When you say your trapezius is atrophied, what do you mean by it?
Sory I am asking this, but I understand in car accident the trapezius gets damage, or am I wrong.
I have pain in my trapezius muscles since the accident. I know it's the trapezius muscle cause my doctor told me that what it's called. But it's only one the left side.
Right side is fine.
Thanks in advance
My right trapezius atrophy is new, within the last 6-9 months. Looking in a mirror, it appears half the size of my left. I hadn't noticed until the Spine/Rehab doctor, who was evaluating me for my neck problems, pointed it out. I knew my right arm/shoulder girdle were weak and it has been painful for over a year, with no specific onset. I have described it as 'my right arm doesn't feel attached'. The spine doctor and webdozer are the only 2 people who understood. The spine doctor thinks I might have a labral tear in my right shoulder socket. The car accident was 30 years ago-I have managed pretty well for a long time. My sympathies on your left trapezius pain-I found the shoulder pain nearly intolerable. Good luck, shoulders are tricky.
Thanks, and I agree. Have to keep getting out and moving. I know the ultrasound is just a preliminary for TOS and I have the full scalene block and exam scheduled in October with a vascular surgeon who specializes in TOS. I knew someone with the extra cervical rib who had the extensive surgery. I know I don't have the extra rib, so TOS wasn't on my radar.
I find your post very interesting as I have gone through a similar situation over the past 20 years. <<TOS wasn't on your radar..>> My story might help it make sense. I believe all of your issues may be connected...like a compounding problem.
After a car accident in 1991, I had pain in the trapezius, rhomboid, shoulder and deltoid of my left side. (As well as the expected neck pain from whiplash). I too had significant atrophy of the trapezius and rhomboid muscles on that side. Three years of one doctor after another, differing opinions - neck or shoulder? Many MRI's and rounds of PT only to still be in pain and the doctors scratching their heads. Neck MRI only showed slight disc bulge, but the shoulder MRI's revealed tears in two muscles. My shoulder was hyper-mobile by this point but was not at the time of initial injury.
Long story short ... The MAIN problem was coming from the scalene muscles on that side. Significant nerve compression was revealed with EMG and nerve conduction studies. The final test for confirmation was a nerve block performed by a neurosurgeon - it was near the collar bone. (Long time ago - don't remember specifically what they called it). I ultimately had surgery of the scalene muscles to decompress the dorsal scapular nerve. This is the "origination" nerve that serves the muscles of the scapula area, top of shoulder and upper arm. The surgery almost immediately relieved the referred pain I was having and after several months of PT, I was able to regain the muscle strength and function. At the time no one ever referred to my situation as TOS, but doctors I have seen in recent years have called it that.
So next came the 2nd problem - rotator cuff repair surgery. Once he opened me up, he thought most of the damage had been caused by all the muscle disfunction that had been created by the (scalene) nerve compression. I must have been compensating with whatever muscles I could get to work in that shoulder and arm. I had literally worn holes in the 2 muscles by mis-using my arm & shoulder. Muscles shortened and sewn up, a small amount of bone removed and the bursa was so huge - had to go too.
Now, some 19+ years post car accident, I have the expected neck issues. DDD, osteophytes, disc bulges, an extruded disc, facet hypertrophy, reversal of lordosis at C4-5 and grade II spondylolithesis of C3 on C4....blah...blah...blah. Several neck surgeries are on the horizon.
Just wanted to comment on your post as is sounded so similar to my journey. I'm glad you are getting that nerve block of the scalenes - it should determine whether or not you have TOS. Then they may follow up with NCS & EMG's to pinpoint the location of the compression.
You obviously have multiple issues going on: several cervical spine problems, shoulder issues and that "possible TOS" causing muscle atrophy. You obviously will be having at least neck surgery in the near future. I've had the TOS surgery and the rotator cuff repaired, but will hold off on the spine surgeries as long as I can.
Sorry you are having to deal with all these problems and wish you the best getting everything figured out. Hopefully you can have the least amount of surgery necessary to relieve your pain and symptoms.
Good luck and please keep us updated on your progress.
What is TOS? that is very interesting by the way. I had a whiplash and never experienced any shoulder pain.
So as you see, whiplash last a lifetime. Not like doctors think that it comes and go. It stays with you for life.
At least with wagons there was not whiplash.
too many miserable and sad people are left in this world to suffer cause of car accidents. (most common injury whiplash).
THere is nothing more frustrating and hurting than neck pain. Literally pain in the neck. Tendons, ligaments and and muscles get damage for life and there is no cure. not even single treatment to take this agony away.
Look what happened to both of you. One whiplash and all your life has been destroyed.
Back and forth with your neck and that's it.
What is TOS? that is very interesting by the way. I had a whiplash and never experienced any shoulder pain.
So as you see, whiplash last a lifetime. Not like doctors think that it comes and go. It stays with you for life.
At least with wagons there was not whiplash.
too many miserable and sad people are left in this world to suffer cause of car accidents. (most common injury whiplash).
THere is nothing more frustrating and hurting than neck pain. Literally pain in the neck. Tendons, ligaments and and muscles get damage for life and there is no cure. not even single treatment to take this agony away.
Look what happened to both of you. One whiplash and all your life has been destroyed.
Back and forth with your neck and that's it.
TOS is Thoracic Outlet Syndrome-it would be worthwhile for you to look it up. You might find some helpful information with regards to your situation. Best of luck to you. I would like to emphasize once again that I don't feel my life has been destroyed-many people are dealing with far worse health problems-and I have finally found a couple of excellent doctor's who are making all the difference. I hope you can find some relief from you neck injury.
I find your post very interesting as I have gone through a similar situation over the past 20 years. <<TOS wasn't on your radar..>> My story might help it make sense. I believe all of your issues may be connected...like a compounding problem.
After a car accident in 1991, I had pain in the trapezius, rhomboid, shoulder and deltoid of my left side. (As well as the expected neck pain from whiplash). I too had significant atrophy of the trapezius and rhomboid muscles on that side. Three years of one doctor after another, differing opinions - neck or shoulder? Many MRI's and rounds of PT only to still be in pain and the doctors scratching their heads. Neck MRI only showed slight disc bulge, but the shoulder MRI's revealed tears in two muscles. My shoulder was hyper-mobile by this point but was not at the time of initial injury.
Long story short ... The MAIN problem was coming from the scalene muscles on that side. Significant nerve compression was revealed with EMG and nerve conduction studies. The final test for confirmation was a nerve block performed by a neurosurgeon - it was near the collar bone. (Long time ago - don't remember specifically what they called it). I ultimately had surgery of the scalene muscles to decompress the dorsal scapular nerve. This is the "origination" nerve that serves the muscles of the scapula area, top of shoulder and upper arm. The surgery almost immediately relieved the referred pain I was having and after several months of PT, I was able to regain the muscle strength and function. At the time no one ever referred to my situation as TOS, but doctors I have seen in recent years have called it that.
So next came the 2nd problem - rotator cuff repair surgery. Once he opened me up, he thought most of the damage had been caused by all the muscle disfunction that had been created by the (scalene) nerve compression. I must have been compensating with whatever muscles I could get to work in that shoulder and arm. I had literally worn holes in the 2 muscles by mis-using my arm & shoulder. Muscles shortened and sewn up, a small amount of bone removed and the bursa was so huge - had to go too.
Now, some 19+ years post car accident, I have the expected neck issues. DDD, osteophytes, disc bulges, an extruded disc, facet hypertrophy, reversal of lordosis at C4-5 and grade II spondylolithesis of C3 on C4....blah...blah...blah. Several neck surgeries are on the horizon.
Just wanted to comment on your post as is sounded so similar to my journey. I'm glad you are getting that nerve block of the scalenes - it should determine whether or not you have TOS. Then they may follow up with NCS & EMG's to pinpoint the location of the compression.
You obviously have multiple issues going on: several cervical spine problems, shoulder issues and that "possible TOS" causing muscle atrophy. You obviously will be having at least neck surgery in the near future. I've had the TOS surgery and the rotator cuff repaired, but will hold off on the spine surgeries as long as I can.
Sorry you are having to deal with all these problems and wish you the best getting everything figured out. Hopefully you can have the least amount of surgery necessary to relieve your pain and symptoms.
Good luck and please keep us updated on your progress.
Your situation sounds almost identical-including the trouble with the rhomboid. Thanks very much for sharing your story, it is very helpful.
The spine surgeon, who is dual certified in ortho and neuro, said my discs have 'pancaked' and will require either fusion or artificial disc replacement. He likes the artificial discs, but said the insurance coverage could be an issue (off label application). He only does an anterior approach. The post-op recovery for ADR is 6 weeks, no collar versus 3 months with a collar for ACDF. Both the head surgeon and the surgeon doing his fellowship were a bit surprised at my almost normal EMG studies. The head surgeon said the 3 level posterior foraminotomy wouldn't have worked-I had far too much disc compression and stenosis. ADR seems more attractive to me, and it looks like I can wait out the insurance issues, given that the nerve's aren't showing severe damage.
I am seeing an OS today about my rotator cuff tear. MRI shows no labral tear, but a complete supraspinatus tear. Not sure that tear would cause the hand drop. The scalene block is not scheduled until 25 October. I am going to wait for the results of the TOS assessment so that I can prioritize the issues. TOS does cause hand drop and headaches and I definitely have very tight, bound up scalenes on the right side.
You guys need to do lot's of surgeries(especially neck) caused by car's accidents.
Was it worth it? no.
The hell with all those cars - it caused more damaged then good. They cannot cure
chronic pain not even with surgeries. Neck pain will stay with you for life even if you do a surgery. and then more and more pain medications all the time especially narcotics if you suffer from chronic pain caused by car accident. (which is impossible to treat soft tissue damaged-----cause doctors don't have the technology to fix soft tissue damage).
They have many other technologies but to fix soft tissue damage???----no no no, doctors cannot do anything about it. (muscles, tendons and ligaments that got damaged).
They should have kept the carriages and keep the world a little slow just like at the time of Lincoln. AT least no WHIPLASH was there. Carriages cannot cause whiplash.
and so no chronic pain in the neck that last for EVER.
Just keeping the world slower should not be a problem. Too many chronic pain patients from even the lightest car crash like happened to me. Doesn't have to be an horrific one.
You guys need to do lot's of surgeries(especially neck) caused by car's accidents.
Was it worth it? no.
The hell with all those cars - it caused more damaged then good. They cannot cure
chronic pain not even with surgeries. Neck pain will stay with you for life even if you do a surgery. and then more and more pain medications all the time especially narcotics if you suffer from chronic pain caused by car accident. (which is impossible to treat soft tissue damaged-----cause doctors don't have the technology to fix soft tissue damage).
They have many other technologies but to fix soft tissue damage???----no no no, doctors cannot do anything about it. (muscles, tendons and ligaments that got damaged).
They should have kept the carriages and keep the world a little slow just like at the time of Lincoln. AT least no WHIPLASH was there. Carriages cannot cause whiplash.
and so no chronic pain in the neck that last for EVER.
Just keeping the world slower should not be a problem. Too many chronic pain patients from even the lightest car crash like happened to me. Doesn't have to be an horrific one.
Can you please leave this be? My car accident was 30 years ago. I was able to compete on a crew team, run 6-10 miles regularly, go into a full backbend from a standing position, do a handstand and much more in the past 5 years, until the rotator cuff tear last year. I agree the neck pain has remained, but I am not on narcotics or seeing a pain management doc; I am specifically trying to avoid that. Look into 'Relaxation Response' through the Benson-Henry Institute at Massachusettss General Hospital. Might help, can't hurt.
In the time of Lincoln I would more likely have died from pneumonia I had at age 3, if I didn't die from polio, measles, cholera or in childbirth.
I think that the FDA has only approved the ADR for one level in the cervical region. (Not 100% positive on this but just what I have read)
And even though this surgeon says they are both board certified in Ortho and Neuro....it's more about what do they specialize in and focus on now.
I would ask them specifically how many ADRs they have done in the cervical area.
I would ask to speak with other patients who have had success with this surgery. Most all Drs. have gotten the ok from some patients (following the HIPAA law) to share their story with another patient.
And most important, ask the surgeon directly if he has any financial agreement with the manufacturer of the ADR he wants to use.
I also have not heard of someone needing to be in a collar for 3 months after ACDF surgery. With the use of hardware/titanium....a collar is either not necessary at all or only for a few weeks. It's only without hardware is it needed but many surgeons don't do that type anymore.
Again...I have all the same issues as you with many severe herniations, stenosis, bone spurs, radiculopathy...etc. So I'm quite familiar with all of this.
My Neurosurgeon and their practice is rated one of the top 20 in the country and my Neuro only did cervical surgeries. Orthos are more focused on the lumbar area. So that is why it's important to know which one this Dr. specializes in because the more they do of one or the other, the better their expertise.
This is where I would be very careful that they are not going for the foraminotomy or the fusion because he wants to "have fun" using the new ADR...LOL...I say this half in jest but half not. You need to read the latest (October) Readers' Digest and the article about "50 things your surgeon won't tell you". It's very eye opening.
I would just make sure that you have gotten all the opinions you feel comfortable with, talked with other patients, and feel 100% comfortable with what is being done since it's your body.
I'm not sure why they were surprised about your EMG studies...Many people can have herniated discs and stenosis but have no symptoms. If they aren't pushing on specific nerves....this is a good thing but it's not unusual.
If you took 100 people off the street right now over the age of 30...you would find close to 75% of people with disc/spine issues. As mentioned...some can have little to no symptoms at all and those who do, 85% of those issues resolve themselves over time or through non surgical means.
Then you can have someone with excruciating pain but a pretty clean MRI but all it takes is a spur or disc pushing on a nerve.
Anyway....whatever you choose we are here to support and hope it goes well for you
Last edited by Ilovemycutedog; 09-21-2012 at 10:05 AM.
ADR is his specialty; he is considered one of the top researchers/surgeons in the field at a top 5 medical school/hospital in the country. I have spoken with several doctors I know, they all said this surgeon is the one they would want to operate on their own necks. He was specific about 3 months in a collar.
You are correct about the FDA approving only one level ADR. According to the chief surgeon, insurance companies are reluctant to cover the procedure, so I am looking into what my insurance will and will not cover.
I am compiling a list of questions for the follow up appointment next month and will add yours to the list.I appreciate the input, separating out the 3 issues and figuring out what questions to ask and organizing all the records/tests is really important. I will check out the Reader's Digest as well.
Last edited by Administrator; 09-22-2012 at 09:11 PM.
That's great that this Dr. is so highly recommended...
And I'm just going on what I know from my own experience with having 3, two-level, cervical fusions. The first fusion they didn't use hardware and took bone from my own hip, I was in a collar for 2 months.
The last two fusions, even the really major one with going in through the anterior and posterior approach, they used titanium rods/screws/plates....I wore a collar only when in the car or when fatigued the first few weeks.
So...that is why I was saying I have never heard of having a collar for 3 months if a fusion is done with hardware.
Anyway....I'm hoping you can get some answers soon with insurance and where to go from there..
And most important, ask the surgeon directly if he has any financial agreement with the manufacturer of the ADR he wants to use.
I'm not sure why they were surprised about your EMG studies...Many people can have herniated discs and stenosis but have no symptoms. If they aren't pushing on specific nerves....this is a good thing but it's not unusual.
If you took 100 people off the street right now over the age of 30...you would find close to 75% of people with disc/spine issues. As mentioned...some can have little to no symptoms at all and those who do, 85% of those issues resolve themselves over time or through non surgical means.
He was clear on his financial involvement, or lack thereof, with the manufacturer, as is the University website. The hospital also adopted 'the checklist' advocated by Dr. Atul Gawande to prevent avoidable complications.
I am guessing they were surprised at the EMG results because the of the recent issue with dropping things/grip strength. The difference between the imaging from 4 years ago to now is fairly significant. I have improved my range of motion from 4 years ago by being consistent with following the home exercises from PT.
He also said the bone grafts from the hip bone were quite painful. You have clearly been through a lot. We are the lucky few that are both symptomatic and the issues don't resolve themselves over time.
The one part where I was very lucky is that I barely had any pain from the hip bone graft. But I hear that quite a few people have issues with it.
My first anterior approach fusion was really pretty easy and I recovered quickly but unfortunately I had bone resorption and the two levels collapsed again.
My second surgery I had a terrible Neurosurgeon and PM Dr. but was kind of stuck and needed the surgery asap. But I knew the moment I woke up that this guy did an awful job and I was in more pain than before the surgery! He was such a jerk and told me that I shouldn't hurt at all because he "fixed" me....
Thankfully I found the Neuro and PM I have now. They are a God send to me. The first appt. with the Neuro...he hugged me and said, "I'm so sorry for the awful pain you are in and if you stick with us, we will make sure you never have to suffer again". Obviously he told me that with my severe issues that the surgery he was going to do was to only fix the mechanical issues and hopefully help with the nerve pain, but that I would need chronic pain mgmt. for the other pain.
And the posterior approach is what hurt the most cutting through muscle so the anterior part didn't bother me much at all. Didn't hurt much or have any swallowing issues...But he had to use the posterior as well at this point to really shore up the levels from front and back since they kept having issues..
Anyway...sorry for rambling...just sharing that yes...we are the 15% that have chronic issues and have awful spines that are following apart. I never smoked which they now know that this dehydrates the discs and is the cause for many people's disc herniations...
It sounds like you are in really good hands...literally! LOL...And I'll keep following your thread to see what happens with the insurance company.
Trust me, you aren't rambling. You have been through a lot and the contrast between the 2nd and 3rd NS's is an important story for anyone facing surgery to hear. Thank you.
I wonder if second hand smoke exposure or living near a freeway/railroad has a similar effect of dehydrating discs. People who have never smoked can and do contract lung cancer. I didn't smoke but my parents did for years, both eventually quit.
It's possible...My mom smoked for over 30 years so I grew up around that as well.
Thanks for understanding my last post and that yes, I think it's very important that people understand how important it is to choose wisely when they are having such a major surgery.
You have certainly done your homework and seem to be asking all the right questions..
Re: MRI Analyses 
