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new to forums, new pain diagnosis

Hi everyone,

As I said in the subject, I'm new here.

I've had shoulder and back pain for going on 10 years now (I'm 24) and have only recently sought treatment for the problem. The pain in my shoulder had been worsening significantly over the last couple years. Every time I move my left arm, in any direction, it clicks and pops painfully, and I can't move it over my head without shooting, grinding pain. I decided to go in and get checked out after I lost strength in my arm and dropped my infant son on two occasions.

My primary care Dr prescribed me Naproxen 500mg, which doesn't do **** for me in terms of pain relief, but I still take it. He referred me to an orthopedic, and I fully expected to hear that I had bursitis or something similar, since my father has the same issues. After the orthopedic doc tested my strength and mobility he found that I have limited mobility in my neck and almost no strength in my left arm. He sent me in for an x-ray, and then scheduled me for an MRI, saying that he was pretty sure I have a herniated disc in my neck. What!?!?! I had not even considered this.

I went in for the MRI, and was told that I have bulging discs at c3-c4, c6-c7. The doctor's assistant told me they were going to send me to a pain management specialist. I was kind of expecting and hoping for physical therapy, but that wasn't even mentioned, and they told me I'm not a surgical candidate, but didn't say why.

I have a couple questions. First, what is the difference between a bulging and a herniated disc, if any? And does anyone with experience in this kind of condition/injury know if doctors always say no to surgery in this situation? I feel a little confused, as I went to this doctor expecting answers, and left with more questions than I when had started.

Any insight and/or advice is greatly appreciated! (I know it's not medical advice, I would just like to hear some other experiences with similar/same problems)


  • LizLiz Posts: 7,832
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    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • GDFmamaGGDFmama Posts: 5
    edited 05/31/2013 - 5:47 AM
    Thank you for the warm welcome, Liz! I hope I didn't make any faux pas; I did read over the FAQs and rules before posting but if I have missed any portion of these, please let me know so I can avoid those mistakes in the future.

    Though I am not thrilled about these neck issues, I am incredibly grateful that there is a dedicated, well-moderated forum in which to speak freely with others.
  • AllMetalAAllMetal Posts: 1,189
    edited 05/31/2013 - 11:48 AM
    I have no experience with neck problems, but in general I tell everyone to always get a 2nd opinion, but in this case I'd CERTAINLY want a second opinion. This doctor might be completely right and making the best choice for you, but he still should have explained why you are not a surgical candidate. If you do choose to go for a 2nd opinion, you need to think of a few more questions to ask, for example if you aren't a surgical candidate now, are there "signs' that you need to watch out for that might indicate you could become a surgical candidate? I hope you don't have to have surgery and certain it's not always the best option, but you do deserve some clarification.
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • BonnitaBBonnita Posts: 13
    edited 05/31/2013 - 12:18 PM
    Hello, I can certainly relate to what you are going through. Sometimes doctors do not operate because the herniation's are not considered to be large by whatever standard the doctor himself may of set. This by no means that it is not painful.
    I would also suggest a second opinion.

    If you feel you would like to try therapy then by all means mention this to your doctor, most will be happy to send you to therapy to see if it is beneficial to you.

    I do have a question about your shoulder though. Sometimes yes cervical problems do indeed cause severe shoulder pain, but sometimes the shoulder pain could in fact be a separate issue. Because you can not life your arm above your head has your doctor even remotely considered doing an MRI of your shoulder to rule out a torn rotator cuff to be on the safe side? Does your shoulder hurt if you press into the joint in any given direction? Perhaps you should speak with an orthopeadic to rule this out.

    Clicking, popping and or grinding of the shoulder is not a symptom of disc herniation. It is more a symptom of arthritis, potential spurs or even rotator cuff issues. Your may actually have two totally different problems going on and they are being lumped into 1. If in fact it is your shoulder any surgery on your cervical spine will not help the problem.

    My rotator was torn years ago and I can honestly say the pain from it was very much like the pain caused by cervical compression. I couldn't raise my arm above my head at all due to extreme pain. The pain also shot down my arm.

    I have also had the reverse situation where my shoulder was hurting so bad the doctor thought it was my rotator cuff because of past problems with them that he operated on it only to find spurs and arthritis. Turns out that case it was really my neck even though it didn't hurt. I guess to be on the safe side I'd really question that.

    As for surgery, some doctors are very conservative because once you have one or more levels fused the levels above and below the fusion are put under incredible stress and can herniate causing even more pain. There could be a chance that the herniation's are not visibly appearing to intrude on the spinal cord. There are many factors that can take place. I've had a herniation's at C7/T1 for 6+ years now that appeared after my second fusion. It hasn't been operated on in the past because it was rather small 1.5mm or so and didn't appear to be doing an significant damage.

    Good luck and I hope you find the answers you are looking for.
  • I've had similar pain. I went to an orthopedic surgeon, had x-rays done of my shoulder. Doctor told me everything was fine and had me do PT. Which I followed everything they told me, went when I was told. It made the pain worse and worse. Went back to the doctor and was told there was nothing more he could do for me. Told me not to move my arm the way it makes my shoulder pop and hurt. So I stopped looking because I was told there was nothing wrong. So I'd have to deal with it. And I did for 15 more years until it got disabling. Long story short, after MRI's and various treatments that I faithully followed. There was nothing else to do but manage the pain with meds. Until recently I went to a doctor who specializes in the Atlas and the Axis, C-1 and C-2. He's the one that had percise enough x-rays to see how serious my problem was with them. My Axis because of the way it is is hard to see on the x-rays. He is treating me. He is a NUCCA Doctor. Which is a non-traditional Chiro. Very gentle on the neck. You can google NUCCA. Reasearch is key. You can also PM me if you would like to know more about my experience so far and to what degree my severity is.

  • GDFmamaGGDFmama Posts: 5
    edited 06/03/2013 - 12:59 PM
    Thank you all for everything you have shared and suggested. I have gotten a second opinion from an orthopedic doctor who specializes in pain management, and he was much more helpful. He did not see any significant bulges that would be causing the amount of pain and symptoms I am complaining about, but noted that I have cervical kyphosis and said that's unusual for someone in their mid-20s who has never had a car accident or injury.

    My c-spine results from my first appointment are:
    extension:5 degrees
    flexion:45 degrees
    rotation: 85 degrees

    He also said that I seem to have lost a lot of muscle in my hands and that could indicate carpal tunnel, so I have to get some kind of test with electrical something-or-others (can't remember what it's called, but the process sure sounded pleasant... not!). I also have to check into my family history to see if there are any autoimmune disorders that could be affecting my joints, as there is pain in my lower back as well. I've found out there is lupus, rheumatoid arthritis, multiple sclerosis, and parkinsons, all on my father's side. I'm not sure yet about my mom's.

    Overall, I'm satisfied with this doctor... so far, and am very happy that I took everyones' advice to get a second set of eyes on my case :) He seems to have taken my concerns about being rushed in and out of the other office to heart and is making sure that I leave there a little smarter than I walked in. Even though I didn't really get answers today (yet again, walked out of there with more questions than anything) but at least we've got a direction to go in. He wrote me a prescription for gabapentin 300mg, 4x a day. We'll see if it helps.
  • Have any of these doctors mentioned cervical traction therapy as a means to alleviate the pain? I'm not sure if this would apply to your injury but after finding out my neck pain was probably being caused by a compressed disc, i was told traction therapy might be a good option. I've been using this little machine that i strap my head into and inflates and deflates air chambers underneath my neck, sort of pushing my neck up and down. After a month of regular visits I feel like its helping a lot. My injury wasn't very severe to begin with so Its hard to say how effective it actually is but it might be worth asking about.
  • I'm a huge gabapentin fan because of how much it has helped me. I did start on a much lower dose and built up. Lots of people hate it because of the side effects, and quit it before they give it time to work... its one of those medicines that could take weeks and even months for it to really work well. I'm some what surprised that you have started on such a hefty daily amount, but that also tells me the surgeon is going to aggressively try to treat your pain, which is a good thing... but if you really are having problems with the medication, please do call the surgical nurse to see if maybe you could reduce the dosage and build up. (hopefully though, you'll have little to no side effects)
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • I absolutely loved gabapentin, even if it wasn't 100% effective in terms of pain relief. I tried to build it up slowly (half the recommended dose the 1st day, 3/4ths the dose the next day, and full strength after that) and felt as if it were easier to move around, and I got back that proverbial "spring in my step" that I'd been missing for longer than I realized. Then, 5 days after being put on the drug, I had to take myself off of it... I ended up with hives all over which turned into a VERY itchy rash all over my top half and it was difficult to breathe through my nose. The rash is still hanging around, and it's been a while since I've gone off the stuff. Benadryl won't do much, so I'm just watching and waiting.

    I went in for EMG testing, which was exactly as pleasant as the good Dr. described. They had me on a low setting, like, 1/10th of what someone would normally be shocked with, and I was still jumping up in pain a good portion of the time, or the wrong muscle would jump (even after re-positioning the electrodes). There's something wonky going on in my nerves.

    I don't know much about the results, but the doctor said that the numbers don't lie, I am in pain the majority of the time (I felt like jumping up and saying I TOLD YOU SO to every doctor and person who has insisted that I'm faking it for drugs/attention/time to myself) and that it is definitely not caused by carpal tunnel. I have to go in on Monday; he's going to review my MRI once more and refer me to a neurologist, as he suspects Multiple Sclerosis could be causing these symptoms.

    Once again, more questions than answers, but I am so, SO thankful that there is now proof that I'm not full of it!
  • I'm surprised you got any relief from gabepentin in just days... it usually takes much longer. I wouldn't suggest you take it any more with your reaction, but do be cautious and keep an eye out to be sure you aren't reacting to something else and still getting exposed to it.

    I'm glad you were able to get true "data" showing your pain. That has to be a relief for you to finally have something concrete to show your doctors. Good luck, keep us posted.
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • It surprised me too. It wasn't as if it instantly helped, but the last few days I was on it I could tell that it was easier to move around. That was more relief that I had gotten from months of taking mild NSAIDS, and I was so ticked once the rash showed up. My grandmother always warned me to look out for medication allergies, as they run in our family, and they usually present as a Rubella-type rash. Which is exactly what I got, and still have (though it has gone down a great deal since I stopped taking it). Fun times all around!

    I got the results from the EMG, and they are as follows.
    Bilateral Median Compound Muscle Action Potential shows normal latency, amplitude, and conduction velocity.
    Bilateral Median Sensory Nerve Action Potential shows normal peak onset latency and amplitude.
    Bilateral Ulnar Compound Muscle Action Potential shows normal latency, amplitude, and conduction velocity.
    Bilateral Ulnar Sensory Nerve Action Potential shows normal peak onset latency and amplitude.
    Bilateral Radial Sensory Nerve Action Potential shows normal latency and amplitude.
    Bilateral Median F-wave latencies are within normal limits and symmetric.
    Bilateral Ulnar F-wave latencies are within normal limits with a slight prolongation on the right compound compared to the left.

    Needle EMG of the right upper extremity shows increased insertional activity and mild fibrillation potentials within the pronator terres, brachioradialis, and biceps musculature.
    Needle EMG of the left upper extremity shows some increased insertional activity and mild denervation in the pronator terres and biceps musculature.
    Needle EMG of the bilateral cervical paraspinals shows 2+ fibrillation potentials at the bilateral c6/7 cervical paraspinal region.

    IMPRESSION: Electrodiagnostic examination is consistent with a bilateral cervical c6 radiculopathy. Correlation will be made to her cervical spine MRI. There is no evidence at this time to suggest a focal neuropathy or brachial plexopathy.
    And, that's Greek to me :/ I couldn't tell you what much of that means.

    Last week, the PM doctor went over my C-spine MRI again and, once again, did not find any bulges or herniations that would be causing these problems. He's ruling out disc problems and is referring me to a neurologist and rheumetologist.
    I feel silly for feeling so impatient; now I am getting the feeling that the road to a DX is going to be longer than I imagined. My GP is going to wonder what the heck happened in the two months since I've seen him... last he knew, I was going for a rotator cuff exam and now, hah... all of this insanity.
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