Let's Diagnose My Shoulder Pain!

Discussion in 'Off Topic' started by StarPattern, Jan 10, 2018.

  1. StarPattern

    StarPattern Senior Member

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    Hey all! I've been on this forum long enough to know there are some very smart people here. Perhaps you can share some insight into my shoulder issues that seem to confuse a bunch of doctors.

    Back story: On November 8, I was throwing hay to horses at the barn. In all, I was feeding 4 horses and was forking hay over the fence to them. Hay was not particularly heavy, nor was I moving fast or in any unfamiliar ways. I'm not a stranger to throwing hay and this is a fairly common thing for me to do. The next day, I could not move both of my arms and when I did, pain radiated from the front of my shoulder, down my upper arms and dissipated around the elbow. I figured I tweaked a muscle, used some muscle liniment and took it easy for a couple days; pretty typical routine for sore muscles.

    Muscles did not feel better after over two weeks of waiting and advil/ibuprofen/aspirin/robax did not have any bearing on the pain. That's not unusual for me, since most pain meds don't really work. Codeine and T3s also have no effect (I know this from the time I did something to my collar bone and the doctor prescribed liquid codeine first and then T3s when the codeine didn't help the collar bone pain).

    Treatment: (ETA) I went to the doctor first, who told me it was sore muscles and to take it easy - despite me telling him I'd already taken it easy and treated it as sore muscles for the last couple weeks. Then I went to the Chiropractor, who told me my neck was out. He prescribed gentle adjustments 3 times a week for two weeks, plus icing the area for 15 minutes every 4 hours. After two weeks, there was no improvement, so he ordered x-rays of my spine. Turns out I have something called Spinal Subluxation, which is a $1200 treatment on top of thrice weekly adjustments. He was only ever adjusting my neck and not addressing my shoulders, so I decided to visit a Physiotherapist for Sports Injuries.

    The Physio determined I had a torn bicep muscle in my right arm and minor strain in my left. He did a round of ultrasound wave therapy and something called Inter Muscular Stimulation and gave me light exercises to do. After the first appointment, I could move my arms which was great. He asked me to come back three times a week for the first two weeks, then twice a week for the next two weeks and gradually taper off to once a week. I did that for about 3 weeks, even though the pain did come back. After three weeks of that, I visited a doctor to see if they had other ideas.

    The doctor (a rheumatoid specialist) sent me for blood work and x rays. Blood work came back completely normal and my thyroid tested at "optimal" levels. Apparently they can test for rheumatoid arthritis in blood now (cool!), but my results came back negative for that. X-rays showed absolutely NO damage to my shoulder, neck or upper arms. In fact, the doctor was surprised given my history with horses. No breaks, chips, spurs, nothing. My ultrasound is scheduled for February 1 and he gave me 10% Diclofenac to use as a topical anti inflammatory.

    Currently: I am still in horrible pain and the Diclofenac absolutely does not work. I guessed it wouldn't, since other topical anti-inflammatories have a history of not working on me, but the doctor seemed sure it would help. I am unable to sleep on my side or back, and wake up hourly due to pain. I actually don't want to go to sleep because I know it will hurt. My hands go numb and this morning, it took me almost 20 minutes to put my socks on since it feels like I have no strength in my hands. I know I do, because I've done 4 separate strength tests with 4 different professionals and all are surprised at how much strength I have given the amount of pain I'm in.

    I went back to the doctor tonight (a different one at the same clinic) and after looking over my file, he has opted to send me for two more blood tests - one to test again for arthritis (the first test missed this specific one) and muscle enzymes or something like that. He also gave me a number to call to expedite my ultrasound, even though he feels it'll come back clean give the results of everything else. He asked if I had a history of illness, and I don't. As a kid, my worst illness was chicken pox on the back of pneumonia. Since then, I've had the occasional seasonal cold. About 5 years, I contracted mono, but it was a minor case, mostly stress related apparently - 14 days of antibiotics and a couple days home in bed and I felt 100% better. I can count on one hand the number of colds I've had since then. I don't drink, smoke or do drugs and I eat pretty healthy - I'm in good shape, not over or under weight and I'm fairly active. The only health issues in my family is breast cancer (aunt - maternal), carpel tunnel (mother) and glaucoma (grandmother - maternal). My dad's side has one instance of heart issues and dementia. The majority of my family is extremely healthy, living until 90+ with minimal health issues.

    So that's where I am. I have a very high pain tolerance (to the point where I broke ribs and continued working and didn't know I broke the bone in the top of my foot). Having both shoulders in such pain effects my life to the point where I can't function normally. Putting socks on takes 20 minutes, easing my arms into a jacket takes about the same and careful maneuvering, showering and washing my hair is a trial of patience. I haven't had a full night's sleep since the beginning of November and it's starting to affect my mental stability - my temper is through the roof, I can't focus and I have no attention span because I'm tired. I find myself crying for no reason. I can't lift my arms above my head without moving extremely carefully and sudden movement causes shooting pain down my arms. I can't move my fingers independently (but that's been ongoing since I was a kid) and now the pain is spreading into my left knee.

    Sorry for the novel, but maybe someone here has an idea of what else I could ask my doctor to look into? I've already paid close to $1000 in treatments (since I don't have benefits and pay for chiro, physio and medication out of pocket) and I'd love to be able to reduce this pain by even 50%.
     
    Last edited: Jan 10, 2018
  2. Dona Worry

    Dona Worry Senior Member

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    From you description, it sounds like nerve pain.
    I think it is well beyond my experience, but a cheap thing to try that *I* have found to help with that sort of pain (but never anything so severe) is a Vitamin B supplement. Like I said, doubt it will achieve anything, but a bottle costs in the ballpark of 5 bucks, so it's worth a shot.
    You can also try to eliminate any inflammation you can with a diet avoiding ALL grains, starches, and sugars. Basically, you can eat eggs, olive oil (butter technically contains sugar, as do all dairy products), meat, and vegetables. This is a really boring diet, BUT it has helped me deal with persistent pain in the past, and it is helping my mother with her back injury.
    Again, it might not help much, but it also can't hurt you either.

    Good luck, sorry you are dealing with this!
     
  3. Circle C

    Circle C Senior Member

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    Make an appt with a good Physiatrist. Get into a good PT program.
     
  4. slc

    slc Senior Member

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    There are a couple possibilities when you have pain down your arms.

    Now...until you get your ultrasound, you don't know much. Xrays show a lot, but not everything. And...the ultrasound may only check one or two spots - the most likely ones to look for, given your other test results, your age, etc.

    I also assume that thus far, no one xrayed your NECK.....that might be where it is.

    So. Anyway, a couple possibles.

    One is that you have injured your neck, and the pain 'radiates' or 'refers' to your shoulders, and down your arms. You hurt so bad when you lay down or put your socks on because of how you position your neck when you do those things. Very often, pain 'runs' down nerves, it doesn't always pinpoint where the actual injury actually is, where the pain is actually originating from.

    How does that work? The bones of your spine form a protective column with a small hollow down the center, and that hollow column contains your spinal cord, or nerves. The nerves go down that channel inside the bones of the spine.

    But branches of the nerves emerge from that bony column and then take a sharp 90 degree turn and go down your arms(and other pairs emerge further down, and enervate your sides, and legs, and so on, but we're only worried about the pairs of nerves that go down your arms).

    So. Where the nerves emerge from that protective bony column, they then take a sharp turn to go down your arms. And many, many things can irritate them right there. There is very little room there. Little things mean a lot in that narrow space. Bone chips or rough spots around the hole('foramen') where the nerves emerge from. Swollen muscles or tendons. Spinal disks(the 'pads' between the bones of the spine), that are deteriorating or sticking out. A lot of things can irritate the nerves and it's often right where they emerge from the bony column that they get squeezed.

    Even muscle spasms can clamp down on the nerves. There just isn't much room there.

    Many people who do barn work have very tight strong muscles in shoulders and neck, and if they get some injury anywhere along there, those muscles clamp down like mad.


    OR.....as noted, the nerves still have a long way to go down your arms and hands. SO. What's hurting your arms need not be right in your neck, it can be farther along the trail those nerves follow. Those nerves still have to squeeze through very narrow spaces in your shoulder anatomy, which is incredibly complicated and has a huge tight bottleneck where you transition from 'shoulder' to 'arm.' Just let anything in there get inflamed, spasmed, suddenly those nerves are running very, very short on space.

    So what often happens is that the nerves don't just get slammed, they get chronically pressed on, and irritated for a long time, and they start firing off all the time, in a crazy way, as one neurologist told me, 'the fact is, they just get p'd off.' Then you get your chronic pain that just won't go away.

    So what to do. First is you have to find where the pain starts from. If the xray shows nothing is hot, the ultrasound might - ultrasounds are good at showing injuries to soft tissues. Or you may need an MRI. Sometimes that's the only way to find out where the hot spots are.

    Now...you've got pain in BOTH arms. You could have two separately injured shoulders, or a neck that is injured on both sides...or....

    You could also have an injury to the BACK of your neck - those 'facet' joints. Your...ah...withers. Yes, we have bony projections from the back of the neck, basically...'withers.' They're meant to stabilize and strengthen the neck, but they can get roughened up by arthritis or injuries.

    The key is your age. If you're young, you may simply have one clear injury that you can rest, heal and medicate and do PT for a while. It might not even be in your neck. You could have two injured shoulders.

    If you're older, you might just be experiencing what some really annoying doctors call 'old age.'

    Many people as they get older have what's called a 'cranky neck.' Horse folk often get this and at an earlier age than other people do.

    A 'cranky' neck has lots of changes spread around here and there - each individual change is little, but they add up to one irritated neck. Foramens getting roughed up, discs that are sticking out or getting crumbly on the edges, and facets that are getting arthritic and rough. Treated with traction(it seems to loosen up muscles so they don't clamp down so hard and irritate the nerves so much), and maybe tiny amounts of a drug like neurontin to cool the nerves down. No, neurontin is not a pain killer. It cools nerves. It's different.

    If it's mostly facets(those 'withers' on the backside of your neck), getting bad, your ceiling painting days are over. You can't 'hyper-extend' your neck back(such as to look at a ceiling when you're standing up straight), or it will hurt like hail and you'll start irritating those nerves again. You'll need to not pull on your arms really hard with them straightened out all the way. Keep a bend in your elbow when you pick up or pull on things.

    If it IS mostly facet joints and it's really really bad, you can have the little nerves responsible, ablated. That means basically, you're 'nerved'. The nerves that cause all the hurt in the facets are tiny and not exactly necessary for survival, at least not the part that is jammed in between the facet joints. Since the nerves can grow back together, some people have them ablated annually.
     
  5. ibsammy

    ibsammy Senior Member

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    This might sound like hippy witch doctor, but do you drink red wine? It could be exasperating the inflammation you already have. If I drink red wine after a physically trying day I am in agony, specifically through my shoulders. I am another with a crazy high pain tolerance (dislocated my shoulder, then went on vacation with it dislocated, relocated it myself when I got back and saw pictures of how out of place it was, it was just dangling in front). Of course, that dislocation is why my shoulder is my "weakest link".

    The big culprit for me is the pec minor. Do you spend an extended period of time seated or in front of a computer? I'd be willing to bet yours isn't helping anything. Pec minor releases can be done at home, but be warned it HURTS. How to Release Your Pec Minor Fascia – For Shoulder Pain & Shoulder Mobility Issues | Mobility Mastery

    This all comes with the disclaimer, I am not a doctor, I've just done years of violent sports and my body shows it now.
     
  6. slc

    slc Senior Member

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    Now the warning part: don't, no matter what, no matter how much you hurt, don't jump at surgery, especially not at these 'laser spinal surgery centers.' Most of them make very unrealistic promises, and just give cortisone shots, you feel great for a few weeks, then sort of lousy, then those wear off completely in a few months.

    And in fact, you really, really want to get a lot of investigation and imaging done and talk to a LOT of surgeons before you ever even THINK surgery. Not the ones at these standalone 'clinics.' Ask around which surgeons work on the nearest professional football team players. They're jamming their necks and shoulders something awful, all the time. And....working with horses for 20 or 30 years is...well, basically like playing professional big league football for a few years....

    And NO surgeon EVER should be like....'hi, yeah, let's cut on you.(unless you actually have a real severe injury that's just like totally obvious, but most situations just are not like that). The GOOD surgeons are like 'wait a minute, hold on there, WHAT did your other doc tell you....do we know where this is coming from, lemme see your MRI...hm......I don't know...I really don't know if surgery would help, I gotta think about this....'

    The first thing you need is locating the source of the trouble. Because surgeons are so specialized today that some only do necks, some only do shoulders, some only do certain surgeries on shoulders...it's mind boggling. But it's so advanced now, that that's what happens. You've got a neck guy, a shoulder guy....so your first step is always finding where it's coming from.

    If it's your neck, in many cases, surgery just make a neck more p'd off. You need to not get it mad at you.

    And....It may seem impossible right now since you hurt so much, but there are ways to deal with ALL the possible sources of pain here, that do not involve surgery. And you might be absolutely shocked at how much rest and physical therapy and maintenance exercises really can do. Or carefully administered traction. Or tiny amounts of neurontin.

    BUT you can never tell WHICH PT or WHICH exercises will work, or what stuff NOT TO DO...... UNTIL you figure out exactly where it's coming from.

    That's always step one. WHERE is it coming from.

    Hang tough, work the problem and stay strong. You are going to get this better.

    I know exactly how you feel, unfortunately. I wouldn't wish this on the worst person in the world. It sucks, and it hurts. It affects your whole life - for a while......
     
    Last edited: Jan 11, 2018
  7. BluemoonOKy

    BluemoonOKy Senior Member

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    I read only the op. Chiropractic is generally a waste of time and money. I have gone myself and only find Chiro is beneficial if one goes within 48 hours of an acute injury. Otherwise, the muscles and soft tissue will continue to pull "adjustments" out. I find Chiro for the most part to be total bunk. I have had many yoga students who have come to me after plenty of Chiro. And I would never let a Chiro adjust cervical spine.
    Anywho...I have had my own shoulder issues and it sounds as if you have some issue of compression with the lateral brachial intermuscular septum. This is super common because many muscles intersect here and its affecting your radial nerve. That is why the anti inflammatory pain meds dont help. I wish you were here because I know how to adjust it and exercises for it. I'm so sorry because I know how bad it hurts. I had it myself and a doctor showed me how to adjust it/ deal with it and I have developed a program for dealing with it regarding several yoga students. I do online consults and private online traditional hatha yoga (real yoga, not westernized "yoga" nonsense) sessions if you are interested. I imagine you now are experiencing some "frozen shoulder". I would absolutely not have surgery.
     
  8. slc

    slc Senior Member

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    Generally, the advice is to NEVER have any chiropractor or any other kind of 'adjustor' methodology anywhere near anything that has any chance of being a neck injury.

    Ever.

    Basically because....um...people have died from having their neck adjusted by a chiropractor.

    Yes. They have.

    Why? It's complicated.

    Some peoples' necks are actually 'unstable.' Meaning the nerves and blood vessels in the neck could easily come under pressure that could cause a major - issue.

    Move a certain way and their spinal nerves are injured. The bones are damaged (sometimes by cancer or by injury or bone spicules that just form over time...) and they don't protect the nerves properly.

    Some elderly women have actually had heart attacks by leaning backward into a sink at a beauty salon, so, like, obviously, messing around with a neck is really, really not a good idea until you have a very, very clear idea of what's going on in there, and maybe not even then. One of the salons in this area just got fitted with 'rolly' sinks that keep elderly womens' necks straight and are becoming more and more used. In other cases, the gals have to sit forward, with their face facing the sink, for shampoos and rinses.

    Some early surgeons would be merrily doing their surgery, and go to pick a cervical artery up - to clean up bone spurs under them that were irritating the nerves, and....boom....the patient would have an heart attack. And die. On the operating table. Now, obviously, we are well aware of how easily teed off these arteries are and what they can do, and this doesn't happen . But great care is still used when doing anything with necks. Always.

    These are some really, really important, LARGE blood vessels that have real estate in your neck. And they are right next to some really, really important Sympathetic system nerves.

    You can't put any abnormal pressure on those arteries or nerves. It can cause cardiac arrest. All the nerves and blood vessels in that area have a very complex relationship and you just do not want to annoy them. So until you have a very, very clear picture of what's up in there (and maybe not even then...) no adjustments to necks.
     
    Last edited: Jan 11, 2018
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  9. StarPattern

    StarPattern Senior Member

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    I have had my neck x-rayed. That's how the Chiro determined I had subluxation. The x-ray was from the base of my skull, all the way to my tailbone, so it looked at my neck and all of my spine.

    I don't drink at all, which includes wine of any type. I don't even drink sugary drinks... water is my go to 99% of the time. Sometimes, I'll have apple or orange juice, or clear pop with lots of ice to water it down. I also don't drink coffee or any form of caffeine, aside from the occasional cup of tea in the winter.

    I currently have a very paleo-based diet. I don't eat much for grains or gluten, very little dairy and very little processed food. I'm a sucker for McDonald's fries, so I may have a treat every 6 months or so. I don't eat pork since it bothers my stomach and prefer things like wild game and fish.

    I originally went to the chiro because it almost felt like my shoulder was out of joint. It felt locked up. So he adjusted a bit at the base of my neck, kind of where the neck curves into the shoulder. But it didn't solve the pain issue.

    I've already seen a Physiotherapist and after 3 weeks of going 3 times a week... there was no marginal change. It helped for a bit and then the pain came back even more. When I saw the doctor, he told me that if the physio didn't make a marked difference in 2 weeks, there was a chance it was something more involved, which is where the blood work and other x-rays came into play. Every single x-ray came back completely clean. Originally, they were looking for bone chips in my shoulder that were pressing on a nerve. The doctor knows I'm a horse person and apparently, bone chips are a common thing for horse people.

    I'm not going to jump into surgery because, frankly, it terrifies me. I already know most pain medications and stuff don't work, and I'm irrationally scared that the doctor drugs won't work as well and I'll feel every aspect of the surgery. I don't like the idea of being cut open if they don't know exactly what's wrong.

    This morning, I woke up with less pain than I have in a long time. I don't know if it's a coincidence or not, but before bed... I had a big glass of water and gently rolled my shoulders. In bed, I arranged about four pillows so my shoulders were supported and my head was just slightly lower. I didn't use any of the topical Diclofenac cream. When I woke up in the middle of the night, I had more water and rolled my shoulders again. Same thing when I woke up with morning. I rolled my shoulders, and had another big glass of water. I'm still hurting, but less than yesterday. I'll do the same routine today and see if it was a fluke or if there's some connection between drinking even more water than I already do and gentle shoulder rolling. I also had a 15 minute scalp and neck massage the other day, so that might have something to do with it... and I wouldn't be hurt if I had to go for one of those regularly.
     
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  10. uncanny580

    uncanny580 Senior Member

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    You really do sound like a much worse off version of me right now. Where did you go for pyhsio?

    My treatment has been sloooooow. But I am starting to finally get more noticeable relief. My fingers haven't gone numb in about a month and I am able to move more freely. Did they do the needling throughout your back and your traps?

    Have you tried massage therapy?

    Also, most Dr's, as I found out, don't support their patients going less "traditional" routes like physio/chiro/massage. The Dr. I went to after my accident was a total moron, and getting a referral note for my insurance was hard because he "does not believe in them". Straight up what he told me. Can't get better when its muscle related when you aren't doing anything about it.
     

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