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  • aprokop
    Participant
    Post count: 16

    Dr. Corenman,

    I’m 4 months PO of a one level ACDF C5/C6. Is it common to still experience pain, inflammation, and stiffness at this point? My x-rays look good and I have been doing Physical Therapy two times a week for the last month. It doesn’t seem to help much. I’m 39 and I’m in pretty good shape. My surgeon said I should be feel pretty good by now. The x-rays show that I’m showing signs of fusion. Also is it safe to start take Advil etc?

    I’m concerned.

    Thanks,
    Andy

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    Is the pain in the neck, shoulder or arm? Does pain radiate from one spot to another. What motions or actions increase the pain. How intense is the pain (0-10)?

    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.
    aprokop
    Participant
    Post count: 16

    Dr. Corenman,

    My neck is tight and sore most days. My right upper shoulder is stiff and I don’t have a lot of strength when I use arm above my chest. I rarely use my right arm for anything. I could not throw a baseball or anything like that. However if my arm just hangs there I don’t have pain. I have pain in between my shoulder blades as well with quite a bit of swelling in that region. I seem to have some swelling in the upper neck around my right ear. My right thumb is still numb but I’m used to it.

    One of my biggest concerns is a pressure feeling that I get whenever I bend over or when I have to yell or get stressed. I’m a football, wrestling ,and track coach so I often need to project my voice and when I do I have pain that radiates down my neck and into my upper shoulder and between my shoulder blades. Stress also seems to aggravate the pressure pain. This pain is new since the surgery and its hard to describe but it can bother me to a level 7/10 at times. Not sure if that is considered nerve pain or muscle pain or both?

    I have some tingling and pins and needles pain in the right armpit area however I would describe it as a 2/10 feeling. This really doesn’t bother me but it is there.

    The positives is that I have good bicep and grip strength and I sleep pretty well. I usually wake up feeling better but by 11:00 I start to feel pretty crappy. I would says most days are 6/10 pain. I’m always trying to stretch and put heat and ice on my pain. I’m a middle school teacher so my work is done either in front of a computer or walking around with my students.

    Right now all I take is Tylenol and occasionally a muscle relaxer. I ‘m trying to stay away from taking more stuff but I’m at the point I wanting to take something stronger because I’m wearing down. Not sure if Advil would help or if that is safe to use yet at 4 months PO. At 3 months I was showing signs of fusing but still had a lot of dark spots in the x-rays.

    Thanks for your advice and help. I really thought I would be feeling pretty good by now after a one level fusion. The surgeon thought I would be golfing by April and I’m not even close to be able to do something like that.

    Also the surgeon said the nerve was very calcified and irritated when he went in for the surgery and he said there was a lot of calcification on the disc as well. Not sure if that makes a difference on my recovery.

    Thanks again for helping me out. This has been the hardest 4 months of my life! I want to be able to coach again and right now the pain after a day of teaching is keeping me away from the profession I love.
    Andy

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    My first thoughts are of a pseudoarthrosis of C5-6 (non-fusion). Your symptoms of “My right upper shoulder is stiff and I don’t have a lot of strength when I use arm above my chest. I rarely use my right arm for anything. I could not throw a baseball or anything like that” could be from a C5 or a C7 radiculopathy. These are the two nerve above (C5 nerve at the C4-5 level) and below (C7 nerve from the C6-7 level). The deltoid muscle (C5 nerve) lifts the arm up over your head and the C7 nerve is responsible for throwing (the triceps muscle-think Peyton Manning). See https://neckandback.com/conditions/symptoms-of-cervical-nerve-injuries/

    Another potential disorder that might fit your symptoms is Thoracic Outlet Syndrome- see https://neckandback.com/conditions/thoracic-outlet-syndrome/.

    Finally, a rotator cuff tear could be one cause. See https://neckandback.com/conditions/rotator-cuff-syndrome-shoulder-impingement-syndrome/

    I think a good physical examination and new imaging studies are called for. Maybe a new MRI and/or CT scan along with X-rays.

    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.
    aprokop
    Participant
    Post count: 16

    Dr. Corenman,

    Thanks for your reply.

    Wouldn’t four months be too early to consider to have a non fusion? (pseudoarthrosis) My surgeon said it could take a year for my bone to completely grow. He says the x-rays look good. He is worried that I may have a problem at c3/c4 but I don’t think that follows any of my symptoms.

    Lastly do you let your patience use advil at the four month mark or not?

    Have a great weekend,

    Andy

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    You can get a reasonable idea of the chance of fusion via flexion/extension X-rays and if necessary, a CT scan. Some ACDFs will heal late but there can be some obvious signs that this fusion “might not take”. The C4 nerve root (C3-4 level) does not go below the shoulder and does not affect arm strength or motion (other than pain inhibition).

    I let my patients use Advil after three months as the inflammatory portion of bone healing passes after three months and Advil affects only that stage.

    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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