Increasing pain 5 months after ACDF C5-6

///Increasing pain 5 months after ACDF C5-6
Increasing pain 5 months after ACDF C5-6
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  • Cynthialrn
    Participant
    Post count: 5

    Hi Dr Corenman! I asked a question a few months ago & since then things have gotten worse so here I am again. Thank you in advance for taking the time to answer me. I suppose a little history may help as it may be relevant in determining what may be going on. I was in an accident last november in which I was rear ended while stopped to make a turn, by a bus. I underwent an ACDF of C5-6 at the end of March this year & prior to the surgery had an MRI that showed a large herniation of C5-6 and bulges of the 2 discs above it. Afetr surgery my headaches went away, as did any pain I had been experiencing. However, within a couple of months I began having pain between my shoulder blades whenever I turned my head in any direction. It felt like the pain you get when you have a crick in your neck. Nothing relieved it other than not turning my head. I spoke with my surgeon and based on the fact that the x-rays showed my vertebrae fusing normally, she decided it was probably a sprain. I started PT for this but since then it has only worsened to the point that now I can’t lift my arms without illiciting the same pain. I was reading online that one way to check for cervical radiculopathy is to raise the hands and place them on top of the head and if this stops the pain it is radicular pain. I tried it and it did indeed stop the pain. As long as my hands were on my head I could turn my head without pain but the moment I put them back down the pain returned. I asked my family practice doctor to please order an mri which I am having today. My question to you is this…do you think this is possibly the higher level bulges that have become herniations or do you think, based on where it hurts (right between the shoulder blades) that it’s something going on with the surgical site at C5-6? Again, thank you for your time, your answer will help me talk to my surgeon. I wish you were near me so I could have you do my next surgery if I need one.

    Donald Corenman, MD, DC
    Moderator
    Post count: 6438

    If you have posterior shoulder pain after two months of relief after an ACDF, the two potential possibilities are a pseudoarthrosis of the fusion level or a new involvement above the fusion. Since the pain is not into the tops of the shoulders or down the arms (“within a couple of months I began having pain between my shoulder blades whenever I turned my head in any direction”), it may not be a nerve root generated pain but a referral pain from a degenerative disc, even though holding your hands above your head relieves your pain (Bakody’s maneuver). Check carefully the new X-rays including flexion/extenision for motion at the fusion site. A new Mri would also be helpful but if there is motion, a CT scan would be preferable.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    Cynthialrn
    Participant
    Post count: 5

    Thanks so much for your answer. I wanted to add that I also have pain in my neck when I move it but it isn’t consistent…it comes and goes. Some weeks I’ll have the same feeling of a crick in my neck and then it’ll go away and only the shoulder blade pain remains. Also, I have been having pain in my right shoulder and arm all the way to my thumb which will burn at the nail bed it seems. However, a recent Mri of the shoulder revealed microtearing of the infraspinatus tendon and a partial tear of the spinatus…on top of that I’m also dealing with tennis elbow. So that arm is extremely painful right now and it’s impossible to tell what pain is coming from where. I suppose I should have the arm removed and then it would definitely stop hurting….no wait, then I’d probably develop phantom limb pain… Ha! I try to stay light hearted about these things. Anyway, if any of this info makes a difference in your opinion let me know. By the way, I’m not a physically active person and I have no idea why these tendon issues keep occurring. Bad luck I guess or bad genes.

    Donald Corenman, MD, DC
    Moderator
    Post count: 6438

    Tendon issues can be genetically based so lack of activities does not protect you. You could have a shoulder injection to determine what pain is generated by the shoulder vs. the neck. See pain diary: https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/.

    X-rays with flexion/extension views can be helpful.

    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.
    If this forum has helped you, please let Dr. Corenman know!

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