Terrible pain

not quite sure if this is more appropriate for ortho or neurosurgeon - I am a health care provider & still not sure!! approx 4 months or so ago I noticed some vague weak/tight feelings back of my neck, left shoulder after carrying a moderaely heavy purse on my RIGHT shoulder - never carry on left - would quit carrying/place in buggy, etc - then replaced that handbag altogether - the discomfort went away after using the purse. However I am a very busy NP - we have all computer charting - I am constantly up/down, im tall 5'10 - healthy, lots of extra hours on computer over last few months, end of day, neck, posterior left shoulder felt "tired,sore" would go away after getting home, relaxing/heating pad; this has progressively worsened until about 2 weeks ago the pain was severe in my posterior left scapula area, felt burning, about mid day at work the pain intensifies to my posterior cspine, more on left side of neck, left jaw, down whole arm, anterior chest wall pain, hand began to feel cold/numb; then at times when severe my whole left arn feels flaccid/weak, like I can't hold it up; usually after 30min at home on heat - NSAID, sometimes muscle relaxer, pain subsides within 30min. I had nuclear cardiac stress test done to r/o cardiac - normal except prior to excercise/isoptope I had to lay on my back with left arm over my head for about 20 minutes - this started the pain cascade, after test was complete - 20 more minutes of left arm over my head for more scanning my whole left arm was cold/throbbing feeling over my head; after the 20min had elapsed I could not lift my arm to bring it down - the tech had to do it for me; I had no strength/movement. I have also had normal brain MRI, I did have cspine MRI with minimal findings in cspine that personally I didn't think would cause this much pain - some deg disc changes, did have some mild to moderate disc herniation in 2 or 3 places - can't remember which.......would my next move be neurosurgery - blocks, etc. or ortho????? I am thinking nerve inpingement - but more in shoulder area???? Also the day my arm was over my head I felt the burning all down my arm and also my left lateral torso only I feel that pain is too low for cervical dermatone pain. Please help - I can only work 2-3 hrs before this begins; I am pain free in the am when I wake up, occas just some mild burning/dull ache left posterior shoulder....in addition have had terrible overall work and home stress this year - never any neck or shoulder injuries in the past was very athletic growing up

[S. Kaul, MD]

Hi there!

This does sound like a cervical stenosis or nerve impingement at the level of cervical spine or lower. It is also possible that the neck pain and the arm/ shoulder pain are separate issues. Possibilities include neck muscle spasm, cervical spondylitis, spondylosis, cervical disc herniation, spondylolisthesis etc. and nerve involvement at a lower level. This is an area that is handled both by orthopedics and neurosurgery and you could consult either for an evaluation. After a cause is diagnosed, it can be decided as to what would be the best mode of management in your case.
Hope this helps.

Take care!