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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for shingles symptoms and shoulder bursitis

Answered by
Dr.
Dr. Suresh Heijebu

General & Family Physician

Practicing since :2010

Answered : 3633 Questions

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Posted on Tue, 15 Dec 2015 in Brain and Spine
Question: Hello,
I've been getting a bit concerned about an ongoing issue. Here are the details: About a week ago I started experiencing severe (anywhere from an 8 to a 9 on the pain scale) pain in my left shoulder right around the lower part of the shoulder blade. I had experienced a couple day-long bouts of left shoulder pain over the course of the past month or two, but they went away quickly with no treatment at all. I chalked this pain up to two factors; 1) I run a daycare and have had a new baby join daycare as of three months ago - which I tend to carry on my left hip or in my left arm more often than not. 2) for my second job I do online work and about three months ago my ergonomic chair broke and I replaced it with a really bad hard shell one with no back support....SO, I didn't think much else of it, but NOW it has been just a couple days over a whole week of pain....two weekends ago, on or about the 14th of Nov the shoulder pain came back at the left shoulder blade and WRAPPED AROUND MY LEFT RIB CAGE to just under my left breast! It was exceptionally painful and persisted to the point where I had difficulty sleeping for four nights. I went to a chiropractor- limited relief, a masseuse was better as there did appear to be a knot at the pain point of origin (left shoulder blade) but still, I had to resort to taking constant ibuprophren, starting with 2x200mg and moving up to IP-466 every 6 hrs for about three days. I'm generally an aspirin person, so this was the MOST Ibuprofen I'd ever taken in a stretch. THEN, after about three days on Ibuprofen I developed a rash (photos to be attached) which ran along the pain site from back to side to just under my breast. At first I thought it was hives due to the ibuprofen (I also have adult onset asthma) which I stopped taking at first sign of rash...then I thought shingles (due to stress?) - I had them once on my right upper top thigh when I was ten years old, but this rash doesn't seem to weep or blister and there's no crusting....then I remembered the night before the rash I had used the following on the area where the rash appeared the next day: A lidocaine patch, some linament/muscle ointment I got a couple years ago in a sample at the fair and a heating pad- so I thought the rash could be from those things too....the rash has been with me now for four or five days and might be fading a bit, but it isn't going away. It doesn't itch, but it hurts if you scratch it a bit and it felt burny under the breast especially for the first few days. I went to a doctor on Saturday, she said she thought the pain was muscular/skeletal, she found the little knot at my shoulder blade, suggested it was a fatty deposit maybe...I showed her the rash at my side and under my breast and told her about the heating and ointment (I had forgotten the lidocaine patch) and she just kind of shrugged. It was an uneventful visit, leaving me wanting more expert insight. She didn't even know some basic things about menopause it seemed.....ANYWAY, the pain never limited my mobility and I'm not sure if it was worse at night or if I just needed to sleep and couldn't because of the pain, but nighttime was the most frustrating though it always hurt bad for that first week. I just got a new desk chair. I've been stretching out and the pain is now more of a 2-3 most times, with the occasional spike to a 4 or 5 at most. I don't know what to do about the rash. I am concerned about the possibility of lung cancer- I am 48, previously smoked when I was around second hand smoke and when I drank, esp in my 20s and early 30s...I do not smoke now. I also worked club jobs in VERY smoky night clubs for 6 years 2-4 nights a week back in my early to mid 20s. I had a clear chest xray on May 30th of this year in the ER after a trigger event (DOwn feathers) with my asthma. I also had follow up bloodwork after I came back borderline anemic in the hospital that day.....I was 11. 65 blood iron, but now I'm over 13 and all my bloodwork is fine. My mammogram just came back clear as well as of a couple months ago. I've never had cancer. How should I proceed? What is this rash? What do you think the shoulder pain/wrap to chest is about? SEATING/POSTURE/COMPUTER USE? or should I consider a more serious possibility? I do not have any other symptoms, but for a small little cold that the entire day care has had which turned into a resp infection for my daughter and only the slightest hint of illness for me that I muscled through....I've had a day or two of a few hours of light fever through this and a small little cough that cleared out some lung butter once I felt fine again and now there's nothing but an occasional tickle in my throat. No blood in sputum. No pain in arm or hands. No dizziness or actual nausea.
doctor
Answered by Dr. Suresh Heijebu 9 hours later
Brief Answer:
Possible Shingles and Shoulder bursitis? Need MRI for the later.

Detailed Answer:
Hello, Madam.

I can certainly understand your concerns.

I have worked through your query and attached images in detail.

The rash possibly represents Herpetic origin-Shingles/Post herpetic neuralgia.

The inciting factors for which in your case are undue stress, and associated shoulder discomfort.

This rash needs to be treated with oral pills of Valacyclovir and Pregabalin for an immediate and effective relief. Please check with your physician if he shares my view and if can prescribe these drugs to you.

With regards to shoulder pain, the possibility of muscular/ligamentous/bursa associated injury is high. This is directly related as an occupational hazard in your case pertaining to your posture and work nature.

For further assessment, I would to advise you to get an MRI scan of the involved shoulder to accurately detect the location of injury. This report will guide us further.

Post your further queries if any.
Thank you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Suresh Heijebu 28 minutes later
thank you for your assessment. It's the holidays here, Thanksgiving is in two days and I won't be able to get to my doctor until after the weekend. my understanding is the antivirus only really work if you start taking them within the first 3 days of the outbreak, at least insofar as they would protect against chronic ongoing pain after an outbreak. Is this true? I don't know how I can get my hands on the medicine that I would need before say Monday won't it be too late then? I think I first noticed the outbreak either Friday morning or Saturday morning
doctor
Answered by Dr. Suresh Heijebu 5 hours later
Brief Answer:
Early antiviral therapy is effective

Detailed Answer:
Hello, Madam.

I can understand your concerns.

Yes, it's true that antiviral drugs are effective in the first 3 to 4 days, but never the less these drugs can still be effective within the first week.

Hence my suggestion would be not to delay intake of medications as early as possible.

Thank you
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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