Hey everyone,
I’m asking for my dad—he’s dealing with this intense, sharp pain in his right shoulder. It hits hardest when he reaches up or stretches, and it’s been dragging on for months now. It’s bad enough that even just shaking hands or lifting anything slightly heavy is a struggle. He already went through 22 injections of naproxen, which did absolutely nothing. After that, he was put on 16 mg of Medrol.
He’s 60, stands about 6'0", weighs 165 lbs, and has a pretty standard build. He works a job that’s physically demanding.
I’ve attached the radiology report and the orthopedic findings here.
Radiology Report:
Working diagnosis: Back Pain
Slightly decreased bone mineralization. Cervical spine lordosis is maintained, but there’s a break in the SIIL at the C4-C5 level, with C4 sitting about 2.1mm back compared to C5. The SIL remains intact in the other segments. The cervical vertebral bodies (LL shown up to C6) have maintained height. Signs of osteochondrosis at C4-C5 and C6-C7 with marginal osteophytes.
Advanced degenerative changes in the small joints.
Calcifications are visible ventral to the C3-C4, C4-C5, and C6-C7 spaces, primarily consistent with seronegative spondylitis.
Degenerative changes in the anterior atlantoaxial joint.
Unkarthrois. Bilateral paravertebral calcification shadows in soft tissues, corresponding to calcifications along vascular structures on the AP view.
Lumbar spine imaging shows the axis is maintained on profile, though there's slight straightening of the lordosis with a break in the SIL at the L5-S1 level and L5 sitting about 4.5mm back relative to S1. The SIL is intact elsewhere. Lumbar vertebral bodies have maintained height, with mild biconcave shaping due to Schmorl's nodes.
Ventral to the sacrum and lateral on AP views, there are rounded syndesmophytes consistent with seronegative spondylitis, along with advanced degenerative changes in the small joints and visible interspinous arthrosis. The AP view shows bilateral signs of sacroiliitis.
Diagnosis: Back Pain
-------------
Orthopedic Findings:
Clinical: Severely limited neck mobility with positive signs for right cervicobrachialgia.
X-ray: C4 retroposition by 2 mm, osteochondrosis from C4-C6. Spondyloarthrotic changes in the LS spine.
Prescribed: Analgesics, topical NSAID creams, oral Vitamin B.
Next steps: Perform EMG on upper extremities. Also requesting a rheumatology consult.
Diagnosis: M75.8 Other shoulder impairments.
Since nobody is actually talking to the patient or explaining things in plain English, I’m reaching out for advice. What should he be doing while waiting for more tests? Should he be exercising or just resting? Is it better to ice the area or use heating gels? Is massage or physical therapy okay?
Basically, what works and what doesn't... because after all those heavy-duty injections and meds, nothing has changed, and no one has given him a straight answer. Where is this pain coming from? Is this a chronic thing or will it pass? If it passes, how long is the recovery/rest period? And most importantly—can he keep working his current job?
Thanks a million in advance.
ivan
I’m asking for my dad—he’s dealing with this intense, sharp pain in his right shoulder. It hits hardest when he reaches up or stretches, and it’s been dragging on for months now. It’s bad enough that even just shaking hands or lifting anything slightly heavy is a struggle. He already went through 22 injections of naproxen, which did absolutely nothing. After that, he was put on 16 mg of Medrol.
He’s 60, stands about 6'0", weighs 165 lbs, and has a pretty standard build. He works a job that’s physically demanding.
I’ve attached the radiology report and the orthopedic findings here.
Radiology Report:
Working diagnosis: Back Pain
Slightly decreased bone mineralization. Cervical spine lordosis is maintained, but there’s a break in the SIIL at the C4-C5 level, with C4 sitting about 2.1mm back compared to C5. The SIL remains intact in the other segments. The cervical vertebral bodies (LL shown up to C6) have maintained height. Signs of osteochondrosis at C4-C5 and C6-C7 with marginal osteophytes.
Advanced degenerative changes in the small joints.
Calcifications are visible ventral to the C3-C4, C4-C5, and C6-C7 spaces, primarily consistent with seronegative spondylitis.
Degenerative changes in the anterior atlantoaxial joint.
Unkarthrois. Bilateral paravertebral calcification shadows in soft tissues, corresponding to calcifications along vascular structures on the AP view.
Lumbar spine imaging shows the axis is maintained on profile, though there's slight straightening of the lordosis with a break in the SIL at the L5-S1 level and L5 sitting about 4.5mm back relative to S1. The SIL is intact elsewhere. Lumbar vertebral bodies have maintained height, with mild biconcave shaping due to Schmorl's nodes.
Ventral to the sacrum and lateral on AP views, there are rounded syndesmophytes consistent with seronegative spondylitis, along with advanced degenerative changes in the small joints and visible interspinous arthrosis. The AP view shows bilateral signs of sacroiliitis.
Diagnosis: Back Pain
-------------
Orthopedic Findings:
Clinical: Severely limited neck mobility with positive signs for right cervicobrachialgia.
X-ray: C4 retroposition by 2 mm, osteochondrosis from C4-C6. Spondyloarthrotic changes in the LS spine.
Prescribed: Analgesics, topical NSAID creams, oral Vitamin B.
Next steps: Perform EMG on upper extremities. Also requesting a rheumatology consult.
Diagnosis: M75.8 Other shoulder impairments.
Since nobody is actually talking to the patient or explaining things in plain English, I’m reaching out for advice. What should he be doing while waiting for more tests? Should he be exercising or just resting? Is it better to ice the area or use heating gels? Is massage or physical therapy okay?
Basically, what works and what doesn't... because after all those heavy-duty injections and meds, nothing has changed, and no one has given him a straight answer. Where is this pain coming from? Is this a chronic thing or will it pass? If it passes, how long is the recovery/rest period? And most importantly—can he keep working his current job?
Thanks a million in advance.
ivan