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    Suggest treatment for tendinitis in the left shoulder

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Posted on Fri, 11 Aug 2017 in Hypertension and Heart Disease
Question: Hello I have a question for Dr sharka we have confirmed that my holter monitor and my 24 hr blood pressure is good and normal tests attached I also did stress echo dex 2016 I am wondering if u can confirm if I should be worried my left arm hurts it has hurt on and off before I do have tendinitis in left shoulder and elbow and only hurts between shoulder and elbow back of arm just want to confirm this is not cardiac and if I should seek further testing
doctor
Answered by Dr. Ilir Sharka 30 minutes later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello dear,

Welcome back on HCM!

Regarding your concern, I would explain that your symptoms are not related to any cardiac disorder.

This pain location is typical of tendinitis or any other musculoskeletal pain!

Are your symptoms triggered by arm movement of pressure? This would be another argument in favor of musculoskeletal pain.

So, there is nothing to worry about!

I recommend taking ibuprofen 400mg three times daily and avoid straining physical activity for some days.

Hope to have been helpful!

Kind regards!

Dr.Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 7 minutes later
Hello thank u my shoulder joint hurts if I move my arm and my arm hurts to touch in that area it also hurts when I don't touch it if I press on it that area hurts and is sore I just wanted to make sure it is not cardiac related as I am unable to get in to my gp till Monday
So no further cardiac testing is required
doctor
Answered by Dr. Ilir Sharka 6 minutes later
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Thank you for the additional information!

As a cardiologist I would like to reassure you that your symptoms are not related to any cardiac disorder and there is no need to perform any cardiac tests.

There is no need to go to the ER!

Just relax!

Taking ibuprofen for some days will help.

If your symptoms persist, I would recommend consulting with your GP and performing shoulder joint X Ray study and inflammation tests ( complete blood count, PCR and ESR).

Wishing a nice weekend,

Dr.Iliri


Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Ilir Sharka 15 minutes later
Thank u u have reassured me have a great weekend
doctor
Answered by Dr. Ilir Sharka 2 hours later
Brief Answer:
You are welcome!

Detailed Answer:
I am glad to have been helpful to you!

If you have any other question, please don't hesitate to ask me again!

Kind regards,

Dr.Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 3 days later
Hello
I was having a bad flare up on Sunday that took me to emerg I have attached the following tests the cardiologist said he is certain it is not cardiac and that the ecg could just be my heart reading but my d dimer test and ck levels r high I do have a follow up to do an echo and stress test on Monday am I in any immediate danger cardiologist said I can continue with my speed walking
Please advise
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

I passed carefully through your uploaded tests and would like to explain that your lab tests confirm a slightly increase of Troponin T, CK and D-dimer level.

Considering the fact that you have experienced a symptomatology that was not specific for cardiac ischemia and a musculo-skeletal disorder could be the reason of that persistent and pressure modulating pain it is necessary a careful differential diagnosis of the last findings.

Besides a musculoskeletal inflammation complicated by rhabdomyolysis which could lead to a similar laboratory pattern, other alternatives should be considered as well.

Pulmonary embolism is one of the most important disorders to be excluded first as it is a dangerous disease. An increase of Troponin , CK and especially D-dimer levels (above 1000) may be suggestive also of pulmonary embolism when symptoms like sudden dyspnea (difficulty of breathing), tachycardia and also chest pain appear.

Coming to this point a ventilation/perfusion lung scan is recommended.

Also, a pulmonary angioCT would be helpful in this regards (though it may reveal in general pulmonary embolism up to the segmental artery level).

A better alternative would be a triple rule-out chest angioCT (if available) with the capability of exploring concomitantly the pulmonary arteries, coronary arteries and also the aorta.

At the meantime, the recommended echo would be helpful in the differential diagnosis workup (excluding a cardio-pulmonary implication).

Regarding cardiac stress test, it would be better to first exclude the possibility of pulmonary embolism before deciding to proceed with the test.

Pulmonary angioCT would be a better option in this regard.

You should discuss with your attending physician on the above mentioned issues.
Please, let me know how things will go on!

I remain at your disposal for any further discussions.

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 31 minutes later
I had a ct scan done at the hospital that rules out embolism already I was told my traponin was not of concern she I be asking for other tests and should I go back to emergency right away .
That the traponin and d dimer could be high bc of inflammation once cardiac was ruled out I had the following g done
Ecg several - slight depression
Was hooked up to monitor over night to monitor me
Normal blood pressure
Normal heart rate when not anxious
Blood work that was uploaded
Ct scan - said negative for blood clots or embolism
Is the traponin very high ?
doctor
Answered by Dr. Ilir Sharka 50 minutes later
Brief Answer:
I would explain:

Detailed Answer:
Hi again,

Troponin is slightly high but its absolute value should be judge in relation of the assay being used, as different assays have different cutoff values.

Nevertheless, as pulmonary embolism is excluded and also aortic disorders excluded as well (evidence are generally drawn by chest angioCT), then the option of inflammation seems to be more reliable.

Inflammation could be musculoskeletal, costochondritis, etc., but a pleuro-pericardial inflammation should be sought as well.

Markers of inflammation and also rhabdomyolysis should be checked like:

- PCR,
- ESR,
. AST & ALT,
- LDH,
- CPK,

Cardiac ultrasound would be helpful for investigating the pericardial and also pleural layers.

At the meantime, anti-inflammatory drugs like ibuprofen, ketoprofen, naproxen, etc. would be beneficial for relieving the pain.

Wishing you are going to be fine soon!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 26 minutes later
Thank you .. so I am not in any current danger of cardiac and I can continue to speed walk and work till I get my ultrasound done on Friday as well I am getting my arms and legs checked for clots and echo to rule out anything and stress test if ultrasound comes back normal
doctor
Answered by Dr. Ilir Sharka 8 hours later
Brief Answer:
Opinion as follows:

Detailed Answer:
Hello!

You may continue following your usual daily activity without worrying about any dangerous complications, as far as acute cardiac and pulmonary events are excluded.

When you get those medical tests done, I would like to review them directly here on HCM.

So, when they are available to you, please upload them here for a second professional opinion.

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

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