Expert: Gerald Anzalone, D.C. - 2/20/2008

Question
Good afternoon,  My husband (68 years of age)has had severe mid-scapular pain since Dec. 2006.  He has had MRIs which show degenerative changes in his cervical spine, but the changes do not seem to warrant the severity of the pain.  He has been to several doctors...physiatrist, orthopedist, osteopath, accupuncturist.  No-one seems able to help him.  He first noticed the pain when he was doing "pull downs" in the gym.  He said he felt something give.  X-rays were normal.  First MRI showed a small rotator cuff tear, which he had before the injury last Dec..  Since then, the pain has become quite debilitating.  If he walks any distance, or pulls anything, the pain becomes worse, and he has to stop for several minutes until it subsides.  He now has a TENS unit which he wears if he needs to do any walking. Even with the TENS unit, he has to keep stopping until the pain subsides.  When the pain is at its worse, he says it sometimes radiates down his arms.  The latest thing he's had done is a series of cortisone injections under fluoroscopy which have done nothing to ease the pain.  To say he's at the end of his rope would be an understatement.  We just don't know what to do.  
Thanks, Fran

Answer
Fran,

A few points in your description of your husband's symptoms and treatment are not clear to me:

Is the pain he is experiencing in the spine (between the scapulae) or in the shoulder blade region of one or both sides?

If the pain is in the spine which worsens upon exertion or walking, sneezing, coughing, or straining, then an MRI of the thoracic spine would be indicated to rule out spinal cord compression, bone marrow changes in the vertebrae, disc displacement/herniation, or a space-occupying lesion.

If the pain is located in the shoulder blade region that worsens with raising the arm over the head, dressing, grooming, or physical activity, the concern would be for a rotator cuff tear. If an MRI reveals a large tear, orthopedic surgery would be the most likely route to take. If an MRI shows only a small tear, convservative (non-surgical) intervention might be more appopriate.

However, I'm not sure from your description where he is having cortisone injections or where he is using the TENS unit (in the spine or the shoulder blade region). If the injections are being introduced into the spine, then it would seem that he is being treated for a disc displacement or herniation. If the injections are focused in the soft tissues of the shoulder blade region, then I would assume that he is being treated for a tendon disorder.

What is the diagnosis that has been given to him for which he is receiving cortisone injections as a treatment?

Feel free to post a follow-up response to these questions, which would help me to better understand what your husband is experiencing.

Thank you.