[39F] With pimple-like bump on back shoulder and history of shoulder injury

Patient Description

A 39-year-old female presents with a pimple-like clear bump on her back shoulder area that is slightly painful and leaking clear fluid. The bump developed gradually over a couple of weeks and recently came to a head. The patient attempted to pop it, resulting in some redness and increased pain around the bump, as well as minor swelling. No pus, spreading redness, streaks, or warmth specifically at the bump were noted, and the patient has not experienced any fever or chills. The patient has a history of an old shoulder injury that did not heal properly, leading to a pinched nerve, numbness, and muscle soreness. The numbness is described as a lack of feeling on the surface of the skin, sometimes accompanied by a pinching or tingling sensation. The muscle pain is sharp, particularly when moving the head side to side, and is rated as a 6 out of 10 in severity. This pain worsens when standing for long periods or sitting at a work desk. The patient smokes about a pack of tobacco a week and uses marijuana a couple of times a week for sleep and anxiety. There have been no recent surgeries, medical procedures, changes in overall health, new symptoms, changes in diet, or recent travel. The patient does not take any medications and has no other pre-existing conditions or chronic illnesses.

Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

Pimple-like bump on your shoulder

Folliculitis or a small abscess: This could be an infection of the hair follicles or a small collection of pus under the skin. The clear fluid and redness suggest some inflammation or infection. Typical treatments include warm compresses, keeping the area clean, and sometimes antibiotics if the infection is more severe.
Cyst: A cyst can form under the skin and sometimes leak clear fluid. These can become inflamed or infected, especially if you try to pop them. Treatment may involve drainage by a healthcare provider or minor surgical removal.

Pinched nerve, numbness, and muscle soreness

Nerve compression: Your symptoms of numbness, tingling, and sharp pain could be due to nerve compression, possibly from your old shoulder injury. This could be something like cervical radiculopathy or thoracic outlet syndrome. Treatment often includes physical therapy, pain management, and sometimes surgical intervention if conservative measures fail.

What you can do

For the pimple-like bump:

Keep the area clean: Wash the area gently with soap and water.
Apply warm compresses: This can help reduce pain and promote drainage.
Avoid popping or squeezing: This can worsen the infection and cause more inflammation.
Over-the-counter treatments: You can use topical antibiotic ointments like Neosporin.
Seek medical advice: If the bump doesn't improve, becomes more painful, or shows signs of severe infection (like pus, increased redness, or warmth), see a healthcare provider.

For the pinched nerve and muscle soreness:

Physical therapy: Consult a healthcare provider for a referral to physical therapy to help manage your symptoms and improve function.
Pain management: Over-the-counter pain relievers like ibuprofen (Advil) or acetaminophen (Tylenol) can help manage pain.
Ergonomic adjustments: Make sure your work desk and chair are set up to support good posture. Take frequent breaks to move around.
Gentle exercises: Stretching and strengthening exercises can help alleviate symptoms. A physical therapist can guide you on the best exercises for your condition.
Heat and cold therapy: Applying heat or cold packs to the affected area can help reduce pain and inflammation.

What you should look out for

Given the symptoms and potential causes, you should seek medical care if you notice:

Increased redness, warmth, or pus: These could be signs of a worsening infection.
Fever or chills: These could indicate a systemic infection.
Worsening numbness or weakness: This could suggest worsening nerve compression.
Severe pain or inability to move the affected area: This could indicate a more serious underlying issue.

Remember, while I can provide some guidance, it's important to consult with a healthcare provider for a formal diagnosis and appropriate treatment. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

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