the neck of the tiger

Wednesday, May 12, 2010

Neck pain and numbness in his hand has sent Tiger Woods to the sidelines and immediately into an MRI to find a diagnosis. That shortcut to imaging may the norm for an elite athlete but it isn’t routine for the rest of the world. Even for cervical radiculopathy, patience may be a virtue and potentially save a little money.

The spinal cord allows the brain to connect to the rest of the body, sending electronic messages that direct legs to walk, bodies to sit and hands to grasp. The return messages tell the brain about the world. Pain, touch, temperature, vibration and position are sensations that are transmitted from every part of the body. These messages are transmitted through nerves that enter and return to the spinal cord though spaces between the vertebral bodies that make up the neck and back. If the route where the nerve runs becomes narrow, the nerve can become inflamed causing pain and perhaps making it stop working. Often, there is just back that radiates along the course of the nerve, but numbness or electrical shooting pain can follow the nerve’s course. It’s like hitting the funny bone in your elbow, causing irritation to the ulnar nerve and causing difficulty making a fist, numbness of the little finger and pain at the elbow.

The nerves leaving the spinal cord can be inflamed for a variety of reasons including spasm of muscles that help support the vertebral bodies, bone spurs that form due to arthritis and excess wear on the joints between the vertebrae or injuries to the disc that help act as shock absorbers for the back. Regardless of the reason, the initial treatment tends to be less than aggressive. Diagnosis is usually made by history and physical examination and plain x-rays aren’t needed unless trauma was involved, like a fall or car wreck. Otherwise, rest, ice, anti-inflammatories like ibuprofen and pain medication may resolve the issue within days. If the pain persists, imaging may be suggested but physical therapy may be an option.

MRI or magnetic resonance imaging is the test of choice to look at the soft tissues of the back: the spinal cord, nerves, discs, muscles, tendons and cartilage that allow the body and brain to connect. It’s a lengthy test, requiring the patient to lie still for minutes on end and images need to be interpreted by a radiologist. Patients with metal in their body may be excluded, since the powerful magnetic force can literally rip metal out of the body. Playing “Alien” in real life is not wise.

The MRI results can help guide treatment if conservative therapy fails. There are different options available to treat a ruptured or bulging disc and surgery is only one. Therapy and injections are only two other options that are non surgical.

There are times when an MRI is emergently done but often it is a catastrophe that causes the emergency. Symptoms that point to a spinal cord at risk make tests and treatment happen quickly but the signs are not subtle. Inability to urinate or loss of bowel control, the acute inability to walk or use an arm or difficulty breathing are reasons to skip medication and therapy and run straight to MRI and potential surgery.

It is understandable that elite athletes whose timeframe to compete is limited by short careers jump the gun to get tests that “normal” people would forgo. They ask their bodies to do things that the rest of us cannot imagine and a minor injury can become major if not treated. Few of us can generate the force of a golf swing that a Tiger or Phil can and if we could, our bodies might break down, just like theirs have. The difference is that we can return to a restful workday but they have to walk to the first tee.

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