Diagnose my shoulder pain. [Post-Op Update]

In My Humble Opinion
21

Yet another update:
I saw the “nationally recognized leader in the practice of shoulder reconstruction”. He looked at the MRIs and said it’s a SLAP tear (duh). Gave me a shot of cortisone to bring down the inflammation and told me if that doesn’t help with the pain ‘we’ll have to fix you’.

The cortisone shot made my shoulder way worse for about 24 hours and then way better for about 2 days and then I think I over worked it and I’m right back where I started. It was nice to know a cortisone shot can help, but if using my shoulder is going to make it hurt again, what good is it. I might as well have not had it to begin with.

Anyways, I’m sure this doctor is great, but I think I’m going to go to a different one. Between the time I first saw him and the time I walked out of the office I think he spent a total of 60 seconds in the same room as me. He pushed on my arm a few times. Left to look at the MRI’s. Popped back in to tell me about the tear and ask me if I wanted a shot, gave me the shot and told me to come back in in 6 weeks.
I practically chased him down the hallway to ask him another question.

Sorry, I was hoping for someone that can spend a few minutes with me. What happens if I don’t get the surgery, will it get worse? Will it be the same? Will it get better? Now that we have MRIs and a (real) diagnosis is it worth trying PT again?

Both my parents have used the same Ortho for their shoulders and really like him, I’m going to give my worker’s come agent a call and see if I can switch to him.
I think the problem is that I went to a very busy doctor with a very mundane case. What I need to do is take a mundane case and go to a doctor who isn’t quite as busy and has some time to talk to me.

And it would have been really nice if he would have told me about ‘cortisone flare’ instead of leaving me to Google what the hell was going on with my shoulder after that shot. Just a simple “Just so you know, the pain might get a little worse in a few hours, if it does ice it and it should go down in a day or two”.

22

Ouch!!!

Yeah, this is one of the reasons why “nationally recognized” is not always what you need.

If you’re a zebra (or a whole stableful of zebras) you need those guys.

For a garden-variety shoulder injury, sometimes you need someone who doesn’t pout when presented with a “boring” case, and who will take the damn time to EXPLAIN stuff to you.

I’ve had the “cortisone flare” with a shot into the sesamoid area of my foot - was in A-GO-NEEEEEEE for much of the rest of that day and the next, and then felt great (until I re-injured the spot). The trauma of the injection, I think. Though in my case the pain didn’t start until the anesthetic (the shot was a combination of a steroid and a lidocaine, I think) wore off.

23

I’ve got an appointment with the other guy (that both of my parents like) on January 6th. My dad offered to sneak me in earlier, but I can wait. If it gets that bad, I’ll see about getting in earlier, but it’s not like I can get another cortisone shot too much sooner.

Also, on top of everything else, I’m getting allergy shots which hurt in and of themselves. I’ve started asking them to do them lower on that side. It ends up making my elbow hurt a bit, but that’s better then making my shoulder hurt because of the allergy shots on top of my shoulder hurt because of the tear.

The other thing I wondered about when I saw this doctor was that I was supposed to see the PA and then the doctor showed up in the room. I’m curious if he came in because he had time or if he noticed that it was a worker’s comp claim.

24

I had some bad AC inflammation… what they told me, and I found to be true, is that AC pain is very obvious and specific. The patient will point directly to their AC joint as the source of pain, and when a steroid/anaesthetic bolus is injected there, the pain will immediately relieve. Sounds like your thing is something different from that.

25

I had terrible frozen shoulder problems and only found any relief through neuromuscular therapy. I have no absolutely no interest in alternative/new-agey ANYTHING, so believe me, this is not it. And it may not help you at all. But it’s so worth trying if no other clear physical cause is found and/or the OP continues to have problems. Try to find a therapist in your area. This isn’t necessarily easy, but here’s some info about Doug Nelson’s practice. It’s based on the original “trigger point” work of Dr. Janet Travell and Dr. Simmons, so some people may have heard of it under that name.

26

So, it’s been seven and half months since I’ve updated this. I just got off the phone scheduling surgery to get my shoulder fixed. I’ve been putting it off and putting it off. I wanted to get it done between lawn mowing season and snowblowing season and the PA said if I did it in early September and I’d probably be safe to (carefully) snowblow by January, which is usually when it snows around here. As for mowing the lawn, I’ll probably call a lawn service just to finish out the last few weeks of mowing and deal with the leaves. Maybe catch the first few snowfalls if I’m not up to it yet.

I’m still kicking myself for not doing it last spring when I had a four month break of no snow and no grass to deal with and I’m not going get into next summer and feel the same way. Also, my worker’s comp agent is, officially, starting to nag me. As in, she’s calling me once a week to ask if I’ve scheduled it yet.

Sooner or later I’m going to have to deal with it. It’s not even that my shoulder hurts, it’s that now my other shoulder is starting to hurt. I don’t know if it’s just worn out or if it’s tendonitis from overuse (from favoring it now, but I can’t remember if I always used it more when lifting to begin with) or if it’s just sore in the way that someone going through weight training is sore. That is, things I’d usually carry with two hands, I carry with one, so it’s working more.
Whatever it is, hopefully when this is all over, I haven’t wrecked that shoulder too and it just goes back to normal on it’s own.

27

Sorry to hear that, Joey P, I was hoping thaht it would heal on its own. I had a SLAP tear repaired and some minor rotator cuff trimming in my shoulder a couple of years ago. It was worth it, I went from being pretty much unable to use the shoulder at all to, now, back to 100% with no pain ever. That said, don’t let anyone kid you, the recovery period is very painful and long term. I was back to 50% after 3-4 months of hard rehab (I’m married to a PT), but it was a full year before it was back to 100%.

Not trying to scare you at all, but I wish I had known going in how painful it was going to be. I can handle things much better when I know what to expect.

28

That makes it sound like frozen shoulder (aka senior shoulder). I had it last yr. They sent me to PT (that cost a LOT!!). But in the end, it self-recovered. PT did give me more range of motion.
I certainly wouldn’t have surgery on a shoulder that doesn’t hurt!!

29

It’s been nearly a year since the original injury and I’ve gone from ‘gee I think I fucked up my shoulder, the doc’ll probably just write my a script for something and tell me to take it easy for a few days’ to “Surgery scheduled for next week”.

30

I for one look forward to some one-handed over-posting on drugs a week from now :slight_smile:

Good luck - hope this is the answer to all the problems!

31

I’m sorry, Joey :frowning: I hurt my shoulder in a stupid way last Sunday(bent down close to the entertainment center to plug something in, then misjudged how close I was to it and caught the edge as I stood up), and although there’s no bruising the fact that it still hurts after a week and a half is making me wonder what sort of damage I’ve done to it.

32

I’m, um, experienced on drugs. I’ve posted over on GB pretty whacked out on percocets from my kidney stones. But I majored in drugs in college, I think I may have also minored in drugs as well*. In general, opiates tend to rev me up instead of knock me out. In fact, I stocked up on benedryl because I know that, IME, if I take Vicodin/percocet after about 7 or 8pm I need 3-4 benedryls to fall asleep around midnight, otherwise I’m up until 2 in the morning.
I get the feeling that taking my last Percocet at 5 in the afternoon isn’t something my shoulder is going to give me a choice about.

Now, as for one handed typing, that’s going to be tough, but I’ll get loads of practice at work. I’m going to have to move my adding machine (calculator) to the left side of my desk the night before the surgery. Using that with my left hand and counting cash with one hand is going to seriously slow me down at work.

*A few years ago I had a problem with a wisdom tooth and my dentist, who’s also a friend, sent me to another dentist to have it pulled. He mentioned that they’d offer Nitrous and asked if I’d had it before, my response was "um, not under the care and supervision of a doctor’. I could literally see his expression change from :confused: to :dubious: to :smiley: over about 3 seconds.

33

I never ever bruise. Sometimes I wish I did because I rarely have anything ‘to show’ for how badly I manage to hurt myself sometimes. Nothing serious, I just mean like pinching my palm in a pliers or slipping on the ice, no bruises at all.
When I did this, I rolled my ankle (as I do all the time), and I saw some boxes next to me. Naturally, I stuck my elbow out to break my fall and it pushed my shoulder up. I remember a few hours later seeing some red lines on the outside of my shoulder. The labrum isn’t there, but I think I did some damage over there as well. I assume, while the doctor is in there, they’ll check everything out.

34

Don’t exclude the possibility of a cervical disc problem …I had similar pain which was due to a damaged disc pressing on the spinal nerve controlling the shoulder and forearm or something medical-ish like that… Do you have any hand issues, does it seem worse after sleeping?

35

You’ll probably need x-ray and/or MRI.

I have my shoulder MRI plates (the “negatives”).

When they circle an image with a red pen, you know it’s not a good sign.

I have osteoarthritis - that’s pretty much worst case - probably an pulled or inflamed muscle or tendon. I don’t know what Tendonitis shows as.

36

I’ve had an MRI, there’s an image of it in post 16. FTR, I made the circle in it, not the doctor/radiologist.

37

All fixed up and officially on the road to recovery.

Here’s the pictures I know everyone one was dying to see.

I was supposed to get a video of the surgery as well. If I see one of the PAs on Wednesday for my followup, I’ll ask them about it.

38

deleted, cause it’s no longer a point.

Glad the OP has a dx and is on the mend.

39

I know GrumpyBunny’s post is gone, but this is all typed up so I’m posting it anyways.

Speaking of heartburn, before the surgery, about 97 times, during several calls and in the hospital they asked me about all the meds I was on and about any allergies. Each and every time I told them I can’t tolerate NSAIDS at all (even when given IV). Often times the person I was talking to would say “I see Torodal (or NSAIDS) are on your allergy list” and I would explain that I’m not allergic to them, but one of my other doctors put them on there. He figured if my reaction is that bad, it might as well be on the list to make sure I don’t get them by accident as he almost gave me Torodol once after I had just finished telling his nurse that I can’t handle it (long story, not relevant to this).

So, a few minutes before the surgery, the nurse comes around with two pills, I asked what they were, one was an Oxycontin (for pain relief afterwards) and the other was a Celebrex. I asked her if it was an NSAID, she said yes, and I told her (again) that I can’t take NSAIDS since they cause such bad heartburn, she told me this one didn’t but went on to say I didn’t have to take it if I didn’t want to, I passed on the Celebrex.

Surgery went fine, as I’m getting ready to go, she hands me some scripts, one of them is for Asprin (325mg). I told her (again FFS) that I can’t take NSAIDS because I get such bad heartburn from them. (At that point I should have just said “If you’d like to, you can call me GI doc, he’s in the same building”). She said “Well, why don’t you just try it for a few days and if it doesn’t work, they can call in something else” I don’t know why I had to think of this, but I told her that I’m not going to take the aspirin, and maybe she could get me the script for the other thing right away. Again, she insisted that I ‘just try it’* for a few days and see if I can tolerate it. I told her that I took some Excedrin a few months ago and threw up from the heartburn. I didn’t, but I got HORRIBLE heartburn a few years ago when I took some Excedrin for the first time since I didn’t know that Aspirin was an NSAID. She walked out and another nurse walked in to do something and asked if I had any questions, I said “Yea, I was just telling the other nurse that I can’t take aspirin because it caused such bad heartburn and she said that I should try it for a few days anyways and it didn’t work for me I should call back they would write me a script for something else, I’m not going to take this, could you just have them write me the other script now so I can make one trip to the pharmacy” She said “sure, no problem” (was that so effin hard). Then the other nurse walked back in and said “is there a problem” and I said "well, I was just asking her if she could get that other script right away, I really, honestly can’t take aspirin, so she’s taking care of it for me.

She was nice and everything, I just don’t know why she had a stick up her butt about the aspirin.

The funny thing was, after all that, she second nurse came back and told me the doctor said to just skip the aspirin, make sure I’m doing this and that etc etc and ‘don’t get a blood clot!’.
*even while I was there, I was thinking of the thread we had a few weeks ago about telling someone you’re allergic to a food just to avoid eating it so they’ll stop nagging you. I didn’t know how many more ways I could tell this nurse “it’s not that it gives me a little tummy ache, it’s that it’ll make me sick”. Next time I have a kidney stone, I won’t let them give me Torodol either, I’d rather have the stone for a few extra hours than have the stone and the debilitating heartburn that NSAIDS give me, it really is that bad and can last days sometimes.

Just for reference, I’m on 40mg of prilosec a day (double what you get in an OTC pill). I can have a full stomach, take a couple of Tums, take a single 200 mg Ibuprofen and go to bed and about 2 hours later I’ll wake up wondering why my esophagus hurts so much. It’ll be a few minutes before I remember that I made the boneheaded mistakes of seeing if I could handle Motrin. I do that once every 3 or 4 years. When I was in the hospital for my first kidney stone the nurse walked over with something to push into my IV line, I asked what it was, she said “It’s like a thousand times more potent then tylenol”
“Yeah, but what is it”
PUSH “it’s called Torodol”
“Is it an NSAID”
“Yes”
“Oh, I really wish you hadn’t given me that, I’m going to have really bad heartburn”
“No, you’ll be fine since it bypass the GI tract, and if it does we can get you our GI cocktail of lidocaine and Mylanta”
“Nope, I’ll still get it and that’s not going to work”

Two hours later, I had heartburn so bad I couldn’t talk and it took almost two days before it was totally cleared up.
That’s how Torodol ended up on my allergy list.

40

Egad, that is so fucking INFURIATING!!! Some of these “professionals” need to learn that yeah, sometimes the patients DO know what we’re talking about.

I know I’ve related this here before but when I was in induced labor with my son, and in agony, and asked for help, they tried to give me something preserved with sulfites (sulfites in food can be Very Bad News for asthmatics). The doctor tried arguing with me “What will it do to you?” and I replied “I don’t know, and I don’t think NOW is the time to find out!!” (truly don’t know; the mechanism isn’t well understood, Tylenol 3 has sulfites and has not caused problems for me).

And when I had my gallbladder yanked, I told the surgeon beforehand, and the anesthestiologist, that I needed to avoid any antinausea meds except for Zofran (as they all aggravate Restless Legs Syndrome). The anesthesiologist gave me Zofran. I saw my records later on and the surgeon ordered either Reglan or Phenergan (I forget which). Either of these would have given me a truly bad night. Fortunately I didn’t need them.

That said, as I mentioned upstream you MIGHT be able to tolerate NSAIDS if you take a proton pump inhibitor or something well beforehand (or maybe you can’t, I don’t know your metabolism). Worth discussing with your GI doctor just to have in your back pocket if needed at some point in the future. Tylenol is good but it just doesn’t touch some things.

Arthrotec (as I also mentioned) had the fun side effect of giving me death farts from hell :eek:. One may view this is a negative or a benefit :D.