On July 26, I got my arm stuck between my driver's seat and the center console while driving (I know - real stupid). I had to yank on it several times to get it out, and the last yank was really hard (I literally almost had to call 911 to have it extracted - the space I was stuck in was about 1/2 inch wide). I ended up going to the dr. 3 weeks later, and have been going ever since ... I've had x-rays, was in PT and taking pain meds, and finally had to go for an EMG and 2 MRIs because I'm still in horrible pain. The pain is mostly in the top of my arm (it feels like those muscles), and in my shoulder. The EMG showed no "damage" and that I had Carpal Tunnel Syndrome (which I already knew I had). It was at some point after starting PT that my arm started tingling and going numb while doing certain movements, and I noticed I couldn't fully turn my head to the right - I get so far, then I get the pain shooting down my arm (that's why I was sent for the EMG and an MRI of my shoulder - I had the MRI first, and the Dr. who did the EMG asked if it was of my neck, too, because it sounded like a "nerve root" problem, but it wasn't, so I had to go back for a 2nd MRI, this time of my c-spine).

After all of this, at my most recent visit (5 days ago), my Dr. stopped the PT (which I had been going to for about 4-5 weeks, or maybe 5-6), continued me on the pain med (which I was allowed to start taking 2 at a time a week and a half ago because the pain was so severe and excruciating), he added a muscle relaxer, told me to get and wear a soft neck collar, and I have to go back to see him in 2 weeks. I had noticed a slight improvement by that last visit, in that I could turn my head further to the right than previously .. but now, 5 days later, I'm back to where I was before with my neck (there's no pain in my neck at all, it just always shoots down to my shoulder/arm, although my upper back feels sore and tight sometimes, too).

MRI of my Right Shoulder: ("IMPRESSION" only)

1. Partial bursal surface and intrasubstance supraspinatus tendon tear
2. Partial interstitial infraspinatus tendon tear
3. Superior labral tear
4. Acromioclavicular joint arthrosis w/hypertrophic spurring effacing the
supraspinatus

My questions on this MRI of my shoulder are:

1. Is there any way to explain all of that in terms I can understand? I understand that the supraspinatus and infraspinatus are tendons (the MRI said the subscapularis and teres minor are normal, and there is "no tendon rupture of retraction"). But what does it mean that it's the "bursal surface and intrasubstance" (in #1), and that it's the "interstitial" infraspinatus tendon (in #2)?

2. From #4, is "arthrosis" different from "arthritis"? (because I do have rheumatoid arthritis, though not very advanced, and osteoarthritis somewhere, but not sure where, and for over a year now I have suffered with extreme stabbing shoulder pain - in both shoulders - that comes and goes, mysteriously, and can last anywhere from 1 week to 4 months, which my rheumatologist does not seem to think is RA - so would "arthrosis" indicate that it IS from RA or OA, or is it caused by something different? I have been a typist/wordprocessor for the last 18 years - so maybe it's caused by poor posture, etc.?).

3. Also from #4, what does "hypertrophic spurring effacing the supraspinatus" mean?


MRI of my Cervical Spine: (for this one, I will give both the "Findings" and "Impression," because the "Impression" was really only 1 thing, yet there's a whole lot more "descriptions" of the individual vertabra given in the "Findings," that I'd like to know exactly what they mean)

FINDINGS:

There is straightening of the normal cervical lordosis which may relate to muscle spasm and/or degenerative changes. Otherwise, vertebral body heights and alignment are maintained and the interspaces are intact. Facet joints are intact. Craniocervical and cervical-thoracic junctions are intact. No acute displaced fracture, traumatic malalignment, compression deformity, or destructive osseous lesion is present. Prominent posterior bulging is seen at C4-C5 and to a lesser degree at C6-C7. Spinal cord is otherwise normal in signal intensity and morphology on the sagittal sequences. Visualized posterior fossa structures are unremarkable. Mildly prominent scattered non-specific cervical lymph nodes. Otherwise, prevertebral and paraspinal soft tissues are grossly unremarkable given lack of intravenous contrast.

At the C2-C3 level, there is no significant central canal or neural foraminal narrowing.

At the C3-C4 level, there is a broad-based posterior disc osteophyte complex and bilateral uncovertebral joint hypertrophy resulting in no significant central canal or neural foraminal narrowing.

At the C4-C5 level, there is a broad-based posterior disc osteophyte complex resulting in complete effacement of the ventral CSF (cerebrospinal fluid) space and mild mass effect upon the ventral aspect of the spinal cord. No significant neural foraminal narrowing is identified.

At the C5-C6 level, there is a broad-based posterior disc osteophyte complex and bilateral uncovertebral joint hypertrophy resulting in mild bilateral uncovertebral and facet joint hypertrophy resulting in mild bilateral neural foraminal narrowing and near complete effacement of the ventral CSF space with minimal mass effect upon the ventral aspect of the spinal cord.

At the C6-C7 level, there is a broad-based posterior disc osteophyte complex resulting in moderate effacement of the CSF space with no significant neural foraminal narrowing or mass effect upon the spinal cord.

At the C7-T1 level, there is no significant central canal or neural foraminal narrowing.

IMPRESSION:

1. Straightening and slight reversal of the normal cervical lordosis centered at C4-C5, with multi-level posterior disc bulging and uncovertebral joint hypertrophy, resulting in varying degrees of neural foraminal and central canal narrowing as detailed above. No obvious focal disc herniation.

2. No acute fracture or traumatic malalignment.


My questions on the MRI of my Cervical Spine are:

1. What, exactly, is a "bulging" disc? Is it the same as a "herniated" disc? And will these eventually go away on their own?

2. What is a "broad-based posterior disc osteophyte complex"?

3. What is "bilateral uncovertebral joint hypertrophy"?

4. What does "complete effacement of the ventral CSF space" mean?

5. What does "mild mass effect upon the ventral aspect of the spinal cord" mean?

6. What is "mild bilateral neural foraminal narrowing and near complete effacement of the ventral CSF space"?

7. From the "Findings" section - it says, "Mildly prominent scattered non-specific cervical lymph nodes." I know that "non-specific" means, basically, that "they don't mean anything" (just because they're there). But if it means nothing, or if it's "normal" that they are showing up, why is the radiologist bothering to mention them? Are lymph nodes usually mentioned on MRIs when seen? Or, does it actually mean something that he is saying that they're "mildly prominent"? I only ask because on any blood tests I get, my WBC count is usually elevated, (not to any great degree, I don't think) but the doctors always say that it's normal for my condition (having RA). But i don't think I've ever read anywhere that it's also normal to have "mildly prominent lymph nodes" with RA .. There's been other things going on (with my body) that I've been questioning, and have even gone to an endocrinologist for, so I am just wondering if I should, indeed, have my PCP check into that, or if it truly "doesn't mean anything" that they were mentioned.

I know this was pretty lengthy, but I thank everyone who reads the whole thing, and can help me with any answers! The dr "repeated" what the MRIs said, but didn't fully explain it all, and I read the reports myself when I got home, but my next appt isn't for 2 weeks, so that's why I haven't asked my doctor any of these specific questions yet. I did ask him (regarding the "bulging" discs): "Did I do that to myself???" because it's kind of hard to believe ... but he didn't really give me an answer ....

I'll try to help:

A bulging disc is NOT the same as a herniated disc. A herniated disc actually bursts thru whereas the bulging disc does not.

A broad based disc osteophyte complex is a large or more than one bone spur.

Bilateral unconvertebral hypertrophy is overgrowth of bone.

Complete effacement of the ventral CSF space, means it takes up all the space.

"Mild mass effect upon the ventral aspect of the spinal cord - it means it doesn't have a huge effect on the spinal cord - only a mild effect.

Mild bilateral neural foraminal narrowing -- the foramen is the hole where the nerves go in to the spinal cord -- there is mild narrowing. And again, it says that it is taking up all the space.

I'm sorry I cannot answer your questions regarding your shoulder. I'm more the cervical & lumbar person. LOL I don't have experience with shoulders, etc.

Perhaps someone else who has had these ailments can chime in and help you with this. I sure hope so.

Maybe DUBIOUS will help! And i hope he corrects anything I got wrong too!
God bless & take care. Hugs, Lee

You also could have injured or strained soft tissues in the brachial plexus area - http://en.wikipedia.org/wiki/Brachial_plexus

That might have been what the PT was helping with, the soft tissue part of the injury. You might ask to go back to PT now that you know things have regressed.

It's all a crap shoot without knowing any clinical findings as well but from what you state about the history and imaging findings, Jomar's guess would be mine too at this point and more information could be gleened from SSEP's of selected peripheral nerves of the upper extremities. Try not to get too hung up on the definition of this or that....differentiating diagnoses between different regions sometimes becomes more conceptual of the larger picture.

Your shoulder MRI impressions could be acute or chronic and may or may not relate to the pain you are experiencing; but just shoulder pain. A SLAP tear can be asymptomatic and incidental finding or excrutiatingly disabling. You would need to consult with a shoulder-ortho if you have not already and probably should as subacromial spurs are known to eventually rupture rotator cuff tendons.

No, lymph nodes are not normally commented upon but that might just be that individual radiologist's pet peeve. Since you likely see your rheumatoligst frequently, just show the report to them and ask if further workup is necessary.

And yes Leesa, you did splendidly!

Easier for me to reply this way as it was a lot to remember

I am going to send this same "THANK YOU!!!" to all 4 of you - Leesa, Jo*Mar, Dubious and Gatorhead ....

WOW!! I really, really appreciate you guys taking time to read my whole post ... And you were ALL very helpful to me! I was freaking out when I got home and read these - because as I said, the doctor showed me a few areas and said things about them, but the way he said things, it didn't sound so bad, yet the words of the entire reports sounded horrible - I actually gasped in horror - wondering how in the world I could have done that to myself!! I know the doctor sent me away with just pain meds the first time I went to see him (which was 3 weeks post-injury). He said to come back and see him in 2 weeks, unless I felt better, and he specifically stated that that I most likely won't need to see him again (he, too, was of the opinion that my own pulling on my own arm most likely couldn't have done much damage). Sure enough, I went back 2 weeks later because the pain was not gone (the pain in my elbow and wrist seemed "gone," but not the upper part of my arm - and that had been getting even worse and more frequent). That's when he put me on PT, then checked me 3 weeks later ... where, again, the pain had gotten worse, not better, and in fact it was during PT that the "nerve issue" seemed to have started (where I started getting the tingling and numbness, along with a shooting pain down my arm, and my thumb and index finger were going numb .. and actually, for about 4-5 weeks, the tip of my thumb was constantly 1/2 to 3/4 totally numb, all the time - but that has since resolved).

I did have an injury to my right elbow 3 yrs ago, where I slipped and fell while trying to walk down a wet, grassy slope, and hyper-extended my elbow. That took a year and 5 mos to completely heal. Also, the PT told me that my arm joints were all "very loose" - when I showed him how I can bend my fingers, because they're "double-jointed," he said, "Oh yeah - that would explain the loose joints." and he told me how having one extreme or the other (either joints that are too loose or joints that are too tight) can cause extended healing times.

My problem is that I am a typist/wordprocessor for a living - I have been off work for this since Sept. 17. I can type, but not "straight thru for 8 hours" like I'm used to doing - even typing these things up in the forum causes my arm/shoulder to have pain, and eventually tingling/numbness - I have to keep stopping and resting in between typing. But there are days I do not go on my laptop at all - in an attempt to "rest" my arm/shoulder and help it heal. But so far that has not worked - at least not yet. I'm worried about how long I will have to remain off work - I do get 2/3 of my pay through my Long Term Disability, and my employer pays "my part" of the cost for our Blue Cross/Blue Shield medical (that normally comes out of my pay checks, and they then pay the rest - I forget what that is called - it's in addition to my office co-pays and annual deductible) - but they will only do that for 6 months ... if I hit 6 months off, I have a choice to get COBRA - but that's way too much for me to afford. I know there's SSD, or medical retirement, but I haven't even looked into either one of those, because I never, ever thought I'd even be off work THIS long!!

So you can see why I was freaking out about the MRI reports - because I'm not sure what they mean, and if they are things that will "get better" soon or not, and if I need to start looking into other options as far as "work" is concerned, etc. So I thank you all SO MUCH for your replies and helping me understand a little bit more - you've definitely given me other things I need to "search for" in this website's forums, as well as other things on the web. God bless you all ... I can't express my thanks and gratitude enough!!!

Right now, I almost can't do anything with my right arm without excruciating pain (and yes, I'm right-handed) especially movements where I bend down and forward - like getting something out of the fridge that's on the bottom shelf, or leaning forward to open/close blinds on windows - and it doesn't matter if I lean on my left hand/arm and reach with my right, or vice-versa. And once I've "aggravated or irritated it," it will literally take HOURS of taking pain pills and using my ice pack and heating pad. Some days I suffer all day long with the pain, because it won't go away, and I've had many nights where I can't sleep all night because of it.

You are welcome and Dubious typed their's as I was typing out mine lol, and as usual I agree