Diagnose my shoulder pain. [Post-Op Update]

In My Humble Opinion
1

Right off the bat, I made a doctor’s appointment for Monday, but I’ve been racking my brain trying to figure out what’s going on here. Either it’s nothing (just a pulled muscle) or it’s more then one thing so the symptoms aren’t lining up with any one specific diagnosis. Either that of playing internet doctor by myself isn’t working as well as I’d like it too (I seem to have about a 50/50 shot at diagnosing myself this way).

Anyways, 4 weeks ago this Monday I was walking, literally just walking and I felt something happen in my shoulder. If I was doing something at the time I would have assumed I pulled a muscle or hurt myself or something, but I was just walking and swinging my arms like I normally would, and I suddenly found myself grabbing my right shoulder wondering what happened.
Since then I’ve had some pain (tightness/spasm) on the right side of my neck and a small amount of pain on the lower part of my shoulder blade. The majority of the pain and aching has been on the outside of my right shoulder.
Also, it hurts to make a throwing motion. Right before my arms gets overhead. Nothing horrible, I can do it just fine, in fact I do it throughout the day to keep all the muscles stretched out.
Rotator Cuff, right. Okay, makes sense. So my first question is, can rotator cuff pain come and go? Right now I have a little bit of aching, probably wouldn’t even notice it if I wasn’t thinking about it and that’s it. There’s no pain at all moving my arm up and over my head. Also, the pain has never really been excruciating. Between it not being awful and it coming and going, I’ve been putting off going to the doctor. I hate showing up at the doctor and having whatever was bothering me be gone. But even though I’m fine now, I’m sure it’ll return.

So here’s the next hint. About oh, 2 or 3 months ago I actually did injure my shoulder. I rolled my ankle, fell straight down (as one does when they roll their ankle) and caught myself on a stack of boxes with my elbow. So my elbow pushed my shoulder straight up. That hurt I went back to my office to sit down for a while. My shoulder was in pain for about a week after that and I noticed that I even had a small bruise on the outside of my shoulder later that day.

I’m wondering if this pain is that injury flaring back up again. At the time I came up with a SLAP tear but it didn’t seem right. Rotator cuff tear still doesn’t seem quite right. I’m wondering if maybe I separated my shoulder that day and maybe I did something a few weeks ago to exasperate it.

Couple of things. There’s no weakness in my hand or arm but I do notice that hand/arm getting tired much faster then it should be.

I mentioned above that my neck is stiff/spasmed, but I’m not sure if that’s due to what’s going on or a secondary thing because I often find myself with my right arm raised up a little bit (I don’t know if my body is doing that because of a tight muscle or it hurts to let it hang down all the way).

As far as pain at night, I think I’ve only woken up from it once and that was because I was actually sleeping on that shoulder and normally I sleep on my other shoulder.

No tenderness/redness/swelling/bump that I’ve noticed.
My guess is that the doctor is going to tell me I have a strained muscle in my shoulder, give me some muscle relaxers and tell me if it’s still bugging me in a week to either go for PT or imaging to see what’s going on. I suppose that’s better then having a torn muscle. The only reason I’m worried is A)the fall and B)this current bout of pain has been going on for a month now.

2

If you injured your shoulder some time back, you may have been favoring it. This may have led to a “partially frozen shoulder.” You can actually get these for almost no reason as well. As I understand it there are fibers in your shoulder that help keep the bones in place. If you underuse your shoulder joint these fibers can stick making certain motions difficult – commonly raising your arm fully or putting you hand behind your back.

I have this right now and am doing physical therapy to loosen things up again.

3

My first thought is inflammation/impingement. I’ve had that and it lasted a few months. I had to do broomstick drills and dead hangs to get rid of it. It took about a week for the pain to go away.

4

I had something pretty similar that ended up being inflammation as well. I was painting some high ceiling and stretched that muscle out badly. It came and went for a long time and it was very easy to overuse that arm.

I hope you feel better soon.

5

My first guess would be you damaged the a/c joint in that fall.

6

That’s my thinking right now (separated shoulder).
What I’m trying to figure out is if that can refer pain to other areas of my shoulder (outside, neck, blade) and if it can come and go.
Right now the top of my shoulder is aching, a few hours ago I was wondering if I should cancel my appointment.

7

Well the joint itself wouldn’t refer pain too far generally but muscles spasming in response to the joint pain definitely could.

A family doctor is usually only going to give a pretty generic diagnosis of the problem, a physiotherapist would probably be a lot more useful. However many insurance programs are only going to pay for a PT or a orthopedic surgeon visit if you get a referral from your GP. In my area you fant even get an appointment with a specialist without a referral.

8

This. I’ve had just about every shoulder problem/injury out there and what you’ve described sounded a lot like my a/c joint strain. It can absolutely refer pain to surrounding areas such as the neck and shoulders (for me it was the neck especially). Ice is going to be a wonder drug and your best friend if you use it frequently.
ETA: Does it hurt when you shrug your shoulders up as high as possible?

9

That’s what I’m worried about, but my doctor has been pretty good about giving me a ‘generic diagnosis’ (and some pills and directions for what to do) as well as a script for PT or imaging and telling that if whatever’s bugging me doesn’t get better in X weeks to just go and get an X-Ray or go right to PT instead of coming back to him first. Saves him time and me money. He’s also a believer that sometimes just being out of pain for a few days will help heal the problem. For example, in my case, I’ve been walking around with this shoulder tensed up for 4 weeks now. Maybe talking muscle relaxers for a few days so the knot in my shoulder lets go will give it a chance to heal up on it’s own.

As for a specialist, I’ve never had any issues going right to them without referrals. I have an allergist, an ENT and a GI doc that I saw without asking for permission. The only thing that ever happened with any of them is that I got a letter from my insurance company saying that they did some research on my endoscopy and decided that it was, in fact, medically necessary (gee thanks) so they will pay for it.

Just shrugging them, not so much, if I shrug them while pushing them back (like if I wanted to have a soldier like posture) then it does a bit.
I have looked at some of the tests on the internet that a doctor is likely to do and some of them do produce pain concurrent with a Shoulder Separation.
There’s one called a Cross Arm Test. Put your arm out straight (think of walking like a zombie). Now bend your elbow in 90 degrees At this point, your right arm is pointing directly to your left. Apparently this ‘isolates’ the AC joint and if it’s damaged it’ll produce pain.
I tried this and I’m sitting (well, standing when I did it, it makes a difference, I’m always surprised at how interconnected everything is) here moving my arm back and forth thinking that it kind of hurts, but it’s an awkward thing to do, so it should hurt, right? Then I did it with the other arm, the other arm just swings back and forth like it’s no big deal.

So yeah, I’m leaning towards Shoulder Separation that just hasn’t healed yet. Probably going all the way back to when I fell on my elbow. My shoulder must have pushed my AC up and away from my clavicle and pulled the ligament apart.
I’m going to guess it’s just a Type 1. In other words, I sprained my shoulder.

10

It sounds like an injury to/inflammation in your bursa, in my non-professional opinion. Since the majority of the pain is on the outside of the shoulder. Of course shoulders are full of little parts which can hurt so it may not only be bursitis.

I sympathize, I have shoulder impingement and when it leads to a bout of tendonitis, it can cause stiffness and pain in just about every part of my upper body on that side. I’ve luckily never had bursitis, though. All of my pain is in the inside front of my shoulder. Hope you feel better soon! ICE, Advil and resting that arm will probably be what the dr. orders and you can start that now.

11

So, here’s where we stand…
I went to the doctor, after doing a couple of things and finally pushing my arm into a position that hurt enough that he had to sit down since he was laughing when after I swore at him he felt it was either rotator cuff inflamation or a torn labrum. I asked him about a separated shoulder and he said the pain would be higher then where I was pointed. He sent me off to get an x-ray and told me that PT would be calling.

A few days later I saw the X-Ray report (I had the pictures right away, but they don’t mean much to me). In the end they say that my AC joint is 6mm and suspicious for a separation. It should be noted that they did not take pictures of both sides so I don’t know what they’re comparing that to. Everything else looked normal, but all that really means is that there’s no broken bones.

Yesterday I went in for a PT evaluation. They ran me through the gamut or measurements and, of course, I wasn’t in a lot of pain yesterday. He felt that my diagnosis was impingement and the problem is that everytime I move my arm though the pain I’m actually making it worse since that re-inflames everything. He gave me some stretches to do at home, set me up to come back twice a week and we’ll see how it goes. I’m considerably more sore today then I have been for a while, my shoulder actually feels bruised, which is odd since it wasn’t bugging me much at all yesterday.

On the one hand, maybe all these stretches will help, as well as me not moving my arm through that area that hurts now that I know not to do that. OTOH, it might not help at all (since it’s been a while since the injury) and we’ll have to keep moving forward. I assume an MRI and/or cortisone shot* is next. Too bad they can’t do an MRI first.

*I never knew until know that cortisone was an NSAID. I just never gave it any thought since I’ve never had an NSAID shot. I just assume it was a steroid. Actually, looking at wiki, it’s not an anti-inflammatory at all. Part of my whole problem is that I can’t take NSAIDs, they give me terrible heartburn. I can have full stomach, take some tums (I already take Prilosec) and take a single Advil and my heartburn will be bad enough to wake me up. Not being able to take NSAIDS kinda sucks sometimes.
A few months ago when I had a kidney stone they gave me Toradol in the hospital without telling me what it was. As soon as I got the nurse to tell me that it was an NSAID I told her I was going to end up with heartburn. Even with it being IV (and bypassing the GI tract) within a few hours my heartburn was so bad I had a hard time talking.
Oh, one other thing, the PT guy made it sound like something that’s going to make this more difficult (or more pointless) is that this is due to an injury as opposed to a posture/movement/age etc issue. IOW, there aren’t bad habits to correct which is also something that can cause impingement. He suggested that impingement caused by a trauma injury might just need time to heal. Since this is a worker’s comp issue, I got the feeling (from my GP) that an X-Ray and PT is just where you start and we can’t skip ahead. I think if I went to my doctor and told him I did this at home he would have sent me to get an MRI and referred me to an Ortho if he could see something that he couldn’t fix with some muscle relaxers and ice. That’s probably what’ll happen if there isn’t any improvement after a few weeks of PT.

12

Cortisone is not an NSAID and is a steroid; albeit a corticosteroid, as opposed to the more commonly known anabolic steroids.
And in regards to your chronic “heartburn”, have you had this checked out by a gastroenterologist? Because what you describe sounds more like gastric reflux, even possibly gastric ulcers, than simply heartburn.

13

I’ve had several endoscopes so I know I’m in the clear WRT ulcers.
As for why I get such insane heartburn from NSAID’s, the next time I see my GI (and I have no idea when that will be), I should try to press for a reason. I had to stop drinking (craft) beer because it was doing it as well. Literally just 3 or 4 sips and I’d have to go home, my heartburn was debilitating. I’ve always had heartburn, but only a few things brought it on that fast and that bad. NSAIDs and beer being two of them. Anyways, the reason I want to press for an actual ‘diagnosis’ is to A)find out if there is some possible answer and B) when I do go to a doctor with pain I really hate saying "I can’t take Advil/Naproxen/whatever NSAID you’re going to write me a script for and I always get worried that they think I’m pushing for narcotics. I’m not, I just physically can’t take those drugs. As I mentioned above, even taking an IV NSAID caused it.

I should try again now that I’ve had my esophagus dilated. Maybe that’ll make a difference. A while back I was wondering if maybe part of my heartburn was acid getting up unto my esophagus and not being able to drain back down because it was so narrow/strictured.

14

I’ve had rotator cuff issues off and on since 2009, and they definitely can come and go, pain-wise (maybe others can as well, just speaking from my own direct experience). In my case, there was no evident cause for it, but as it developed, certain motions became very ill-advised. For example the kind of bend/twist you need to do to get a can of food off a lower shelf at the grocery store, especially if it was back a bit from the edge, would often elicit some very bad words from me.

Your primary care doctor might refer you directly to a physical therapist, or might send you to an orthopedist (would might then send you for PT). You might get an MRI somewhere along the way to confirm it, especially if your symptoms don’t sound like obviously one particular type of injury.

What the primary care doc (or the ortho, or the PT) will do is put you through some range-of-motion and strength-testing based on your history, and it’s quite possible that something that had otherwise settled down a bit will be sufficiently aggravated by that mistreatment that it’ll give them some very good data. I know my shoulder ached more for days after my first ortho visit.

If it is rotator cuff, the conservative treatment is PT - they are not eager to jump to surgical correction. I found that with my right shoulder, it really seemed to help. Then of course 2 years later, the LEFT shoulder started hurting for no good reason. I saw the ortho, got a scrip for PT, lost the scrip so never went… and the shoulder got better.

15

NSAIDs are (as you know all too well) linked to stomach issues. My WAG is that the esophageal dilation (well, the need for it) was NOT aggravating the acid situation - strictures tend to result from the acid.

Are you on any kind of proton pump inhibitor? That would be stuff like Protonix, Prilosec etc. If not, you might be able to use an NSAID as appropriate if you use those (or a more immediate antacid, e.g. Tums or Zantac or Tagamet). They also package one prescription NSAID, Arthrotec, which is a combination of diclofenac (Voltaren) with misoprostol (Cytotec) - the theory being that it will help protect the stomach against the damage of the NSAID.

Something like that might be helpful (if not to your stomach, then to the drug company’s bottom line - the ingredients are both off-patent and much cheaper purchased separately). I did find that it helped my knee and shoulder pain MUCH better than the OTC ibuprofen I’d been using. So much so, in fact, that I sprained my ankle (see, I could walk faster without being in agony…), for which I blamed the doctor :).

Reflux can also worsen, for no apparent reason. About a year ago, my voice started to get hoarse. Enough so that it was startling people. And it seemed like my asthma wasn’t being well controlled either. Objective tests ruled out issues with asthma, as did a very short course of prednisone (didn’t make me feel better) so we looked for the mimics - of which GERD is a big culprit. A repeat scope and yep, the GERD had gotten quite a bit worse. No idea why - but they switched me to a higher dose of a different formulation (Dexilant, which is the right-handed version of Prevacid, in a sustained-release formulation that supposedly helps your stomach better as well as doing more for the company’s bottom line) and the upper damage (that was causing the hoarseness) gradually got better over several months.

If you haven’t seen a gastro recently, it may be worth a visit. Uncontrolled GERD can be unpleasant, and can also do long-term damage (read up on Barrett’s esophagitis some time).

Tylenol doesn’t do jack for some of this kind of pain. Right when my shoulder and knee were at their worst, I had my gallbladder yanked. So for 10 days prior to the surgery, I had to give up my ibuprofen. Yeah, that kinda sucked.

16

So, after a really long time I finally got an MRI (after 8 PT sessions). I just got back and looked at the images. After almost giving up on the assumption that I can’t read an MRI scan, I found what I’m almost positive is a labrum tear. What kind it is or how bad, I’m not sure, but this sure looks like one. Even without contrast that seems pretty clear.

As for PT, it did seem to clear up some impingement issues, but it really sucked. I was in a lot of pain during those four weeks and came out the other end with a different issue. Of course when I fell I’m sure I caused both issues and the impingement was hiding the tear. Clearing up the impingement revealed the pain from the tear which is why the PT felt like it didn’t do anything. After the 8 PT sessions when the therapist asked me if there was any improvement I told him I felt like I went ‘sideways’. I didn’t want to tell him there was none, but I certainly wasn’t better.

My PCP also referred me to a shoulder specialist. I called and tried to make an appointment with them, but I might not be able to get in for a month or so. But before we made the appointment the person I was talking to said she would talk to the coordinator to see if she could squeeze me in sooner, which would be great since it, ya know, hurts (but I know everyone else that’s seeing him is in pain too). If it’s too far off, I might call my PCP back and see if I can get some pain killers, some days get kinda rough. I hate asking for drugs, but I can’t take NSAIDS or the heartburn is worse then the shoulder pain, and even just sitting here it’s aching.

I have this funny feeling surgery is in my future, but I’m hoping maybe the ortho will say something like “just take it easy on that arm for a few months and it’ll be fine” or “all you need is a cortisone shot and it’ll be okay” but I’m pretty sure laburms don’t work that way.

17

My own experience – Playing volleyball, I hyper extended and ended up with a little tendonitis. The swollen tendon then started rubbing on a bone spur, and the rubbing prevented it from healing.

I went to PT for WEEKS with no help (probably made it worse). The MRI ended up showing what the real deal was. Orthoscopic surgery and I’m right as rain.

18

Speaking of which, reading through this the thing that jumped out was you were out for a walk when the pain hit. That made me think of sports activities like shot-putting, pitching, competitive swimmers, where they often wind up treating the opposite side of the body from the sore shoulder - not to treat the injury but to resolve the cause of the injury. For instance weak obliques on the left side can cause the opposite shoulder to be working harder to maintain stability. I’m not a doctor and all that jazz but side planks are an easy low-risk exercise you can try for a while. You won’t want to do them on the side with the sore shoulder probably but it might point you in the right direction for preventing a recurrence (and if not you’ll just have a stronger midsection :D).

19

I just went up to see what I wrote and it reminded me that I forgot to mention shoulder separation to the MRI tech. Maybe she looked at the AC/CC* joints and I just can’t see them on the scans (not that I have any idea what I’m looking for) I just wish I had mentioned that before hand so she could have made sure to do it. I’d prefer not to spend another 10 minutes in the tube but that would be better then having to go back and start over if the ortho thinks that might be possible.
At one point I was worried that since the PCP did this without contrast that I might have to do it again with contrast but that tear is pretty clear (to my untrained eyes) so I don’t see the ortho needing to look at it again, at least not to diagnose the tear.

Thinking about it maybe there’s the chance that I DO have a separated shoulder which is causing all the pain and the tear isn’t the issue here. In that case there’s a better chance of not having surgery. I don’t that it’s going to be that though. I guess I’ll find out whenever I can get into the Ortho, which might not be for a while.
*Actually, now that I think about it, I do recall seeing at least the tip of my clavicle on the MRI, so the AC joint is probably in the image.

20

Doctor (primary) called yesterday and said that after he looked at the MRI (and I don’t know if he only looked at the images or read a report as well, I haven’t seen the report yet) he didn’t see a tear just some rotator cuff inflammation. He thinks a cortisone shot will do me some good. I asked him A) about the tear that I saw and B)if he’s going to to do the shot or the ortho.
A)He reiterated that he didn’t see a tear, just inflammation (tendonitis?) b)it’s a ‘tricky spot’ so he wanted to leave the cortisone shot up to the ortho, which is fine with me.

I managed to get an appointment with the Ortho’s PA on Friday and we’ll go over the MRI then. To the best of my knowledge they don’t have the MRI since they asked me to bring them in. If she’s (the PA) going to look at them with me there I’ll be able to ask her about what I saw so it’ll be nice to get an answer on that.

My WAG is that if it’s just inflammation then a cortisone shot and ice will help, but it’s a labrum tear then then the shot and ice won’t do anything. On the one hand I don’t think it’s that, or I have that AND the tear. OTOH, it would be nice not to be looking at surgery and being out of commission for several weeks.