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Suggest treatment for injury on the lower back and right shoulder

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Posted on Sat, 16 May 2015
Question: MY MRI's and CAT Scans are attatched can you give me some insight on what is going on form my car accident in 2/12/2015. A doctor last night couldn't retrieve them so I sent them to customer care and now they are there. I am in so much pain and don't know why this is going on.
doctor
Answered by Dr. Vivek Chail (1 hour later)
Brief Answer:
There are signs of probable injury to the lower back and right shoulder

Detailed Answer:
Hi Derozario2010,
Thanks for writing in to us.

Hope your pain has reduced after physical therapy and rehab.

I have read through your query in detail.
Please find my observations below.

1. MRI LEFT SHOULDER

There are mild degenerative changes noted in the left shoulder joint. The MRI also mentions inflammatory changes in the supraspinatus and infraspinatus (muscles helping in rotatory movement at shoulder), which is more likely a result of the degenerative change and less likely due to the car accident.

2. MRI RIGHT SHOULDER

In the right shoulder, there is a tear along the upper fibers at surface of supraspinatus tendon at the point where the muscle and tendon meet (musculotendinous junction). This is mentioned as a 22 mm break. This however can be considered a mild injury and repairs by itself in 3 months time.

The infraspinatus tendon shows findings consistent with mild degenerative changes which are also seen in other joint structure.

3. MRI LUMBAR SPINE

This refers to the lower back. There is grade I post traumatic misalignment of the bones in the lower back at levels L 4 - L 5 and L 5 - S 1. Since it is grade I therefore does not require any intervention.

It is to be noted that due to the accident, you also suffered disc bulges at L 4 - L 5 and L 5 - S 1 levels. The discs are displaced from their position and at L 4 - L 5 level it is causing pinching of the nerve on both sides while at the L 5 - S 1 the pinching is seen on the left side.

From the above it is possible that you are having mild to severe pain in the lower back and legs, which is more on the left side.

4. MRI THORACIC SPINE

This refers to the upper back. There is mild displacement of discs between the bones at levels T 1 - T 2 and T 4 - T 5. This is not causing any significant pressure or nerve pinching. The finding are mild.

CONCLUSION

(i) You need to continue physical therapy and discuss the pain relief with your doctor and physiotherapist. Applying heat pack and ointments might help you temporarily should you encounter sudden pain.
(ii) Please allow yourself rest from heavy physical activity and avoid participating in strenuous exercises.
(iii) Avoid lifting heavy weights as this can increase your symptoms.
(iv) In most patients, the shoulder pain might resolve in 3 months time. However the lower back pain requires rehab and pain relief for a slightly longer duration.
(v) The back pain might require pain relief medications and shots if the pain persists even after months of rehab.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (6 minutes later)
Can you take a look at the health portal Cat scans and MRI that are attched also.
Also I have severe pain in my back, legs and feet with tingling and numbness. My jaw is popping and I can't chew solid foods. My arm & hands feel numbness & tinglng also is that part of the shoulder issue?
doctor
Answered by Dr. Vivek Chail (37 minutes later)
Brief Answer:
The cervical spine MRI shows advanced degenerative changes

Detailed Answer:
Hi Derozario2010,
Thanks for writing back with an update.

1. MRI CERVICAL SPINE
This shows that there are moderate degenerative changes involving the neck bones and discs. This was existing before your accident and is present at multiple levels with significant pinching of nerves seen at C 5 - C 6 and C 6 - C 7 levels with pressure on the covering of spinal cord. It is to be noted that the accident might have increased the pinching of nerves and symptoms.

2. The jaw popping, numbness and tingling in hands is due to the pinching of nerves in the neck region which are detailed above. There is significant pressure on the nerves and if not relieved by physical therapy, pain relief medicines or shots, then surgery might be required to decompress the nerves and treat the numbness and tingling. The shoulder injury is not contributing as much towards the numbness and tingling in arms and hands.

3. Severe pain in lower back, legs and feet is due to pinching of nerves in the affected disc levels as described in earlier reply. Presently this appears to be of a milder nature but if your pain increases along with numbness and tingling, then treatment is rehab, pain medication, shots and if these do not help then surgery for decompression of the pinching nerves.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (45 hours later)
Sir that was the scan right after my accident those were taken right after in the wrong they were Cat & MRI they were for February 12th 2015 . The previous scan was for April 2015 for the doctors after physical therapy due to more pain .
doctor
Answered by Dr. Vivek Chail (1 hour later)
Brief Answer:
Please find details below

Detailed Answer:
Hi Derozario2010,
Thanks for writing back with an update.

1. I have acknowledged going through reports concerning (i) the cervical spine MRI dated February 12 2015 and (ii) the right and left shoulders, lumbar spine and thoracic spine MRI dated April 16 2015.

2. The first one was done right after your accident while the next set of MRI scans were done few days back due to your persistent pain.

3. It is clear that you had some degenerative changes at the time of accident and following the trauma your symptoms have been aggravated indeed. The accident has caused increase in the severity of neck symptoms.

However, the numbness and tingling in lower back and legs is most probably due to the accident. The lower back pain might need a longer rehabilitation.

At the same time please do not ignore your neck problems as they look more serious at the moment and cause significant distress if not taken care of.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Vivek Chail

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Suggest treatment for injury on the lower back and right shoulder

Brief Answer: There are signs of probable injury to the lower back and right shoulder Detailed Answer: Hi Derozario2010, Thanks for writing in to us. Hope your pain has reduced after physical therapy and rehab. I have read through your query in detail. Please find my observations below. 1. MRI LEFT SHOULDER There are mild degenerative changes noted in the left shoulder joint. The MRI also mentions inflammatory changes in the supraspinatus and infraspinatus (muscles helping in rotatory movement at shoulder), which is more likely a result of the degenerative change and less likely due to the car accident. 2. MRI RIGHT SHOULDER In the right shoulder, there is a tear along the upper fibers at surface of supraspinatus tendon at the point where the muscle and tendon meet (musculotendinous junction). This is mentioned as a 22 mm break. This however can be considered a mild injury and repairs by itself in 3 months time. The infraspinatus tendon shows findings consistent with mild degenerative changes which are also seen in other joint structure. 3. MRI LUMBAR SPINE This refers to the lower back. There is grade I post traumatic misalignment of the bones in the lower back at levels L 4 - L 5 and L 5 - S 1. Since it is grade I therefore does not require any intervention. It is to be noted that due to the accident, you also suffered disc bulges at L 4 - L 5 and L 5 - S 1 levels. The discs are displaced from their position and at L 4 - L 5 level it is causing pinching of the nerve on both sides while at the L 5 - S 1 the pinching is seen on the left side. From the above it is possible that you are having mild to severe pain in the lower back and legs, which is more on the left side. 4. MRI THORACIC SPINE This refers to the upper back. There is mild displacement of discs between the bones at levels T 1 - T 2 and T 4 - T 5. This is not causing any significant pressure or nerve pinching. The finding are mild. CONCLUSION (i) You need to continue physical therapy and discuss the pain relief with your doctor and physiotherapist. Applying heat pack and ointments might help you temporarily should you encounter sudden pain. (ii) Please allow yourself rest from heavy physical activity and avoid participating in strenuous exercises. (iii) Avoid lifting heavy weights as this can increase your symptoms. (iv) In most patients, the shoulder pain might resolve in 3 months time. However the lower back pain requires rehab and pain relief for a slightly longer duration. (v) The back pain might require pain relief medications and shots if the pain persists even after months of rehab. Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek