Who is BU: Physios or GP/consultant?

[LittleGreyFluffyCat]

Medical professionals are disagreeing about my MRI results:

GP & spinal consultant say: 'Normal wear and tear, wouldn't cause any symptoms'
Physios x2 say: 'Not a negative MRI, would definitely cause your symptoms'

^MRI says:
Mild spondylotic changes at C5-C6 and C6-7 levels. There is mild osteophytic encroachment of bilateral neural foramina at C5-C6 level causing mild impingement of bilateral exiting nerve roots. Bilateral neural foramina are minimally compromised. The spinal canal is adequate.^

YABU: GP & spinal consultant correct
YANBU: Physio is correct

I've had ongoing symptoms (worsening arm pain, tingling around neck and back, pain in back near arms) for over a year. I can't get help unless a GP or consultant agrees with the physio point of view. I can afford one more private consultation with a new spinal consultant but don't want to waste £££ if the physios are just talking nonsense.

Posting this in the desperate hope a medical person or two will see this and have a helpful opinion.

Italics fail sorry!

Fiancée is a physiotherapist, she asked how old are you? If you are in your 20s-30s then it’s not normal, if you’re 40+ then it’s abnormal, but either way it would cause your symptoms. So I guess it’s a bit of both unless you’re very young.

Sorry 40+ is normal

Where in the UK are you? I can recommend a couple of excellent spinal neurosurgeons if you're in Scotland. I saw one NHS, and one privately.

My sister is a respitory physio and based on her anecdotal stories, I would trust the physio over the GP.

Considering the dermatome pattern and it being C5 and 6 I would agree with your physios. But I am not qualified (did some of a physio degree though).

What sort of help do you mean?

I think the results could be a cause for your symptoms, but from the scan it doesnt sound severe enough for surgery

@HollaHolla

Where in the UK are you? I can recommend a couple of excellent spinal neurosurgeons if you're in Scotland. I saw one NHS, and one privately.

I should say that both were extremely reluctant to slice and dice (even though we all know how much surgeons like to cut things! ) They both only operated on me when it was absolutely necessary. I have had four surgeries on my lower (L4/L5 & L5/S1) spine, but I took the opinion of neurosurgeons, rather than orthopedics. You probably need a specialist to look at your reports - not the GP, with all respect.

If you are in pain then what matters is how they are going to deal with it. I had a scan after losing use of my arm. The mri specialist said nothing was wrong. The gp said well we know there is a problem because I couldn't move my arm. What are the differing solutions. Don't let them ignore the issue.

You probably need a specialist to look at your reports - not the GP, with all respect.

She already said that her Spinal Consultant has said the scan is essentially normal.

You probably need a specialist to look at your reports - not the GP, with all respect.

The spinal consultant is the specialist.

So if the spinal consultant thinks it's normal them why are you having issues then

Really it depends what can be done about it all. If the Physio thinks the scan findings are the cause of your symptoms, what treatment do they think you could have? If physiotherapy can you continue with this anyway?

Presumably the Spinal Consultant thinks surgery and injections won't be helpful. Do they think you should have other investigation for these symptoms? Or that the scan is normal for your age, but the symptoms don't need further investigation?

I can't see the benefit of paying for a private appointment unless you can continue to be treated by that person.

So what do the GP & Spinal Consultant think is causing your problems and what is their suggested solution?

Have you had your B12 levels checked?

@HopelesslydevotedtoGu

You probably need a specialist to look at your reports - not the GP, with all respect.

She already said that her Spinal Consultant has said the scan is essentially normal.

Whoops - apologies, I missed that they had also looked at it.

To answer questions:

• I've just turned 50
• I'm in the South East so sadly not Scotland
• By 'help' I mean get a diagnosis and treatment plan (and know what I should or shouldn't do to make it better)
• Physio diagnosed hypermobility spectrum disorder, with minor nerve impingement in neck and other injuries in my right arm, suggested 6 weeks off work, prescription anti-inflammatories, then harder drugs - I don't believe this drug path will fix the problem.
• GP disagrees with physio's diagnosis and doesn't recommend prescription anti-inflammatories.
• GP can't help me any more - the only help available is a re-referral to this IPASS spinal service where you get seen by a physio - I already did that and they said 'muscle tension' (bollocks it is) - for a new referral I'd wait 12-18 months to get seen again.
• Spinal consultant didn't recommend anything else, just 'go away this is nothing to do with me' but to be fair my symptoms have changed a lot since I saw him
• Might have had B12 checked can't remember, will check

TBH it's hard to get all the details into this thread, it's been going on a while, and I'm just so fed up. I can't move my arms without it kicking off a load of arm pain and weird sensations up my neck and into my head.

I used Dr Google and found thoracic outlet syndrome (TOS), went to a specialist who said 'it's hard to diagnose it but you probably have it, I'll refer you to a specialist physio' - the specialist physio said I didn't have it but had spine impingement plus tennis elbow and shoulder tendon damage - GP said physio was wrong but that she can't help me anymore... I'm just kind of stuck now!

If I get a diagnosis privately that my GP will accept (so needs to be a consultant not a physio) then I can either get referred back into the NHS, or see if I can borrow some money to continue treatment privately - depending on what the diagnosis/treatment/outcomes etc are.

Essentially they’re all right from their own perspective, it’s normal for your age but if it’s impacting your life then listen to your physio

However, big shout out of agreement to @DonGray suggestion regarding B12 status (and folate as they need each other)

I’ve spent decades with physio’s and surgeons arguing over my various issues, suffered due to failed recognition of B12 deficiency and it’s role in my L4/5/S1 problems that my fantastic physio did pick up

If I had to believe only one I’d pick the physio every time

Just checked back on bloods taken summer 2020 when my issues began, and my B12 was good, so I don't think it's that.

You've got HSD. Have a look at thoracic outlet syndrome. Negative on mri. Normally only diagnosed by ct angiogram or doppler ultrasound. Plenty of thoracic outlet sufferers are bendy people

Should have continued reading. You need to see a vascular surgeon

This is a specialists’ area not a GPs!

Get a second opinion

@Iamaslummymummy physio said HSD, but I've read that it needs to be diagnosed by a rheumatologist and the GP won't refer. The GP said that physio says that everyone has hypermobile joints!

I've already seen a vascular surgeon, he was a bit useless, through him I've had an ultrasound and it showed artery compression in certain positions, so he diagnosed ATOS and NTOS - I was never convinced by his diagnosis as I don't have symptoms of ATOS and the NTOS diagnosis was just him saying 'I might have it'.

He referred me to a physio who is a specialist in TOS who says that lots of people lose pulse with their arms in certain position - he diagnoses TOS a lot and he doesn't see evidence of TOS with me.

I have so far spent a blooming fortune on all these specialists who all disagree with each other, so it's difficult to know which type of specialist to go and see next.

My OP was a bit misleading - I can afford more than one appointment, I just meant that because I'm paying for so many private appointments I can't afford to trail around loads of spinal specialists for an opinion on this specific bit - my MRI on the neck.

I guess the point of this post was to see if anyone understood why there was so much disagreement around my neck MRI. Personally, I find it confusing - if there is minor nerve impingement then surely it would cause some reaction in my body?!

There's a lot to untangle!

It's really sounds like tos to me. I had a ct angiogram that showed total compression on one side and Almost total on the other. Are you in the thoracic outlet syndrome support group on fb? Where in the country are you and which surgeon did you see?

Plenty of people who are asymptomatic will show up with issues on an mri.

@Iamaslummymummy I'm on all the TOS FB groups. I saw Adam Howard in Colchester (travelled a long way from South East).

I've asked him what he thinks of what the physio said, I'm awaiting his reply.

I see a lot of MRI reports in my line of work. It's rare to see one that doesn't mention some degree of nerve impingement. I can see why neither your GP or spinal surgeon think the scan findings explain your symptoms