Persistent shoulder pain after arthroscopy

Patient

Q: Approx 2 years ago I was carrying a 300lb board with my co-worker when he dropped his end of the beam and I took all the weight! I had immediate intense pain in my right shoulder/arm which radiated down into my hand, as well as severe back pain. I immediately went to the emergency room for treatment, were they did some xrays, made sure I was stable, gave me some pain meds, and got me a referral to see an orthopedic doctor. This ended up being a workers compensation case since I was on the construction site at the time. All of my doctors were really good when it came to documentation, but the WC company would only allow one area to be treated at a time. I have always had excruciating pain in my right scapula, ribs, back, in the T-5 thru T-8 area. The ortho doctor ordered an MRI of my right shoulder and the results required a shoulder arthroscopy. The ortho doctor insisted that my right scapula pain, rib pain, and back pain were all related to my shoulder and he said it would all go away after the surgery. So I had a right shoulder arthroscopy, clean out, and he shaved my clavicle, no labral or rotator cuff repair. Well after my surgery the pain in my right shoulder, back, ribs, right scapula doubled. Workers comp has refused every test, and my WC lawyer has to fight for months to get me testing thru the judge. My cervical MRI was normal, and my EMG was normal. I finally had a thoracic MRI this week, 2 years after my accident the thoracic MRI impression is as follows: left paracentral T6-T7 disc protrussion with mild flattening of the left ventral cord without cord edems. Smaller left paracentral T4-T5 disc protrussion only partially effacing the ventral subarachnoid space. Mild thoracic spondylosis. Minimal disc bulges at T7-T8 and T8-T9. Now my ortho doctor want me to see a back doctor, but in the meantime my shoulder and arm are still killing me! Now the ortho Dr says he can't figure out why my right side is hurting, since the MRI shows things happening on the left. Can you help me figure out what my thoracic MRI results mean please? Is this related to my accident 2 years ago or not. What else would you recommend I do? I am 38 years old, NKDA, no major medical history, exercise induced asthma which I take albuterol inhaler for. I have always been extremely healthy and atheletic. I weighed 190lbs of muscle two years ago. went to the gym daily, have always done construction, played basket ball, foot ball etc. Never had an injury. Now I am 165lbs, and I physically can't do anything. I am in so much pain. The doctor has me on Methadone 5mg three times a day and it doesn't even touch the pain. I do not want to be on this medication at all, I just want to get better. Do you think I have had a back issue from day one, but the ortho doc has just been treating the shoulder issue, which is worse now than it was before. Are the results of my MRI related to this injury do you think? Is there any medical reason why my right scapula hurts so badly? I have also seen my GP, and my GP put me thru a battery of medical tests which are all normal, I used my private health insurance for those tests. But I can't use my private health insurance for the work related injury. Can you please help shed some light on my situation. I need all the help and professional advise I can get. Please. God Bless

Doctor

A:   The findings in the thoracic MRI do not correlate with your symptoms, in other words they are not the cause of your pain, besides you have a cervical MRI normal, along with a normal EMG, both studies rule out the cervical root nerve compression as a cause of your shoulder-arm pain. I strongly recommend that you start a comprehensive physical therapy program that helps you to manage the pain, anxiety and even correct inadequate postural habits.

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