In 2008 I was seen by this Rehabilitation physician. Another pain management physician that missed my diagnoses of T spine arachnoid web. No T spine MRI ordered! Compression in the T spine can cause anything below that point! Note: My pain has really been the same all along. Here are her treatment notes:
Dec 16, 2008
THERESA A OSWALD Tue Dec 16, 2008 9:41 AM Addended Requesting
Terry is a 54-year-old male here today for Spine Care consultation for back pain. Symptcrns have been present for episodically for~years with increased over last 2 months. Symptom onset was gradual. Pain level is 3-6/10. Symptoms are worse with massage, lifting, coughing, lying down changing position and improved with rest, medication and standing. Patient has tried physical therapy at the VANC in Appleton which ircreased symptoms. He has not tried chiropractic care. Recent spine imaging include: NEW Lumbar MRI shows L5—Sl annular tear and L4-5 decreased dis~~pace. No previous spinal injections. Previous medications tried include:cyclcbenzaprine and
tylenol #3. He will be leaving out of state 1/1/09 for 3
months.
He has more pain with lumbar extension and can flex forward fingertips to mid shin.
He can walk on heels, toes, do a knee bend, single limb knee bends and single limb toe rises.
Coordination normal with no evidence of dystaxia. Gait is without deviation or need of a assistive device. Cervical range of motion is normal and pain free. Strength is s/s in bilateral upper and lower ex~iremities.
Deep tendon reflexes are normal in biceps, triceps, pronator teres, patella and hypoactive achilles tendons. Sensation is intact to light touch bilateral upper and lower extremities with episodic left L5 sensory symptoms.
Straight leg raising is increases left posterior thigh pain.
Patrick maneuver increases left buttock pain. Upper and lower extremity range of motion normal. Upper and lower extremity joint appear stable to
examination.
He has no lower extremity atrophy or edema. He has pain to palpation over lower lumbar paraspinal muscles.
Peripheral pulses normal in radial and dorsalis pedis arteries.
Abdomen soft, nontender, nondistended.
No spinous process tenderness in the cervical, thoracic or lumbar spine.
No costovertebral angle tenderness.
IMPRESSION AND PLAN: Mr. Nier has mechanical low back pain with L5-Sl annular tear. Lumbar MRI was reviewed with patient in detail. He disagrees with results and states MRI is not useful because his spine was not extended during the test and extension reproduces symptoms. Treatment options were discussed in detail including physical therapy, medication, injection options, bracing and surgical consultation. He would like to schedule a leftLstransforaminal epidural injection as soon as possible. He will continue tylenol #3 and cyclobenzaprine pm. He was instructed in proper use and side effects of the medication. Patient will return to clinic 1 weeks after the injection and call in the interim with any problems or questions.