Question
QUESTION: The first of July, after doing a couple of days of unusual lifting and moving of stuff at work, I felt twinges in my lower right hip.  I recognized it as a usual discomfort from past sciatic problems.  I rested over the weekend, applying heat and cold to the area.  On Sunday morning it was gone but was replaced by significant pain between my shoulder blades.  I had never had this before and just thought I had slept wrong.  A week later, it was still there and  I went to a chiropractor.  During my 5th visit in 10 days, I felt something move in the problem area and the pain was significantly less, but was replaced by a feeling of 'tingling', much like when your foot goes to 'sleep'. I thought it would go away and went home.  The tingling covered my entire torso, from armpit to upper thigh and down to my right knee.  I also have intense 'tightening' that runs in a band around my waist, much like having pants on that are way too tight.  I also experienced weakening in my right hand, unable to grip a pen to write as usual, open jars, etc.  The Dr. said it was unusual and continued to work on me for another 3 visits, even checking for signs of a stroke.  He finally said an MRI may be in order.  As I have no insurance, I could not afford that or return visits to him and now am stuck with this sensation.  Please help with what could be wrong and what I need to do.

ANSWER: Beth,

I can't provide you with a diagnosis over the Internet, but in general, it sounds as though two separate problems occurred, the first being a lower back or hip region problem, and the second being a thoracic spine problem (with regard to your pain in between the shoulder blades).

Your symptoms seems troublesome to me for a possible thoracic disc herniation with possible spinal cord compression, or nerve root compression. I would strongly recommend a MRI scan of your thoracic spine to evaluate for the possibility of disc herniation or even for spinal tumor. I would not proceed with further spinal manipulation until you obtain additional information.

The lack of insurance is a problematic in this case, but based on your symptoms, you really need to see a medical physician and most likely, an MRI scan. Please explore all options for going this route. If your symptoms worsen, you need to go to an emergency department immediately.

---------- FOLLOW-UP ----------

QUESTION: MRI Results were as follows:
1.  Disc desiccation with diffuse disc bulge at T9-T10 which is partially imaged on this study with the disc bulge producing flattening of the thecal sac anteriorly and which may abut the anterior aspect of the lower thoracic spinal cord without underlying cord edema or myelomalacia identified on this study.
2. Moderate disc height loss at the L3-L4 and L5-S1 levels with mild disc bulges which abut the thecal sac anteriorly along with moderate bilateral facet arthropathy without associated significant central canal stenosis, neural foraminal stenosis or nerve root compression identified.
3. Mild chronic appearing anterior wedge deformities involving the T10 and T11 vertebral bodies with height loss at T10 estimated at 20-25% and height loss at T11 estimated at 10-15%.
4.  No acute fracture or subluxation of the lumbar vertebral bodies identified.
5. Findings suggesting a markedly atrophic left kidney.


Basically, I have no idea what most of this means and I still don't have insurance, so what would be the best treatment to find some relief?

Answer
Beth,

Based on your MRI findings, I would strongly recommend seeing a neurosurgeon for the thoracic spine disc herniations causing mild compression of the anterior thecal sac (the front of the outer covering of the spinal cord). It is possible that the T9-T10 disc bulge may be responsible for some of your lower body symptoms. Please see this link for more information about thoracic disc herniations:

http://emedicine.medscape.com/article/96284-clinical

This link explains the significance of thecal sac compression resulting from disc herniations:

http://emedicine.medscape.com/article/340014-overview

Your MRI also indicates significant osteoarthritis of the low back, and essentially describes a condition known as lumbar facet arthropathy. Typically, lumbar spine facet arthropathy causes low back pain, but may also contribute to leg pain as well. Please see this link for more information about this problem:

http://emedicine.medscape.com/article/310069-clinical

Lumbar facet (joint) steroid injections are often helpful for these symptoms, as described on this link:

http://emedicine.medscape.com/article/310069-treatment#a1139

Anterior wedge deformities essentially describe a type of compression fracture; osteoporotic patients are much more likely to show such findings than other individuals, with the exception of those who have had a trauma to that area of the spine. It would be prudent to consult with a primary care physician regarding these findings, as a DEXA bone density test may be required to determine if you need to take medication for osteoporosis. The description of the wedge deformities in your MRI suggest that these are most likely older, healed compression fractures rather than something more recent.

The MRI also describes a left kidney of inadequate size; the possible significance of this finding is best determined by a nephrologist (a kidney specialist).

I hope that this helps to answer your question, and please bear in mind that this information is provided for general information purposes only, and does not replace seeking appropriate medical advice from a qualified health care provider.

Best of luck in your treatment.