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Suggest Treatment For Pinched Nerve In The Neck After Rotator Cuff Surgery
Question: Dr.
I had rotator cuff surgery 2 months ago. This seems to be going OK
But diagnosed now with a pinched neck nerve-I think c4-c5 and c5-6
I recieved a cortizone shot but it had no impact
Now I will be sent for a nerve conduction (abduction??) study
Can you tell me what is going on and what could be found?
An idea what might be found, treatments an prognosis
I had rotator cuff surgery 2 months ago. This seems to be going OK
But diagnosed now with a pinched neck nerve-I think c4-c5 and c5-6
I recieved a cortizone shot but it had no impact
Now I will be sent for a nerve conduction (abduction??) study
Can you tell me what is going on and what could be found?
An idea what might be found, treatments an prognosis
Brief Answer:
Test is needed to confirm diagnosis and the nerve responsible.
Detailed Answer:
I read your question carefully and I understand your concern.
You shouldn't be alarmed by the nerve conduction study test. It is a simple and non invasive test. The aim is simply to confirm the diagnosis, the presence of a nerve suffering from compression. It is used when the MRI and the clinical exam info do not make for a certain diagnosis. Not always pain is due to nerve compression, it is common with age to find some changes on MRI but they are not necessarily the cause of the pain.
In particular in your case where there is the rotator cuff history doctors might want to make sure that the pain is not due to rotator cuff issue, which may cause muscle spasms and pain irradiating in the neck making it difficult to distinguish from a pinched nerve origin of the pain. So the doctors want to complete the evaluation with nerve conduction studies to confirm there is indeed a suffering of the compressed nerve, that is what they expect to find. Also since you mention 2 pinched nerves, which can both cause pain in similar location, the tests serves to distinguish which of the pinched nerves is responsible for the pain, in order to know where to intervene in case further shots or surgery are to be attempted.
As for treatment, physical therapy is always the first step along with steroid and analgesic shots. In 75% of patient they do improve gradually. If they do not in the first 6-8 weeks, the pain is severe enough not to be controlled with medication and to affect quality of life then surgery is the next step, providing relief in over 80% of the remaining patients.
I remain at your disposal for other questions.
Test is needed to confirm diagnosis and the nerve responsible.
Detailed Answer:
I read your question carefully and I understand your concern.
You shouldn't be alarmed by the nerve conduction study test. It is a simple and non invasive test. The aim is simply to confirm the diagnosis, the presence of a nerve suffering from compression. It is used when the MRI and the clinical exam info do not make for a certain diagnosis. Not always pain is due to nerve compression, it is common with age to find some changes on MRI but they are not necessarily the cause of the pain.
In particular in your case where there is the rotator cuff history doctors might want to make sure that the pain is not due to rotator cuff issue, which may cause muscle spasms and pain irradiating in the neck making it difficult to distinguish from a pinched nerve origin of the pain. So the doctors want to complete the evaluation with nerve conduction studies to confirm there is indeed a suffering of the compressed nerve, that is what they expect to find. Also since you mention 2 pinched nerves, which can both cause pain in similar location, the tests serves to distinguish which of the pinched nerves is responsible for the pain, in order to know where to intervene in case further shots or surgery are to be attempted.
As for treatment, physical therapy is always the first step along with steroid and analgesic shots. In 75% of patient they do improve gradually. If they do not in the first 6-8 weeks, the pain is severe enough not to be controlled with medication and to affect quality of life then surgery is the next step, providing relief in over 80% of the remaining patients.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I am worried Doctor
The Doctor only gave me one shot of cortison 12 days ago and since no relief at tall he sending me for above study.
I am in constant pain. I am thinking the worst now. The pain seems to be increasing
Oxycone,and over the counter really have only minor impact
What else short of surgery and nerve rehab can be done. I have started rehab but no effect either
It was not until one month after rotator cuff sugery did this begin. I have no idea how this started
I there something call electrmagnetry (Sp?) that can be use?
Oh and doctor the pain shoots straight and steady pain from shoulder to upper and forearm to the wrist.
It is constant now
The Doctor only gave me one shot of cortison 12 days ago and since no relief at tall he sending me for above study.
I am in constant pain. I am thinking the worst now. The pain seems to be increasing
Oxycone,and over the counter really have only minor impact
What else short of surgery and nerve rehab can be done. I have started rehab but no effect either
It was not until one month after rotator cuff sugery did this begin. I have no idea how this started
I there something call electrmagnetry (Sp?) that can be use?
Oh and doctor the pain shoots straight and steady pain from shoulder to upper and forearm to the wrist.
It is constant now
Brief Answer:
Read below
Detailed Answer:
Since I suppose you have had imaging which has shown only the pinched nerve you do not need to fear the worst. While I know the pain can be really severe and disabling it is not threatening.
As I said the test might help to identify the responsible nerve. That way applying another shot may be considered, better aimed this time. If say the test shows the C5 nerve to be the main nerve suffering (while the shot might have been in the C6 vicinity) then the shot will be aimed as near that nerve root as possible, hopefully with better results.
Apart from oxycodone and over the counter medication, drugs for neuropathic pain may be added, such as gabapentin, pregabalin or duloxetine.
Physical therapy is the only proven therapy by large scale studies. Other possibilities may include traction therapy, pulsed radiofrequency (I suppose that is what you mean by "electromagnetry") or even acupuncture. However while there individuals who report improvements by one or the other of those methods, there are not enough large scale studies, benefit is not really proven. Also benefit doesn't come overnight. Studies of pulsed radiofrequency of which you inquire show benefit over several months of treatment.
Let me know if I can further assist you.
Read below
Detailed Answer:
Since I suppose you have had imaging which has shown only the pinched nerve you do not need to fear the worst. While I know the pain can be really severe and disabling it is not threatening.
As I said the test might help to identify the responsible nerve. That way applying another shot may be considered, better aimed this time. If say the test shows the C5 nerve to be the main nerve suffering (while the shot might have been in the C6 vicinity) then the shot will be aimed as near that nerve root as possible, hopefully with better results.
Apart from oxycodone and over the counter medication, drugs for neuropathic pain may be added, such as gabapentin, pregabalin or duloxetine.
Physical therapy is the only proven therapy by large scale studies. Other possibilities may include traction therapy, pulsed radiofrequency (I suppose that is what you mean by "electromagnetry") or even acupuncture. However while there individuals who report improvements by one or the other of those methods, there are not enough large scale studies, benefit is not really proven. Also benefit doesn't come overnight. Studies of pulsed radiofrequency of which you inquire show benefit over several months of treatment.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Doctor I will just ask a couple of more questions an then give you the top rating.
Do mean the conduction test is being done to get a closer look at where to give the 2nd shot, possibly
And does Nortriplyne (sp) t the anti depressant work?
Do mean the conduction test is being done to get a closer look at where to give the 2nd shot, possibly
And does Nortriplyne (sp) t the anti depressant work?
Brief Answer:
Read below
Detailed Answer:
Yes, that is what I mean, that it may give better information on where (and whether) a second shot is needed.
The antidepressant Nortriptiline is an alternative similar to the other ones I provided (duloxetine which I mentioned is another antidepressant), so yes, it is a valid alternative, it is among those antidepressants which are employed for neuropathic pain. It doesn't work for everybody (neither of those do), it provides relief in a little more than 50% of the patients.
I hope to have been of help.
Read below
Detailed Answer:
Yes, that is what I mean, that it may give better information on where (and whether) a second shot is needed.
The antidepressant Nortriptiline is an alternative similar to the other ones I provided (duloxetine which I mentioned is another antidepressant), so yes, it is a valid alternative, it is among those antidepressants which are employed for neuropathic pain. It doesn't work for everybody (neither of those do), it provides relief in a little more than 50% of the patients.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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