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Help with Cause of Referred Shoulder Pain
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Help with Cause of Referred Shoulder Pain

First, I'd like to thank you for all the time you have put into answering questions on this form.  Your insight is invaluable.  

Brief summary:  My neurosurgeon has recommended that I have a C5-C6 anterior cervical disectomy and fusion.  He said that it would probably eliminate the left arm pain that I am having.   All most equally as troublesome, I have chronic burning/tingling in my right shoulder blade area over the trapezius muscle and sharp neck pains when my head is tilted back or to the side (like ear to shoulder).  He said that the shoulder pain was "referred pain" and may or may not be helped by the surgery.  I am sure there are a ton of variables, but is there a common cause for referred pain in this area?  My chiropractor said that it was due to hypoxia to the muscle, and the neurosurgeon said that it "could" be part of the disc problem and that it was a very common complaint among patients.  I have spent days on the internet trying to find some insight to the cause of the shoulder pain.  Could you give me your thoughts of what are the common causes for it?  (I think that it is unusual because the pain has been on my right shoulder, whereas the MRI report states " Left parasagittal disc protrusion/herniation producing moderate left lateral recess stenosis and mild left neuroforaminal stenosis.)  Also present is a mild disc bulge at C6-C7, but that was not the Dr.'s main concern.

Thank you so much for your time and answer.  Even if it could direct me in the right direction to research it more, that would help.  I have had daily trouble with that right scapula area for 5 years and surely there is a reason for it.

God bless!  
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I had ACDF (C5-C7) in Nov 2006.  The only thing that it did help was my arm pain.  In fact my neck and shoulder pain is worse now that before surgery.  I know alot of people really benifit from the surgery, especially with only one level.  I have about given up hope of getting better.  It's been over 10 months since my surgery and the only way I survive is with muscle relaxers and Demeral.  I to have searched every where for an answer to the cause of this pain.  My doctor says that some people are left with presistant neck and shoulder pain after this surgery.  So I guess I'm going to be left in that catagory.  I'm sorry your having so much pain, but I understand exactly what your going through.
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Avatar_m_tn
hey glenn-- hope i can help. I am a dentist, not an MD, but i have done ALOT of reding on neck back shoulder pain syndromes after the traditional medical/surgical community failed me-- and i fixed this nastiness on my own. so- i may be able to help. tell me about your pain--what kind, where, when is it the worst, anything that makes it better.. and what you do, your habits, work etc-- on the computer alot?? also are you overweight, in shape, athletic etc....

if your herniationion is to one side and you have pain on the other side.......logic would tell you.that pain aint from a disc !!
dont make the assumption that it is "referred".. i made this mistake-- cost me a year of my life and an unecessary surgery on my neck.

the worst thing you can do is consent to allowing a doctor to operate on pain.
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Avatar_n_tn
Mike, I was hoping you'd respond.  I noticed you were active in reading some of the posts and had some solid advice to offer.

I teach Honors Biology and am either at the PC, white board or hovering over a stack of papers to grade.  I do have posture problems, especially when it is hurting/and I’m tired.  I fit in the average weight category, thankfully since the average American woman is in a size 12. *lol    I have always been very strong for before the accident I benched 150lbs. but now I feel lucky to hold out a can of soup during aerobics class. *grin.     I was hit from behind about 13 years ago and my spine is degenerated from there.  For the last 5 years I have had chronic pain in my right shoulder, about 2-3 fingers with from my spine and about a hand width down.  I guess the trapezius muscle is the biggest offender, but it might be something deeper there which and I can’t pin point.   It burns, feels prickly, tingles, and just flat hurts…especially when I raise my right arm or have been using it for a while.  (i.e.  When I’d feed my 7 month old or writing on the board in class.)  Now that area along with the rest of my neck and shoulders have geared up for battle and rebel against even the slightest offenses.  Ie. Folding clothes, extending my arm out for 20-30 seconds, holding my neck as I bend over to empty the dishwasher, tie my daughter’s shoes, dress her, etc.  The muscle spasms have got the best of me these past 3 months.  (Usually, I can work through them in 2 weeks.)   The past few weeks I’ve taken enough medicine to kill a small horse. I’ve been taking skelaxin, naproxen, hydrocodone, and had several rounds of steroids to no avail.    (And in addition to my shoulder, I have sharp neck pain if I lean it back or lower it to the side touching my ear to shoulder, which also causes arm and hand pain.)  ….all of this said, I finally gave in and went to another neurosurgeon.  He looked at my MRI’s and strongly suggested fusion, but again, that is what neurosurgeons do.  His nurse did point out that he is very conservative and rarely offers surgery on the first visit.  I guess after looking at my MRI’s and what all I’ve tried over the past 13 years he decided to skip the courtship and go for the home run.

My chiropractor said my shoulder pain was due to hypoxia, because the muscles don’t get enough oxygen.  Have you heard much on that?  What are your thoughts on posture belts?  I saw one the other day to help my shoulders stay back.  Over time they have been pulled in and it takes extreme effort to keep them back.

I don’t care what the solution is, I just need one.    If surgery is route I have to go (even though surgery and I don’t mix well), then I’ll do it.  If it takes 3 hours a day of therapy, I’ll do that too.  I don’t know if I have conveyed enough info, but I have reached my max sitting at the PC.  If you have any favorite books or web sites on neck and shoulder pain, please let me know.  

Thank you for your time in reading people’s posts and offering advice.  
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Avatar_n_tn
Thanks for your response.  My luck usually runs like yours, that is why I am trying to make sure I look at all of my options before I get it done.
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Avatar_n_tn
Glenna, I have the exact same trouble as you.
I was hit by a drunk driver years ago.
Have had headaches, and neck pain for years, went to PT, Chiro, then my Dr. Recommended MRI which showed c-5-6-7 ruptured or herniated.
well, went to see Neuro and he recommeded surgery.
Was told that I qualified for a clinical trial and had the surgery done December of 2003
Since then, the pain in my right shoulder has gotten worse, especially in the last year.
Cannot tip my head to the side or back, showering and washing my hair is the worse!
I am back in PT and have been doing a lot of the posture exercises that Mike 1105 was talking about. It does help, but you really have to keep at it to retrain the muscles.
Some days I can't even stand it. Feels like my head weighs about 20 lbs.....the right shoulder, the right side of my neck have horrible spasms, and am taking all kinds of stuff I HATE TO TAKE! Muscle relaxers, pain pills, sleep aids.
I want to make it all go away!
I had the Prestige Artificial disc done, and the way I feel now, would not recommend it to anyone.
Wish I had know about all the posture and upper crossed syndrome before I was cut open!
Anyway, not trying to tell you what to do, not sure what the right thing is.
I just know that when I have ultrasound, and do my exercises and stand tall, which is hard...I do feel better. I lay on my back with a foam roll and let it stretch my muscles and open up my chest area, and that feels great....hmmmm now only if I didn't have to work, and could just stretch all day!
Hope you figure it all out.....when you do, let me know!
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Avatar_n_tn
Thank you for your comments.  I can relate to washing my hair.  ...the added water weight doesn't help much.  

What is upper crossed syndrome?
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Avatar_m_tn
Glenna-- you can look up Upper crossed syndrome on the net. A guy named Vladimir Janda first identified it, but the best resource I've found is on a site by Erik Dalton. search around his site (which is mostly geared towards his business of training therapists, and you will find it). It is an imbalance of front to back muscles in the upper body. it comes from a hunched, closed in posture. i believe you may have it based on your post. if fixed it doing the appropriate stretching of the tight muscles with trigger point work (especially the nasty scalenes) and strengtheneing my mid back with extenion exercises and shoulder blade pinching exercises.

tight/short muscles-- pecs (chest pain) upper traps (tight neck, neck pain, shoulder pain) SCMs (neck pain) scalenes (neck pain., chest pain, arm and shoulder symptoms)

weak stretched out muscles-- longitudinal muscles of the spine, rhomboids, posterior scapular stabilizers.

exercising the latter is easy--stretching the tight musclse was much harder-- muscles have incredible memory. It took me 4-5 months of working on these muscles 2-3 times per day for 45 minutes each time just to start feeling better. even now after an hor on the computer I need a good 15-20 minutes of pec and neck stretching combined with some back extension exercise--just for a few minutes.

this syndrome can caue arm symptoms. I know the terminology in an MRI report but I am a dentist not an MD---I do not mean to tell you to disregard what your neurologist advised you--- ultimately the decision is yours but i wanted to give you another possibility. to me, it makes sense to fix your posture and retrain these muscle groups before laying on a table for surgery. I used a clavicle retractor and it helped somewhat-- if for nothing else than that it showed me where my shoulders belonged--- way further back from where they were !!!
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Avatar_m_tn
best resources for me

websitte by Jolie bookspan and her book "the AB revolution"
trigger point manual by Clair Davies
posture book by Paul D'Arezzo


PT only teaches you whAt to do at home (LIKE YOU AS A TEACHER !! !!!!

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Avatar_n_tn
Have you ever tried a posture belt/brace that you can wear under your clothes?  I wondered if that would help stretch my shoulders back and be a reminder to do so throughout the day.
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Avatar_n_tn
I ordered the books you recommended.  Thanks.
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Avatar_n_tn
I ordered the books you recommended.  Thanks.
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Avatar_n_tn
I ordered the books you recommended.  Thanks.
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Avatar_f_tn
I hd C5-6 fused on June 4th, with cadaver bone and titanium plate.didn't even beep at airport(LOL) It has relieved most of my numbness and tingeling on the left side. On my right side, however, which is where they cut, just above the collarbone approx an inch, I still have a lot of pain. The big muscle that runs frombehind your ear down to collarbone hurts all the time. Plus constant headaches.The occipital points just below my skull in back hurt all the time, like they are on fire. But I'm getting strength back in my left arm. I tried conservative theerapy for 6 months, whith no improvment. How long since you injured yourself? My neuro told me if it hadn't improved in 6 months, it likely wouldn't without surgery. I hope you can get some help. Please keep us up to date.
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Avatar_n_tn
Hello Glenna and all the rest of you who suffering from spine-related chronic pain.    

I would recommend you take a look at the PostureJac as part of your solution.  The comments made are very interesting.  Mike's comments about muscle memory are so true.   It takes deliberate effort to replace it, but it can be done.    

The PostureJac is not as much a brace as an exerciser.   The trouble with braces is that they substitute for muscle support and without muscle activity........well you know what happens to them.   The PostureJac guides the exercise in a consistent pathway to create new muscle memories.    It stretches out the tight structures described in Dr. Janda's upper crossed syndrome and strengthens the weak ones so that it feels comfortable to be at rest in correct alignment.

I can't say it is the solution to everyone's problem, but you all know that staying in a position of mechanical stress, particularly in the neck area, is going to have long term affect on the whole body.   Poor alignment often results from protecting ourselves from pain and then we get locked in and it becomes the problem rather than the solution.

I am just a guy with a degree in biomedical science who also taught biology for awhile, but I work closely with Dr. Makofsky, Professor of Physical Therapy, textbook author and creator of the PostureJac.   We have gone to a lot of expense on the website to provide extensive video explanation and professional demonstrations of the various exercises that will align and condition the whole spine.   This has benefits to all areas of the body.   I would invite you to visit the website at www.posturejac.com.    Some say we have too much information there.    For those who are looking for more in-depth coverage on the upper crossed syndrome, plus reference to Ida Rolf and F.M Alexander, pioneers in posture theory, watch the talk by Dr. Makofsky.   It takes about 20 minutes but you may find it worthwhile.

Dr. Makofsky's upcoming second edition of his textbook on manual therapy has a whole chapter on posture and the PostureJac.   He has given me permission to offer access to it on request.   You can find our contact information on the website.

Correcting the alignment and mechanics can alleviate much of the chronic pain that we face; cervicogenic headaches, TMD, shoulder pain and muscle weakness, myofascial pain and even fibromyalgia..    For some it will be immediate.   Recently an elderly lady told me that the shooting pain in her leg was immediately relieved when she straightened up.

One further item that is worth discovering on the site is the MyoPresser.   Myofascial pain and trigger points are common problems rooted in poor alignment.   Current thinking is that the tender points in fibromyalgia are a type of trigger point.  The MyoPressers are accessories that attach under the straps and can bring pressure over 3 common trigger point areas in the shoulder, pec minor, upper trapezius, and levator scapula.    This can bring relief, but the real issue is to correct the source of the pain - poor alignment and mechanical stress.

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