AVN AND CORE DECOMPRESSION versus CERVICAL DISC INJURY

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I am a 50-year-old female who has AVN in bilateral ankles, hips, knees and ankles (presumed due to steroid use for asthma through the years). I had a core decompression for my shoulder (most symptomatic joint) on 11/21/2002. At Duke I was told I have two problems in my shoulder 1) AVN; 2) adhesive capsulitis. My surgery also consisted of adhesive capsular release. I have been taking extremely painful physical therapy since my surgery and have not progressed one bit in increased ROM.

To complicate matters, I have a known cervical disc bulge in C5-6 disc from an old swimming injury at age 14, and I reinjured my neck by lifting a heavy suitcase about 3 months prior to the pain starting up in my shoulder.

My question is could any of this limitation of motion in my shoulder be caused by the disc problem in my cervical spine. At night my neck hurts and I cannot get comfortable in bed. My quality of life is really not good right now. I cannot explain why my shoulder suddenly started progressing with the AVN and my hips, knees and ankles appear to be staying stable and I can live with the pain in those joints for now. Should I have a 2nd opinion and take my MRI of my neck to a neurosurgeon and get a consultation to see if any of this limitation of range of motion is coming from that cervical disc now?

The reason I had an MRI of my shoulder was because in May 2002 I lifted a stiff pump handle in my yard. They thought at first rotator cuff tear and did a very painful arthrogram. Later they did the MRI. From June (nothing showed up on plain films) to October 2002, a crescent sign was already showing up on the plain film. I am now worse than I was prior to core decompression.

Main question - is it worthwhile to get a neurosurgeon or neurologist to examine me and my MRI to see if my neck is causing any of this pain or limitation in range of motion???

-- (), January 20, 2003

Answers

It is difficult to be sure of the source of your ongoing pain, as both your shoulder and your neck have been the source of problems.

Generally however, pain from a cervical disc has a radiating quality, and tends to go along the distribution of the nerve. In your case if you have a C5-C6 disc problem then the C5 nerve would be involved. This nerve does supply the shoulder as well as the upper arm and the biceps muscle. Normally a cervical radiculopathy pain would be aggravated by movements of the neck and would not normally be accompanied by shoulder stiffness or limitation of movement. Yes, it would be a good idea to get a neurosurgeon/neurologist to examine you and review your MRI.

-- Errol Bennett, M.D. (ebennet6@jhmi.edu), March 03, 2003.


Velva, I am a physiatrist, that is, a specialist in Physical medicine and Rehabilitation. It has been a long time since you posted. I wonder how you are doing. If indeed you have a significant C5 nerve root impingement it could contribute significantly to your shoulder problem via production of weakness of your rotator cuff muscles. These muscles are mostly supplied by the C5 and C6 roots. This could produce symptoms of impingement. A physical exam would reveal this via a variety of signs, from atrophy of the involved muscles to weakness, to impingement signs on physical testing. If indeed the above are present, and physical exam is unequivocal, then appropriate physical therapy to strengthen the involved muscles while improving your posture and biomechanics could help a lot. If physical exam is equivocal an electromyography (EMG) test might be helpful in determining if there has been nerve damage to a specific nerve root. The key is to combine the neurologic exam with a functional musculoskeletal exam. This is what Physiatrists do. Good luck and please give us an update,

Matthew G. Michaels, MD FAAPM&R FAAEM

-- Matthew G. Michaels, MD (endurancemd@msn.com), November 03, 2003.


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