Cervical Radiculopathy - No Pain but Severe Weakness in Triceps and Lats (with video) Cervical Radiculopathy - No Pain but Severe Weakness in Triceps and Lats (with video)

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Thread: Cervical Radiculopathy - No Pain but Severe Weakness in Triceps and Lats (with video)

  1. #1
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    Default Cervical Radiculopathy - No Pain but Severe Weakness in Triceps and Lats (with video)

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    Hello!

    I will be documenting my journey with cervical radiculopathy, as this injury is beyond frustrating and confusing. It also appears to be a forum topic that pops up every now and then, but with most of them trailing off with minimal follow up about conclusions or outcomes.

    As of today, Iím a bit into the movie, so let me catch you up:

    How it started:
    • Was doing bar muscle upís, when I felt a tweak in the upper back during the lock out. It didnít bother me then, so I continued on.
    • ~3 days later, glowing left shoulder pain started and radiated to the elbow and then to the ring finger. No numbness or paresthesia. Pain level 6/7 of 10.
    • Pain disappeared with manual therapy and chiropractic care.
    • Duration of these events: ~3 weeks.


    Where I am today:
    • What remains is severe weakness in left triceps (for sure) YouTube and lats (I think) YouTube.
    • As you can see in the videos, the left side is "turned off.Ē I canít do a tricep extension with 20 pounds, and my pull-up is completed leaning to the right.
    • After 3 weeks of physical therapy, with marginal strength recovery, paresthesia started in the left shoulder to the elbow and now to the index finger (unlike the ring finger that presented pain before). No numbness or pain.
    • This alarmed me to see a physiatrist.
    • The physiatrist did a few strength tests, and he suspects C7 radiculopathy as my triceps weakness is ďsevere" and a "red flag.Ē Iím meeting with him to review MRIs this Thursday (6/14).
    • In the meantime, Iím on Medrol.


    Looking forward ó Your advice please:
    While my meeting to review C7 radiculopathy with MRIs is this week, what Iím struggling to understand is how my pull-upís at the top of the movement are affected by tricep weakness. Are there other pathologies that I should ask about with the doctor?

    Thanks!

  2. #2
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    You have probably injured C6-7, with nerve impingement. Don't do muscle ups. Don't rely on a horribly catabolic oral steroid for relief from this obvious mechanical problem. Do get the MRI immediately. Do have the surgery ASAP.

  3. #3
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    Quote Originally Posted by Mark Rippetoe View Post
    You have probably injured C6-7, with nerve impingement. Don't do muscle ups. Don't rely on a horribly catabolic oral steroid for relief from this obvious mechanical problem. Do get the MRI immediately. Do have the surgery ASAP.
    Can you elaborate on why you recommend the surgery ASAP? Due to stupidity, I did this to myself twice. I was able to make a full recovery both times, taking around 3-4 months before complete loss of paresthesia and strength levels returning to previous high. The first surgeon recommended surgery right away, but the second surgeon recommended waiting 3 months. I was hesitant to wait, because I was seeing minimal change in symptoms even 4-8 weeks after the injury. Around 8-12 weeks after I started seeing noticeable improvement. Eventually everything did come back.

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    Because if the MRI shows a mechanical impingement, the sooner the nerve is unimpinged the better the chance for recovery to full function. Nerve damage is slow to repair, and will be incomplete if too severe.

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    Quote Originally Posted by Mark Rippetoe View Post
    Because if the MRI shows a mechanical impingement, the sooner the nerve is unimpinged the better the chance for recovery to full function. Nerve damage is slow to repair, and will be incomplete if too severe.
    Yes, that is a good argument for surgery. I was worried about the exact same thing. I hoped giving it 12 weeks wouldn't substantially increase the risk of making it permanent. However, neither doctor (or the internet) gave me any indication of how much risk waiting ~3 months actually posed. Without that information, I didn't see how I could make a rational decision about how long to wait before surgery.

  6. #6
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    If you need the surgery, it's because things will not heal, so get it NOW.

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    I had a two level ACDF (C5-7) exactly one week ago. Funny this thread came up, because I had wanted to thank Rip for the information he's shared here about his fusion. It reassured me that things were going to be okay--that I'd get better, and be able to train again--if I had to have this done, which obviously I did.

    I had four bouts of right C6 radiculopathy across about 3 years, each time more painful and with worse numbness. The most recent one started four weeks ago, and it involved both C7 and the symptom of weakness for the first time. I'd had an MRI last fall, after round three, so I knew I had impending myelopathy as well, and when my left (unaffected) hand started contracting involuntarily with sneezing last winter, I knew it was a first clinical symptom. So, it was time.

    I spent the rest of the winter getting good and strong (for me, anyway), knowing I'd probably need surgery soon, and this last flare gave me the final push. I had a repeat MRI, EMGs and nerve conduction studies (to make sure both levels were necessary), and to the OR.

    Woke up with the radiculopathy pain completely gone--there's the C6 and C7 numbness, and triceps/wrist extensor weakness I went into surgery with, which will hopefully resolve completely, but that takes months.

    So, one week later I can say it's not really a walk in the park, but being strong sure makes life easier. I can't lift more than 5 lbs for six weeks, so my full time job is currently sitting, gentle walking, and sitting again. Which is annoying. But I was off narcotic pain meds in four days, and I was able to function quite well pretty much from the start, simply because moving your body in space is easy when you're strong. I started walks outside day 2, and can go a few miles with no difficulty. (And every time I go walking I think grimly, "walking is only exercise if you're 2/3 dead.") I feel like my spine was rearranged some--things are definitely uncomfortable at times--but nothing I would really call pain. Sleeping isn't super comfortable yet. But hey, seven days! Not bad!

    That is to say, if you need surgery, you need it, and everyone's mileage will vary, but for me at least it hasn't been nearly as bad as I expected. Hopefully it's a reassuring story.

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    Now I'm wondering if I'm suffering from something similar.

    My upper body lifts (presses, chins) quickly *plummeted*.

    This has been going on for a few weeks. There was no original incident of acute pain, but every morning I wake up with a sharp pain under my left rear deltoid which usually lasts throughout the day. Lifting (squats) eliminates the pain.

    I've never experienced anything like this before.

    It's probably time to see a doctor.

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    Quote Originally Posted by Mugaaz View Post
    Can you elaborate on why you recommend the surgery ASAP? Due to stupidity, I did this to myself twice. I was able to make a full recovery both times, taking around 3-4 months before complete loss of paresthesia and strength levels returning to previous high. The first surgeon recommended surgery right away, but the second surgeon recommended waiting 3 months. I was hesitant to wait, because I was seeing minimal change in symptoms even 4-8 weeks after the injury. Around 8-12 weeks after I started seeing noticeable improvement. Eventually everything did come back.
    Hi Mugaaz, your healing timeline is interesting, and I'm glad you were able to bounce back twice. In the 3 month period, did you seek non-operative treatment like physical therapy, massage therapy, etc?

    Quote Originally Posted by Mugaaz View Post
    Yes, that is a good argument for surgery. I was worried about the exact same thing. I hoped giving it 12 weeks wouldn't substantially increase the risk of making it permanent. However, neither doctor (or the internet) gave me any indication of how much risk waiting ~3 months actually posed. Without that information, I didn't see how I could make a rational decision about how long to wait before surgery.
    A statement worth considering, and what Rip has been supporting with immediate surgery:
    "There is no clearly established consensus regarding indications for surgery in patients with cervical radiculopathy [6, 16, 19]. Given that most patients with cervical radiculopathy improve with conservative management, a trial of observation is warranted in patients without any concerning signs or symptoms. Concerning signs or symptoms that might merit early surgical intervention include progressive neurologic deficits, signs of myelopathy, fractures or other signs of cervical instability or ligamentous injury, osseous lesions, or destruction [42¬ē]. In the absence of these signs, a trial of non-operative management is typically attempted."
    - Cervical radiculopathy

    Quote Originally Posted by Heather View Post
    I had a two level ACDF (C5-7) exactly one week ago. Funny this thread came up, because I had wanted to thank Rip for the information he's shared here about his fusion. It reassured me that things were going to be okay--that I'd get better, and be able to train again--if I had to have this done, which obviously I did.

    I had four bouts of right C6 radiculopathy across about 3 years, each time more painful and with worse numbness. The most recent one started four weeks ago, and it involved both C7 and the symptom of weakness for the first time. I'd had an MRI last fall, after round three, so I knew I had impending myelopathy as well, and when my left (unaffected) hand started contracting involuntarily with sneezing last winter, I knew it was a first clinical symptom. So, it was time.

    I spent the rest of the winter getting good and strong (for me, anyway), knowing I'd probably need surgery soon, and this last flare gave me the final push. I had a repeat MRI, EMGs and nerve conduction studies (to make sure both levels were necessary), and to the OR.

    Woke up with the radiculopathy pain completely gone--there's the C6 and C7 numbness, and triceps/wrist extensor weakness I went into surgery with, which will hopefully resolve completely, but that takes months.

    So, one week later I can say it's not really a walk in the park, but being strong sure makes life easier. I can't lift more than 5 lbs for six weeks, so my full time job is currently sitting, gentle walking, and sitting again. Which is annoying. But I was off narcotic pain meds in four days, and I was able to function quite well pretty much from the start, simply because moving your body in space is easy when you're strong. I started walks outside day 2, and can go a few miles with no difficulty. (And every time I go walking I think grimly, "walking is only exercise if you're 2/3 dead.") I feel like my spine was rearranged some--things are definitely uncomfortable at times--but nothing I would really call pain. Sleeping isn't super comfortable yet. But hey, seven days! Not bad!

    That is to say, if you need surgery, you need it, and everyone's mileage will vary, but for me at least it hasn't been nearly as bad as I expected. Hopefully it's a reassuring story.
    Best wishes with your recovery!

    Quote Originally Posted by VNV View Post
    Now I'm wondering if I'm suffering from something similar.

    My upper body lifts (presses, chins) quickly *plummeted*.

    This has been going on for a few weeks. There was no original incident of acute pain, but every morning I wake up with a sharp pain under my left rear deltoid which usually lasts throughout the day. Lifting (squats) eliminates the pain.

    I've never experienced anything like this before.

    It's probably time to see a doctor.
    VNV, if I had to do this "over," I would immediately visit a physiatrist and get MRIs. From there, I feel the determination by the MD with MRIs is going to set a clear objective path of whether non-operative or operative treatment is appropriate for you. I decided for myself that non-operative treatment would work (hadn't done much reading about CR so I didn't really know any better), which essentially could've cost me critical time should the doctor recommend surgery immediately.

  10. #10
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    Quote Originally Posted by uxdale View Post
    H...
    VNV, if I had to do this "over," I would immediately visit a physiatrist and get MRIs. From there, I feel the determination by the MD with MRIs is going to set a clear objective path of whether non-operative or operative treatment is appropriate for you. I decided for myself that non-operative treatment would work (hadn't done much reading about CR so I didn't really know any better), which essentially could've cost me critical time should the doctor recommend surgery immediately.
    Thanks UXDALE,

    I'm on it: sent out a feeler to a fancy connection at an orthopedic practice.

    I had to ask the internet for the defn of "physiatrist"---a physical medicine and rehabilitation (PMR) doctor. I didn't know "PMR" was a specialty.

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