Still having issues 4 months post op ACDF C4-C6

Posted by amywood20 @amywood20, May 1, 2020

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!

@jenniferhunter

@amywood20 That sounds like good news. The shoulder injection should confirm it, if it is the source of inflammation. Inflammation from surgery definitely makes other places with inflammation worse and 4 months post op is when that happened to me too. The "shoulder neck syndrome" he describes sound like thoracic outlet syndrome to me which is what I have and that is what the MFR helps, and you don't have to do painful stretches for that, it's all manual therapy. If you don't improve, you may want an evaluation for thoracic outlet syndrome. It is common among spine injury patients and can be caused by a whiplash. I hope you'll check in and let me know how you are doing after treatment. Take care.

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@jenniferhunter I will definitely update things as I go. I will add that today I mailed both the shoulder MRI I had done in January and the cervical spine CT scan from April to Mayo Clinic. They did an interpretation of another one a while back and picked up on a few things missed here. It's just for peace of mind…and I love Mayo. 🙂

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@amywood20

@jenniferhunter I will definitely update things as I go. I will add that today I mailed both the shoulder MRI I had done in January and the cervical spine CT scan from April to Mayo Clinic. They did an interpretation of another one a while back and picked up on a few things missed here. It's just for peace of mind…and I love Mayo. 🙂

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@amywood20 I'm glad to hear that. If you need names of any of the the doctors who evaluated me, just ask. It was coordinated by the neurosurgeon and neurologist. I love Mayo too, and I miss being there. It's also good to know that I can go back to my neurosurgeon there if I need him. He told me he will always be my doctor until he retires (and that should be a long time) and he still authorizes my PT for thoracic outlet syndrome. He did suggest an evaluation at 5 years post op.

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@jenniferhunter

@amywood20 I'm glad to hear that. If you need names of any of the the doctors who evaluated me, just ask. It was coordinated by the neurosurgeon and neurologist. I love Mayo too, and I miss being there. It's also good to know that I can go back to my neurosurgeon there if I need him. He told me he will always be my doctor until he retires (and that should be a long time) and he still authorizes my PT for thoracic outlet syndrome. He did suggest an evaluation at 5 years post op.

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@jenniferhunter I noticed in the Mayo Clinic patient portal that my left shoulder MRI w/contrast and cervical spine CT scan has been read/interpreted by their radiologists. Below is what the reports noted. Doesn't really give me any answers as to what is still going on with the left shoulder. The C5-C6 stuff noted is right-sided and if I recall correctly, is pretty much what was noted in a pre-op report. I am still waiting to get scheduled for that guided bursa injection. I am sure COVID-19 has caused a backlog at the pain management clinic that will be doing it. Not sure what to think anymore.
Mayo Clinic impression of CT scan of cervical spine
-Interval postop changes related to anterior plate-screw and interbody fusion C4-6.
-Straightening of lordotic curvature.
-C5-6 right-sided uncovertebral hypertrophy contributes to moderate right foraminal narrowing.
-Otherwise unremarkable.

Mayo Clinic impression of CT scan of cervical spine
-Previously described articular sided fraying of the distal supraspinatus and infraspinatus tendons is less conspicuous on today's examination.
-No discrete rotator cuff tendon tear.
-Muscles of the rotator cuff remain normal in signal and bulk.
-Trace degenerative arthritis of the acromioclavicular joint.
-There is slight lateral downsloping of the acromion.
-Trace subacromial/subdeltoid bursopathy, which is similar to prior exam.
-There is new glenohumeral joint synovitis, which is primarily within the subscapularis
and axillary recesses.
-Latrogenic contrast within the subcoracoid bursa the extending medially within and along the subscapularis muscle.
-Minimal degenerative type undersurface fraying of the superior and posterior superior
glenoid labrum without discrete linear tear or paralabral cyst.
-Long head biceps tendon is intact.
-No abnormal stress reaction or fracture about the shoulder.
-No abnormal soft tissue masses.

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