[Auric]

#8723

I am grateful that this forum continues, thanks to your detailed responses.

I have some questions about a left shoulder parasthesia. But first, some context and history.

In September of 2011, I had a single level ACDF on C6-C7, using a PEEK cage without instrumentation.

At that time, I sought two other opinions. One neurosurgeon suggested C5 to C7 (two level), and another orthopedic recommended C4 to C7 (three level). As you can see, I took the most conservative route. Prior to surgery, an EMG flagged only C6-C7.

After my ACDF, the acute symptoms of C7 radiculopathy resolved.

Through and after the operation, till the present day, my left shoulder evidenced a pins and needles feeling. Frankly, like thumb tremors, hand strangeness, forearm numbness, EMG-confirmed ulnar entrapment (both arms) and carpal tunnel (left hand), I have until recently thrown the left shoulder numbness on the scrap heap of “getting older” (I’m 56).

But I may be facing a right shoulder labral tear / cyst removal surgery, based on an MRI I just had. Should my deductible be met, I may pursue the left shoulder issue more directly. Hence, this post.

This left shoulder numbness seems to be a C5 issue. Elsewhere on the net, I have read, “C5: pain and/or numbness in an ‘epaulet’ pattern that includes the superior aspect of the shoulders (suprascapular) and the lateral aspect of the upper arm.”

This is accurate, as there seems to be no symptoms below the deltoid. The sensation is very “surface-y,” covering the cap of the delt, extending along the trap and up the neck.

On your site, you say, “Compression of the C5 nerve will produce numbness, paresthesias (pins and needles) and pain into the top of the shoulder and the top of the arm but these symptoms will not radiate down below the elbow. Commonly, pain can also radiate into the shoulder blade region (scapula).”

This is true as well. There is some pain in the scapula.

There is no loss of strength in the deltoid, nor is there any uncertainty of movement such as I have known in my right shoulder labral tears.

But here is the most specific and concerning symptom: when the left shoulder buzzes, I crane my head to the right, and the buzzing goes away. Always, in no more than five seconds.

In September of 2011, my conservative ACDF neurosurgeon said that if additional work was needed, “there can always be a foramenotomy.”

Regarding foramenotomies, you write, “Restrictions to this procedure are that the nerve has to be compressed strictly by a herniated disc fragment and not by a bone spur. The disc fragment can be removed safely but a bone spur from the uncovertebral joint cannot be removed by this procedure. In addition, if the disc fragment originates from underneath the spinal cord, this procedure should not be used as manipulation of the cord to retrieve the fragments is not advised.”

Question 1: Is an MRI the only way to tell what is causing the left shoulder paresthesia? (That is, if I am a candidate for a foramenotomy.)

Question 2: Is an MRI from September 2011 helpful to a current diagnosis, or is it too dated?

Question 3: Am I right that numbness by itself is not sufficient to seek a foramenotomy? The seems to be suggested on your site and one other.

Question 4: Given the above symptoms, can you think of any other likely diagnosis other than C5?

This site remains head, neck, and shoulders above all other resources.

[Donald Corenman, MD, DC]

#8730

First- an MRI over a year old is generally considered not worthwhile to use as a diagnostic instrument. In your case with the symptoms unchanged, it might be of some value but not as the main diagnostic tool.

An MRI will certainly be able to diagnose the pathology (along with a history and physical examination of course).

The best way to determine if the C5 nerve is involved is with a selective nerve root block and a pain diary (see website for details).

Your noting that “when the left shoulder buzzes, I crane my head to the right, and the buzzing goes away” fits with foraminal stenosis as leaning the head away from the “buzzing” opens the foramen and should reduce symptoms if the source is foraminal stenosis.

Numbness might be enough to prompt surgery. It really depends upon how severe the buzzing is and how it affects your life.

Both the C4 and C5 nerves radiate to the shoulder so the differential includes both nerves.

Thanks for the kind words.

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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