Neck Pain vs. Shoulder Pain with Dr. John Klekamp – Facebook Live

Dr. Klekamp, Tell Us A Little Bit About Yourself And What Specialties You See Here At Bone And Joint Institute:

Dr. John Klekamp: My name is John Klekamp, I’ve been practicing in Nashville professionally for 20 years but I also did my residency here starting in 1990 and went through the Vanderbilt Orthopaedic Residency program so I’ve essentially been here almost 30 years. I see all sorts of things spine from the base of the neck all the way to the tip of the tailbone and enjoy seeing patients hopefully get by with non-operative treatment, but if surgery is required we can do that as well.

Tell us a little bit about the spine program here at Bone and Joint Institute:

Dr. Klekamp: We have a comprehensive spine program at Bone and Joint Institute. We have three spine surgeons – myself, Dr. Michael McNamara and Dr. Casey Davidson – and we also have a physiatrist in Dr. Zachary Kalb, who is one of our non-operative spine practitioners. He performs our injection therapy such as epidural shots and facet injections. We have physical therapy, all spine-specifically trained physical therapists. We have physician extenders who all rotate through our spine program and all well versed in spine treatment, evaluation and diagnosis. We have diagnostic imaging, including MRI which is just now being installed (in our building). Currently we have a CT scan and, of course, we’re very close to Williamson Medical Center right across the parking lot which has all sorts of diagnostic studies for all our inpatient needs. Then we have a surgery center for all of our outpatient surgical treatment options.

When you see a patient, how are you able to differentiate between neck and shoulder pain?

Dr. Klekamp: There’s a lot of overlap. You would think that it would be very easy to distinguish between neck and shoulder pain – and that’s not to say that some people can have both. You can have problems with both your neck and your shoulder but, ideally, I get a history from interviewing the patient. If they tell me it started in their neck and radiates over their shoulder and then there’s numbness, tingling and burning involving their muscles and arms all the way down to their fingertips, that tips me that it’s more nerve related. If they’re telling me their shoulder started hurting initially and it started radiating up to their neck, it hurts to reach into the back seat of their car or it hurts to reach above their head and they feel a clunking in their shoulder or a mechanical symptom in their shoulder, that leads me to believe it’s more of a shoulder issue. But, it can be very hard to distinguish.

Do you do any type of imaging to help determine what’s going on?

Dr. Klekamp: Yes. After interviewing and a physical exam – and the physical exam itself can really help in distinguishing between the neck and the shoulder – if I’m believing it’s more of a neck issue, we’ll get cervical X-rays. If I think it’s more shoulder related we’ll just get shoulder X-rays. If I’m not sure yet, then I’ll get both.

Is there anything an MRI might show after they’ve seen you?

Dr. Klekamp: Yes. After initial treatment, there are other treatment options that really help for me distinguish between neck and shoulder pain. If I’m suspicious that it’s a shoulder issue but I’m not absolutely sure, often times I’ll offer and suggest to the patient that we can try a shoulder injection and we can do that during their visit in the office. I’ll just numb the shoulder up and inject a cortisone injection. From there, we’ll wait 10 to 15 minutes and if their shoulder gets better then I’m pretty sure it’s a shoulder issue. If, however, it doesn’t get better, I oftentimes will try some anti-inflammatory and physical therapy on the neck and shoulder and then have you return to see me in a couple of weeks. If we’re not getting better, we’ll probably end up getting an MRI. X-rays are good at looking at bone alignment but MRIs will show soft tissue abnormalities such as disc herniations, bone spurs, pinched nerves or a rotator cuff tear.

What do you do with a patient if you’re sure it’s shoulder pain?

Dr. Klekamp: If I’m certain it’s shoulder pain, I mentioned doing the shoulder injection. Part of that treatment option, I’ll also bring in anti-inflammatories and physical therapy.

What about when you think it’s neck pain? Anything else other than things like physical therapy?

Dr. Klekamp: There are a multitude of different medicines, anti-inflammatories or muscle relaxants. There are nerve calming medicines that I use that can help with some of the burning or pain down the arm. Sometimes, even oral steroids are helpful.

Once you’ve done these initial treatments for neck pain, what are some other options a patient has down the road?

Dr. Klekamp: Once we establish where we suspect the pain is coming from through an MRI, then oftentimes we can do an injection and that’s where I get Dr. Kalb involved. He’s our injection specialist and we have a fluoroscopy suite here at Bone and Joint Institute. If I can see an area where I suspect a nerve is being pinched, I can have Dr. Kalb underneath a fluoroscopic imaging machine guide a needle to that area and inject a long-acting combination of cortisone and numbing medicine and 75 to 80 percent of the time it will really help with the pain.

It really is a comprehensive approach here at Bone and Joint Institute with many options for a patient, isn’t it?

Dr. Klekamp: Yes, I mentioned having you see Dr. Kalb, our physiatry injection specialist. If there’s a shoulder issue, I have multiple partners that all do shoulder evaluation treatment and surgery if we need to go that route. We have all bases covered here at Bone and Joint Institute.

To watch the full segment with Dr. Klekamp’s from Facebook Live, click here.

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