Shoulder and Neck Pain: Seeking the Right Treatment Options

Pain, soreness, and numbness?

Hello, four years ago I experienced soreness and numbness in my shoulder, neck, and arm.
After a doctor's diagnosis, I underwent surgery on cervical vertebrae 4-7.
Recently, for the past six months, I have been experiencing constant tightness and pain in my left scapula, which sometimes radiates to my chest and left arm.
When I returned to the hospital for a follow-up, the doctor said the surgical site looked good, but my condition has not improved.
I undergo rehabilitation therapy daily, which only provides relief for 2-3 hours.
If I exert myself with my hands, the soreness and discomfort worsen significantly.
Could you please advise me on what type of examination I should undergo or which medical specialist would be most appropriate for my treatment? Thank you.

Mi Mi, 60~69 year old female. Ask Date: 2006/11/20

Dr. Pan Yingda reply Rehabilitation

Hello, I apologize for being busy lately and almost forgetting to reply.
If surgery is not being considered (which is generally unnecessary), then definitely consult a rehabilitation specialist! My recommendations are: 1.
Posture: Keep your head extended upward to lengthen the neck, with the head positioned horizontally back (most people tend to position their heads too far forward), maintain an upright thoracic spine, and open the shoulders.
2.
Stretching and joint mobility: Rotate the head side to side, bend forward, and laterally flex to each side; also lean back while bringing the shoulders forward, upward (shrugging), backward, and downward.
Perform these movements with a large range of motion while staying relaxed, 24 repetitions, then switch directions.
3.
Head resistance exercises: Push your head against your hand to the left while pushing your head to the right against your hand, maintaining for six seconds (ensure the head remains centered).
Perform this in six directions (left, right, forward, backward, and include rotations), three times for each direction.
4.
Avoid swinging your arms or striking (as it can jolt the neck), and refrain from looking down or up for extended periods.
5.
In addition to traditional rehabilitation therapy, if you can find deep tissue manual therapy or acupuncture (trigger point injections), it can also be very beneficial.
I hope this information helps you.

Reply Date: 2006/11/20

More Info

Shoulder and neck pain can be quite debilitating, especially when it affects your daily activities and quality of life. Given your history of cervical spine surgery and ongoing symptoms, it is crucial to approach your situation with a comprehensive understanding of potential underlying issues and treatment options.

From your description, it seems that you are experiencing persistent discomfort in your left shoulder blade, which radiates to your chest and left arm. This could be indicative of several conditions, including but not limited to, post-surgical changes, muscle strain, or nerve involvement. The fact that your previous surgery was on the cervical spine (C4-C7) suggests that there may be residual effects from that procedure, or new issues may have developed since then.

Potential Causes of Your Symptoms
1. Post-Surgical Changes: After cervical spine surgery, some patients may experience ongoing pain due to scar tissue formation or changes in muscle dynamics around the surgical site. This can lead to muscle tightness and discomfort in the shoulder and neck region.

2. Muscle Strain: If you are engaging in activities that require repetitive use of your arms or shoulders, you may be experiencing muscle strain. This is common in individuals who have had previous neck issues, as they may unconsciously alter their movement patterns to compensate for pain.

3. Nerve Compression or Irritation: Given your history of cervical spine issues, there is a possibility that nerve roots may still be affected. Conditions such as cervical radiculopathy can cause pain that radiates down the arm and into the shoulder.

4. Shoulder Pathology: Conditions such as rotator cuff injuries, bursitis, or tendinitis can also lead to shoulder pain that may radiate to the neck and arm.

Recommended Actions
1. Consultation with Specialists: Given the complexity of your symptoms, it would be beneficial to consult with a multidisciplinary team. This could include:
- Orthopedic Surgeon: Specializing in shoulder and neck issues, they can assess for any structural problems that may require surgical intervention.

- Neurosurgeon: If there is a concern about nerve compression or other neurological issues, a neurosurgeon can provide insights into whether further imaging or intervention is necessary.

- Physical Medicine and Rehabilitation (PM&R) Specialist: They can help develop a comprehensive rehabilitation program tailored to your needs, focusing on pain management and functional improvement.

2. Imaging Studies: Depending on the findings from your physical examination, your doctor may recommend imaging studies such as MRI or CT scans to evaluate the cervical spine and shoulder structures for any abnormalities.

3. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around your neck and shoulder, improve flexibility, and reduce pain. Therapists can also provide modalities such as ultrasound or electrical stimulation to alleviate pain.

4. Pain Management: If your pain is significant, discussing pain management options with your healthcare provider is essential. This could include medications, injections, or alternative therapies like acupuncture.

5. Lifestyle Modifications: Incorporating ergonomic adjustments in your daily activities, practicing good posture, and avoiding heavy lifting can help reduce strain on your neck and shoulders.

Conclusion
In summary, your ongoing shoulder and neck pain requires a thorough evaluation to determine the underlying cause and appropriate treatment. Engaging with the right specialists and considering a combination of imaging, physical therapy, and pain management strategies will be crucial in addressing your symptoms effectively. Don’t hesitate to seek help, as timely intervention can significantly improve your quality of life and functional abilities.

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