Arm, Neck, and Shoulder Pain

ramona131313

So I am looking for anyone who has had similar symptoms to chime in and let me know what tests you think are best. I am very active and work with my hands a lot. I am three years out from my last surgery and my right arm has always been strong, but since surgery, not so much. Because of pectoral stiffness I cannot work out in the same way I did pre-dx. The past two months I have had symptoms ranging from severe pain in my thumb, hand, elbow, upper arm, shoulder, and neck, to slight shoulder and neck pain and numbness. The numbness in my hand and arm never completely leaves. I have been doing pretty much nothing but sitting around and light housework at my husband's behest. Primary ordered a bone scan/SPECT and suggested physical therapy.

Bone scan completed. I asked for the DVD (as I always do), got home and there were two images on it. Called for new DVD. Drove to hospital and picked up a second incomplete DVD. Called the next day, and after two more days they finally resolved the problem and loaded the 2,700 images correctly. I looked through the images, noting increased uptake in my right shoulder, hips, and a bit on my spine (I am having lower back pain as well, but have had that off and on pre-dx-maybe a bit worse now). I read the report that was now included on the DVD. It was completed 10 MINUTES after my scan. I was amazed to think that a radiologist could say everything looked fine, "no increased uptake, and likely arthritic changes on long bones", in just 10 MINUTES. It took me longer to load the disc!

I looked up the doctor and it said he was a resident at the hospital, so I called. They said that a resident could not finalize a report, but there it was his name on the report as reviewer and the doctor who signed off. So I called my primary. She said the scan results were not in yet.I thought, Oh good, an attending must be reviewing it. She called back in an hour and said everything was fine. I asked who reviewed it and she gave me the same doctor's name! She read me his three line assessment exactly as I had read it on the DVD. I asked if it is normal to take the word of a resident who reviews the scans in super-fast mode? She said her friend in radiology had confirmed the results. She said I should just "get physical therapy-don't worry, you're fine."

I called radiology to see who the attending was who supervised the evaluation so that I could have my oncologist at Mayo call him. After 15 minutes of back and forth, I was finally told that the doctor who's name is on my report is now an attending (as of last month) and is perfectly qualified to sign off on the report. UGH! I think an MRI is in order. I have a physician friend who has ordered that for me and then I will either go see my onc with the results or if she thinks it's just arthritis, she will get me in to see an ortho at her location.

I guess my question is, does anyone know how they differentiate between arthritis and mets on SPECT? Also, has anyone else had anything similar? My pain is better without activity (unless I am sitting or laying completely still, then it gets worse). Any input is appreciated!

Ramona

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kcat2013

Hi Ramona, I had some persistent pain that had my MO send me for a bone scan. My scan showed uptake in several spots (none where I was having pain) and the radiologist noted the uptake and said it was consistent with degenerative arthritis. I have rheumatoid arthritis so that made sense. I'm surprised if your scan really did show uptake that it wasn't noted by the radiologist, because even if the uptake is from benign causes it should still be noted.

Kendra

ramona131313

Hi Kendra,

Thanks for your reply. Yes, that is my biggest concern. I feel as if the radiologist did not evaluate all the scans and just took a glimpse at them.

Ramona