Cervical Radiculopathy Improves with Prolotherapy
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A patient story
Cervical Radiculopathy Improves with Prolotherapy Ross Hauser, M.D. Excerpts from the Journal of Prolotherapy
A 38 year-old male, came in April 2008 with complaints of severe pain in his neck that radiated down his right arm with numbness of his right index finger and posterior wrist (C6 distribution). His pain began earlier that month after lifting a TV. Prior to this injury he was an active person who did not have pain. He stated that his pain was at its worst when lying down (a 10 out of 10 pain), but is helped by wearing a neck brace while sleeping. He was taking Norco two to three times per day for pain, a Medrol dose pack, and Daypro at the time of his first visit. An MRI ordered by his primary doctor revealed a right sided disc herniation at C5-C6 and C6-C7.
Upon initial exam, his right arm muscle strength was normal but had slightly diminished sensation in C6 dermatome. Upon extension of his neck and right lateral rotation he had shooting pains down his right arm. The patient received Prolotherapy at his first visit to his entire neck and right scapular region. He was taken off Norco and Daypro and given Ultram for pain and Ambien to help him sleep.
He returned every 2 weeks for the same treatment and at his 3rd visit he reported 50% improvement in pain. His pain was down to 5 out of 10. He still had numbness of his right index finger with lying down. He moved his appointments to every 3 to 4 weeks over the next few treatments and at his 5th visit he reported 70% improvement in pain and that he no longer had pain unless he was lying down. His finger was unchanged at this time.
The patient continued his Prolotherapy every 6 weeks or so over the next few treatments and, at what would have been treatment #9, he reported that his neck was doing "really good." He did not receive treatment at this visit to his neck but wanted to get his knees and feet treated for unrelated injuries because Prolotherapy had worked so well on his neck. He was on no pain medication for his cervical radiculopathy after his 8th visit and the sensation to his right index finger and posterior wrist was back to normal. He was also back to full activities including exercise. Six months after his last Prolotherapy treatment he continues to do well.
CERVICAL 'RADICULOPATHY' SYMPTOMS SUCCESSFULLY TREATED WITH PROLOTHERAPY About once every two weeks a patient comes in worried because they believe they have a pinched nerve in the neck. Typically they have had an MRI which some some degenerative arthritis and degenerated discs in the neck and they have tingling in the arm and hand. So is this cervical radiculopathy or is this just a referral pain from the upper thoracic area. How do you tell?
THE EYES I look at people's eyes. People who have a true 'nerve' being pinched, really can't smile because the pain is awful. When the eyes loose their luster and the look on the persons face is 'panic' I think cervical radiculopathy. If the person is able to converse with me and laughs at my jokes, then there is a good chance they have a thoracic ligament problem.
THE HUB A person who puts their hand between the spin and the scapula and says that is where their pain emanates from, I think thoracic ligament problem. In cervical radiculopathy cases, the person will point to a specific area of their neck causing the pain. Thoracic ligament problems can cause some neck pain as the case study indicated but typically the person will tell you this is a referral pain and the neck pain is minimal compared to the thoracic pain.
NUMBINESS Cervical radiculopathy gives 'true' numbness. If a person senses numbness in the fingers but can feel everything, this is called numbiness. This is a referral symptom typically from thoracic ligament problems (generally thoracic #1-3). Numbness that is true, meaning the person has lost sensation in part of their hand or fingers, indicates a nerve problem. Then one thinks of cervical radiculopathy.
BREATHING Cervical radiculopathy is not affected by breathing and vice versa. Breathing can aggravate thoracic problems and thoracic problems can aggravate breathing. Someone whose symptoms are affected by deep breathing, makes me think thoracic ligament problem.
ARM MOVEMENT AGGRAVATION Believe it or not in my experience, when arm movement aggravates the symptoms, I think more thoracic ligament problem. Simple movements of the arm only occur by stabilization of the scapula. Stabilization of the scapula affects the upper thoracic segments more then it does the cervical spine.
RESPONSE TO PROLOTHERAPY Thoracic ligament problems often feel better right away with Prolotherapy. Cervical radicular symptoms generally need a nerve block to feel better right away. Prolotherapy can be used with cervical radiculopathy but often you need other modalities also to treat the person.
For people who have been told that they need surgery for cervical radiculopathy I would recommend that they get a second opinion from a Prolotherapist. You would hate to get surgery and not be better because your problem was a thoracic ligament problem and all you needed was Prolotherapy.
The thoracic ligaments that can refer pain down the arm are those involved with Thoracic segements #1,#2, and #3. The ligaments that connect these vertebrae together and the ones that connect these vertebrae to the ribs (costovertebral ligaments).
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