Anyone have cervical stenosis and scapular instability?

@nhbfan
I had ACDF surgery on C5-C6 due to cervical stenosis/radiculopathy/myelopathy. Before surgery, I had daily headaches, neck, shoulder, shoulder blade pain/muscle knots, weakness in arms/hands/legs and bladder control issues. I would drop things, have difficulty writing, and difficulty walking. This was all tied to my cervical spine because myelopathy is a spinal cord compression injury which affected everything at/above/below the C5-C6 level. Most of my symptoms resolved after surgery (still have some residual weakness/numbness in arms/hands/legs). My neck/shoulder pain and knots went away and no longer have daily headaches. When you search online, there are links of cervical spine and shoulder/shoulder blade. Look at the nerve maps tied to cervical spine and symptoms.

I would go to an orthopedic doctor who specializes in the spine and get MRI of your cervical spine to see if it is behind your symptoms. You may also want to see a neurologist to have EMGs/nerve conduction studies of your upper limbs to check muscle nerve health and if you have any radiculopathy.

Good luck and don’t give up advocating for yourself. Doctors/surgeons are not perfect so do your research to help you understand your MRI reports and ask good questions. If doctors dismiss you in any way or don’t give you the time to answer your questions, move on. You need to have a positive relationship with your doctors/surgeons so find those who you have a good connection with. I had to go through multiple doctors/surgeons before finding my current surgeon. He had great reviews online and has an amazing personality and friendly/personable/respectful and very good at spine surgery. He did both of my surgeries.

That sounds really frustrating. It’s tough when different specialists have conflicting opinions. It might be helpful to seek out a physical therapist or a specialist in biomechanics who can look at the entire kinetic chain—from your neck to your shoulders and scapula stability. Sometimes, a holistic approach can reveal issues that might be missed when focusing on just one area. Have you tried any specific treatments or exercises that have made a difference?

@nhbfan Welcome to Connect. The scapula has an interesting function in that it rotate to allow your arm to raise, and it has muscles tied to your spine and cervical levels in your neck. If you have had a whiplash injury, that can affect both neck and shoulders. The scapula is often pulled forward because so much of what we do is with our arms in front of us, and it may not stay where it belongs on your back if the muscles are weak.

What you may want to investigate along with evaluating possible spine problems is a condition called thoracic outlet syndrome. that can pinch the blood vessels and nerves that supply your arms and cause pain, tingling, weakness or perhaps hands that turn bluish because circulation is affected. TOS is most often missed, so you need a specialist at a medical center that says they treat TOS on their website. Doctors usually think this is rare, but it can be caused by injury or repetitive stress. This can make getting a correct diagnosis more challenging for a spine condition if you have both.

I have had both a spine condition with a ruptured C5/C6 and TOS. I was working on the TOS with my physical therapist at the time the spine condition became evident. I had a whiplash about 20 years earlier, and had a bulging disc for years which ruptured and grew bone spurs that compressed my spinal cord. I had a spinal fusion of C5/C6 which improved things, but I still have TOS and keep stretching to improve my function.

Here is some information about TOS.
https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/symptoms-causes/syc-20353988
https://mskneurology.com/how-truly-treat-thoracic-outlet-syndrome/
What symptoms are you having that concern you?

Thanks for the replies.

I've tried many therapies, CT's MRI's and EMGs and literally at least a dozen neurosurgeons and the best orthopedic shoulder doctors.

One orthopedic surgeon (who is world renowned) told me to quit seeking so many opinions. I tried to explain I just wanted a reasonable consensus.

After 9 weeks of PT for scapula dyskinesia he discontinued the therapy and told me my problem was in my neck and referred me to yet another spine surgeon

Approx half of the neurosurgeons did recommend surgery (differing opinions from arthroplasty to ACDF @ C4/5) citing the level of stenosis would justify the surgery. NONE thought it would improve my scapular instability issues.

I was test for TOS and it was determined I had venous TOS, but again not tied to the shoulder instability.

@nhbob2023 I'm not so sure that your spine specialists understand TOS, and you have that diagnosis which in itself is hard to get figured out. It is a complex problem when you have TOS and a cervical disc issue. Do you also have spinal cord compression or compression at the nerve roots?

The best specialists for TOS are usually thoracic vascular surgeons. Often TOS is best treated with physical therapy, not specifically PT to strengthen muscles, but myofascial stretching. Generally speaking with TOS, there is compression on the front of the body, perhaps in scalene muscles at the side of the neck, perhaps an extra rib, perhaps under the collar bone or under pec minor. Myofascial release can stretch out and loosen tight tissues on the front of the chest. Since the muscles on your back such as shoulder blade connections need to oppose the tightness on the front of the chest, it does pull scapulae away from where they are supposed to stay, and you may have a forward shoulder position. There may also be possible weakness from nerve compressions due to spine issues.

If you were to have surgery, it will cause scar tissue and that gets tight. My ACDF at C5/C6 did cause tightening that made my TOS worse, and I needed to stretch out that scar tissue, and I continue to do this to maintain my condition and keep TOS from getting worse. This was why coming to Mayo for evaluation of both problems helped me get where I needed to be as they have specialists who understand TOS. I absolutely did need spine surgery, and I had been doing MFR with my PT for several years before that, and as soon as possible in my recovery after spine surgery. MFR helped get me better function. If I overdo with heavy lifting, I kick up TOS and neck muscle spasms, and doing my stretching helps me maintain good ergonomic spine posture to help prevent wear and tear.

Here is our discussion on MFR. I think this may be able to help you, but you need a specialist who is onboard with this type of treatment, and it doesn't sound like your ortho will support this. You can ask for your primary care doctor to write a script for PT with myofascial release because of your diagnosis, and having pain is enough to justify therapy.

Neuropathy - "Myofascial Release Therapy (MFR) for treating compression and pain"
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/
Provider search
http://mfrtherapists.com/
I continue to self treat what I can with MFR using several tools and things I've learned from my therapist. In my case, having looser muscles in my neck made it easier for my spine surgeon during surgery, and when it was the right time after surgical healing, MFR helped me prevent tightness and muscle spasms.

Have you heard of myofascial release before?

I have tried myofascial release with a chiropractor in the past.

The instability I experience from the time I wake up often ends in tightness and spasms by late afternoon early evening and myofascial release probably would provide moderate relief as did dry needling performed by DPT.

In my layman's opinion I believe my C4/5 stenosis impinged one of the many nerve roots that eventually innervate the scapula from foraminal stenosis. It's my understanding EMGs can't detect nerve impingement at that level. Otherwise, I don't have classic symptoms of cervical stenosis, e.g. radiculopathy. I literally feel like a rubberband man with complete instability of my scapular even sitting in a chair.

My TOS is vTOS (venous) which occludes the subclavian vein when my arms are raised. I do not have neurogenic TOS.

@nhbfan EMG's detect when a muscle does not receive nerve impulses or receives an abnormal pattern of nerve impulses. If stenosis is at the nerve roots, a dermatome map shows where those nerves go in the body. Here is an explanation.
https://my.clevelandclinic.org/health/articles/22278-cervical-spine
If stenosis is in the central spinal canal, it is hard to tell which nerves are affected below that level, but that can be general things. I do know that cervical spine issues cause muscle spasms in the neck in muscles which also connects to the scapula, so I think you can feel pain there. I did with my C5/C6 central canal stenosis. I didn't have any nerve root stenosis.

Thanks, Jennifer

The osteophyte that's causing my C4/5 spinal canal stenosis is also likely causing my foraminal stenosis according to MRI interpretations.

I may have misspoke using root stenosis referring to foraminal stenosis.

@nhbfan The nerve roots pass through the foramen which are the spaces around them between the vertebrae. That must be a big osteophyte (or a few of them) if it is affecting the canal and the foramen. I think we are just saying the same things.