Cervical Radiculopathy?

Medical Q&A [Moderated]
1

Hi Dr. Baraki,
I appreciate all the great content you put out on pain and training. I’m hoping you might have some advice for me.
Background info:
I’m a 36 year old male with no chronic medical problems. I’ve been training about 4 months and I’m coming to the end of LP. About 3 weeks ago during an overhead press set I developed a sharp pain in my right upper back between my scapula and my spine that shot down my arm. I had read your articles on pain and listened to the podcast episodes so I did my best not to panic and continued my workout. I was able to go the OHP range of motion with lower weight, so I did that. The pain remained constant. When I attempted to bench press, I found that I had right sided weakness. My working sets are at 185lbs but I was only able to bench 100 lbs. The pain wasn’t worse when benching, but it just felt like I had no strength on my right side. I saw my primary care doctor, took naproxen and did some back and neck stretches for about a week. The pain remained pretty constant - sharp in my upper back and achy with some pins and needles feelings down my right arm. These feelings were worse around my triceps but occasionally were shooting past my elbow into my forearm. Sleep was pretty difficult with the pain, and I went back to my PCP after a week and half. I got a referral to a sports medicine doc and to physical therapy and some flexaril. She didn’t think imaging was necessary and diagnosed me with a “muscle spasm.” she didn’t think it was thoracic outlet syndrome and didn’t see significant weakness with a pretty quick physical exam, though she believed me about my weakness when attempting to bench. After a couple days taking flexaril, the pain in my back improved significantly and I was able to sleep. I continued to have the nerve type pain in my right arm, but it also is gradually improving. I stopped flexaril after a few days because my back was no longer tight and it didn’t seem to need it anymore. Unfortunately the weakness in my right arm hasn’t improved. When I try to flex my right triceps, the lateral head remains noticeably softer than the lateral head on my other arm when I flex. I’ve attempted to bench press several times and can only do about 100 lbs due to weakness on the right side. I notice that when I try to flex my right tricep I have achy pain shooting down my right arm for an hour or so afterwards. Best I can tell this is consistent with a cervical radiculopathy I’ll see the sports medicine doc this week and the physical therapist as well. I’ve been training around it best I can, but was on vacation for the last 10 days so I wasn’t training at all during that time (which was my plan before the injury).
Questions:

  1. Now that I’m back from vacation do you think I should keep trying to train my OHP and bench at a weight I can do? The pain I get down my arm after any pushing motions or triceps flexing has made me reluctant to do that, and I’m not sure If I should push through it or not.
  2. Can you tell me if I can expect my strength to return? My own reading suggests that if this is cervical radiculopathy the symptoms usually resolve over 6 weeks, but the fact that I have not seen any improvement in weakness so far has made me anxious.
  3. Do you have any suggestions for rehabbing weakness due to motor nerve dysfunction?
  4. Do you have recommendations for further evaluation of the weakness?

I understand that this may not be something that can be addressed over the internet and I appreciate your time and any suggestions you have for me.
Erik

2

  1. I wouldn’t want you to stop using your arm, but if that particular motion causes significantly worsening discomfort, I’d see if you can find a different movement that you tolerate better.

  2. Yes, you are correct that this will likely resolve on its own with some time. You are doing a good job not freaking out and managing expectations here!

  3. Normal training will facilitate this process.

  4. Not having examined you myself, I would defer this question to the sports medicine physician you will be seeing. Let us know how it goes!

3

I highly doubt this has anything to do with a rhomboid spasm, but I agree that you are likely to improve :slight_smile:

4

Hi Dr. Baraki
I have another update. I’m now about 5 weeks out from the initial injury and my pain has decreased significantly. I occasionally have some upper back or shoulder soreness and occasional tingling down my right arm both of which are pretty mild and easy to ignore. I’m really happy about that. Unfortunately the weakness in my right triceps and pec hasn’t improved at all. I’m still only able to bench press about 75 lbs. There is also a noticeable size difference between my right and left pec now. I have some mild winging of my right scapula. I suspect I have some weakness in my right lat or serratus anterior as I still can’t do a pull up even though pain isn’t in the way anymore. The sports medicine doctor referred me for an EMG which will happen in a couple of days. I haven’t been able to find as much information about this kind of weakness as I would like. It might not be useful to try to (self) diagnose this weakness but I’m having some difficulty waiting for answers and/or recovery. Do you know of any useful resources I could read? Or would it be better for me to spend less energy thinking about this and instead focus on the fact that my pain is better and sort of wait it out?
Thanks again,
Erik

5

Update: I had the EMG today and the EMG physician told me that my areas of weakness are consistent with a C7 cervical radiculopathy. She saw evidence of acute and chronic denervation. She recommended I get an MRI as it appears the nerve is still not functioning properly and there is a possibility that a steroid injection or other intervention would be helpful. She told me that the symptoms of 95% of cervical radiculopathies resolve within 12 weeks. I’m trying to be reassured. The waiting is hard. She also suggested that I do more right sided exercises when I work out, so my left side can’t compensate for my right sided weakness. This makes sense to me, is this reasonable?