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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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I have pain in upper right arm/shoulder which I think

Answered by
Dr.
Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2474 Questions

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Posted on Thu, 4 Apr 2019 in Pain Management
Question: I have pain in upper right arm/shoulder which I think is tendonitis, muscle strain/sprain, or some kind of nerve pain. It came on slowly a week ago and has gotten worse. Can't really sleep at night. I have an appointment with my Primary Care MD for Wednesday, But how to manage bad pain right now? Ibuprofen doesnt seem to work at all, and Aleve has never worked.
The pain is sharp and stabbing if I move that arm the wrong way
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Follow up: Dr. Dariush Saghafi 0 minute later
I have pain in upper right arm/shoulder which I think is tendonitis, muscle strain/sprain, or some kind of nerve pain. It came on slowly a week ago and has gotten worse. Can't really sleep at night. I have an appointment with my Primary Care MD for Wednesday, But how to manage bad pain right now? Ibuprofen doesnt seem to work at all, and Aleve has never worked.
The pain is sharp and stabbing if I move that arm the wrong way
doctor
Answered by Dr. Dariush Saghafi 1 hour later
Brief Answer:
You should go to an Urgent Care Center...

Detailed Answer:
Hi,

If this is something that came on since last week and is increasing in severity then, I would want to get at least an X-ray of the shoulder area to see if anything is potentially dislocated or subluxed since that will not really get better until it's reduced.

Also, a chest x-ray may also reveal something compressing the brachial plexus from the apex area of the lung on that side and this then, need a further workup but at least the doctor could prescribe something more appropriate for pain than OTC things that don't seem to be working.

Should you end up having some sort of simple muscle or joint strain then, even though it's been a week you may also get relief from icing the area with most pain using crushed ice in a plastic bag rolled in a towel and applied to the area for 20-30 min at least several times daily. That may help bring a little swelling down throughout the day and take some of the edges off the pain until you are seen Wed.

At least I see no downside to using an ice bag for a few days. Some people may wish to argue with the opinion since it's been a week since the pain started and the common thinking about musculoskeletal injuries (if that's what this is) is that ice should only be applied in the first 24-48 hrs.

Afterward, it's supposed to heat applied. Honestly, I used to follow that rule strictly and found that it was useless since diseases never read the books. I recommend whatever the patient feels works best for them....if it's cold therapy or warm therapy, or even a little of both....so be it...I was never a stickler for that rule but you could literally try one then, the other and see what is better.

If on the other hand there is some type of lesion in the armpit area such as an infected cyst or sweat gland then, this can easily be detected by the physician by an examination and perhaps a blood count. Antibiotics and some appropriate analgesics or compress therapy would be most helpful and you'll be on the mend well before seeing your doctor in several days.

If neither of those turns out to be the case then, at the very least you'll have been looked at by a physician who can determine whether or not there is something that needs immediate attention AND they may choose to give you a sling or strap the shoulder so that at least you don't unnecessarily move it about which is what seems to be really triggering the pain.

But I definitely think you should be seen by a physician before next Wed. and not wait any longer to get someone really looks at that shoulder to determine what could be going on as well as getting a more robust prescription for pain....make sense?

I wouldn't resort to self-immobilization until the neck, shoulder joint, and axilla have been examined and I wouldn't recommend that you continue to simply "experiment" with more or different OTC analgesics because you just might cause unnecessary irritation to your stomach, etc. and it probably is not likely to help.

You really need to have it looked at to tell what is going on and to get something more robust for your pain relief than you'll be able to do on your own or by taking OTC agents which are no better than the Tylenol, Motrin, and Advil which don't seem to be helping.

You will also want to take note of the function of your arm, forearm, hand, and fingers on the affected side. If anything starts to lose power or strength then, I suggest you be seen at an ER because that could signify some form of spinal cord compression at the level of the neck which would require urgent imaging and taking care of to prevent significant complications. So long as you're not losing strength and it's just pain that you're dealing with then, just getting a simple physician to examine you with a couple of X-rays as I've mentioned is plenty attention enough along with the prescription the doctor may give you for pain relief that should be better than what you'll get OTC.

You've got my hopes at a rapid road to some pain relief and that they can figure out quickly what might be causing this problem all the way around.

If I've provided useful or helpful information to your questions could you do me the utmost of favors in not forgetting to close the query along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I am definitely interested in getting updated information on how things are going in the next few weeks if you'd drop me a line at www.bit.ly/drdariushsaghafi

You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.

This query required 23 minutes of professional time to research, assimilate, and respond in complete form.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Dariush Saghafi 0 minute later
Brief Answer:
You should go to an Urgent Care Center...

Detailed Answer:
Hi,

If this is something that came on since last week and is increasing in severity then, I would want to get at least an X-ray of the shoulder area to see if anything is potentially dislocated or subluxed since that will not really get better until it's reduced.

Also, a chest x-ray may also reveal something compressing the brachial plexus from the apex area of the lung on that side and this then, need a further workup but at least the doctor could prescribe something more appropriate for pain than OTC things that don't seem to be working.

Should you end up having some sort of simple muscle or joint strain then, even though it's been a week you may also get relief from icing the area with most pain using crushed ice in a plastic bag rolled in a towel and applied to the area for 20-30 min at least several times daily. That may help bring a little swelling down throughout the day and take some of the edges off the pain until you are seen Wed.

At least I see no downside to using an ice bag for a few days. Some people may wish to argue with the opinion since it's been a week since the pain started and the common thinking about musculoskeletal injuries (if that's what this is) is that ice should only be applied in the first 24-48 hrs.

Afterward, it's supposed to heat applied. Honestly, I used to follow that rule strictly and found that it was useless since diseases never read the books. I recommend whatever the patient feels works best for them....if it's cold therapy or warm therapy, or even a little of both....so be it...I was never a stickler for that rule but you could literally try one then, the other and see what is better.

If on the other hand there is some type of lesion in the armpit area such as an infected cyst or sweat gland then, this can easily be detected by the physician by an examination and perhaps a blood count. Antibiotics and some appropriate analgesics or compress therapy would be most helpful and you'll be on the mend well before seeing your doctor in several days.

If neither of those turns out to be the case then, at the very least you'll have been looked at by a physician who can determine whether or not there is something that needs immediate attention AND they may choose to give you a sling or strap the shoulder so that at least you don't unnecessarily move it about which is what seems to be really triggering the pain.

But I definitely think you should be seen by a physician before next Wed. and not wait any longer to get someone really looks at that shoulder to determine what could be going on as well as getting a more robust prescription for pain....make sense?

I wouldn't resort to self-immobilization until the neck, shoulder joint, and axilla have been examined and I wouldn't recommend that you continue to simply "experiment" with more or different OTC analgesics because you just might cause unnecessary irritation to your stomach, etc. and it probably is not likely to help.

You really need to have it looked at to tell what is going on and to get something more robust for your pain relief than you'll be able to do on your own or by taking OTC agents which are no better than the Tylenol, Motrin, and Advil which don't seem to be helping.

You will also want to take note of the function of your arm, forearm, hand, and fingers on the affected side. If anything starts to lose power or strength then, I suggest you be seen at an ER because that could signify some form of spinal cord compression at the level of the neck which would require urgent imaging and taking care of to prevent significant complications. So long as you're not losing strength and it's just pain that you're dealing with then, just getting a simple physician to examine you with a couple of X-rays as I've mentioned is plenty attention enough along with the prescription the doctor may give you for pain relief that should be better than what you'll get OTC.

You've got my hopes at a rapid road to some pain relief and that they can figure out quickly what might be causing this problem all the way around.

If I've provided useful or helpful information to your questions could you do me the utmost of favors in not forgetting to close the query along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I am definitely interested in getting updated information on how things are going in the next few weeks if you'd drop me a line at www.bit.ly/drdariushsaghafi

You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.

This query required 23 minutes of professional time to research, assimilate, and respond in complete form.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
default
Follow up: Dr. Dariush Saghafi 48 hours later
Good advice - went to ER and found out I had bad tendonitis aggravated by calcifications in the area where the biceps tendon inserts into the shoulder bone. Got IM anti-inflammatories and serious pain meds. Thanks!

5 stars.
default
Follow up: Dr. Dariush Saghafi 0 minute later
Good advice - went to ER and found out I had bad tendonitis aggravated by calcifications in the area where the biceps tendon inserts into the shoulder bone. Got IM anti-inflammatories and serious pain meds. Thanks!

5 stars.
doctor
Answered by Dr. Dariush Saghafi 53 minutes later
Brief Answer:
Wonderful news Young Lady!

Detailed Answer:
Hey, That's terrific news my dear! Very glad it worked out and you got a bit of relief...now you can sleep a little more comfortably until it heals.....how in the world did you do it? Were you doing some type of repetitive lifting, pushing, or pulling for housecleaning, yard work, or other chores? Remember, you need to pace yourself if you're not quite used to a lot of physical or manual labor, right?

I'm very glad to hear that you're better. You have what's called a BICIPITAL TENDINITIS....those can take weeks and sometimes longer to heal.

Cheers my dear! Write back to me in about 1-2 weeks and let me know how things are going.....hopefully, ER gave you some other advice on using THERMAL interventions on the shoulder. Since they've shown there to be calcifications in the bursa region where the biceps tendon inserts then, COLD COMPRESSES will be helpful throughout the day....

I don't think warm compresses will be the ticket...that may merely promote inflammatory types of reactions in the area with increased blood flow, etc. Look into this device called a THERMAZONE because there's a SHOULDER PAD attachment that fits right around the area affected and you can get the pad chilled down to 31 degrees. You don't have to mess with cold packs, things melting, and the machine is there whenever you need it at home.

I also don't know about surgery being a good option. PHYSICAL THERAPY or OCCUPATIONAL THERAPY with the objective of keeping the shoulder and arm XXXXXXX will help naturally FILE those calcific lesions down (literally FILE them down)....it won't eliminate them...but the more activity you get into that shoulder (aquatherapy may be ideal for this type of problem) then, the more slowly the condition will progress.....

Look into aerobic programs that can get you rockin' and rollin' with the shoulders and arms....silver sneakers is OK...but you're young enough and if you approach this with a little aggressiveness I'm sure you can tolerate something a bit more robust because that's what you'll need.

PURE REST I believe is a mistake here...even though one may argue that the bicipital tendinitis will only stay irritated and inflamed if you get too much activity into it too soon...I understand that....but if you rest it...at what point are you going to get active again? Tricky question to answer because what I've seen more times than not in the real world is...once someone starts to "rest" something like this....you probably won't get more active because at any point it will start to hurt again and this will simply beget UNSCHEDULED/UNWANTED IMMOBILITY which will lead to more deposition of calcium into the area due to lack of circulation and blood flow and this increases pain levels when you try and move it or exercise. What you need young lady is to get a good physical REHABILITATION specialist who can map out a program for this problem and combine appropriate rest and time off with necessary activities.....make sense?

BTW, if you could CLOSE the QUERY on your way out from this message....the system will then, ask you for a STAR RATING.....and that's where you can put a few words of how this consult helped you along with your WONDERFULLY KIND 5 STAR grading.

Maybe the next person with BICIPITAL TENDINITIS will read your case and feel better that they likely don't have some terminal malady...though maybe they will wish they did before I get done getting them into the exercise and theapy program that you're going to get into, RIGHT????? LOLOLOLOLOL!!

Cheers my dear!

Don't forget that you can always reach me at www.bit.ly/drdariushsaghafi for this or other questions. Don't forget to let me know how things are going and if you were able to get into a good therapy program....and if you were able to secure that THERMAZONE device. I know that many insurance companies don't cover the cost of that sort of equipment...maybe the company has a payment plan you can work out with them?

This query required 51 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Dariush Saghafi 0 minute later
Brief Answer:
Wonderful news Young Lady!

Detailed Answer:
Hey, That's terrific news my dear! Very glad it worked out and you got a bit of relief...now you can sleep a little more comfortably until it heals.....how in the world did you do it? Were you doing some type of repetitive lifting, pushing, or pulling for housecleaning, yard work, or other chores? Remember, you need to pace yourself if you're not quite used to a lot of physical or manual labor, right?

I'm very glad to hear that you're better. You have what's called a BICIPITAL TENDINITIS....those can take weeks and sometimes longer to heal.

Cheers my dear! Write back to me in about 1-2 weeks and let me know how things are going.....hopefully, ER gave you some other advice on using THERMAL interventions on the shoulder. Since they've shown there to be calcifications in the bursa region where the biceps tendon inserts then, COLD COMPRESSES will be helpful throughout the day....

I don't think warm compresses will be the ticket...that may merely promote inflammatory types of reactions in the area with increased blood flow, etc. Look into this device called a THERMAZONE because there's a SHOULDER PAD attachment that fits right around the area affected and you can get the pad chilled down to 31 degrees. You don't have to mess with cold packs, things melting, and the machine is there whenever you need it at home.

I also don't know about surgery being a good option. PHYSICAL THERAPY or OCCUPATIONAL THERAPY with the objective of keeping the shoulder and arm XXXXXXX will help naturally FILE those calcific lesions down (literally FILE them down)....it won't eliminate them...but the more activity you get into that shoulder (aquatherapy may be ideal for this type of problem) then, the more slowly the condition will progress.....

Look into aerobic programs that can get you rockin' and rollin' with the shoulders and arms....silver sneakers is OK...but you're young enough and if you approach this with a little aggressiveness I'm sure you can tolerate something a bit more robust because that's what you'll need.

PURE REST I believe is a mistake here...even though one may argue that the bicipital tendinitis will only stay irritated and inflamed if you get too much activity into it too soon...I understand that....but if you rest it...at what point are you going to get active again? Tricky question to answer because what I've seen more times than not in the real world is...once someone starts to "rest" something like this....you probably won't get more active because at any point it will start to hurt again and this will simply beget UNSCHEDULED/UNWANTED IMMOBILITY which will lead to more deposition of calcium into the area due to lack of circulation and blood flow and this increases pain levels when you try and move it or exercise. What you need young lady is to get a good physical REHABILITATION specialist who can map out a program for this problem and combine appropriate rest and time off with necessary activities.....make sense?

BTW, if you could CLOSE the QUERY on your way out from this message....the system will then, ask you for a STAR RATING.....and that's where you can put a few words of how this consult helped you along with your WONDERFULLY KIND 5 STAR grading.

Maybe the next person with BICIPITAL TENDINITIS will read your case and feel better that they likely don't have some terminal malady...though maybe they will wish they did before I get done getting them into the exercise and theapy program that you're going to get into, RIGHT????? LOLOLOLOLOL!!

Cheers my dear!

Don't forget that you can always reach me at www.bit.ly/drdariushsaghafi for this or other questions. Don't forget to let me know how things are going and if you were able to get into a good therapy program....and if you were able to secure that THERMAZONE device. I know that many insurance companies don't cover the cost of that sort of equipment...maybe the company has a payment plan you can work out with them?

This query required 51 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by : Dr. Raju A.T
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The User accepted the expert's answer

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