[39M] With shoulder pain and swallowing difficulties

Patient Description

A 39-year-old male presents with a sudden onset of right shoulder pain that is dull and throbbing, rated at 6 to 7 out of 10 in severity. The pain intensifies in the afternoon or evening and has been occurring daily for the past two weeks. The patient reports tightness and tenderness when rotating the shoulder forward. Over-the-counter painkillers provide some relief. Additionally, the patient experiences hip and ankle pain. There is difficulty swallowing, with food and drinks feeling stuck, accompanied by weight loss, heartburn, acid reflux, and hoarseness. The patient also reports nausea and vomiting. He smokes half a pack of cigarettes daily and does not consume alcohol. His medical history includes Raynaud's syndrome affecting the right hand, with symptoms of white fingers and pain during winter for the past three years. He suspects having Crohn's disease due to flare-ups with pain during or after bowel movements but has not been formally diagnosed. There is no known family history of autoimmune diseases, and the patient has not been evaluated for such conditions.

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Arora's Assessment

What might be happening

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

  1. Shoulder Pain: The dull, throbbing pain in your right shoulder that worsens in the afternoon or evening could be related to a condition such as bursitis or tendinitis, which are common causes of shoulder pain. These conditions can result from overuse or strain, even if you haven't had a specific injury. The tightness and tenderness you feel when rotating your shoulder might also suggest a rotator cuff issue.

  2. Difficulty Swallowing and Gastrointestinal Symptoms: The sensation of food and drinks getting stuck, along with heartburn, nausea, and weight loss, could indicate a condition like gastroesophageal reflux disease (GERD) or esophageal stricture. These conditions can cause inflammation and narrowing of the esophagus, leading to swallowing difficulties. Given your history of diverticulosis and suspected Crohn's disease, it's also possible that these symptoms are related to an underlying gastrointestinal condition.

  3. Joint Pain and Raynaud's Syndrome: The pain in your hip and ankles, along with your history of Raynaud's syndrome, could suggest an underlying autoimmune condition such as rheumatoid arthritis or lupus. These conditions can cause joint pain and are sometimes associated with Raynaud's phenomenon.

  4. Alopecia: The patches of hair loss resembling alopecia that have grown back could be related to stress, autoimmune conditions, or other underlying health issues.

What you can do

Shoulder Pain:

  • Consider seeing a healthcare provider for an evaluation of your shoulder pain. They may recommend imaging studies or physical therapy to help manage your symptoms.
  • In the meantime, continue using over-the-counter pain relievers as needed, and try to avoid activities that exacerbate the pain.

Difficulty Swallowing and Gastrointestinal Symptoms:

  • It's important to consult a healthcare provider about your swallowing difficulties and gastrointestinal symptoms. They may recommend tests such as an endoscopy to evaluate your esophagus and stomach.
  • To help manage symptoms, try eating smaller, more frequent meals, and avoid foods and drinks that trigger heartburn.

Joint Pain and Raynaud's Syndrome:

  • Consider discussing your joint pain and Raynaud's symptoms with a healthcare provider, who may recommend tests to evaluate for autoimmune conditions.
  • Keep your hands warm to help manage Raynaud's symptoms, and consider using gloves in cold weather.

General Health:

  • Since you smoke, consider seeking support to quit smoking, as it can exacerbate many health issues.
  • Use MDandMe to journal your symptoms, track progress, and share insights with your healthcare provider.

What you should look out for

Seek medical attention if you experience any of the following:

  • Severe or worsening pain in your shoulder, hip, or ankles
  • Significant difficulty swallowing or unintentional weight loss
  • New or worsening gastrointestinal symptoms, such as severe abdominal pain or blood in your stool
  • Any new or concerning symptoms related to your Raynaud's syndrome or suspected Crohn's disease

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan.

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10 d ago


People Also Ask


What could be causing my shoulder pain that worsens in the afternoon or evening?

Your shoulder pain could be due to conditions like bursitis or tendinitis, which are often caused by overuse or strain. These conditions can lead to inflammation and pain that worsens with activity or as the day progresses.


Why am I experiencing difficulty swallowing along with heartburn and weight loss?

Difficulty swallowing, heartburn, and weight loss could be symptoms of gastroesophageal reflux disease (GERD) or an esophageal stricture. These conditions can cause inflammation and narrowing of the esophagus, making swallowing difficult.


Could my joint pain and Raynaud's syndrome be related to an autoimmune condition?

Yes, joint pain and Raynaud's syndrome can be associated with autoimmune conditions such as rheumatoid arthritis or lupus. These conditions can cause joint pain and are sometimes linked with Raynaud's phenomenon.


What steps can I take to manage my symptoms of suspected Crohn's disease?

To manage symptoms of suspected Crohn's disease, consider consulting a healthcare provider for a formal diagnosis. In the meantime, maintain a balanced diet, avoid trigger foods, and keep a symptom journal to track flare-ups and identify patterns.

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