I was in a bad car accident 15 months ago and still have burning and tingling in my left arm down to my thumb and shoulder pain. Two orthopaedic dr’s said nothing wrong with arm and that the only damage to my discs is normal degenerative damage not caused by accident and though an MRI showed bursitis, they say that this too is not necessarily caused by accident. The pain and burning/tingling started after the accident, though so I am confused. Had nerve testing done twice, two steroid injections, and myelogram done but the injections didnt help and the tests came back either normal or with moderate degenerative changes. Anyway, insurance company has yet to pay all my bills which many of which have gone to collections and I am still in pain and the burning/tingling drives me crazy all night. Is there another dr. or test or anything out there that might help me find some relief? How long will this last? I can’t seem to get any straight answers from Dr’s I have seen.

Doctor Sinuhe Answers:

Thanks for your question. It is a known fact that if an issue like this has not been resolved with an insurance company, the symptoms are less likely to disappear. Furthermore, return to normal life is associated with disappearance of the symptoms. From the literature it seems clear that the sooner you can leave the thing behind you, the better it is - although, as I said, it may be possible to leave it behind only after the pain is gone.

Without seeing the MRI and not having the possibility to examine you, I can’t really act as your doctor, only to present talking points for your next visit with your doctor.

If you have burning and tingling in the left arm down to your thumb, there is a reason to suspect that something is compressing your nerve root C6 on the left side. Since you say your pain is also “burning” in nature, it may be already (partly) neuropathic. Please see Dr Joshua’s previous explanation about the difference between normal, nociceptive, and neuropathic pain types and discuss the matter further with your doctor. It is important, because in most cases neuropathic pain can’t be cured by surgery. Root C6 starts from between the vertebras C5 and C6. Sometimes, even if, say, an motor vehicle accident does not cause anything “new” structurally, it may somehow irritate the nerve root if its canal is too narrow in the first place. Thus, it is possible that the accident has not caused anything visible on MRI, but it may have caused the nerve root irritation. I guess the same goes with shoulder bursitis. It is sometimes, although not usually, difficult to say if a pain originates form the shoulder or from the cervical spine level. A hint to make the difference comes form the fact that shoulder pain usually does not radiate that far from the shoulder, not all the way to the fingers.

Insurance companies usually don’t cover this, since the root canal was narrow in the first place, and especially, if there is a delay between the accident and onset of the symptoms. The logic or justification comes from the fact that the compressed root would have started to give symptoms sooner or later anyway and that the accident did not cause structural damage. No matter what they think, it is still possible, however, that you would benefit from operation - assuming you do indeed have a root compression at that specific level. It is also possible that a nervous “network”, a structure between neck and shoulder (called plexus brahcialis) has been stretched by the accident. If the neck MRI does not show anything specific, this would be my second guess. To rule put this is probably one reason why an “nerve testing” (ENMG?) was done in your case. In most cases, a root compression should be visible there as well.

Dr Sinuhe

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