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    Suggest remedies for radiating pain in posterior right shoulder, biceps and arms

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Posted on Tue, 31 May 2016 in Bones, Muscles and Joints
Question: Fell of the stairs of a bus more that 4 months ago. My right shoulder got injured and have been hurting since. I was only treated with ibuprofen and naproxen and have been doing physical therapy twice a week for 2 months now without significant improvement. My mobility has actually improved but I constantly have a pain in the posterior right shoulder. Pain radiates anteriorly along bicepts tendon and towards the arm. Physical Therapy and movement increase the pain. Pain is in the form of a burning sensation inside the shoulder. Since 2 months I have noticed increased episodes to numbness, stiffness and light tingling in the right hand.These symptoms have become slowly more and more frequent since. Right hand gets very cold normally when the other is warm to the touch. Discoloration was noticed too. Constant sensation of weight over the shoulder. Mobility not too bad. Dicreased strenght and grip. Did an open MRI to the shoulder in January. At the time it was noticed a mild supraspinatus tendinosis. No linear rotator cuff tear, retraction or atrophy seen. Tiny possible paralabral cysts adjacent to the anterior-superior labrum. Tiny amount of fluid seen adjacent to to the anterior superior joint space. What would you recommend next. what do you think it might be going on? I feel that Phisical therapy might be targeting the symptoms and not the cause. Thank you
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Answered by Dr. Matt Wachsman 4 hours later
Brief Answer:
some thoughts.

Detailed Answer:
an exam would be rather helpful. I've had rather a lot of patients with Thoracic outlet syndrome of late so that sticks in my mind, but I rather doubt that is the case. But... if it were... Holding the hand in the air in the manner of a zealous student answering a question for 3 minutes would produce dramatic, if not alarming effects (pain, paleness, and decreased function up to near-paralysis!).

Type of pain, location, and elicitation are clues to the source of the pain.
Various tissues can be the source of pain. "burning", "tingling", or shooting or electrical feelings would, of course, imply the nerves as the source of the pain. Since pain of nerve origin XXXXXXX outward from the source, one can deduce the source as at the most central part of the pain. Furthermore, the size of the region affected implies the size of the nerve involved. Small. And at the site of the injury. Nerves pained by an injury do not invariably get better with even long intervals after their injury. There could be something still whacking on the nerve. in which case, movement would trigger a Sudden! jolt of pain like hitting the funny bone or hitting the nerve in a damaged tooth. This is why an exam would be helpful, and would not only show if there were such a particular trigger, but identify WHERE and WHAT the trigger is. (if scar tissue, deformity, or the cysts were "hitting a nerve" then particular movements would give a definite trigger of pain and localize where the problem precisely is).
If there's a particular trigger, it might...emphasis 'might'...be surgically correctable.

I doubt it, because people mention what the exact trigger is, and describe it as quite eventful.

Then, irritation/injury/perturbation of a small nerve by a previous injury isn't going to be as amenable to treatment and the best treatments are medications that damp down nerves generally. These include any anti-epileptic and the lidocaine like effects of amitryptiline/nortryptiline.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Matt Wachsman

Addiction Medicine Specialist

Practicing since :1985

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