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  • Pinched nerve and shoulder blade pain?

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    Old 09-22-2014, 07:20 AM   #1
    kbe523
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    Pinched nerve and shoulder blade pain?

    Hi all,

    I am having so much pain in my right shoulder blade, sometimes it travels to the back of my right upper arm and occasionally to my elbow. I had an MRI a couple weeks ago - it didn't call out a pinched nerve, but I have no idea what else it might be. Not many things help - not pain meds, not muscle relaxers. Laying on ice sometimes alleviates it for a short time.

    My primary doc referred me to neurosurgery at the giant university hospital I live near - but of course, haven't heard from them as to when my appointment will be. It's very frustrating - "don't call us; we'll call you." I realize my issue is small potatoes to them, though.

    Does anyone have any suggested exercises or things that might combat the pain? Sometimes it just hurts, sometimes it burns, sometimes it feels like Icy Hot burning. I'm happy for any suggestion!

    I should also mention I am fused at C6/7; had an ACDF seven years ago. No issues from it, but this pain is eerily similar.

    Here is my MRI report:

    MRI CERVICAL SPINE NONCONTRAST 9/8/2014

    CLINICAL INFORMATION: Increasing neck pain with radicular symptoms into
    the arms. History of C6-C7 surgery. Request noncontrast examination.

    PROCEDURE: Using a 1.5 Tesla GE unit, an MRI of the cervical spine was
    performed. Imaging sequences included sagittal T2, STIR and T1 FLAIR
    weighted images as well as axial gradient images through the disks.

    COMPARISONS: None.

    FINDINGS:

    No abnormalities are seen at the cervicomedullary junction. The
    morphology and signal characteristics of the cervical and upper
    thoracic cord are normal throughout. The cord is visualized from the
    skullbase to upper T4.

    With regards to the marrow space, there is straightening of the
    cervical spine without malalignment. Susceptibility artifact is seen
    related to anterior spinal fusion hardware at the C6 and C7 levels.
    Marrow signal and vertebral heights are normal.

    With regards to the discs, a small focal midline disc protrusion is
    seen at the C2-C3 level slightly indenting the thecal sac without
    spinal or neural foraminal stenosis.

    At the C3-C4 level, a broad but shallow disc protrusion is seen
    slightly indenting the anterior thecal sac without spinal stenosis.
    Minor uncovertebral spurring is seen causing minimal encroachment on
    the neural foramina.

    At the C4-C5 level, a midline disc protrusion is seen indenting the
    thecal sac and closely abutting the cord. There is no significant
    spinal stenosis. Minor left-sided uncovertebral spurring is seen
    encroaching on the left foramen. No right neural foraminal narrowing is
    seen.

    At the C5-C6 level, a broad disc bulge and osteophyte complex is seen
    minimally indenting the thecal sac and mildly encroaching on the neural
    foramina.

    No significant disc abnormality is seen at the C6-C7 and C7-T1 levels.
    The spinal canal and neural foramina are patent.


    IMPRESSION:

    1. Anterior spinal fusion at C6 and C7. No malalignment.

    2. Low-grade degenerative changes seen in the mid cervical spine.

    Thanks,
    Kelly

     
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    Old 09-22-2014, 12:30 PM   #2
    ChuckStr
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    Re: Pinched nerve and shoulder blade pain?

    Hi Kelly,

    Welcome to the board!

    From what's in the report there doesn't appear to be any significant nerve pinching or compression on the spinal cord. There are a couple of interesting things though:

    C4/C5 they mention a disk herniation touching the cord, yet they note no significant stenosis. I would think there would be some stenosis in that case, but since they don't supply canal(AP) diameters, we can't tell.

    C6/C7 they mention susceptibility artifact which basically just means that the picture was blurred by the presence of the metal from your fusion. I assume you had follow-up that confirmed your fusion actually fused, right? If you've had no problems for 7 years then most likely you did get complete fusion.

    Above are a couple of things to bring up when you get the appointment with the spine specialist (make sure you see one, not just a general neurosurgeon).

    Another thing that comes to mind from the description of your symptoms is brachial plexopathy. This is where you get impingement of the nerves in the brachial plexus. How long has the pain been going on? Have you started to have any weakness/atrophy in the affected shoulder/arm? The classic presentation is severe pain possibly accompanied by paresthesia (numbness, tingling etc) for as much as several weeks followed by acute weakness in the affected limbs. This is another possibility you could ask the spine specialist about.

    While you are awaiting your appointment, could you potentially get a referral for PT from your general doctor? A good PT could help you with exercises, e-stim, TENS etc which may help with the pain. You may also want to hit up your GP for some different pain medication. I found the "nerve" pain medication like Gabapentin to be more useful than narcotics.

    Good luck and let us know how you get on...

     
    Old 09-22-2014, 12:40 PM   #3
    kbe523
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    Re: Pinched nerve and shoulder blade pain?

    Hi Chuck,
    Thanks so much for your reply - that helps a lot! I think I am going to revisit my GP and ask for a referral to the spine program rather than neurosurgery - it seems like it would make a lot more sense. I also think he could refer me to PT pretty easily, too, and at this point, I will try anything! I had not heard of brachial plexopathy, so I will look that up. I notice a bit of weakness in my hand, but not too much. This has been going on since late July, unfortunately. I really thought it was muscular, but the pain is really much more like nerve pain like I had previously - especially the burning feeling.

    Thanks again - I appreciate the response!
    Kelly
    PS: Yes, I had a successful fusion at C6-7, thank goodness.

     
    Old 09-22-2014, 01:19 PM   #4
    ChuckStr
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    Re: Pinched nerve and shoulder blade pain?

    The pain I had was a mix of the burning nerve pain and more "muscular feeling" pain. I thought I had a torn rotator cuff or something. My pain only lasted less than a month but I have persistent although mostly resolved weakness and minimal atrophy of my forearm and upper arm muscles. Scary stuff. One neurologist I went to thought brachial plexopathy, the other thought spine stuff and 5 different spine specialists all thought spine. I think I believe them but the fact my arm is still a little bit weak and atrophied worries me. I go back the end of next month to see if all my nerves have managed to reattach themselves to my muscles (EMG).

    If the spine program you are going to is like the one here at UW, they'll listen to your symptoms, get a copy of your MRI and hook you up with the appropriate clinician, probably a spine specialist surgeon of some sort either a fellowship trained orthopedic spine surgeon, or fellowship trained spine specialist neurosurgeon. If it ever comes down to surgery, having both opinions is useful as they tend to look at things a little differently.

     
    Old 09-23-2014, 05:01 AM   #5
    kbe523
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    Re: Pinched nerve and shoulder blade pain?

    Hi Chuck,
    YES! You described it perfectly! Like muscular pain, but burning too. Here's another thing I find interesting - when I get up in the morning, it's usually OK - I don't feel it, if at all. By the time I'm driving to work, though ... it's baaaaaaaaaaaaack!! (no pun intended).

    The spine program I'm going to get a referral to is at University of Michigan ... I think it would make a lot more sense than neurosurgery. Of course, getting in at UM, I MIGHT get in before my 75th birthday if I'm lucky! Grrrr.

    I think the atrophy in your arm is worrisome, too - can you do normal activities, or has it impeded you? I hope the EMG brings good results that the nerves have reattached. I'm finding more and more, nerves are a funny thing. I still have some numbness between my middle and ring fingers on my right hand from my C6/7 herniation seven years ago!

    One question for you - in my report at C4/5, you mentioned a herniation, but they didn't call it that specifically - is it safe to assume that bulge = herniation? Or that eventually, it will?

    Another thing that bums me out entirely is that I really can't go to the gym and lift weights. I enjoy that, and right now, I'm afraid to.

     
    Old 09-23-2014, 10:33 AM   #6
    ChuckStr
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    Re: Pinched nerve and shoulder blade pain?

    My U of Washington spine surgical referral was only 2 1/2 weeks and I had already seen a spine specialist before that at Swedish (a large regional hospital). I developed some twitches in my legs at the same time and my spine surgeon suggested a neuro consult. That consult at UW was 2 1/2 months! I did get in to see a neuromuscular neuro at a large regional hospital after about a month. Those specialty neuros are busy!

    I don't have any restriction of activities anymore, although I did for a while. At one point I was down to only 20% ROM in my neck and the pain was pretty debilitating. Now, my arm just feels kind of weird, kind of heavy. It's almost like I'm going to get a cramp but I don't. There is still a small dent in my brachioradialis and my shoulder pops a lot, I'm guessing from a bit of atrophy in the shoulder muscles although it could be from arthritis. Strength is pretty much back to normal, so mostly what's left is just a nuisance. My PT and neuro both seem unconcerned and are generally very pleased with my progress so I guess it's ok.

    The text from your MRI at c4/c5 is : a midline disc protrusion is seen indenting the
    thecal sac and closely abutting the cord

    A midline disk protrusion is a herniation. Bulge is another way to say that. So bulge=protrusion=herniation. Midline means it pushes out to the center which means it is likely to impact the central spinal canal. Yours is "closely abutting" the cord which generally means "barely touching".

    I would not lift weights without supervision. If the problem is neck-related weights could make it worse. After a couple of months my PT had me on a strengthening program where I was doing some weight lifting to regain strength and muscle. My left bicep looks pretty normal and is only about 10% weaker than my right from 50% weaker at the start. Maybe bike riding would be good exercise until you get the ok from a Dr to do more.

     
    Old 09-23-2014, 12:07 PM   #7
    kbe523
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    Re: Pinched nerve and shoulder blade pain?

    Hi Chuck,

    I totally agree about lifting weights. Somehow I think that's what got me into this predicament in the first place all those years ago - at least, I think it was a contributing factor. If I knew then what I know now! Today I plan to go to the gym and just ride the recumbent bike; I figure at least that's something, until I can get an appointment scheduled.

    Darn, and here I thought I was all good because I didn't have any herniations! Ah well - I guess I should not be surprised, given the pain and the circumstances. Thanks for the clarification on the terminology; I've always found it confusing.

    I'm glad to hear you don't have any activity restrictions anymore - that is good to hear. It sounds like you've made really good progress. Having had two AC joint surgeries (one in each shoulder), I understand the frustration of the weaker shoulder muscles, too - that type of pain mingles quite successfully with the neck/shoulder blade pain; there were times I had a hard time differentiating it! In fact when I herniated C6/7 and needed surgery (my neurosurgeon called it a "big honkin' disc" ... nice, huh??), I thought I had injured my trapezius muscle instead. No such luck!

     
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    burning pain, cervical spine, neck pain, shoulder blade



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