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  • LowBack
    Participant
    Post count: 7

    Dr. Corenman,
    I am a dentist who had a microdiscectomy in December i recovered well. I was an ultra marathon runner and after the herniation i stopped running. I got into distance swimming(swims over 2 miles). I was really enjoying them and in May started to develop scapular pain and crepitation around the scapula with movement of my shoulder. The pain persisted, no decrease in strength some “strange” sensations of the forearm and lesser fingers but overall able to work without difficulty. I had an MRI four months ago and this is the report
    C2-C3: No evidence of significant disc disease, spinal canal
    stenosis or significant neural foraminal narrowing.

    C3-C4: No evidence of significant disc disease, spinal canal
    stenosis or significant neural foraminal narrowing. The right
    foramen is mildly narrowed due to small uncinate osteophytes.

    C4-C5: Right posterior T2 hyperintense annular fissure with a
    small associated right paracentral disc protrusion measuring
    approximately 0.7 cm craniocaudal, 0.3 cm AP and 0.9 cm
    transverse, contacting and mildly flattening the ventral cord,
    with mild canal narrowing. The dorsal CSF space is preserved. No
    cord edema or other intramedullary cord signal abnormality is
    seen. No significant neural foraminal narrowing.

    C5-C6: No evidence of significant disc disease, spinal canal
    stenosis or significant neural foraminal narrowing. Minimal
    posterior annular fullness, without canal compromise. Incidental
    small elongated left perineural cyst.

    C6-C7: No evidence of significant disc disease, spinal canal
    stenosis or significant neural foraminal narrowing.

    C7-T1: No evidence of significant disc disease, spinal canal
    stenosis or significant neural foraminal narrowing.

    The left vertebral artery flow-void is diffusely smaller than the
    right, most often reflective of normal congenital anatomic
    variation. The right vertebral artery is dominant. The
    visualized portion of the posterior fossa demonstrates no
    cerebellar tonsillar ectopia. Paraspinous muscle bulk is
    preserved.

    three weeks ago i had an injection of the C5 nerve root. This did not do much for my pain. My PT says this will improve yet the pain in the shoulders is constant. Is not a ten but a 3-5 but has not subsided. I am taking celebrex 200mg QD. I wanted to get your thoughts and see what your next steps would be. Should i just keep doing PT and another injection or should i see my Otho Spine Doc. THanks for all you do.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    You note “started to develop scapular pain and crepitation around the scapula with movement of my shoulder. You don’t note what side this shoulder problem is on so it is difficult to determine if there is any neck involvement. However, swimmers and tennis players get the “snapping scapula” syndrome. There is a bursa (thin oil-filled water balloon) between the rib cage and the scapula which can develop adhesions and inflammation triggered by arm motion.

    The vertebral artery findings are of no consequence. You do have a “right paracentral disc protrusion” at C4-5 which can radiate pain into the scapula.

    Dr. Corenman

    LowBack
    Participant
    Post count: 7

    Thanks so much for the quick reply. I apologize for the lack of info. The pain is all on the right side with tenderness and mild decrease of neck motion to the right as well. With end range of motion looking to the right there is some pain as well. Thanks again for your response

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    To differentiate between “snapping scapula syndrome” and cervical spine root compression, keep your shoulder relaxed at your side and then extend and laterally bend to the right side your head. This will narrow your intervertebral foramen (the nerve exit zone in your neck). Then, keep your head flexed (chin on your chest) while doing overhead shoulder motions (simulate swimming)

    If your neck motion (while holding shoulder at rest) aggravates your posterior shoulder, this is most likely a neck problem. If your shoulder motion (with your neck flexed) causes pain, this is a shoulder problem.

    Dr. Corenman

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