@amywood20 I'm sorry you are having issues. I understand your concern with that image. The screws do seem kind of long like they could be breaking through to the spinal canal. What I am not sure about is what kind of artifacts could be caused by the hardware itself on the imaging, so I don't know if the screw is pushing into the spinal canal or right up to it. If you don't get a satisfactory answer from your doctors, you may want to see a neurologist for another opinion who is not associated with the medical centers of your current doctors. If a doctor misses something, others associated with that facility don't want to challenge the current opinion. I had run into that myself before I had surgery when the various surgeons who evaluated me didn't understand my symptoms. I had found the answer myself in medical literature and asked for help in bringing that to the attention of the surgeon, and none of the doctors would help with that even though I had been their patients for several years before I saw the spine surgeon. The only thing they would say is to get another opinion, and I did at Mayo which is where I did get help.
If you see a neurologist who specializes in spine issues or thoracic outlet syndrome, that would be best. You could have thoracic outlet syndrome in addition to the other issues you mentioned and it causes arm and hand pain, and TOS is more common with spine injury patients. You also have surgical scar tissue in an adjacent area if you had a frontal approach in your surgery. I do have TOS in addition to my spine issue which was at C5/C6, and after my ACDF, my TOS got worse and everything tightened up, and doing myofascial release helped me loosen that up. I do have extra tightness on one side of my neck and shoulder that pulls into my rib cage. I keep working on this with myofascial release which I was also doing for several years before my spine surgery. I think it helped surgery go easier because the tissues were looser which made it easier to retract. You might want to look at our MFR discussion for information. Mostly, this is hands on stretching by the therapist while you lie on the table. I have not been seeing my PT because of COVID-19, but I continue on my own as best I can.
You are also at 4 months spine surgery post op and when I was at that stage, that is when my muscles really tightened up. I had no hardware and had to be really careful not to do anything until I fused, but it was at the 4 month mark that I was beginning to fuse and was cleared to begin PT and myofascial release again. MFR might be able to help you even if you don't exactly know the source of the pain. If your PT is not trained in MFR, there is a provider finder on the MFR website. If you do have TOS, it causes compression of nerves in the brachial plexus and blood vessels where they pass between the ribs and collar bone. It is usually missed and misunderstood by doctors, so look for a neurologist at a facility that treats TOS as a condition. I have had some shoulder issues too, a SLAP tear in the capsule in one, and a frozen shoulder in the other caused by the contrast that they injected during an MRI for shoulder instability. Neither of the shoulder issues was the source of my ongoing pain, it was caused by my spine (cervical stenosis) and TOS. My spine has been corrected, and I'm still working on the TOS and making progress. https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/ https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/symptoms-causes/syc-20353988 https://trainingandrehabilitation.com/how-truly-treat-thoracic-outlet-syndrome/