: : My name is Kathy and I am a 41-year-old woman with pain concentrated in my right shoulder and radiating to my upper arm and armpit area. I also have numbness and tingling traveling down my right arm to my little finger. This pain and numbness intensifies on movement of the shoulder such as lifting my arm across my body. It also is very uncomfortable to sleep at night. I can not lie on my right side as it causes increased pain and numbness to the arm. When lying on my left side, it is difficult to get my right arm comfortable as it will be numb and cause pain. The most comfortable position is lying on my back. However, this will still cause numbness and tingling depending on where I position my arm. I consulted an orthopedic surgeon who ordered an x-ray of the shoulder. The x-ray was normal. After an examination, he diagnosed an inflammation in the joint area and prescribed Motrin 400-mg BID and physical therapy. After evaluation by the physical therapist, he felt that there might be a nerve being pinched somewhere. After 4 physical therapy treatments with ultrasound and cortisone treatments, there is no improvement. In fact the condition is getting more uncomfortable with more intense pain in the shoulder area. Should I continue seeing an orthopedic surgeon for this problem or should I consult a neurologist? What further tests would you recommend? What neurologist could you recommend that I see at the CCF if I were to seek care there? Thank you for your reply.
: Thanks for your question. The symptoms described in your message cannot be
: explained by a simple osteo-articular problem (e.g. inflammatory process
: in your shoulder joint). These symptoms are suggestive of either a cervical
: radiculopathy (likely affecting C8 and/or T1 cervical roots) or a peripheral
: neuropathy (less likely), such as a ulnar nerve lesion.
: An EMG/NCS test would be greatly helpful in clarifying the diagnosis of
: your symptoms. If you are interested in a second opinion, a good option
: would be a neurologist specialized in peripheral nervous system. If you
: are interested in a referral to the Cleveland Clinic, the Department of
: Neurology has a group of neurologists specialized in peripheral nervous
: system (Drs. Levin, Shields, Pioro, and Stevens).
: If you would like to make an appointment at the Dept. of Neurolgy
: please call 1-216-444-5559 or 1-800-CCF-CARE.
: I hope this information is helpful. Best of luck.
: This information is provided for general medical education purposes only.
: Please consult your doctor regarding diagnostic and treatment options.
If my condition is cervical radiculopathy, what is the appropiate treatment? Thanks for your prompt reply.
Thanks for your feedback. If the EMG/NCS shows signs of active neuronal
damage, a surgical correction of the compression is certainly one of the
options to consider. That decision, however, would be best addressed by
your neuro-surgeon once the definitive diagnosis is made. The Department
of Neurological Surgery at the Cleveland Clinic has surgeons specialized
in spine (Drs. Kalfas and Bingaman).
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