Still having issues 4 months post op ACDF C4-C6
Hello! December 19th I had an ACDF C4-C6. Pre-op most symptoms were in the left arm/shoulder/hand. I am still having issues. I'm in physical therapy and even the stretches the therapist is having me do causes arm pain. It's incredibly weird, as so many movements hurt. I had a MRI with contrast on the left shoulder in January to see if it might show something noteworthy and different than the one I had in August. The radiology report was very similar. Some of the key findings were:
-Tendinosis at the insertion of the left subscapularis and supraspinatus tendons. No discrete cuff tear. Rotator cuff muscle volume is maintained.
-No discrete labral tear. There is some imbibition of the intra-articular contrast into the superior labrum suggesting degeneration. No large paralabral cyst is seen.
-T2 bright signal is present in the subacromial subdeltoid bursa; however, this does not fill with intra-articular contrast. (i.e. subacromial subdeltoid bursitis).
-Left long head of the biceps tendon is intact.
-Mild degenerative changes of the left AC joint. No acute fracture or acromioclavicular separation.
The therapist I am working with has done ASTYM on the shoulder and arm. It hasn't helped. She did note I do still have weakness and that because of that, I could be having the pain that I am (i.e. the movement of the shoulder is being affected because of the weakness). I am back on the hamster wheel of not knowing if my issues are from a shoulder dysfunction or the cervical spine. Because of that, I requested a MRI on the cervical spine via my doc's patient portal. Surgeon said no but agreed to a CT scan, which I had done on Tuesday. I see him on Monday to go over the images. I've already looked at them, as I have a copy of the disk. I am not an expert in reading CTs, not by any means. One image did stand out. I took a photo of it and have attached it here. To me, it looks like one of the screws is pushing into an area that maybe it shouldn't. I think it's the spinal canal. I don't know if this is a big deal or not and if it could be the source of my continued arm/shoulder issues. Of course I will be discussing this with the surgeon on Monday but wondered if anyone had thoughts on this image. I will say that the arm/shoulder issues I have been having over the past month and a half or so are different than the ones I had pre-op. So many things hurt now when I move the arm that didn't before. It's as if it's gotten worse. I also have left side neck pain in the morning that I didn't have much of until now. If the surgeon doesn't think the cervical spine is causing my ongoing issues I guess I will go back to the shoulder doc to get his thoughts. I hope that's not the case though, as I'd imagine he is tired of this much like I am. Prior to surgery I saw him, two physical therapists and the neurosurgeon. All said my issues were from the cervical spine, which is why I proceeded with the ACDF surgery. So very frustrated that I still have issues…and they are worse. Any insight regarding the CT scan image I attached and/or the summary of the shoulder MRI is greatly appreciated!