[54M] With chronic shoulder pain radiating to fingertips

Patient Description

A 54-year-old male has been experiencing sharp pain starting at the shoulder and radiating down to the fingertips for over a year. The pain is most severe in the morning, rated at 9/10, and transitions into numbness and tingling in the fingertips as the day progresses. The patient reports that the pain and tingling typically subside after about an hour of moving around, but recently, the symptoms have also occurred at night. The patient has not found any positions or over-the-counter medications that alleviate the pain. Additionally, there is weakness in the arm, making it difficult to grip items or unscrew caps. The pain does not follow a specific path and is not associated with any recent injuries. The patient has some neck stiffness but no additional pain. There is a history of a herniated disc surgery in the lower back nearly 30 years ago, which resolved previous leg pain. The patient's occupation involves repetitive shoulder and arm movements. No recent imaging tests have been conducted for the neck or shoulder.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your symptoms:

  • Cervical Radiculopathy (Pinched Nerve in the Neck): This condition occurs when a nerve in the neck is compressed or irritated where it branches away from the spinal cord. This can cause pain that radiates from the neck into the shoulder and arm, as well as numbness and tingling in the fingers. The weakness you're experiencing in your grip could also be related to this condition.

    • Typical treatments include physical therapy, medications to reduce pain and inflammation, and sometimes corticosteroid injections. In some cases, surgery may be considered if symptoms do not improve with conservative treatment.

  • Thoracic Outlet Syndrome: This condition involves compression of the nerves or blood vessels just below the neck, which can cause pain in the shoulder and arm, as well as numbness in the fingers.

    • Treatment often involves physical therapy to improve posture and strengthen the muscles around the shoulder. In some cases, surgery may be necessary to relieve the compression.

  • Repetitive Strain Injury: Given your occupation involves repetitive shoulder or arm movements, this could contribute to your symptoms. Overuse of certain muscles can lead to pain and tingling.

    • Treatment typically involves rest, ergonomic adjustments, and physical therapy to relieve symptoms and prevent further injury.

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 in the meantime:

  1. Rest and Modify Activities: Try to avoid activities that exacerbate your symptoms. Consider ergonomic adjustments to your workspace to reduce strain on your neck and shoulder.

  2. Apply Heat or Cold: Using a heating pad or ice pack on your neck and shoulder may help alleviate pain and reduce inflammation.

  3. Gentle Stretching and Exercises: Engage in gentle stretching exercises to improve flexibility and reduce stiffness. A physical therapist can guide you on specific exercises that may be beneficial.

  4. Over-the-Counter Pain Relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may help reduce pain and inflammation.

  5. Use MDandMe: Consider using the MDandMe app to journal your symptoms, track your progress, and share your medical notes with your healthcare provider.

What you should look out for

Seek medical attention if you experience any of the following:

  • Worsening pain or weakness that affects your ability to perform daily activities
  • Loss of sensation or severe numbness in your arm or hand
  • Any new or unusual symptoms, such as changes in bowel or bladder function

Remember, it's important to consult a healthcare professional for a thorough evaluation and appropriate management of your symptoms.

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1 mo ago

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People Also Ask

What is cervical radiculopathy and how is it treated?

Cervical radiculopathy, also known as a pinched nerve in the neck, occurs when a nerve in the neck is compressed or irritated. This can cause pain that radiates from the neck into the shoulder and arm, as well as numbness and tingling in the fingers. Treatment typically includes physical therapy, medications to reduce pain and inflammation, and sometimes corticosteroid injections. Surgery may be considered if symptoms do not improve with conservative treatment.

What are the symptoms and treatment options for thoracic outlet syndrome?

Thoracic outlet syndrome involves compression of the nerves or blood vessels just below the neck, leading to pain in the shoulder and arm, as well as numbness in the fingers. Treatment often involves physical therapy to improve posture and strengthen the muscles around the shoulder. In some cases, surgery may be necessary to relieve the compression.

How can repetitive strain injury affect the shoulder and arm, and what are the treatment options?

Repetitive strain injury can occur due to overuse of certain muscles, leading to pain and tingling in the shoulder and arm. Treatment typically involves rest, ergonomic adjustments, and physical therapy to relieve symptoms and prevent further injury.

What steps can I take at home to alleviate shoulder and arm pain?

To alleviate shoulder and arm pain at home, you can rest and modify activities to avoid exacerbating symptoms, apply heat or cold to reduce pain and inflammation, engage in gentle stretching and exercises to improve flexibility, and use over-the-counter pain relief like NSAIDs. It's also helpful to make ergonomic adjustments to your workspace.

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