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.

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?

Cortisone for Shoulder Spur [posted 11/10/98]
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.

Recurrent Shoulder Problems [posted 11/10/98]
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 [posted 11/10/98]
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 one.

Shoulder & Scapula Pain [posted 11/4/98]
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 [posted 8/6/98]
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.

Shoulder Dislocation
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 you dislocate.

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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