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How do I get a proper diagnosis

Hi all, my first post here, I hope to get some information from you. Last year I had severe pain in my left shoulder(blade) neckmuscles and later my fingers and hand started to hurt too, at first my doctor thought it was rotator-cuff tendons or strained muscles. So he had me take xrays for my shoulder, but aside some wear there was not much to show. When I told him later about my pins and needles in my vingers I got a xray for my neck, the xrays showed spondylosis an wear of c5 and c6, no action was taken (beside painkillers) and about 5 month later I was almost pain free.

Now this year it starts al over again, a stabbing pain in my shoulder, so the doctor referred me to a orthopedic surgeon, he also thought it was rotator cuff impingement or bursitis, so he gave me a cortisone injection but instead of getting better it got worse, also the pain in my fingers and hand came back. (thumb, index, middle vinger)

I didnt tell the orthopedic doc about my pins and needles (stupid I know) because it didnt really hurt then and all I wanted was to get rid off my shoulder pain. since it got worse I called my ortho.doc and asked him if my neck could be the source of my shoulder pain, so we made an appointment for next week.

My questions to you are: is the orthopedic surgeon the right doc for neck problems? can a pinced nerve in the neck give so much pain in the shoulder ? can shoulder problems be the reason for pain in my fingers? what would be the best next step to rule things out or get the right diagnose.


  • The truth is that getting a proper diagnosis and a solution or treatment plan to your problem when it comes to spine problems can be a long road. I'm nine months in and even though I'm quite certain personally of the cause of my pain, getting the doctors to listen to me is very difficult. Hopefully you will have better luck. It is important to make sure you always list all symptoms even if it confuses the doctors more, because leaving some out isn't giving them the whole picture. Orthopedics are fine for neck problems just make sure you have one that is a spine surgeon, but if they aren't getting to the bottom of it you may want to try a neurosurgeon. I'm having better luck with the neurosurgeon route so far.
    Microlaminectomy and discectomy at C7-T1 on April 26th.
  • dilauroddilauro ConnecticutPosts: 12,651
    edited 03/16/2013 - 6:56 PM
    I am sure that you will find your stay here very rewarding. Spine-Health maintains an extensive detailed medical articles and videos that cover almost every spinal condition and their treatments. We also offer a section that helps patients who have had surgery find easier ways to get around. As a bonus, the patient forum (this) provides a vehicle in which you can talk to thousands of other members who understand what you are going through.

    Sometimes diagnosing a problem can be very difficult. First there is the clinical examination in which trained doctors can pick up many different problem areas. Based on those results there are a number of diagnostic tests that can be done to further identify the problem. Then the doctor(s) have information in which to base their diagnosis.

    But here is where things can get muddy. As the patient, you know where your pain is and how it is impacting you. But you might not be getting the feedback that your problem is being isolated. You are given different conservative treatments in attmpt to correct the situation. There are so many different types of conservative treatments aimed at different parts of the Spine, Disc, Nerve and Muscular system. Maybe none are working for you. Why?

    It seems that your doctors are narrowing your problem to your shoulder ( rotator-cuff). But adding the numbness in your fingers pointing to some cervical discs, what is the root problem?

    Orthopedic doctors are trained to isolate these problems. Neurologists can identify if the problem is disc related with some impinged nerve roots. A Neurosurgeon would be the doctor to perform surgeries, specially if they are disc and nerve related.

    Since you really do not have a finite diagnosis, I would politely discuss this with your doctor, expressing your concern that your problem really doesnt seem to be completely identified. Can you refer me to another specialist who might be able to help with this.

    That puts it in their ballpark to either step up the diagnosis or do make the referral. Even when a diagnosis is made, many times seeking a second opinion is the right thing to do.

    I know this is hard, especially when you are in pain and all you want is for them to tell you that you have ABC and this is what we are going to do to eliminate the problem. Hang tight!

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  • Thanks eaduby and dilauro, your right, I should told him about my pins and needles, docs are not psychics :) they need to get the whole picture. The xray didn't show a herniating or bulging disc but degenerated discs, can a mri show a pinced nerve then? as you said dilauro, isolating the source is key, but thats also the biggest difficulty

    To make things more difficult I read somwhere when I was searching with google that nerves also can get trapped in the shoulder area.

    Perhaps its good to wright down some questions before I see the doc, because you always forget some things, and docs often have tight scedules

  • x-rays show a picture of the bones. The doctors can decide that the discs are degenerated when the spaces between the vertebrae are narrower than usual because the discs have collapsed.

    MRI scan also shows soft tissue and because of that, pinched nerves or herniated discs can generally be seen.

    Good luck in getting a diagnosis and then a treatment plan.
    I agree with you that going to your next appointment prepared with a list of questions to ask would be a great idea. :-)
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  • From what I know yes nerves can get trapped in the shoulder area as well as the neck. Having an EMG/nerve conduction study done may point to where a nerve is being pinched, but they are not foolproof tests so don't get discouraged if you have one and it comes back normal. Same with MRIs. All of these diagnostic tools can be great in helping your doctor locate the cause of the pain, but it's a combination of many things that will usually lead to a diagnosis, not one singular test. Everything has it's limitation so by combining them all you can cover the gaps and find the answers. :) I've had four MRIs and because of how MRIs take a "slice" picture and then skip a MM or whatever before taking the next picture only one of the four actually found the disc bulge that may be causing my pain. When you compare them you can see that only that MRI took a picture in that spot, the others took a slice right above and below it.

    Sometimes doctors will act as if a certain test is the end all, so just remember that it's not necessarily the case.
    Microlaminectomy and discectomy at C7-T1 on April 26th.
  • dilauroddilauro ConnecticutPosts: 12,651
    Storm, I know this may sound cold, but many times you have to look at all the testing that is being done for you as not being black and white.
    Now, with today's cars, there really aren't that many automobile diagnostic experts around anymore. Why, because anyone can plug into the cars computer to see whats wrong. Most of the time, the computer read out will say, Device XYZ is bad, it needs to be replaced. Bingo, its done!

    Not the same for us. All the diagnostic testing can be done and the doctors still have not come up with the absolute diagnosis. Our bodies are much more complex, testing aids the doctors in pinpointing the problem, but many times that is not enough.

    Over time, they will find out what is the root of your problem..... till then you just need to keep your sanity, which I know when you are in pain is very difficult to do.
  • Thanks all for your insight and advice in this matter, from what you are telling me it can be a long road to pinpoint the cause of the problem. I'am taking one step at the time and hope I'm getting there :)
  • Hello Brad crowne, thanks but that would only work when I know what/where the problem is.
  • dilauroddilauro ConnecticutPosts: 12,651
    I really liked your last response.
    To me, that says more than anything, Dont treat me until you know what I have

    Time will run its course and you will know exactly what you are dealing with.
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