Question
Recently, I've been helping an elderly friend to therapy and doctor visits for severe shoulder pain and complaints of not being able to lift her right hand or grip a pen to write.  Past hip replacement history, she uses a cane for "security".  I've seen her push a wheeled cart and her gait is good.  The shoulder and arm complaints were a sudden onset in the middle of the night about 3 weeks ago.  She has been seen by a spine surgeon who injected cortizone that brought <2 days relief.  Physical Therapy was prescribed and first session resulted in higher lifting of arms through pulley exercises.

MRI is not being done until Physical Therapy shows no relief of symptoms.

Now, I too am suffering the same symptoms the days after I take her to dr or therapy!  I have had pain in my shoulder blades and neck that has kept me from sleeping unless I take Flexeril or Parafon Forte.  Could I be aggravating or herniating a disc in the process of getting her in and out of my vehicle?  I think this is the common denominator, although I must say, my usual back pain of L5-S1 is not apparanet now that my neck and shoulder blades are killing me.  The one thing that does bring relief for ME is that if I put my arms up behind my head, which I just read elsewhere brings relief for a herniated cervical disc...

Any thoughts would be appreciated,

Answer
Dear Gary,

Yes, you do have some of the symptoms of a disk bulge or injury and placing the hands up over the head to relieve pain does correspond with that.  The reason is that when you raise your hands up, you can actually take pressure off the nerves that exit the spine near the disk...However, increased straining effects on the neck can mimic these symptoms as well.  

Now, if you are feeling pain into the actual shoulder musculature (deltoid area) or anywhere down the arm, it is likely that the disk is pressing on one of the nerves in the neck.  If you are having neck and upper back pain mostly, this can be referred pain from the disk as well, but does not necessarily mean disk bulge.  It could mean a small tear in the outer fibers of the disk, muscle strain, ligamentous injury or another diagnosis.

The best thing to do is actually have the neck tested with a functional and orthopedic examination.  There are specific orthopedic test that are utilized to challenge the disks in the neck to monitor function as well as pain distribution which help to diagnose a bulged/herniated disc. That being said, even if a disk injury is suspected, imaging is the only thing that can absolutely confirm this diagnosis, and MRI is the gold standard.

Good luck Gary.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net