[27F] With severe right shoulder pain and associated symptoms

Patient Description

A 27-year-old female has been experiencing severe pain in her right shoulder for the past week. The pain is described as a mix of sharp, dull, and throbbing sensations, affecting both the bone and muscle. The pain started suddenly without any prior injury and has not subsided. It radiates down her arm, causing tingling, throbbing pain, and numbness in her right hand. The pain worsens with movements like raising the shoulder or holding something, and there is an audible grinding sound when she moves it. She has tried steroids and muscle relaxers, which provided temporary relief. There is a slight weakness in the right arm but no swelling, bruising, neck pain, stiffness, fever, chills, weight loss, or fatigue. No history of shoulder problems or surgeries. Medical history includes PCOS, migraines, arthritis, bipolar disorder, and schizophrenia, diagnosed approximately 14 years ago. The patient vapes daily and occasionally smokes marijuana for pain. Current medications include Zoloft (150mg), famotidine (20mg), Vraylar (1.5mg), and Xanax (0.5mg). No known allergies or adverse reactions to medications.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your shoulder pain:

  • Rotator Cuff Injury: This is a common cause of shoulder pain, especially if it hurts to move your shoulder and you hear a grinding sound. The rotator cuff is a group of muscles and tendons that stabilize the shoulder. Injuries can range from inflammation (tendinitis) to tears.

    • Treatment: Rest, physical therapy, anti-inflammatory medications, and in severe cases, corticosteroid injections or surgery.

  • Shoulder Impingement Syndrome: This occurs when the tendons of the rotator cuff are pinched during shoulder movements. This can cause pain and a grinding sensation.

    • Treatment: Rest, physical therapy, anti-inflammatory medications, and sometimes corticosteroid injections.

  • Bursitis: Inflammation of the bursa (a small fluid-filled sac that cushions the shoulder joint) can cause pain and difficulty moving the shoulder.

    • Treatment: Rest, ice, anti-inflammatory medications, and physical therapy.

  • Cervical Radiculopathy: This condition occurs when a nerve in the neck is compressed or irritated, causing pain that radiates down the arm and can include tingling and numbness.

    • Treatment: Physical therapy, medications, and sometimes corticosteroid injections or surgery.

  • Frozen Shoulder (Adhesive Capsulitis): This condition involves stiffness and pain in the shoulder joint, which can worsen over time.

    • Treatment: Physical therapy, anti-inflammatory medications, and sometimes corticosteroid injections.

What you can do

While it's important to consult a healthcare professional for a formal diagnosis and treatment plan, here are some steps you can take to manage your symptoms:

  1. Rest: Avoid activities that worsen the pain, especially those that involve lifting or raising your arm.
  2. Ice and Heat: Apply ice packs to reduce inflammation and pain, and use heat to relax the muscles.
  3. Over-the-Counter Pain Relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce pain and inflammation.
  4. Gentle Stretching and Strengthening Exercises: Once the acute pain subsides, gentle exercises can help improve shoulder mobility and strength. A physical therapist can guide you on the right exercises.
  5. Posture: Maintain good posture to reduce strain on your shoulder.
  6. Use MDandMe: Journal your symptoms, track your progress, get insights, and share your notes with your healthcare provider.

What you should look out for

Seek medical attention if you experience any of the following:

  • Severe or worsening pain: If your pain continues to worsen or becomes unbearable.
  • Loss of function: If you are unable to move your shoulder or arm.
  • Signs of infection: Such as fever, redness, or swelling around the shoulder.
  • Numbness or weakness: If you experience significant numbness or weakness in your arm or hand.

Remember, while this information can help you understand your symptoms, it is not a substitute for professional medical advice. Please consult a healthcare provider for a formal diagnosis and appropriate treatment.

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4 mo ago

People Also Ask

What are the common causes of shoulder pain that radiates down the arm?

Common causes of shoulder pain that radiates down the arm include rotator cuff injuries, shoulder impingement syndrome, bursitis, cervical radiculopathy, and frozen shoulder. These conditions can cause pain, tingling, and numbness in the arm.

How can I differentiate between a rotator cuff injury and shoulder impingement syndrome?

A rotator cuff injury often involves pain with shoulder movement and a grinding sound, while shoulder impingement syndrome is characterized by pinching of the rotator cuff tendons during movement. Both conditions can cause similar symptoms, but a healthcare provider can perform specific tests to differentiate them.

What are the recommended treatments for cervical radiculopathy?

Recommended treatments for cervical radiculopathy include physical therapy to improve neck and shoulder mobility, medications such as NSAIDs for pain relief, and sometimes corticosteroid injections to reduce inflammation. In severe cases, surgery may be considered.

When should I seek medical attention for shoulder pain?

You should seek medical attention for shoulder pain if you experience severe or worsening pain, loss of function in the shoulder or arm, signs of infection like fever or redness, or significant numbness or weakness in the arm or hand.

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