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Need Advice Re: Pinched Nerve And Mri

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Hi I have posted my story on this forum befor ..But quick review for those who have not read it . A year ago I noticed a shooting painn in my hip when I did yoga and when I tried pulling the covers up over my shoulder in bed. # months ago I noticed bad pain when I tried to cross my left leg over my right . It was so bad I cried out. Int he last 2 months I have developed terrible back pain. It is for sure sciatic pian running down th eback of my leg from my low back. One suestion....I also ave pain running down the side of my thing from my hip. Would that be from a different part of my back? They did an mri this week and I really do not have full information right now but the drs assistant called and said the dr didn't think the mri looked bad but they want me to come in to discuss treatment. The questions in my haed are -- can I still have a pinched nerve that did not show up on the mri? If not why am I ain such horrible pain - right now my low back just above the hip is opinching so hard I could run screaming. If the mri was clean what treatment could they offer? Thanks so much alison ps they did not mri my upper opr mid back nor my hip. My hip seems most painfull.
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First Helper User Profile Gaelic
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replied June 26th, 2004
Experienced User
Stop Speculating
And wait for the results of the mri. It is impossible to decipher what might be happening to you without objective results.
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replied June 26th, 2004
Ok Well I Had a Curiosity Question Here (or Two)
Can someone have a pinched nerve that does not show up on an mri? And what can cause sciatic pain other than a pinched nerve?
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replied June 26th, 2004
Experienced User
Mri
The mri provides a small window of view which sees only the spinal bones and the spinal canal. There are other possibilities extraspinal which would not be picked up by mri. These include psoas muscle components (tumor, cysts, etc. ), piriformis muscle syndrome (entrapment of the sciatic nerve as it travels through the muscle, scar tissue bands over the muscle, foreshortening of the muscle), l5 transverse process neural impingement (entrapment of the nerve root in the l5 transverse-sacral ligaments), or entrapment of the nerve root in the transverse foraminal ligaments. Intraspinal causes sometimes missed during mri readings include high intensity zones in the discs which may leak cytokines such as tumor necrosis factors onto the nerve roots, conjoined nerve roots, far lateral disc herniations, or arachnoiditis.
Sciatica by definition is pain from the back or buttock all the way into the foot.
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replied January 19th, 2012
Undisclosed chronic back pain & Lomb tingling
Can you tell me how these other things are diagnosed if they don't show up on MRI - what testing/imaging is used?
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replied January 20th, 2012
Especially eHealthy
RickyR,

While the MRI is very good at looking at the soft tissues of the body, it is only a static snapshot of the anatomy when it is done. It cannot detect pain.

There are several neuropathies that do not show up on an MRI. If a patient has a herniated disc, spinal stenosis, facet hypertrophy, that are putting pressure on a nerve root, these will usually show up on MRI. But, other neuropathies will not.

A lot of chronic back pain is from musculoskeletal reasons. But, if you are having tingling in the limbs, that can be from irritation of a peripheral nerve. In the lower extermities, sciatica is a very common reason for pain and tingling down the back of the thigh.

Most nerve disorders can be picked up on a thorough examination. If the physician feels that there may be nerve damage, then electrical studies can be performed, such as an EMG (electromyography) or NCV (Nerve Conduction Velocity).

You should see an orthopedic spine surgeon, a neurosurgeon, or a physiatrist (specialist in PM&R - physical medicine and rehabilitation) for a thorough evaluation.

Good luck.
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replied June 26th, 2004
Thanks My Pain Is From Left of Lower Back Through Butt ...
And down back of lack to behind knee. Hip also hurts as well as outside thigh. What sort of treatment might they offer . Just looking for a heads up - food for thought before my appointment. Do they ever locate these other types of problems or just treat the symptoms?
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replied December 29th, 2008
after laser spine surgery
I had a laser spine surgery done about 9 weeks ago on my back because I had a herniated bulging on l4 and l5. after I've got surgery I couldn't walk . after 2 weeks later I could walk with a cane.But I had tingling,burning,shooting,numbing feeling which I never had before the surgery. can anyone help or tell me what is going on?
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replied December 29th, 2008
Experienced User
Possibly due to collapse of the disc space from removal of disc with subsequent bulging of the remaining annulus, or possibly due to further herniation. Injury to the nerve via laser or needle are unlikely, however if a portal instead of needle was used (5-10 times largery diameter), then nerve injury from the portal is possible. Scar requires 3 weeks or more to begin forming.
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replied February 17th, 2010
mri and lowe back pain
I have similar pain, had lumbar fusion of L5/S1 last year but the pain has returned with a vengaence..and had another MRI that only shows a mild circumferential bulge in the disc above it with some neural space narrowing, my question is how can a disc that is only bulging cause more pain than the one I had replaced with a fusion that was actually torn and leaking? I also have arthritis in the facets and disc degeneration, but not being able to even attend my classes has made me wonder if I will ever be pain free. I am tired of hearing that my MRI is not that bad when I can't sit for more than 20 minutes without pain, and I get burning all over my sacrum area-widespread numbness and burning along with occasional warm feeling. Tired of not having real answers.
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replied February 17th, 2010
Thanks, I hope he listens to me when I have my follow up in March. There definitely is nerve pain but I need them to listen to me and not just go by the MRI..not that I want surgery again, but physical therapy for the past ten weeks has not worked and if anything, my pain is getting worse to the point I don't attend classes regularly and that is a huge amount of pride to let go of as I am usually an excellent student and now I can't even study without pain. I need this fixed somehow so I can move on with my life. Thanks for replying:)
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replied October 17th, 2010
Neck pain within L5-L6 and surrounding muscles musculoskelatal
For approx 2 years I have had on and off neck pain that feels like I am being stabbed with something in between my L5-L6 and when I gently rub my finger across it, my neck feels pain like when you touch a sore muslce after working out. During exercise in will kill with pain and then go numb. It feels like someone is pulling my muscle towards the right side right exactly between L5-L6 and my trapezius and shoulder muslce ache. An X-ray showed no apparent cause and i am having an MRI done Oct 19. My question is might yo know what it could be other then major causes because it doesnt hurt all the time and what kind of tests are there to find out what is going on if the MRI is negative. Thank you and God Bless.
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replied October 17th, 2010
Extremely eHealthy
it could be whats called a trigger point in the muscle. deep muscle massage or steroid shots usually help.
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replied March 12th, 2012
I injured my back over a year ago loading a heavy drain cleaning augger into my work van . At the time my back felt like it gave out almost a wave like feeling to the right side. After that I noticed pain but wasnt so bad that I had to stop working.The pain was always there but I asumed that with a few days off it would get better thinking it was muscle pain. After about 10 mounths I noticed my foot and leg on the right side were going numb and some pain in my left calf just behind the knee. I started physio treatment and was pulled from work. After a few weeks I was sent for a MRI and found a few spots were there is mild and med broadbase disc bulges.I was told that this is a normal finding and that anyone with or without back pain could have this. I was sent to another physio place that is susposed to be better for back improvement. I was going 5 days a week 4 hrs a day doing all kind of streaches and core strengthning exercises.I seemed to have ok days and really bad days . I was sent to a back sergion to get another opinion and was told by him to try to keep doing what I have been for another 2 months and see if I will improve. I asked if not what should I do and he said to see him again .I was then pulled from the physio without notice from my insurance company and told that the Orthapedic sergion said I was not benifiting from it . Ok I was confused but thought maybe he thinks that its iratating my back .I continueed to do some home physio and exercises as directed by physio and my doctor. Then after 3 weeks was told they thought they made a mistake and put me back into the physio again 5 days a week 4 hr days.after about 2 more months I was not improving and seemed to be showing signs of flairing when doing the exercises. I was cut from physio again and told that I may have a compressed nerve or a sprain or strain spine that was to get better in only a few weeks 6 at the most I was told . I asked that maybe we should do another MRI and was told it wouldnt help. I asked to see the back sergion again for a follow up and was denied. I was told my treatment is up and I would not be going back to see him.After that week I was let go or fired from my job and told by my insurance company to find a new job driving a forklift for 40 hrs a week. My doctor is trying to find another specialist in the mean time and has placed me on yet another pain pill along with the others I take during the day. I try to do some streatching and Ball exercises everyday along with walking but seem to have to hit the heating pad shortly after and cant seem to get around. My right leg seems to be losing movment and hurts with extream pain even with the pain pills. I dont no what to do weather to exercise or not because it seems to make symptoms worse. Im trying to find work that will be suitable for me but am unsure what will be suitable and not sure if I keep getting worse that I may not be able to get out of bed. I have numbing through my right leg into my foot up between my big toe and the one beside feels like a finger pushing between the two almost.My back seems to want to give out more frequently then ever and when walking feels like I have a knife stabed in my lower right side and when walking feels like its sawing through my hip and spine. I get a hot feeling almost burning in my back and sometimes feels like hot water is being poored down my left leg . theres preasure feeling in my tail bone and seems that laying down doesnt seem to give me much relief anymore. Im confused on the treatment and scared that im going to end up in a wheelchair. if there is any help that can be offered im open to any opinion. I feel like im the first person to go thruogh this as my direction is foggy and dont have proper asnwers from my doctor that says she can only treat the pain . I thank u for reading my long story and appreciate any direction u can point me in Thank you .
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replied March 12th, 2012
Especially eHealthy
Slippery,

Sorry about all of your trials and tribulations.

It is concerning that you have numbness and tingling in your right foot and leg. This is coming from a nerve being irritated somewhere. While this could be coming from compression of a nerve root in the lower lumbar spine, your MRI did not show any compression of the nerve roots.

Unfortunately, it could also be coming from sciatica. While most patients will have some pain in the buttocks or the back of the thigh with sciatica, not all patients do. Some just have the distal nerve problems.


Also, unfortunately, we do not know all there is to know about pain generators around the spine. While we do know about some, and can treat some adequately, there are others we still do know understand at all.

Why is it, in some patients, they have horrible looking x-rays or MRIs, but have little or no pain. While other patients have minimal findings on their studies, but have extreme pain. We still don't know.


If you speak with the chiropractors, it is all about alignment. If you line up the vertebrae, your pain will go away.

Physical therapists believe if you strengthen the core muscles and stretch out the spine, the majority of musculoskeletal pain will go away.

Massage therapist believe that it is all due to spasms in the muscles.

Surgeons can take care of discrete anatomical problems, such as a herniated disc putting pressure on a nerve root or pain caused by spinal stenosis. But, other than that, there is not much they can do.


No one has the full answer.


If you feel that your numbness and tingling, or weakness is getting worse, then you may need a repeat MRI. While disc bulges can be normal, as they are seen in up to 40% of MRIs done on patients who have no back pain (the MRI was done for some other reason, such as looking at the abdominal contents or the aorta).

That is not to say that they cannot also be abnormal. They can be the first sign of DDD (degenerative disc disease). The outer disc, the cartilage part, called the annulus fibrosus, is sort of like a tire. When it loses some of its water content (becomes dehydrated) it can no longer stand up to the stresses applied to it. So, it will bulge outward, just like an underinflated tire.

Again, bulges can be normal, but they can also be abnormal.


So, again, if you continue to have the neurological symptoms of numbness, tingling, and weakness, you may need another MRI, so see if there is pressure on one or more of the lower lumbar nerve roots.



But, again, this may be coming from a peripheral nerve, such as in sciatica. That will take a very thorough physical examination and probably an MRI and/or some electrical studies, if indicated.



Again, I am sorry for all of your troubles.

It may be that you will have to obtain a job that does not put as much stress on your back. And, you will have to learn things to do that make your pain better. It is up to you, a lot, to find out what works and what doesn’t. Some patients get a lot of relief from chiropractic, from massage, from strengthening and stretching. Some do biofeedback, relaxation techniques, acupuncture, TENS unit, music therapy, aroma therapy, water exercises (which can be very good for back patients), counseling, spiritual group assistance, medicines, injections, whatever takes the pain down a little.


Speak with your primary care provider to see if you can get another MRI and spine surgeon evaluation.

Find the things that help your pain.

Good luck.
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replied March 14th, 2012
Thank you for the quick response I'm curently seeking another doctor and going to try to get a neurologist to asses me I never even thought about it and believe that one of the profetionals I've seen should have recommended it I. thank you again and will give a update once I get to the bottom of my problem .
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