[CowboysFan]

#8574

Dr. Corenman, thank you again for your response. The trap spasms issue as it relates to the potential shoulder issue is something I had not considered nor done a good job of asking if it was a possibility in the past. Given that both my shoulders bother me from time to time, the left more than the right, it would certainly explain the traps on both sides being in a state of constant spasm.

Sounds like my next stop really needs to be with an orthopedic shoulder physician, along with a visit with a headache specialist. My pain management physician has his background in neurology, so I should be in good hands there.

Thank you for everything,
Michael

[Donald Corenman, MD, DC]

#8575

Please let us know your outcome.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[CowboysFan]

#9144

Hello Dr. Corenman,

I just wanted to drop in and give an update on what has been going on with my situation since my last post.

Over the past few months, my shoulder has continued to get worse. Movements where I rotate my shoulder cause me the most pain and discomfort. These movements are where I lift my left arm, then move it to one side or the other. Sometimes this has caused a moment of pain in my upper left arm and at other times the pain has been in my upper left arm and shoulder and has caused muscle spasms from my left shoulder all the way up the left side of my neck. Movements like lifting my left arm to put deodorant on or to try putting my arm around my wife have triggered this type of pain.

My pain management doctor did go ahead and send me for an MRI in late May on my left shoulder to see if anything was going on in there. The MRI report showed nothing significant in regards to the rotator cuff. The most significant thing that the MRI report said was in regards to the acromioclavicular(AC) joint region:

“There is intense marrow edema within the distal clavicle and acromion process. Subchondral linear abnormality noted in the distal clavicle may represent a chondral insufficiency fracture. There are mild AC joint degenerative changes with minimal subacromial spurring. There is joint capsule. No evidence of overlying subcutaneous edema.”

After seeing the report, my pain management physician sent me to a sports medicine orthopedic shoulder surgeon who I met with in mid-July. After looking at the MRI imaging and doing some physical tests on me, he said that he felt that I probably had a little inflammation in my AC joint and gave me a cortisone injection above the bursa sac in the area and suggested that I go to physical therapy. He also mentioned that I should consider an EMG (nerve conduction) test and also commented that where he did the cortisone injection is his best guess is to where the problem is and that if the injection does not work, I may need a second injection in a different spot.

For a couple of days my shoulder felt a small amount better after the injection until I tried to untangle a couple of clothes hangers on a bar that is 6 1/2 feet above the floor. I reached up and tried to shake the hangers apart and felt a sharp pain in my AC joint region, then my shoulder muscles seized up and I had muscles spasm from my shoulder all the way up the left side of my neck and the muscles stayed tightened up a great deal for 9 hours and I could barely lift my left arm without discomfort. The muscles did not loosen up until I woke the next morning.

After that happened, I did go physical therapy for 6 sessions, but I have not had any improvement and my physical therapist cannot figure out what is going on. She suggested that I stop therapy until I see the orthopedic shoulder doctor again, which is this next week. There are certain tests that she did where she moved my arm (in the last session) that caused the same exact pain as it did in my initial PT session when she evaluated me.

Also, as I mentioned in a previous post 3 months or so ago, I did meet with a neurosurgeon here who suggested that I wear a bone stimulator for three months to attempt to fuse the level in my neck (C5-C6) where I had a non-union from my ACDF surgery. I had a cervical X-ray performed in late June to see if the stimulator worked and as expected, it did not help fuse that level.

The neurosurgeon’s nurse did call me two weeks ago to report that the X-ray showed that no fusion took place. She also asked if I was still having “neck pain”. I said that my neck still hurts off and on and that my shoulder is causing me more of a problem and that I still have headaches. At that point, she said that the neurosurgeon said that I was a candidate for a posterior fixation surgery at C5-C6 if I said that I was still having neck pain.

I was very surprised by that statement coming from the neurosurgeon’s nurse and not coming from the neurosurgeon himself in person. Is this commonplace for that conversation to have taken place? I was extremely surprised to hear that I was a surgical candidate given that I have had two surgeons already say that there is nothing surgical that can be done on my neck.

From everything that I have just mentioned, is there any insight that you could provide? Does this sound like just a shoulder problem or does it sound like that there may be some cervical spine involvement? Any comments and insight are greatly appreciated.

[Donald Corenman, MD, DC]

#9147

Lifting the arm with pain upon motion generally indicates shoulder dysfunction.

This reading is significant. There is intense marrow edema within the distal clavicle and acromion process. Subchondral linear abnormality noted in the distal clavicle may represent a chondral insufficiency fracture”. You have pretty severe acromioclavicular joint arthritis.

This disorder by itself can cause significant pain with shoulder motion. This can also cause wear of the subscapularis or supraspinatous tendons. The diagnostic injection should have been placed in the AC joint itself and not in the bursa below. I would advise you to send your films to my partner, Dr. Peter Millet for further discussions.

I cannot comment on the news of lack of fusion coming from the nurse. In my practice, if there is a problem, I will call the patient myself but I understand using a nurse to call also. The lack of fusion has about a 50% chance of not generating any symptoms but if this needs to be repaired due to symptoms, a posterior fusion will generally take care of these problems. Interestingly, the posterior fusion will cause the anterior failed fusion to unite almost all of the time.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[CowboysFan]

#9158

Dr. Corenman, thank you so much for your insight and comments in regards to my left shoulder. It sounds like what is going on in my left AC joint is more severe than what I believed after my visit with the orthopedic shoulder surgeon here.

I will most definitely contact Dr. Millet’s office to arrange sending him my images for further discussion.

[Donald Corenman, MD, DC]

#9162

Call Dr. Millet at (970) 476-1100 and let him know that we were in contact.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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