Dr. Atul Prakash
Orthopedician and Traumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 26-year-old woman, and I am suffering from severe pain in my right arm, especially in the joints from the shoulder to the elbow and near my thumb. The doctor gave me arthritis medications, and it does not work for me. It all started when I developed thyroid goiter. The goiter is cured, but the arm pain continues. Kindly suggest.
Hello,
Welcome to icliniq.com.
Please get erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), RA (rheumatoid arthritis) factor, and Anti CCP (anti-cyclic citrullinated peptide) tests done to rule out rheumatoid arthritis.
Thank you.
Patient's Query
Hello doctor,
I am a 26-year-old woman with 187 lbs weight and 5'5 height. Six months ago, I started experiencing severe pain in my right shoulder and neck. A few days later, I also developed thyroid goiter. I went to a hospital where they did an ultrasound-guided FNAC and concluded that it was a cyst of about 1.1 x 1 inch. The cytology report showed that the cyst was degenerating on its own and was noncancerous. I was not given any medication, but the goiter disappeared. After three months, I had my follow-up test on my thyroid function, which was normal. I am now experiencing pain in my arms, from the shoulder to my thumb and index finger. The pain is shooting from my shoulder to my fingers. My elbow joints hurt too. It is a dull kind of pain and is constant. My neck feels stiff, I am experiencing upper back pain, and my chest hurts like there is pressure. I feel tired all the time, and easy tasks feel hard. I am experiencing a dry cough in the morning and evening, and my voice gets hoarse when I talk continuously. My legs hurt from the knees and are stiff, especially in the morning, and my toes sometimes feel tingly.
Seven years back, my doctor asked me to do the following tests -
1. Antistreptolysin O (ASO) titer, which came back negative.
2. Random glucose test showed the normal range of 99 mg/dL.
3. RA (rheumatoid factor) came back negative.
4. They did a hematology test which came back normal, except my lymphocyte range was 24.00 microliter of blood which the doctor said was low, and my MCH (from the red cell indices) was 26.50 picograms.
5. My blood pressure, body temperature, and heart rate were normal too.
After these tests, the doctor prescribed me a Myospaz tablet for five days, and I finished the dose. But unfortunately, it did not help with the pain.
I hope I have provided enough medical background. Kindly help.
Hello,
Welcome back to icliniq.com.
From the information you provided, your symptoms are generalized fatigue with pain and localized pain in the neck and arms with stiffness. It would help if you had both these investigations done -
a) ESR (erythrocyte sedimentation rate), C-reactive protein (CRP) to help rule out inflammatory conditions.
b) Vitamin D levels, if low, will rule out generalized pain and fatigue.
c) Get a neck X-ray and MRI (magnetic resonance imaging) of the cervical spine to help clarify the cause of your neck and shoulder pain.
I would suggest you take anti-inflammatory tablets. Myospaz (Paracetamol and Chlorzoxazone) tablet is a muscle relaxant. If pain is severe, you should, in addition, take tablet Paracetamol and tablet Tramadol (Tramadol hydrochloride), which is a suitable painkiller. Consult your specialist doctor, discuss with them and take medicines with their consent. You also should get some local physiotherapy, which will help ease the pain and stiffness. Regarding voice issues, you should seek an ENT surgeon's advice as we need to be sure that the nerves of the voice box are not under pressure.
Please come back with the reports so I can be more specific with the line of treatment.
Thank you.
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Orthopedician and Traumatology
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