CowboysFan

Hello Dr. Corenman,

I just wanted to drop in and give an update on what has been going on with my situation since my last post.

Over the past few months, my shoulder has continued to get worse. Movements where I rotate my shoulder cause me the most pain and discomfort. These movements are where I lift my left arm, then move it to one side or the other. Sometimes this has caused a moment of pain in my upper left arm and at other times the pain has been in my upper left arm and shoulder and has caused muscle spasms from my left shoulder all the way up the left side of my neck. Movements like lifting my left arm to put deodorant on or to try putting my arm around my wife have triggered this type of pain.

My pain management doctor did go ahead and send me for an MRI in late May on my left shoulder to see if anything was going on in there. The MRI report showed nothing significant in regards to the rotator cuff. The most significant thing that the MRI report said was in regards to the acromioclavicular(AC) joint region:

“There is intense marrow edema within the distal clavicle and acromion process. Subchondral linear abnormality noted in the distal clavicle may represent a chondral insufficiency fracture. There are mild AC joint degenerative changes with minimal subacromial spurring. There is joint capsule. No evidence of overlying subcutaneous edema.”

After seeing the report, my pain management physician sent me to a sports medicine orthopedic shoulder surgeon who I met with in mid-July. After looking at the MRI imaging and doing some physical tests on me, he said that he felt that I probably had a little inflammation in my AC joint and gave me a cortisone injection above the bursa sac in the area and suggested that I go to physical therapy. He also mentioned that I should consider an EMG (nerve conduction) test and also commented that where he did the cortisone injection is his best guess is to where the problem is and that if the injection does not work, I may need a second injection in a different spot.

For a couple of days my shoulder felt a small amount better after the injection until I tried to untangle a couple of clothes hangers on a bar that is 6 1/2 feet above the floor. I reached up and tried to shake the hangers apart and felt a sharp pain in my AC joint region, then my shoulder muscles seized up and I had muscles spasm from my shoulder all the way up the left side of my neck and the muscles stayed tightened up a great deal for 9 hours and I could barely lift my left arm without discomfort. The muscles did not loosen up until I woke the next morning.

After that happened, I did go physical therapy for 6 sessions, but I have not had any improvement and my physical therapist cannot figure out what is going on. She suggested that I stop therapy until I see the orthopedic shoulder doctor again, which is this next week. There are certain tests that she did where she moved my arm (in the last session) that caused the same exact pain as it did in my initial PT session when she evaluated me.

Also, as I mentioned in a previous post 3 months or so ago, I did meet with a neurosurgeon here who suggested that I wear a bone stimulator for three months to attempt to fuse the level in my neck (C5-C6) where I had a non-union from my ACDF surgery. I had a cervical X-ray performed in late June to see if the stimulator worked and as expected, it did not help fuse that level.

The neurosurgeon’s nurse did call me two weeks ago to report that the X-ray showed that no fusion took place. She also asked if I was still having “neck pain”. I said that my neck still hurts off and on and that my shoulder is causing me more of a problem and that I still have headaches. At that point, she said that the neurosurgeon said that I was a candidate for a posterior fixation surgery at C5-C6 if I said that I was still having neck pain.

I was very surprised by that statement coming from the neurosurgeon’s nurse and not coming from the neurosurgeon himself in person. Is this commonplace for that conversation to have taken place? I was extremely surprised to hear that I was a surgical candidate given that I have had two surgeons already say that there is nothing surgical that can be done on my neck.

From everything that I have just mentioned, is there any insight that you could provide? Does this sound like just a shoulder problem or does it sound like that there may be some cervical spine involvement? Any comments and insight are greatly appreciated.

Thank you for those thoughts.

Any ideas as to the loss of range of motion and the very tight trapezius muscles in both shoulders and tight neck muscles? Could rotator cuff syndrome cause he trapezius muscles to spasm?

Thank you again for your comments, Dr. Corenman.

In addition to possibly causing my headaches, could the facets at C2-4 also be causing the muscle spasms in my shoulders?