Discussions By Condition: I cannot get a diagnosis.

Work Injury: Neck, Left Shoulder & Arm Burning

Posted In: I cannot get a diagnosis. 20 Replies
  • Posted By: rattyrandi
  • June 26, 2008
  • 04:31 AM

Hi, and thanks in advance for any - and I do mean ANY - thoughts you might have. 9 months ago, I was injured at work while lifting an object with another worker. As soon as we set it down I felt a burning in the left side of my neck, my left shoulder joint and around under my shoulder blade. I was sent to an orthopedic surgeon who said I had pulled my trap muscle and took me off work for 2wks. I only got worse; my neck muscles (left side) would spasm and cramp, sometimes I couldn't swallow, my neck and shoulder would burn (no sharp pain except when I turned my head or lifted my arm too high), I got an aching burning down my left arm, an electrical shock type pain from my left pinkie up to my armpit, and sometimes from my shoulder down to my index and middle fingers, my fingers tingle like they are asleep sometimes. I had an xray of the shoulder - nothing. I had PT 3xs a week for tendonitis in the shoulder, also not helping except for massage and ultrasound at the end of the session. None of the pain meds ever helped the burning pain. I had an arthragram and mri of the shoulder, and an mri of the cspine and tspine. I was told I had a bulging disk in my neck and sent to another doctor. He confirmed a bulging C6/C7 and recommended CESIs - I had 2 and neither one helped very much. I was put on cymbalta, also no help. I had pt for my neck, which was excrutiating. Then I was sent to a neurosurgeon who said I needed a new MRI of my neck. He confirmed the C7 herniation and said I'd need a fusion or a disk replacement. The last doctor had said I wasn't a surgical candidate because I am only 27, but this doctor said it was quite obviously impinging the nerve exiting the foramen and since 6 months + of conservative treatment didn't help, this was the answer. He put me on lyrica for the burning and sent me for an emg. After 2 wks, the lyrica was not helping (i was upped to 3xs the dose) and the emg test was normal on my left arm. I went back to the doctor to get some surgery questions answered and he did a total 180 - he said no surgery because the emg was normal and the nerve at the C7 level would not be causing all my symptoms. He said there must be something wrong also in my rotator cuff and sent me to a shoulder surgeon. The shoulder dr didn't look at my earlier mri/arthragram, but did an exam and stated conclusively he did not believe I had a rotator cuff injury. He did say I had impingement, but it was very minor and would not cause my symptoms. He said it was my neck. I also had an episode a week ago where I was brushing my hair with my left hand and felt an acute pinch between my neck and left shoulder, followed by sharp pain if I tried to turn my head left or lift my left arm higher than my waste. Because my doctor is out of town, I went to the er and they diagnosed cervical radiculopathy, gave me stronger drugs and some oral steroids. As I took the steroid dose pack, each day I felt better and now I am back where I was with the burning again. I can turn my head and use my arm again. I have been advised I will just have to live with this, but I can't. I can't live in this kind of pain for one more day, let alone the rest of my life. I was told most disk herniations get better on their own, but since mine hasn't by now, it probably won't. They said there's no more tests they can do and they don't know what is causing my burning. They said it absolutely can not be nerve compression because the emg came back normal. I am barely getting through each day and the only reason I haven't done something foolish is because of my little boy. I lost my job because I can't do the work and ran out of leave. The WCI wants me to see an IME. I am desperate and worried. I can't gone on this way. Any thoughts at all are welcome. Thank you for your time, Randi:(

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20 Replies:

  • From your description of the problem, I beleive that you do have a cervical radiculopathy. It seems you have undergone the usual mostly ineffective route of standard medical care. It is a shame how the work comp system is set up these days. I see this over and over. First of all, a negative EMG does not rule out cervical nerve compression. It probably is a bulging disc which is different from a herniated disc. These conditions can respond quite favorably to quality specifc chiropractic adjustments. I would advise you to demand a exam by a good chiro orthopedist or chiropractic neurologist. You should not have to live on drugs ( which only mask the symptoms anyway.). PT will not help because it does not address the underlying structural abnormality / subluxation. I wish you well.
    Anonymous 42789 Replies Flag this Response
  • See a worker's comp lawyer before a year is up. A friend of mine had a machine from another country that had electric pulse programming for all types of conditions. He put the pads where I have problems and then programmed it to deliver the correct pulsing current. I can only guess that something like the electric machine would possible help you, otherwise you are looking at rounds of surgery.
    Monsterlove 2921 Replies Flag this Response
  • Hi and thanks for both the replies - good information! I have located the closet chiro neurologist in Idaho Falls - I live in MT. That is not too far, hopefully the WCI won't give me any grief. I do have a TENS unit, sounds like what you described; a little machine with 4 electrodes you can put on your sore spots and it sends pulses to the muscles. It helps the muscle aches, but nothing touches the burning. I have been trying to get a lawyer, but I have talked to 6 and they all say they have switched from work comp to personal injury because montana's laws changed in 2002 and aside from going after a WCI because they are denying a claim or not paying, you are SOL. I am going tomorrow to get a copy of all my records pertaining to this injury and also my xrays/mri disk. That way, I'll always have them just in case. Well, thanks again for your help and your time! Randi
    rattyrandi 8 Replies Flag this Response
  • Just an update on my situation: I did have to go to an IME and was examined by 2 supposedly "independant" doctors. Their report states that I may have suffered a shoulder strain, but if I injured my neck it happened later and was not related to my work injury (WTF?!?) Also, they said I was obviously depressed (DUH) and I should have a psychiatric evaluation, be treated for the depression, have some PT for my shoulder, and be sent on my merry way. I have been using a TENS unit everyday for like 10 hours a day, gone to the ER twice for the pain, and some days I think about ending it all because it hurts so much (don't worry, I have a little boy to take care of & he keeps me going). I don't know how I'll ever be able to cope with this in the long term, or return to work and function normally. I feel like they're setting me up to fail. I talked to a lawyer and he said he could only help me during the settlement phase of my claim because the WC isn't doing anything illegal. One of the ER docs finally prescribed me Neurontin and THANK GOD it has helped some with the burning. I got a letter today from the WC and because of the IME report they will not authorize any treatment for my neck pain or headaches caused by neck pain. I have an appointment on 11/4 with an orthopaedist to talk about pain management/treatment options for the chronic pain syndrome. Then I guess they'll send me back to work. This'll be the first doctor I've seen for treatment in about 6 months. Any thoughts or suggestions on where to go from here and how to handle myself are appreciated. Anyone who doesn't want to post here can email me: d_rwedlake@q.com. Thank you a million times!:confused:
    rattyrandi 8 Replies
    • November 2, 2008
    • 03:56 AM
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  • It is clear you are in a great deal of pain, which must be very hard to live with. You have mentioned many orthopedic, pharmaceutical and conventional attempts to deal with the situation, but have not mentioned any soft tissue manipulation such as massage, shiatsu, thai massage or the like. I am a PhD candidate in Kinesiology Graduate Diploma Program in Neuroscience and a Thai Massage teacher and practitioner. Obviously, massage is not right for every situation, but I would strongly recommend investigating a qualified and well recommended practitioner in your area. Often the massage therapists who are associated with sports medicine clinics are highly qualified and work in close conjunction with orthopedic and medical doctors associated with the clinic. The bottom line is that sometimes soft tissue work needs to be done to a) relieve pain and overcome spasm and inflammation cycles (and sometimes may need to be done with non-steroidal antiinflammatory medication) and b) to slack off the tension on the muscles enough to stop compression on nerves exiting the spinal column and/or any disks that may be under compression. My personal experience with neck injury and chiropractic treatment would say "avoid chiropractic" but that may just be me: I came out worse than I went in, and that is on more than one occassion with different practitioners and different injuries. I have strong kinesiological reasons for saying that as well, but I suppose it would be easy enough to say I am biased. The clinical evidence regarding the long-term use of TENS is sketchy, and no one really agrees what exactly it does in the nervous system. Certainly, if it is keeping you going from day to day, then continue, but also be aware that there may be long-term repercussions (or not). Whatever direction you go whether orthopedic, pharmaceutical, chiropractic or massage, it will be important for you to find someone you can trust, and whom you perceive as an ally. The practitioner should be willing to work slowly with you, and hear your concerns. Try to find out who comes highly recommended in your community. Also there may be a university near you doing research on back pain. For example, the University of Waterloo in Ontario, Canada, has an excellent back pain research program, and they have helped many people who are at the ends of their ropes. Last, I would encourage you to find a support group for people in chronic pain. It can be frustrating to feel that you are all alone, and knowing that other people truly understand what you are going through, and can laugh and cry with you can make a big difference.I hope you can find the help you need.
    glortman 1 Replies
    • November 28, 2008
    • 01:17 PM
    • 0
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  • Thank you very much for your suggestions. I can say that early in my PT, the therapists believed in massage and most of my sessions consisted of that, rather than modalities and such. It helped a great deal. I have recently been declared at MMI and given an 11% impairment rating (4% for my neck and 7% for my shoulder, which apparently has chronic tendonitis). I feel I am on my own to seek massage therapy, as the insurance always fights what I want to do. For some reason, the doctor I saw is opposed to any kind of pain management and thinks I should just take Ibuprofen, which clearly doesn't help. I definitely will seek a certified massage therapist as part of my own pain management. Thanks again for your advice.
    rattyrandi 8 Replies
    • November 29, 2008
    • 01:41 AM
    • 0
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  • What a run around!!! No, my friend had a different machine than yours, but I forget what it was called...it was programmed to have different frequencies, etc. Did anyone ever think to interview and get a statement from the person who was working with you? I would think that would be important. I would keep looking for a lawyer until I found one who could really help. Make sure you have all of the paperwork filed. Checked this out:http://erd.dli.mt.gov/wcclaims/wccdocs/Benefit%20Pamphlet%202007%20-%202008.PDFWhat if I can’t work at all for a while?If you suffer a total loss of wages due to your injury or occupational disease, you may beeligible for temporary total disability (TTD) benefits until y our physician determines youhave reached maximum medical improvement or you are released to return to the employmentin which you were injured or a job with similar physical requirements. You may receiveweekly compensation of 66 2/3% of your gross wages at the time of injury – up to themaximum rate of $604 a week. These benefits are payable after 4 days or 32 hours of wageloss, whichever is less. If you also receive social security disability benefits as a result ofyour worker’s compensation claim, your weekly compensation benefits may be reduced by upto 1/2 of your social security payment. Request mediation: If you disagree with a decision made by your insurer, regarding benefits, you may request mediation through the Montana Department of Labor and Industry – Employment RelationsDivision, at (406) 444-6543.If you have questions regarding your claim, you Try Legal Aid: http://www.usattorneylegalservices.com/free-legal-aid-Montana.html
    Monsterlove 2921 Replies
    • November 29, 2008
    • 05:35 AM
    • 0
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  • Monster Love, thanks for your info. I will definately call Montana Legal Aid Monday morning! Unfortunately for me, or maybe fortunately, I was on TTD benefits until November 20 when I received my the impairment rating and reached MMI, so now my benefits are being converted to PPD, which is like a settlement I guess. I lose about $800 a month now that it's been confirmed I'll never be better than this. I can collect a lump sum (and lose 5% of the money) or take it bi-weekly for 42 weeks. The thing that sucks is I'm not better, I'll never be as good as I was, but I'm supposed to go back to work. I can't lift more than 15 pounds ever again, I have to do a sedentary job, I can't use my left arm for any repetative work or any work above my shoulders. The doctor said no to all the job analyses the wc's vocational rehabilitation consultant sent to him - I can't even be a video store clerk or a hotel desk clerk! I ask you, what CAN I do??? It's so frustrating!!! I'm impaired, but not disabled. Yay, me. Thanks again for your advice and for listening - er, reading.
    rattyrandi 8 Replies
    • November 30, 2008
    • 02:06 AM
    • 0
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  • I thought I was finally almost done with W/C's B/S, but I got another surprise today. I was informed I now need to have a 3 hour, functional capability evaluation done to determine exactly what I am physically capable of because the W/C wants me to go back to my time-of-injury job. Never mind the doctor said I am not able to return to that job, no matter what modifications are made. I am confused. My t-o-i employer doesn't want the eval, W/C does. I can hardly find any info on these FCEs online. What I did read is that I should be "medically stable" which I'm not, I'm just at MMI. My concern is they are going to try and challenge the impairment rating my doctor gave me by saying I am capable of doing more than he says. According to him, I can't even be a video store clerk. If I can't even be a freakin' cashier, then what CAN I do?!? Shouldn't that qualify me for permanent disability then? He says no, because I am only impaired and not disabled, but I am as good as I'll ever get. I'll always be just 89% of my old self. Until W/C gets a yes or no answer from my t-o-i employer they are going to hold up my wage loss settlement. I have no insurance and no money. Merry Christmas to me.
    rattyrandi 8 Replies
    • December 13, 2008
    • 03:37 AM
    • 0
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  • By what you descirbe it sonds a lot like RSD, Reflex Sympathetic Dystrophy. The burning your talking about is the number one symptom. I myself have full body RSD from a foot surgery. It is caused by nerve damage and is extreamly painful. The other reason I am thinking this is that neurontin is helping, lots of people with RSD take that med as its the one that helps. If it is RSD you really need to find a doctor who knows about this. I went 4 years before my diagnosis and went through 57 doctors. The sooner you get treating the better chance to have that it wont spread and hopfully will go into remission. Try looking up RSDSA.org for info on RSD. Hopefully you will find the answer your looking for.
    Anonymous 42789 Replies
    • December 22, 2008
    • 09:12 PM
    • 0
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  • First,I am so sorry for your pain and your plight.You've been treated to the screwing that injured working people often get,both by doctors and the workers comp. system.I.too,know what it's like to be in chronic pain,but mine was helped by surgery.When I started reading your story,I knew that you had a disc problem at C6-C7,based upon your neck pain and the distribution of your radicular symptoms-to the index and middle fingers.I don't care what the emg shows;if you've still got the same symptoms,then you have a''pinched nerve in your neck.Has anyone done a good neuorological exam on you?You should have both weakness of and a decreased reflex of your triceps muscle.That is clinical proof of a nerve that's damaged.Now,as for your chronic pain there is ample proof that opiates are the drug of choice for it.The risk of true addiction is <1% when patients are chosen well and followed well.I wish I could help you.Oh,I almost forgot to tell you that some antidepressants(mainly the tricylics)help those in chronic pain.Plus,if you can get a doctor to prescribe a narcotic,take it with an antiinflammatory med,such as ibuprofen,naproxen, or even aspirin because it enhances the effect of the narcotic.:)
    richard wayne2b 1232 Replies
    • December 22, 2008
    • 11:35 PM
    • 0
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  • Thank you both for your replies and information. Niki, I did come across RSD at one time and I thought This could be it! Of course, when I mentioned it, they all thought I was nuckin' futs. I believe I read RSD is often brought on by trauma, so that certainly fits. I have had a number of neurological exams, but as to whether or not they were good ones, I don't really know. Richard, thank you so much just for your support. I'm sure you know what it's like to have everyone - loved ones included - look at you like you are some kind of hypochodriac drama queen. They can't understand why you can't just buck up and get on with your life. My husband seems to think it's simply mind over matter, and that I'm just not willing to move on. Believe me, I am SO ready to get over it, I just can't. I finally got so frustrated - and PO'd - I wrote a four page long letter to my most recent treating physician outlining all the things I didn't get to say at my last (and only) appointment with him because the exam ran over the allotted time. At that time, I wasn't depressed, but after hearing there's no avenue left for me to try, no hope for getting better, and that I have to "live with it," I've gotten very depressed. And mad. Doesn't "do no harm" mean anything to these people?!? Well, Niki I hope I don't have to go through 57 doctors before someone decides to take on my case. This last guy seemed very indifferent and acted like his word was final. I don't know how to get the insurance to let me see someone else. I keep getting these letters from them saying they are notifying all my doctors about each other because they think I am just going around getting drugs. Yeah, like I'm getting really high from the Neurontin :p Anyway, thanks again for everything, both of you. As always I will continue to post my continuing saga here for those interested. Maybe what I'm going through now will help someone else down the road.
    rattyrandi 8 Replies
    • December 23, 2008
    • 04:28 AM
    • 0
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  • You're most welcome.I forgot to mention that Neurontin is a good drug for nerve pain,so ask them why it was prescribed for you if they didn't think it was nerve pain.Try to continue the Neurontin even if you're able to get opiates.:)
    richard wayne2b 1232 Replies
    • December 23, 2008
    • 00:05 PM
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  • I don't think you replied to my question about testing your triceps muscle,both for strength and reflex.That's the muscle in the upper back of your arm.:)
    richard wayne2b 1232 Replies
    • December 23, 2008
    • 00:15 PM
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  • They have had me push down on their hands, or try not to let them pull my arm up and such. And they measured my grip. I guess everything was okay because they never said otherwise. The left side feels weak to me because I can not even lift a gallon of milk with my left arm. It is just difficult, not to mention painful. I also have a hard time with my left hand, I can not twist off lids of jars, and sometimes it's as though my index and middle fingers, and thumb just don't want to work. Like I can't really move them, but it's not like that all the time. I know I have about 10 to 15% loss of range of motion for my left arm. I have continued with the exercises the physical therapists gave me even after the doctor discontinued the PT because I did not want to lose any more.
    rattyrandi 8 Replies
    • December 23, 2008
    • 10:04 PM
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  • If you did read on RSD and you really think your symptoms are fiting then you should really look into it some more. I do know what you mean about doctors thinking your nuts for bringing up RSD, I went through 3 hospitals in my home town them saying they dont want to deal with RSD and if you do have we dont want to hear about it. Do you mind me asking where in the country your located, as I have seen many doctors and have done my homework of specialists around the country so maybe I could help with finding one close to you, the specialist I am seeing is the top in the country and knows many doctors so I can ask him too. The hardest part with RSD is getting people to believe what your going through is real and not just made up. There are more people with RSD than with HIV/AIDs, and breast cancer combined yet it is still not that windely known about. Have you seen a pain specialists, I know it sounds wierd but they are the best when it comes to knowing if its RSD or not also best at treating it, only a few nuerologists believe in this disease. My doctor said the reason many doctors dont want to deal with RSD is it isnt a quick fix at all and its pain and symptoms they cant see so dont want to believe. I sure hope you find the answer you are needing. Niki.
    nikiski1 35 Replies
    • December 23, 2008
    • 10:11 PM
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  • If you've got what I think you have,you have to be weak in your left triceps muscle.For example,can you do pushups with equal strength in each arm?
    richard wayne2b 1232 Replies
    • December 23, 2008
    • 11:32 PM
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  • Honestly, I don't think I could do a pushup. I've been too afraid my left arm would just give out on me, and that it would really hurt afterward. I have never been asked to do this. Maybe they will ask me to do it at my functional capacity exam. What a mess this is. It has blown my mind how much every aspect of my life as I knew it has been turned upside down. I wouldn't wish this on my worst enemy. Thanks again for your interest and your advice. Without the support of people like you, life would seem much more hopeless.
    rattyrandi 8 Replies
    • December 24, 2008
    • 06:59 AM
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  • If you're that afraid of doing a pushup,then your arm muscle(triceps)must be weak!:)
    richard wayne2b 1232 Replies
    • December 24, 2008
    • 00:53 PM
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  • Randi, I am sorry to hear about your unfortunate problem. However, there is an answer out there for you. Did you ever see a chiropractor as recommended? If not, why? This is their specialty!!! I am in chiropractic school and we specialize in Central Nervous System problems, not just spinal injury. Here is some info that I think may be helpful to you. The burning pain you feel definitely relates to a nerve problem which could be radicular (from the nerve root impingement) at C6-C7 or it could be a neuropathy (problem from a nerve impingement of some part of the brachial plexus). The brachial plexus is a group of nerves that run from the spine (specifically C5-T1) into the shoulder, then branch down the arm all the way to the hand. You stated you felt tingling in your hand which would indicate an impingement on a nerve. The nerves supply your arm with the ability to feel, move, and react to stimuli. As another member mentioned the triceps, this could indicate nerve root impingement from the shoulder/neck. The special imaging is great if you have trauma, vascular problems, etc. However, your case actually sounds like it would be simple to take care of. You don't necessarily need medication to be cured. Medication only stops the pain for a little while by shutting down the pain sensory system (this is over-simplified, but you get the idea). As you well know, medication is only a quick fix. You need to correct the postural/structural problem in your neck, arm or shoulder; this is where the chiropractor can help. A chiropractor will be able to perform orthapedic tests to determine where the problem lies exactly. If you want to get rid of the pain, ask around to friends and family for a referral to a good chiropractor near you. I am a believer in chiropractic as you can tell... it works! Please keep us informed on how your condition turns out. Keep your head up! You'll beat this!
    January1 2 Replies
    • December 24, 2008
    • 02:18 PM
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