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Doctors' Answers to "Frequently Asked Questions" - Shoulder Pain
These comments are made for the purpose of discussion and should NOT be used as
recommendations for or against therapies or other treatments. An individual patient is
always advised to consult their own physician.
Question: A few months ago I injured my shoulder doing some heavy lifting. It got so bad that my arm started to constantly ache/tingle/ and go numb. The doctor I visited told me that I had a winged scapula, probably since berth and that liftling weights was aggravating it by putting pressure on the scapula nd in turn on the nerves in my shoulder. I was wondering if there is a surgery available to fix this situation. I went through some physical therapy which did nothing. Im tired of my shoulder always aching and not being able to do the things I enjoy doing. I would rather try surgery as an option, but I dont know if such a thing is available. I would greatly appreciate your help.
Answer: This is usually due to nerve damage to the muscle of the scapula. I would check with an orthopedic surgeon but would doubt there is much to be done.
Question: My wife has been treated for severe shoulder bursitis a few weeks ago.
She showed the orthopedist her xrays and was told she has
calcium deposits in there. She has had 2 cortisone injections to attempt
to break up the deposits. Her pain is still severe and doesn't seem
to be responding to the cortisone. Should she continue to take
repeated injections (5,6,7, etc.). If so, what are the short/long
term effects risks associated with this type of treatment. We are NOT
planning on more children so that is not an issue. THanks!
Answer: There is no bursa in the shoulder, you are describing calcific tendonitis. This is calcium deposition due to long term inflammation of the shoulder. The calcium represents that body laying down protection from the inflammation over a long period. This is hard to fix. Aggressive steroid injections and aggressive physical therapy are necessary if surgery is to be avoided. The surgery can usually be done arthoscopically, but occasionally requires an open approach to remove all the calium and restore the tendons.
Question: I have had rhemutoid arthritis since 1976. In Feb. 1999, I broke my right shoulder, collarbone, shoulder blade, six ribs, and compressed two vertabrae in the lower back. All healed up nicely over a period of months. In September, being right handed, I picked up a golf bag and felt a pain in my shoulder. I felt like I strained a muscle or tendon. Since that time, I have experienced a lot of pain in the shoulder and movement is painful and difficult. My doctor felt that it is either a pinched nerve or rotator cup tear. I do not have insurance and I have not had a MRI or neurological test to identify the exact reason for the problem. I get some relief from Aleve but he said that I could not take it with the Ibuprofin. I could take one or the other. Neither by themseleves give any relief. I am considering a chiropractor to see if he can identify the cause, or some other alternative. Do you have any suggestions regarding a medication for pain that I can take with the 800 mg. Ibuprofin (4xdaily)? Any suggestions regarding alternative dianogsis and possible solution? Thanks.
Answer: Acetaminophen with the Ibuprofen will be helpful, also any antihistamine(Benadryl and the like are available OTC at any pharmacy). The antihistamines will produce sedation but, help the pain. The onset of the pain suggests a nerve entrapment unless you experienced a "pop". Pain in the rotator cuff is pretty easy to diagnose-there are only four and any physician should be able to tell if you have pain. This would easily decide between the nerve entrapment and a rotator cuff tear.
Question: My husband wrenched his shoulder more than 3 weeks ago, and is still at the same intensity of pain with muscle spasms as he was when first injured. Because this is a workers' comp injury, we feel he is not getting the full attention/concern of his doctor, who prescribed only Elavil for nerve pain and sleeplessness, and 6 weeks of physical therapy. When he went for his first therapy session, the therapist was amazed that the dr had not prescribed a muscle relaxant. I talked a doctor into prescribing Flexeril without my husband being examined. Is that the best thing to ask for? Do you have any ideas? I am having to ask you because the dr assigned to him has said he won't see him again for six weeks. Thank you.
Answer: You need another doctor. Usually we start some variety of anti-inflammatory as well, sometimes a muscle relaxant like Flexeril. Also, for documentation purposes, he should be seen about 3 weeks to avoid any problems with comp down the road if he doesn't improve.
Question: my dad has been a diabetic for about 5 years now. his medications are glyburide and mevacor and recently was presccribed with nph. my main concern right now is his severe rt shoulder joint and muscle pain which has been going on for about 3 years. the doctor said that it was due to calcium deposits. he was injected with calcitonin 2-3x in a span of 3 years but it's not giving him any relief. hot packs give him minimal relief. it was also mentioned by someone that mevacor can cause muscle pain. how can we diagnose if mevacor contributes to the cause so we can stop the medication. also, how else can we diagnose th source of his rt shoulder pain. what other diseases/causes should we try to rule out.
Answer: If it was the Mevaclor, it would be more than one muscle. Also, the CPK enzymes will be elevated in this situation. Unlikely to be the Mevaclor. But, you would know in 2-3 weeks off the medicine. Calcitonin would not be the treatment for this problem, cortisone would. See a Rheumatologist or Orthopedist.
Question: I am a 35 y/o male with 2 previous shoulder surgeries. My first was a Bankhart lesion repair. My second was for chronic bicepital tendonitis. In which a biceps tenodesis was preformed. My most recent procedure was for adhesive capsulitis. This last surgery was arthroscopic and was done by Dr. K Speer @ Duke University. My question is about severe bruising. My arm is very badly bruised down to my elbow. My Dr. said that it was just the blood running down my arm.If this is true, why didn't it happen with my last two surgeries? I have alot of faith in my Dr.but this just doesn't seem normal.Oh yea, he stated he found a large bone spur,and alot of scar tissue. I am 8 days post op not due to go back until Nov.29th. When should this go away or when should I contact the Doctors office about my concerns? Please reply Sincerely,Steve Elmore
Answer: The bruising is from blood lost during the surgery. Some surgery is less bloody than others, hence less bruising. The blood should take about 6-8 weeks to go away if there is no further bleeding, heat will speed this process.
Question: I have a severe pain in my shoulder that only occurs when
I throw a ball with an overhand motion. It has gotten worse
over the last 4 or 5 years to the point that now it causes
such a severe pain when I throw a softball with any real
speed behind it that I can't move my shoulder for a few
minutes while I wait for the pain to stop. It just feels
like there is something in there grinding at the bones or
tendons. Is this a bone spur or torn rotator cuff? As I
said before, this pain only happens when throwing overhand.
The range of motion in my shoulder is perfectly fine and I
have no pain at regular speeds and movements. I can throw
a football by muscling it (sort of like throwing a shot-put)
and I can throw a softball with a severe side arm motion
(almost underhand). But these are only techniques I have
been forced to use to avoid the pain.
Answer: Probably a torn rotator. The shoulder is the only joint that when being used puts pressure on its tendons. This only occurs when the arm is raised over the midline. Hence when you raise your arm, you are putting pressure on the rotator tendons(four of them constitute the "cuff"). See your md, but I suspect you'll need surgical repair.
Shoulder Soreness [posted 1/4/99]
Question: I am a 31 year old white male. I currently work out
4-5 times a week with weights and have done so since I was 16. Recently I have switched my
diet to high protein, low carbohydrate, and low fat. For some reason my shoulders have
become very sore the last few months although I am not doing anything different than
normal. What could be causing this pain? It feels like it is more in the muscles than the
joints themselves. Is the diet depleting me of some nutrient that I might need? I do take
a good multi-vitamin once in the morning and once at night. Also, am I at greater risk
down the road for arthritis or other joint problems from this lifting?
Answer: I don't know offhand, but doubt strongly that it is the
diet. Try a non-steroidal anti-inflammatory and if it persists see a physician.
Cortisone for Shoulder Spur [posted
Question: I have a spur on my right collar bone in the
shoulder socket and it grinds and pops when I move it. The doctor gave me a cortisone
shot, what is this going to do for me and how is the spur going to go away with just a
shot. Thank you.
Answer: Decrease the inflammation and it won't go away.
Hopefully decrease the inflammation enough that you won't require surgery to fix the spur.
Recurrent Shoulder Problems
Question: I wakeup in the morning with great pain in both shoulders and upper arms.
Gets better as day goes but does not completely disappear.
Answer:If you are over 50 could be polymyalgia rheumatica, you'll need to see a
physician and get an examination and a sedimentation rate checked. If below 50, probably
tendonitis in the shoulders;bain will need an examination to figure out what it is.
Recurrent Shoulder Problems
Question: I have the following problems with the left shoulder: Can not lift my
left arm above shoulder level, and can not raise the left shoulder upwards. This kind of
an attack of pain lasts for 10-15 days & then it subsides for a while. I keep on
having these attacks once a month. During the period of attack I do not have that much of
pain in the morning after I've slept through the night but it becomes worse as the day
progresses. Past history & info about self includes that I am a 24 yrs old, married,
female, with no previous medical problems for the last 10 years. The acuteness of pain has
grown in the last two years. I do not have any history of past illnesses. I would be
thankful for any information or diagonosis that can be sent to me regarding this problem.
Answer: Well, if it occurs while you move the shoulder, it is probably something
intrinsic to the shoulder anatamy. However, tendonitis of the shoulder usually doesn't
come and go quickly. It might be a nerve compression further up the neck. Occasional
patients have an extra cervical rib which can put pressure on the nerve to the arm in
certain positions. You'll need to see your md while you are having pain to diagnose this
Shoulder & Scapula Pain
Question: I am presently 42 and my problem began 8 years ago when I injured my
right shoulder, the doctor said that I had a second degree strain of the AC. He said that
I could either have my shoulder wired down or could try keeping the shoulder muscles in
tone with weight lifting. The weight training worked well for 3 years until one day while
doing a lat pull, I tore a subscapular muscle. The muscle contracted so much that it
caused my right shoulder to raise two inches higher normal. It looked like I was trying to
touch my ear with my shoulder. Pain was very intense. My doctor gave me a cortizone
injection into the muscle(which was knotted up) and then electrical stimulation for a
couple of weeks. It eventually relaxed but it always feels slightly knotted. Cold weather,
stress, or overexertion will cause it to contract and once again affect my shoulder.My
doctor does not know why the muscle will not heal and has prescribed Diclofenac to use
when the muscle spasms, and it works in relaxing the muscle but my shoulder hurts for days
after. Now we get to my question, is it possible that my shoulder injury, with the
clavical being slightly protruded, could be allowing the subscapular muscle to contract
too much. If so, would having the clavicle wired down cause the bones to spread a little
and in turn cause that muscle to remain stretched a little more, reducing the chance of a
full contraction. Any advice is greatly appreciated.
Answer: You are describing a winged scapula, this usually indicates a damage to
the nerve going to this area. Why/how escapes me;but, I strongly suspect you have a nerve
damage. See an internist or a neurologist.
Persisting Pain in Shoulder
Question: My father is in his early 50's and his daily diet has consisted of
cigarettes, coffee, and stress for the past 20+ years. He refuses to seek medical
attention for anything, but I am concerned about him. He has had severe pain in his left
shoulder for at least two years now. He can not lift it or move it, he has trouble taking
off his button up shirts. I have heard of men with certain types of cancer having this
type of pain. Is that true and could there be other life threatening possibilities?
Answer: Could be a tumor in the shoulder, but more commonly will be tendonitis.
He needs heat, non-steroidal anti-inflammatories and exercise. The exercise consists of
putting all your weight on the "good" arm and letting the involved arm hang - a
counter or table is best. Rotate the "bad" shoulder in a small circle for 3
minutes in each direction.
Shoulder Pain / Stroke
Question: I have been suffering from an extreme pain in my right shoulder for
approximately 2 weeks. The pain shoots from the back of my shoulder, up my neck and down
the length of my arm. My fingers and hand are becoming increasingly numb and I am
concerned that this is possibly heart related. I don't think a strain or torn ligament
would hurt so intensely. I am a 32 year old female with a family history of stroke. I am
overweight (5'4"- 250 lbs.) and have recently been diagnosed with some form of
tachycardia, although the sonogram showed no damage to the heart.
Answer: Strokes are rarely painful, so this probably represents a pinched nerve
in your neck rather than a heart or vascular problem. This is particularly the case if it
lasts more than 20-30 minutes since angina is usually limited to this time frame and
caused by exercise. Start some non-steroidal anti-inflammatories (Motrin, Aleve, etc.) and
call your doctor for some neck x-rays.
Shoulder Pain and Drug Reactions
Question: I am a 43 year old male who is taking 10 mg Prinivil, 10 mg Lipitor and
10 mg Zyrtec. Recently I had unexplained pain in my right shoulder. It lasted for a couple
of months and just went away. A couple of months ago my left shoulder began to hurt. I had
pain when I tried to lift my arm straight up or to touch my right shoulder. Is this joint
pain related to the drugs I'm taking?
Answer: I doubt it.
Question: I have suffered from a partial dislocation in my left shoulder for the
past 7-8 years. Basically what happens is it pops out of place and I have to pop it back
in place myself. As you can imagine, this is very painful, and it remains very sore for
days afterwards. This happened from getting into a wrestling match with my sisters years
back, and she flipped me over and it came out. For a while when it would come out I didn't
really know how to put it back in then I figured that out later down the road. I don't
have to be doing anything physical for it to happen. It has happened in my sleep, when
I've been putting on a shirt, etc. I feel real handicap due to this. I am now in a
position where I can seek medical treatment for this old injury, but I'm not really sure
what type of specialist I need to see. Can anything be done about this or is this an
affliction that I'm going to have the rest of my life?
Answer: You need to see a sports medicine specialist (Orthopedic Surgeon). A
good general Orthopedic Surgeon will also do. This probably represents a defect or tear in
the rotator cuff. There are surgical procedures that can stabilize this(generally, some
continue with problems). I would proceed since there is a danger of nerve damage each time
Chronic scapula pain
Question: I have had constant pain in left scapula area for 15 years. Doctors have
not been able to do anything about the pain. One specialist suggested that surgery to
scrape the bottom off the scapula would help. That seems quite drastic when no one knows
what is really causing the pain. Stress makes the pain worse. It feels like a throbbing
knot of muscle that is only relieved with pressure on the spot. I can "rotate"
the shoulder, which causes a "grinding" of the scapular area. That is some
relief even though one doctor said that is not good to constantly "pop" those
bones or "grind" that area. A Cortizone shot to the area didn't relieve the
pain. I am wondering if acupuncture would help or if there was anything else I could do
Answer: Acupuncture might be of help and would not be particularly invasive.
Also, the surgical approach, if acupuncture does not work, is not reversible. Try a
massage therapy and/or a Rolfer (a special type of massage). I would see and osteopathic
physician at least once. They tend to try different techniques.
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