How to Describe Your Symptoms | Neck, Shoulder & Arm Pain

As spine professionals, we are always looking for a disorder that matches the symptoms. If you have reviewed the website, you will note there are many spinal disorders and these can cause a myriad of symptoms. These disorders generally have a typical history of onset and configuration of symptoms that are generated (with some exceptions). Therefore, we look for specific patterns of pain and how that pain is aggravated. This thread discusses how to describe these symptoms to your doctor.

Location and Quality of Pain

Start off with the description of the location and quality of pain. Neck pain might have different causes than shoulder and arm pain. Location is important as neck pain may be midline pain, pain off to the side or even into the top of the back of the shoulder. The pain may radiate. That is, the pain may start in the neck and then migrate into the back of the shoulder, radiate down between the shoulder blades and then down the arm. The pain may even radiate under the armpit or into the front of the chest. You may have no neck pain but your pain may start in only in the shoulder. Your pain may start in the arm and then radiate into the hand. Describing pain may be difficult might be difficult but try to be as precise as you can. This information is invaluable.

What is the quality of the pain?
Is the pain burning, stabbing, sharp, shooting, dull, aching, electrical, gnawing or pins and needles?
Does the quality of pain change with activity?
Is the skin hypersensitive to touch?
Are there associated skin changes like thickening, color change or nail changes? This is important in the shoulder, arm and hand.

Percentage of Pain by Location

What is the percentage of pain in the neck vs. shoulder and arm?
This is important as lateral shoulder region can be typically associated with arm pain or nerve pain while posterior shoulder pain can originate from neck or nerve sources. Don’t forget that the shoulder joint itself can cause pain.
Is it 80% neck vs. 20% shoulder and arm pain or the reverse? Is it 70/30, 60/40 or 50/50 (equal in both areas). This percentage number is quite valuable to determine what type of pain the disorder is causing. The pain may be all posterior shoulder (100%) or even only 100% in the hand (or both hands).

Intensity of Pain

Intensity of pain is described in a 0-10 visual analog scale (VAS). Zero is no pain and ten is intolerable “torture” type pain. The highest pain that currently occurs is noted and the least amount of current pain is also noted. Many patients will put 6-10 VAS on their pain scale but upon further questioning, that index was the maximum pain that had occurred months ago.
The current pain might now be 0-6 VAS. It is important to know where the direction of the intensity of pain is heading. Note the current VAS pain scale now and the worst VAS pain even some months (or even years) ago and label each one so we know which one is current.
Rate each area that you have pain. If the neck has 4-6 VAS, the shoulder has 0-2 VAS, and the arm has 8-10 VAS, make sure that is noted.

Weakness

This might be difficult for a new patient to discern, but don’t distress on this description. Just be as accurate as you can.
Is there weakness associated with the pain?
Is the weakness due to pain inhibition (the muscle is weak from use due to pain) vs. neuropathic weakness (is muscle is weak because the signal from the brain is interrupted due to a pinched nerve)?
Is there now an inability to lift the arm due to pain or to weakness?
Are certain activities more problematic like pushing away or throwing (due to weakness and not pain- such as a weak triceps muscle) or lifting due to a weak deltoid or biceps muscle?

Incoordination and Numbness

Are there now some noticeable problems with coordination and walking?
Do you find yourself unbalanced when you walk?
Do you “misstep” unintentionally much more than you use to do?
Do you have trouble keeping your balance in a pitch black room?
Has your handwriting changed?
Do you now have trouble picking up a dime off a counter, zipping a zipper or buttoning a button?
Do you find lightening type electrical charges down your spine if you tilt your head backwards?
Have your bowel and bladder function substantially changed in association with any of the above symptoms?

Onset and Length of Time Symptoms Have Been Present

How did the pain start?
Was it a gradual onset over years or was there one specific activity or injury that caused it?
When did that injury occur?
Describe the activity or action that brought on the pain. Was it a lifting injury, a bike accident or did the pain onset come on gradually?
How long have the symptoms been present and have they changed in quality or intensity?
For example, did you lift something one year ago that caused neck pain and in the last month you have developed severe arm pain that radiates down to the hand?

Activities

What activities increase or reduce the pain?
Think carefully about this question as the information produced is very valuable. Is it sitting that increases the pain where standing reduces the pain or visa versa?
Can you sit for 15 minutes or one hour before you have to get up? How far can you walk?
Does prolonged exposure to the activity cause more pain?
What does bike riding, sitting, standing, walking, lifting, jumping, computer work, driving or flying do to the pain?
Does the activity cause different symptoms?
Does the neck hurt with sitting and bending but the arm hurt with bending the head backwards?
Does the neck pain become worse with bending forward vs. backwards?
Does raising the arm cause pain or does it relieve pain?
What does overhead activity do?
Does sleeping relieve the pain or does the pain wake you at night?
Is there instability pain? That is, is there only mild pain with activities that becomes excruciating with a certain movement that you avoid like the plague?
Does daily function go relatively smoothly unless you lift something up?

Pain Intervals

Describe the pain intervals.
Are you pain free for certain times of the day or with certain activities?
An example would be that you are pain free sitting but have pain with computer work only at the end of the day. Are there flair-ups that occur?
Are you pain free for most of the day but by the end of the day, pain onset occurs?
Do you get pain crises?
Are you free of pain for a week, month or even year but one event will cause severe, incapacitating pain?
When the pain crisis occurs, how long does it last? I have some patients who are pain free for months but once every three months or so, a pain crisis would occur that would last one week or more.

Activity and Occupational Restrictions

How has the pain changed your life?
Have you adapted to the pain by limiting your activities? If so, what activities do you now avoid? Do you no longer participate in recreational activities that you once did? Which activities have you eliminated? What activities have you modified (bike riding for ½ an hour vs. a previous typical100 mile ride in the past)? You might have given up on running but now swim for fitness.
What do you now do to prevent pain from occurring?
What type of work are you involved with?
Describe your work by its physical demands: Do you have to repeatedly lift, bend and twist? Do you have to sit without position change for long periods of time?
Are you off of work due to the pain or did you have to change your job position secondary to pain?
How long have you been off work or have changed your position?

Liability

Is there liability from another party (motor vehicle accident or workman’s compensation involved)?
Have you been injured by another’s fault?

Liability is too complex to be dealt with by a simple Internet site. Your consultant will need to obtain specific details regarding the injury to help with any decisions on settlement or causality and apportionment.

Previous Consultations or Treatment

What previous treatment have you had?
Have you seen a chiropractor?
Have you seen a therapist?
How successful or non-successful has that treatment been?
Have you seen a surgeon and if so, what did they say?
Did you have previous spine surgery and if so, what procedure?
What happened to your symptoms with the prior surgery?

Disclaimer: This symptom description list may seem obtrusive, long and picky but believe it or not, this symptom list is not fully thorough. Many other factors can cause symptoms. For example, there are disorders that can mimic the pain that you describe but not be spine related at all. However, for the majority of patients, this list will be a reasonable start regarding how spine pain should be described to your provider.

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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

How to Describe Your History and Symptoms of Neck, Shoulder and Arm Pain