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  • Shoulder problems led to cervical DX

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    Old 12-31-2014, 06:09 PM   #1
    Taylor446
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    Shoulder problems led to cervical DX

    After shoulder surgery not relieving symptoms, and dealing with an ortho surgeon that dismissed my continued complaints (severe deltoid pain with minimal abduction ability), it took me 2 months to find a new ortho surgeon to give me a second opinion. Within 10 minutes of being examined and an X-ray of my neck, we had our answer. He could see narrowing of disc space c-4/5, c5/6, c6/7. Also, misalignment of a few vertebrae. I have had an MRI, and my neck is a mess!

    I have been referred to a spine orthopedist and will see him on 1/22. He treated my husband this time last year for a ruptured lumbar disc, laminectomy performed, and my husband is exponentially better for it.

    I have had intermittent neck pain for the last 10 years, usually after working long hours (desk job), and the pain would eventually subside after taking Advil for a while.

    I don't know if it is psychosomatic or my brain finally telling me the truth, but my pain level with my neck has risen since knowing what is really wrong, and Advil is only barely touching the pain. I know this is a strange thing to ask, but is it possible I was in this much pain before, and was able to dismiss the pain? I don't want to go into my appt sounding like an attention hound.

    What I do have on my side is the MRI results. I have advanced changes of DDD at c5/6 & c6/7, disc Spurs in both which is causing spinal impingement in both places as well. Slight reversal of the physiologic curvature at c5/6, spondylolithesis at c3/4.

    I'm nervous as to where this is all leading to, and hope I am not creating pain in my mind. Anyone have any words of wisdom for me?

    TYIA,

     
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    Old 01-02-2015, 07:18 AM   #2
    Taylor446
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    Re: Shoulder problems led to cervical DX

    I think I need to explain my shoulder problems.

    A year ago I had to have my ovaries removed. Tumors on both, thankfully benign. 2 weeks before that surgery I went to a pharmacy to get a flu shot so that I would be guarded as much as possible in a hospital environment. The person that gave me the injection placed the needle very high on my arm, and she even used both thumbs to push the fluid in. I was sitting, she was standing. I now know that is a big no-no.

    Within 7 or so days I was in the ER because I could not move/use my arm without screaming like a banshee. They determined the needle went into my shoulder bursa instead of fully into the deltoid. Here is a chronological timeline since that shot and the onset of what I thought was only shoulder problems:

    - Jan 14 appt with my ortho as follow up for synvisc series 6 weeks before (knee osteoarthritis). I presented my new shoulder problem and he DX'd me with bursitis and possible frozen shoulder. Prescribed PT.

    - Jan to Feb PT until I fell getting out of bed one day. Landed on my knee and face planted as well. Dislocated patella, head and neck seemed fine. Shoulder didn't feel any worse (landed primarily on my right knee and braced with right hand, it is my left shoulder with the problems). Now PT on left shoulder AND right knee.

    - Feb to Apr PT continued, knee much better, no progress with shoulder. Had an MRI, referred to a shoulder specialist.

    - May per MRI had a labrum tear, severe bursa inflammation, possible bicep tendon impingement. Had surgery to clean up labrum and relocate bicep tendon to the front, also inflamed bursa removed.

    - May to Aug PT, deltoid abduction very little improvement, all other areas good improvement. Released to home (self)PT.

    - October follow up on progress. Still no improvement on deltoid. MRI ordered.

    - Oct results, possible small rotator cuff tear, not large enough to warrant surgery. Surgeon advised me to 'hit the gym hard, you will be back if it is worse'.

    Never did he ask about my neck, and I didn't have pain enough to bring it up. I felt my discomfort was coming from having to shift so often with my seating because of the shoulder discomfort.

    I tried to get a second opinion at the only other practice in town, and was denied. I was told there was nothing they felt they could do for me from reading the MRI. I was stuck with nowhere to go.

    - Dec called the original practice and begged to have a different shoulder Ortho give me a second opinion. The original shoulder ortho finally agreed to let me see one of his colleagues. 10 minutes into my appt with him I was having my neck xrayed and then knew I have a crappy neck! He asked if I had pain in it and I said it was sore sometimes but I contributed it to compensating for my shoulder, and possibly iNeck from my tablet and phone. He had me rotate my neck and asked if I felt it crunching. I said yes, doesn't everyone? He said Nooooooo!

    MRI Results:

    Findings: CSF signal is unremarkable. Noise artifacts are present. Artifacts lower the diagnostic sensitivity of this study. No suspicious vertebral body marrow lesions are seen. The cervical cord is not enlarged. Artifacts limit evaluation for cord lesions. CSF flow artifacts limit evaluation of the CSF

    C2-C3: no disc herniation.

    C3-C4: 0.1 cm anterior spondylolisthesis of C3 and C4 is present. No focal disc herniation.

    C4-C5: Degenerative disc disease is present. 0.1 cm anterior spondylolisthesis of C4 on C5 is present. No focal disc hernia tin at this level.

    C5-C6: Disc space narrowing is present. DDD is present. A mild to moderate broad-based disc spur complex is present impinging the cord ventrally slightly more prominent on the left side. Degenerative joint disease of the uncovertebral joints is present. There is a slight reversal of the physiologic cervical curvature centered at C5-C6.

    C6-C7: Disc space narrowing is present. DDD is present. A mild to moderate broad-based disc spur complex is present slightly more prominent on the right. Degenerative joint disease of the uncovertebral joints is present.

    C7-T1: No focal disc herniation. Degenerative changes are present in the upper thoracic spine.

    Impression: There are advanced changes of degenerative disc disease at C5-C6 and C6-C7.

    So, since then, as I wait to consult with a spine orthopedist, my neck does now hurt. And I am also really angry that my first shoulder ortho didn't rule out my neck. Such a simple task could have saved so much time and heartache, and pain!

    With all of that in mind, I am so perplexed as to why my neck has exponentially become very sore now. Why wasn't it sore before my diagnosis was confirmed? I have 3 more weeks before my spine consult, and I have only ibuprofen to help me through. Is this pain all in my head, or was it there all along and my brain dismissed it?

    What should I look for by way of symptoms to make sure I am safe until my appt?

    Sorry to ramble. I am so nervous/scared of what lies ahead.

    Last edited by Taylor446; 01-02-2015 at 10:57 AM. Reason: Added mri report verbatim.

     
    Old 01-02-2015, 11:01 AM   #3
    Taylor446
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    Re: Shoulder problems led to cervical DX

    I added my complete MRI report above.

     
    Old 01-02-2015, 08:42 PM   #4
    teteri66
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    Re: Shoulder problems led to cervical DX

    You may be in some pain until your appointment with the spine specialist, but you are most likely to not be in any danger. The report does not indicate the extent to which the cord is being impacted at C5-C6...and that is the only level where there is contact with the spinal cord.

    When you see the spine specialist, he/she will correlate the findings of the MRI with what is found upon physical and basic neurological exam to determine the diagnosis and plan of treatment. Obviously you have degenerative disc disease, which is something we all deal with, to some extent, as we age. Unfortunately, the spine begins its aging process in our 20s, so "age" is not necessarily an issue when discussing DDD. In some people the wear and tear of daily living takes its toll sooner than in others.

    The discs are comprised of something like 90% water but they must get nourishment from the adjoining end plates, having no direct blood supply. As we age the discs tend to dry out. As this happens, the discs flatten out which allows the vertebrae to move closer together. This is happening in your spine and is referred to as "disc space flattening." It is a part of the degenerative process, as is the disc osteophyte complex that is mentioned.

    There is also a small amount of spondylolisthesis at C3 to C5, where one vertebra slips over the top of the adjacent vertebra. This can happen as the discs degenerate and some instability of the segment is often the result. The amount of slippage you have is quite small, so try not to worry.

    When someone says the pain is in your head, they do not necessarily mean you are making up something that doesn't exist. A lot of our experience is based on how you experience pain, and how the receptors in the brain interpret the signals that are being sent up the spinal cord. I imagine your pain is worse now that you have proof that there are some problems with the cervical spine, partly due to your anxiety of the unknown. But there are very real reasons why you are feeling symptoms as there is some nerve compression or irritation going on.

    Do you have more pain on the left side?

    Try to take it easy till you see the spine surgeon. You can try a heating pad or ice on your neck to see if it provides any relief. And, try not to worry. Anxiety results in muscle tension which will make you feel worse!

     
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