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Jeruba's avatar

Shoulder pain: is there anything short of surgery that I haven't tried?

Asked by Jeruba (51090points) July 4th, 2010

Pain seems to be centered in the right shoulder blade but also includes the areas of the cervical vertebrae and upper arm.

It used to happen occasionally when I was a youngster after prolonged periods of writing or typing. It didn’t become very troublesome until about 20 years ago. Since then it has steadily increased over time. Now it is constant, throbs in the night, interferes with sleep, and worries me because nearly everything I do depends on the use of my right arm. Sometimes my right arm is cold. My hand is also increasingly stiff, but that could be from a lot of things.

I was diagnosed with degenerative disc disease, especially C5-C6, in my forties. More recently a “big spur” was seen in Xrays.

A physical therapist also asked me if anyone had mentioned thoracic outlet syndrome to me, but no one has besides her.

Treatments so far:
— pain medication – side effects of Ultracet and Tylenol 3 worse than the distress; discontinued
— Lidocaine pain patches – 10% benefit at best
— exercises – virtually no effect
— physical therapy—helps a lot for about 45 minutes afterward, then reverts until the next session
— cortisone injections – taken twice: #1 significantly reduced pain temporarily, but sharp headache followed treatment; never had it before, have been troubled by it ever since; #2, 5 weeks later, reduced pain by about 70%, but not for long

All this took about a year and a half. Eventually I gave up hope and stopped seeing the spine doctor. I was not willing to have surgery without confidence that it would help. Now things are enough worse that I have to think again about seeking treatment, but I don’t know why the useless previous efforts would work any better now.

What else is there to do? What am I missing?

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15 Answers

talljasperman's avatar

Have you tried doing nothing and giving your body a chance to heal… for a while…. When I’m in pain I take it as a message to take a break…I’n fact my shoulder was hurting and I took a warm bath and took an Alieve…and I’m happy… And I hate the T-3’s I had to go without them when I broke my ribs in feb this year, because they made me sick…but The anti-inflamitories worked…

Have you tried yoga… and meditation?

cazzie's avatar

This sounds familiar. Pinched nerves in the neck and back for me…

Anti inflammatory meds are the only thing that work on my neck and arm and head. I was going to an osteopath when I lived in a different country and had a proper job and could afford it. It’s not covered by national medicine where I live now, so it’s been really hard, especially now that it’s spread to my lower back, effecting my right hip. I’ve tried physiotherapy, but like you, helps for a short time, then the pain is back.

Hot baths, taking it easy and stretching and hot water bottles. Lots of time with hot water bottles. Taking regular breaks.

I’d go to an osteopath if I could afford it, but it’d have to find one like the last one, and they’re all different, from what I understand. The one I had used therapeutic massage first and then did adjustments, not often with cracking things, but mostly by massage and relaxing nerves that kept things in place. My neck stopped cracking all together and the migraines went away.

SmashTheState's avatar

When I did construction work briefly, the other workers told me about Tiger Balm. They all said they’d have been unable to get out of bed in the morning without Tiger Balm the night before. So professionals who do a lot of strenuous labour and suffer more or less constant sprains and strains, swear by Tiger Balm. And you know, it does work.

gailcalled's avatar

Massage therapy and acupuncture? They are conservative modalities.

Buttonstc's avatar

Have you considered a pain management specialist yet ?

This is a medical specialty in and of itself and the legit ones aren’t only pill pushers. As a matter of fact their goal is to try anything but that. They are up on all the latest advances in this field.

Jerry Lewis found a guy who did wonders for him with some type of small electrical device and he says it saved his life. Prior to that he had been all bloated up from the heavy doses of anti inflammatory steroids and other painkillers they had him on for years.

The trick is finding a good one rather than one just taking the easy way out by writing prescriptions.

It’s very much a matter of basic philosophical approach to medicine which is willing to investigate alternatives other than pharmacological or surgical.

Generally speaking, Physiatrists (NOT Psychiatrists) are oriented toward approaches other than just pills. Their specialty is Rehabilitation medicine. They are likely to be in favor of the more conservative types of treatments mentioned by Gail as well as others as a first resort rather than just pills or surgery.

Their medical training and requirements prior to specialization are identical to any other MD or DO here in the US. the only difference is their area of specialization.

That’s where I would start. If a Physiatrist were unable to help then he’s the one I would ask for a reco. to a hood pain management specialist as he would know the pill pushers from the real deal.

You most likely don’t want to be looking for those who advertise pain management clinics and the like. That’s for folks hunting for pill pushers.

The good pain management guys don’t need to advertise as they’re booked up so full it could take a month or more just to get an appt. And it won’t be a five or ten minute deal either. They’ll do a thorough workup and study your previous medical records, etc.

The guy that did so much for Jerry Lewis is right here in MI but distance is no object for someone with his kind of money. I’m not sure where you’re located, but with a little digging, I’m sure you can most likely find competent pain management Doc or a Physiatrist in your neck of the woods.

I would try both of these specialists to suss out what type of help is available for your particular condition. If you go to an Orthopedic Surgeon, guess what? They’re going to recommend surgery. No surprises there.

I’d see what the other two specialties have to offer first.

www.physiatry.org

www.aapmr.org
(this site contains what looks to be a good searchable database to find one near you as well as good info on this specialty)

lifeflame's avatar

I’ve recently been trying some awareness/passive stretching. It has been doing wonders for me.

Basically you lie down with your hands by your sides, palms up. Relax, breath deeply, let your weight sink into the floor. If it’s better for your back you can bend your knees, planting both feet on the floor.

Then, you gently move your fingertips, one at a time. Pay attention to your breathing, making sure the rest of the body relaxed. You don’t have to move it very much; in fact, there’s research that shows that the more minute the movement, the more neurons are fire up.

Then, imagine your center of your palm to be filled with water. Slowly, tip the water with the same kind of slow pace. Usually I think of my thumb making the journey of the arc. When at last it is face down, allow your hand to rest on the floor, making sure wrist, elbow, etc are relaxed. Repeat at this pace, flipping it back over.

Now, imagine someone taking your third finger and tugging it out slightly. Then, if your body was a clock lying on the floor (your feet at six o’clock and your head being midnight), move your right palm from seven o’clock to eight o’clock. Release. Inhale, middle finger tugs out, move from eight to nine of clock. Feel the space in the shoulder-blades. Release. Repeat.. nine o’clock to ten; ten to eleven, and eleven to twelve. The most important thing is that you allow yourself to fully release and you feel the difference the various postures are give you. If you like, do the palm-tipping at various positions.

If this works for you let me know; I have other variations. This exercise is a permutation from Feldenkrais / Body Mind Centering; though in BMC it is usually the partner who manipulates your limbs/palms, and all you do is relax and sense the change.

For a long time I was stretching with muscles, and then I discovered this alternative where you just use your awareness to release. I’ve been doing tai chi now, similar principles.

You may also wish to ensure that your computer and workplace is ergonomic; or movement awareness alignment disciplines like Alexander technique or Feldenkrais. I too, had/have shoulder pain (another long story, involving a car crash and typing) and I’m finding this type of realignment/awareness of how the body works really helpful.

Cruiser's avatar

Do yoga instead. Find a yoga therapist who will help balance you out and can almost guarantee you freedom from pain.

Jeruba's avatar

Alas, alas, it was doing yoga that broke my foot. After 4 months of weekly classes, which I loved and which definitely improved my overall well-being, I developed a stress fracture. I heard and felt my arch snap while in Dancer pose. The doctor said this injury is common in people who have recently started a new exercise regimen, such as jogging. I didn’t know you could hurt yourself this way.

I’ve been in a soft cast since January and forbidden to exercise. I may have another six months to go, and when I’m finally good to walk on my right foot, I don’t think I’m going straight back to what injured it.

lloydbird's avatar

Sounds to me like RSI.

Rarebear's avatar

It depends on the diagnosis as to whether surgery will help or not. Just because you have DDD doesn’t mean the discs are causing the pain. Everybody in their 40s has some aspect of DDD or DJD (joint), and an MRI finding does not mean that that’s what is causing the pain.

Agree with the pain management specialist suggestion. Also getting a second opinion from a spine specialist may be useful.

Cruiser's avatar

@Jeruba That which doesn’t kill you only makes you stronger…or something like that! Give it another try just no more triple back flips in Dancer pose!

Jeruba's avatar

@Cruiser, I thought we dispatched that notion just a week ago. Some things that don’t kill you do nearly kill you.

cazzie's avatar

Stress fractures can be a sign of low bone density. Have you had a bone scan recently?

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