Came across a good power point presentation of a case of shoulder pain not helped by surgery and how the neck should have been considered:
Available here
Suggestive findings were:
1) Reduced pain with arm in abduction (up and out to side) is seen in cervical radiculitis while shoulder rotator cuff has worsening pain in that position
2) Pain on full passive elevation suggests shoulder pathology see blog note here
3) Arm sensory changes and weakness without pain suggests cervical
4) shoulder impingement tests:
5) Shoulder SLAP lesion test for torn labrium (rim of shoulder joint)
as per Medscape at here
The SLAP test (SLAPprehension test) is performed by suddenly internally rotating the shoulder as the shoulder is adducted 30∞ in 90∞ of forward flexion (Figure 1). A positive test is noted with clicking in the shoulder and/or pain radiating down the biceps tendon or in the posterior aspect of the joint.“
“Although the numbers of patients in their study is insufficient to test the validity of the test, they found that six patients who had positive crank tests all had labral tears, and no patient with a negative crank test had a labral tear.” http://cme.medscape.com/viewarticle/408488_2
6) Shoulder instability – good discussion here
7) Neck radiculitis tests:
30% sensitivity and 93% specificity – so good when you get it but means nothing if you don’t get it.
8) pain in neck and pain that radiates BELOW the elbow.
9) Triggers in trapezius, rhomboid minor, supraspinatus muscle, deltoid, supinator and perhaps forearm extensors, and so on – seen in pre-clinical radiculitis written by Dr. Chen Gunn.
9) Selective nerve root injection can confirm
What can be frustrating is when there is a neck- shoulder complex with both being players.
Recently, a discussion on how neck pain is aggravated by the shoulder:
http://www.aaos.org/news/bulletin/aug07/clinical5.asp
I came across this while searching the web. I have bilaterial shoulder impingement, tendonosis, tendonitis, etc etc so they say. I have been in pain since 2002. I have had 2 MRI’s that show nothing. The surgeon says there is nothing wrong but a little arthritis. I cannot sleep at night because if I roll on either shoulder it hurts and I wake up. Sometimes the pain is so bad I go for days without sleeping. It feels as if my shoulders are pulling out of the sockets. I have stabbing pains that sometimes go to the elbows. The surgeon only suggests more physical therapy or more injections….neither of which have done any good. I take pain pills constantly that I am sick of taking because at this point in time they only take the edge off and I refuse to take anything stronger. I am extremely frustrated and don’t know what to do. There IS something wrong…I can’t imagine having to live like this the rest of my life. I was a massage therapist for 10 years and injured them doing 12 massages a day. I keep telling the surgeon that just because he can’t see something doesn’t mean it doesn’t exist. Any suggestions? I’m desperate.
Phyllis, your so right about the scans not identifying the cause of the pain; I sent my scans to XMRI 2nd opinion radiology, and they identified multiple problems which were missed by radiologist at RUH;
I would start looking out of Province, out of country; for a specialist;
In Prince Albert, injured fireman, (shoulder injury) had surgery in Saskatchewan without much benefits; He traveled to Nebraska, had surgery and is doing much better; (WCB)
I cannot believe the lack of common decency many specialists dish out to injured patients; While many of these physicians are able to give patients back their lives like “GODS” many cherry-pick the easy cases and will not admit when they do not know what is wrong;
Instead of pain injections to try to isolate the cause of the pain, all you hear from these specialists is “There’s Nothing I can Do” – “There’s no reason for the pain you state your having”
For a patient faced with this attitude, this is extremely upsetting;
Unfortunately many “GOOD DOCTORS” who actually cared, and would investigate, have left Saskatchewan, pay and working conditions being the reason;
I know you may not want to hear this, but If I were you, I would take stronger pain medication to try to get some relief, at least until I could find a doctor who was willing to investigate.
I couldn’t imagine living in pain, without at the very least being able to knock the pain down to the point I am not suicidal; With that being said however, you must be careful NOT to injure yourself further by doing things while medicated; Masking the pain, can hurt you, and cause further injury;
“Good Luck”
Hi bi-lateral shoulder pain – just a quick thought- I work with heart patients (seniors) those that have bi-lateral joint and or muscle pain usually are taking cheap statins! Often the dose so too high, a left over from a large study ‘Search’ You don’t have to have the first meds your practitioner suggests- there are better, cleaner (less side effects) statins available- however they are MUCH more expensive ( think 2p vs. 80p)
Good luck I hope you find relief.
JaxAllenFitness
Super Senior Fitness Solutions