[Donald Corenman, MD, DC]

#26243

The artificial discs (ADR) allow motion that can cause in some cases, eventual facet degeneration. There are some cases also of uncovertebral joint hypertrophy (bone spurs) in the area of the exit of the nerve root on the side of the canal.

The typical position to aggravate foraminal stenosis is extension and lateral bending to the side of the pain (“bending my neck backwards to the left or right caused what feels like (facet?) nerve compression into my shoulder, underarm, lower biceps, forearms, wrists and fingers”). You might have breakdown of C7-T1 or T1-2 but this would be less likely that one of the ADR levels causing problems. See https://neckandback.com/conditions/radiculopathy-pinched-nerve-in-neck/.

Unfortunately, MRI scans generally are not as useful after ADR placement due to the metal artifact generated by all the metal of the disc replacement. A CT scan can be more helpful on a newer generation scanner but will only demonstrate bony nerve compression and might miss cartilaginous compression (non-bone).

If a single nerve root can be demonstrated to be the potential culprit, a selective nerve root block can identify the individual nerve and possibly only the block will be curative. If not, a revision of the level to an ACDF would be the answer.

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.

[smccrory]

#26251

That is very helpful, thank you sir!!!
– Scott

[westie California]

#26254

Good morning Dr Corenman,

You mentioned if I have “changes in the deltoid muscle (shoulder muscle) that are identified by the EMG, that is some real evidence of problems”. The reason I bring this up is my neurologist appeared concerned when she performed my EMG of the deltoid muscles and asked me to move my arms behind my back, which i couldn’t do and asked where i had pain when i moved my arms in certain positions. She didn’t go into much details, however all she said was I feel your arm, shoulder pain is coming from your shoulders.

I was given two scripts first for MRI of right shoulder without contrast Dx: rotor cuff tear, and second MRI of left shoulder without contrast Dx: rotor cuff tear. The question is EMG changes of deltoid muscles indicates what kind of problems?

Also can this be my source of arm pain that I’ve been complaining about for years? My MRI’s are scheduled for this afternoon. Thanks again

[Donald Corenman, MD, DC]

#26262

The EMG is only one test to indicate potential problems with the C5 nerve. The examination is important as well as your pain patterns and the findings on you imaging studies. Finally, if there is sufficient indication of a C5 nerve involvement that could be surgically helped, a selective nerve root block would be indicated with a pain diary (see website) to imprecate the nerve to be addressed.

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.

[westie California]

#26318

Good morning Dr Corenman,

I received the update from shoulder MRI’s:

Left shoulder: type 2 acromion process noted. There is a tiny focus of abnormal high signal seen near the insertion of the conjoined fibers of the supraspinatus and infraspinatus tendons on the lateral humeral head/greater tuberosity suggestive of a tiny insertional rim rent type tear.

Right shoulder :type 2 acromion process noted. There is mild subcortical cystic degenerative changes seen on the anterior and posterior lateral humeral head near the insertion of the subscapularis and infraspinatus tendons.

The question is can the above shoulder disorders (rotator cuff syndrome and others) can mimic nerve pain from the neck?

Thanks

[Donald Corenman, MD, DC]

#26335

You don’t have very impressive MRI shoulder findings or rotator cuff involvement but you do have some degenerative changes and a type II acromion. This could cause shoulder pain. You should need a shoulder injection and then a C5 selective nerve root block to differentiate these two conditions.

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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