How to treat left shoulder pain and arm pain in a diabetic patient?

Patient's Query

Hello doctor,

My mom is a diabetic for the past 10 years. She takes Glimidib MV2 SR and insulin Insuman Comb 25. Yesterday, she did sugar levels before breakfast it is 294 and post it is 334. She has been having pain in the left shoulder and the arm, since March 2020. We have been in consultation with orthopedic doctor. Recently, her pain increased and as suggested by the doctor, we did her MRI with cervical screening but he is travelling this week and not available. I am attaching the MRI report and prescriptions from March. We consulted him on 20th June and would like to have your advise on the MRI report and medicines too.

She suddenly gets unbearable pain and so we had to immediately consult a general physician locally. He advised already that my mom's diabetes is high and too much of pain killer would harm her, hence he suggested to have Dolo 650 in addition to the prescribed medicines. Kindly help if medicines need to be reviewed or she has to undergo some treatment.

Below is the medicines she takes for diabetes:

Insulin 15 units before breakfast and 15 units before dinner, and Glimidib MV2, one tablet before breakfast and one tablet before dinner.

Answer

Dr. Chintan

Orthopedics And Traumatology

Hello,

Welcome to icliniq.com.

I have seen the attached reports (attachment removed to protect patient identity).

I have treated many such patients with adhesive capsulitis and cervical spondylitis. I would like to suggest initial management for your mother and she will require a good follow up of the treatment after this initial treatment.

Management of adhesive capsulitis of shoulder and cervical spondylitis includes following:

1. Tablet Dolo 650 (Paracetamol 650 mg to 1 gm) twice a day for 1 week.

2. Hot fomentation of the shoulder and spine to relieve pain.

3. Once the pain is under control then she can start physiotherapy exercises for shoulder and neck with a good therapy (this is required in follow up treatment once pain is under control).

4. For severe pain, tablet Ultracet (Tramadol) once to be taken for severe pain.

5. For muscle spasm, tablet Myoril (Thiocolchicoside) 8 mg once a day for muscle pain.

6. For acute inflammation, tablet Defcort (Deflazocort) 6 mg once a day to be taken (to be avoided if diabetes is not under control).

The Probable causes:

Degenerative condition with diabetes.

Treatment plan:

Medical management followed by physiotherapy protocol.

Preventive measures:

Avoid lifting heavy weights. Avoid bending forward. Control diabetes.

Regarding follow up:

Follow up in five days.

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