bulging disc, shaking hand


I have found your website really useful and wondered if you could help me. I have had 3 separate bouts of neck pain in the last 18 months. I am a saxophone player (music teacher) and put these symptoms down to the neck strap/ hand position for prolonged periods of time. The first two bouts were basically a stiff neck and headaches and disappeared quite quickly. This time, however, it has continued and the symptoms are changing.

I have a clicking/grinding neck throughout the day (although once it has clicked, actually feels like a 'fizz' and makes me a bit dizzy but then eases the neck tension.

I also have had a shaky right hand when held in certain positions and shoulder and back pain as well as headache the majority of the time.

I have had these symptoms for over 3 months and have been to the doctors who thought it was a trapped c7 nerve, referred to a physio (5 appointments later and I had just had the same chat and tests but no manipulation).

I was referred to the senior physio who sent me for an MRI scan. The results came back last week and show some minor degenerative changes in my neck and a bulging disc. The physio has asked me to be referred back to my doctors to explore 'other avenues' but they were unable to suggest what these were when I went today.

The physio would like me to go to neurology but I am confused as to what they would be looking for and why anything they would be looking at hadn't showed up on the MRI scan.

I appreciate that this is a bit of a ramble but I would really like some help!

Thanks for your time.

Actually it's not a ramble at all; you've given me a pretty good synopsis compared to the three liners in terrible grammar that I often get.

Two things you have omitted however; your age and what injuries you've had to your neck. Have you had any old whiplash injuries, falls down the stairs, off horses, and so on?

The shaky right hand is probably not directly related; does it occur when your hand is at rest, or only when you are using it? It could be serious, but probably isn't, depending on your age. For that a consultation with a neurologist would be of value. Is it Parkinson's for example, or an "intention" tremor.

What's really good is that you make no mention of radiating pain, or numbness and tingling down your arm. That clicking and grinding in the neck is the sign of wear and tear arthritis in your cervical spine from an old injury.

The nerves to the upper back and shoulder eminate from the lower neck. The headaches are usually from the upper neck, but there are other causes.

Musicians do have a hard time from the neck and upper back; part of the solution is to keep moving when playing. A strap that shares the weight of the instrument on both shoulders would help too.

This the kind of stuff that chiropractors deal with on a daily basis; after eighteen months it won't necessarily be straight forward. However, it's good that you don't have many significant findings on the MRI.

Fixated joints, as we call them, don't show up on MRI; all them should be moving in tandem when you turn you head, flex and extend it. Usually a non movable area is what causes the pain and discomfort, and nerve irritation; it also contributes to the "immobilisation" arthritis that physiologists have done so much research on.

Start hunting for a competent and thorough chiropractor in your area; talk to friends and family, and your GP. This sounds very treatable to me; I'm busy with folk with similar symptoms daily.

Good luck; let me know how you get on.

Dr B

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