical therapy would be appropriate or beneficial for the neck, cervical spine pain and arm pain.

 

Thanks

Expert:  Dr. Mark replied 5 years ago.
Physical therapy is generally a benefit, yes, but each person is different, so listen to your body.
Dr. Mark, Doctor (MD)
Category: Health
Satisfied Customers: 11946
Experience: U.S. Physician/Surgeon in Neurosurgery
Dr. Mark and 6 other Health Specialists are ready to help you
Customer: replied 5 years ago.

 

 

What other treatment or therapy would be suggested for the spine and arm pain.

 

How is it resolved ?

Expert:  Dr. Mark replied 5 years ago.
Well, in most cases (over 90% of the time), no actual treatment is necessary, as the nerve inflammation improves on its own.

Occasionally steroid injections can help with the inflammation.

And in severe cases, surgical decompression could be needed.

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