[33F] With chronic left shoulder, underarm pain, and other symptoms

Patient Description

A 33-year-old female presents with left shoulder pain radiating down the arm and underarm, ongoing for 7 months. The pain is described as aching and is rated 7/10 in severity today. It is often constant throughout the day until sleep. The patient has tried Gabapentin (100 mg three times a day) without relief. An X-ray of the spine was normal, but a second opinion revealed scoliosis and a pinched nerve. Additional symptoms include left knee pain, a swollen lymph node in the left neck, and sharp chest pain on the left side rated 5/10 today. The patient reports tingling in the left arm or hand, shortness of breath, and dizziness but no weakness. Menstrual history includes prolonged bleeding in June and pink discharge a week after starting the period in July. Past medical history includes a vertical sleeve gastrectomy last year and a double pulmonary embolism diagnosed in September 2023. The patient has no known drug allergies and is also taking Vitamin D (2000 IU once a day) and iron (325 mg). There is a family history of heart disease or stroke (uncle). The patient does not smoke, use tobacco products, consume alcohol, or use recreational drugs.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential diagnoses and conditions that could be contributing to your discomfort:

Left Shoulder and Underarm Pain

  1. Cervical Radiculopathy: Given your history of scoliosis and a pinched nerve, it's possible that nerve compression in your neck is causing pain that radiates down your arm and underarm. This condition can also cause tingling or pins-and-needles sensations.
  2. Rotator Cuff Tendinopathy: This condition involves inflammation or damage to the tendons in your shoulder, which can cause pain that radiates down the arm. It often worsens with specific movements but can also be constant.

Chest Pain

  1. Musculoskeletal Pain: Given the sharp nature of your chest pain and its association with shoulder pain, it could be related to musculoskeletal issues, possibly linked to your scoliosis or pinched nerve.
  2. Cardiac Issues: Although less likely given your age and lack of other risk factors, chest pain should always be evaluated to rule out heart-related issues, especially given your family history of heart disease.

Swollen Lymph Node

  1. Infection or Inflammation: Swollen lymph nodes are often a sign of infection or inflammation in the body. This could be related to your shoulder pain or another underlying condition.

Dizziness and Shortness of Breath

  1. Postural Orthostatic Tachycardia Syndrome (POTS): This condition can cause dizziness and lightheadedness, especially when standing up. It can also be associated with other symptoms like fatigue and shortness of breath.
  2. Residual Effects of Pulmonary Embolism (PE): Given your history of double PE, it's possible that some of your symptoms are related to residual effects or complications from this condition.

What you can do

Left Shoulder and Underarm Pain

  • Consult a Specialist: Given the duration and severity of your pain, it's important to consult a specialist, such as an orthopedic doctor or a neurologist, for a thorough evaluation and potential imaging studies like an MRI.
  • Physical Therapy: A physical therapist can help you with exercises to strengthen your shoulder and neck muscles, which may alleviate some of your pain.
  • Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen may help manage your pain. Applying ice or heat to the affected area can also provide relief.

Chest Pain

  • Seek Medical Attention: Given the potential seriousness of chest pain, it's important to consult a healthcare provider to rule out any cardiac issues. They may recommend an ECG or other tests to evaluate your heart health.

Swollen Lymph Node

  • Monitor and Consult: Keep an eye on the swollen lymph node. If it persists or worsens, consult a healthcare provider for further evaluation. They may recommend blood tests or imaging studies to determine the cause.

Dizziness and Shortness of Breath

  • Hydration and Diet: Ensure you are well-hydrated and maintain a balanced diet. Sometimes, dizziness can be related to dehydration or nutritional deficiencies.
  • Consult a Cardiologist: Given your history of PE and current symptoms, it may be beneficial to consult a cardiologist to evaluate your heart and circulatory system.

Menstrual Changes

  • Gynecological Evaluation: Given the recent changes in your menstrual cycle, it's important to consult a gynecologist for a thorough evaluation. They may recommend blood tests or imaging studies to determine the cause.

General Tips

  • Symptom Journal: Use MDandMe to journal your symptoms, track your progress, and get insights. This can be very helpful when discussing your condition with healthcare providers.
  • Regular Follow-ups: Ensure you have regular follow-ups with your healthcare providers to monitor your condition and make any necessary adjustments to your treatment plan.

What you should look out for

Given the complexity and severity of your symptoms, it's important to seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Worsening Chest Pain: If your chest pain becomes more severe or is accompanied by shortness of breath, fainting, or palpitations, seek immediate medical attention.
  • New or Worsening Symptoms: If you notice new symptoms or if your existing symptoms worsen, consult a healthcare provider promptly.
  • Signs of Infection: If you develop fever, chills, or other signs of infection, especially in relation to the swollen lymph node, seek medical care.

Remember, while I can provide information and suggestions, it's crucial to consult with real healthcare professionals to receive a formal diagnosis and appropriate treatment.

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5 mo ago


People Also Ask


What could be causing my shoulder pain that radiates down my arm?

Your shoulder pain that radiates down your arm could be due to cervical radiculopathy, which involves nerve compression in the neck, or rotator cuff tendinopathy, which involves inflammation or damage to the shoulder tendons. Both conditions can cause pain and tingling sensations.


Why might I be experiencing dizziness and shortness of breath?

Dizziness and shortness of breath could be related to postural orthostatic tachycardia syndrome (POTS), which affects blood flow and can cause these symptoms, or they could be residual effects from your previous pulmonary embolism. It's important to consult a healthcare provider for a thorough evaluation.


What should I do about a swollen lymph node in my neck?

A swollen lymph node in the neck is often a sign of infection or inflammation. Monitoring the lymph node and consulting a healthcare provider if it persists or worsens is recommended. They may perform blood tests or imaging studies to determine the cause.


How can changes in my menstrual cycle be related to my other symptoms?

Changes in your menstrual cycle could be related to hormonal imbalances or other underlying health issues. It's important to consult a gynecologist for a thorough evaluation, as they can provide insights into whether these changes are connected to your other symptoms.


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