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Shoulder, neck and back pain with a negative MRI
Dear Ask The Doctor:
I am a 35 year old male who is in pretty good shape. I am 5' 9" and I weigh 150lbs and I have always been a pretty active person. About 2 years ago I hurt my shoulder at work lifting a server up to about head height which weight about 60lbs. I saw a ortho and they said it was probably a muscle strain and they sent me to physical therapy for 6 weeks which seemed to help a little. Over the next few months it seemed to feel better although at times it was tender. About 6 months after the injury I started to get a nurning sensation in my left shoulder in the same area of the original injury. It is about 3 inches below the bottom of my neck and about 3 inches over from my spine. I would ice it and take iadvil and it seemed to help, but never really made it go away. It would last a couple hours sometiimes and then a full day sometimes. It seemed like gong to sleep would help. I would wake up and I would be sore where it had been burning, but the burning sensation would be gone. Over the past year this has continued and become more frequent and lasts longer. About 1 month ago my shoulder was burning and bothering me quite a bit and the tension was in my neck and upper back and then the burning was also in this area. I went to the emergency room and there was an xray done and the doctor thought I had a pinched nerve and recommended I see a ortho. I have seen the ortho and he sent me to have a MRI done on my shoulder and neck. There was even a marker put on my shoulder to help identify the area. I went back to my ortho and he has told me that he sees nothing in the MRI that he can say is the problem and fix it. He did a trigger point injection which helps a little, but it has not made the burning go away. My neck and back have felt better even before the injection, but my shoulder is no better. It burns like it is on fire for days at a time. No one activity seems to make it start. It has been very random but more frequent and lasts longer and longer as more time goes by. You can visibly see the swelling in my shoulder at the area. When you push in on that area you can feel little nodules in there. I really do not know what to do. This is affecting me at work and at home. I can't do the things I want to do with my kids. I am even depressed and I feel hopeless because I know what I am feeling and no one can seem to tell me what is wrong. If you have any suggestions I would greatly appreciate it. I don't know what to do, but I know that I can't accept that I have to live with this for the rest of my life.
Answer:According to your description it would be important to rule out a cervical nerve compression. In the younger patients, cervical radiculopathy may be a result of a disc herniation or an acute injury causing impingement of an exiting nerve. In the older patient, cervical radiculopathy is often a result of spinal canal narrowing from bone (osteophyte) formation, decreased disc height and degenerative changes due to aging process. The treatment strategy usually includes: start a physical therapy program aimed to control pain and inflammation, and the use of anti-inflammatory medication (“motrin”, “aleve”), also you should have a re-education of habits and posture to improve your quality of life. You also should be independent in a stretching and strengthening program and continue with these exercises under the periodic supervision of a physical therapist initially and then completely on your own. If your condition fails to improve with a comprehensive rehabilitation program and selective injections, you may be considering a re-evaluation by an Orthopedic surgeon to explore other treatment options more aggressive.
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