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What could be wrong if the shoulder pain subsides with rest and recurs while exercising?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Anuj Nigam

Medically reviewed by

iCliniq medical review team

Published At November 4, 2022
Reviewed AtDecember 14, 2023

Patient's Query

Hi doctor,

I went on a trip eight months ago, and I swam in a swimming tank for a long time. I have also been exercising regularly in the gym for more than two years. However, while exercising with weights, I experienced a mild pinching pain in my left shoulder eight months back. After that, though, I was able to lift weights normally but felt a slight weakness in my left shoulder. But I continued exercising. However, I stopped exercising for 10 to 15 days to wait for it to heal. After that, I again experienced mild pain while exercising. A few days after the incident, I consulted an orthopedic specialist, and he examined and suggested undergoing X-rays at different angles. However, the X-ray reports were normal, and the doctor did not find anything abnormal while examining, and he prescribed me some medicines. So I avoided exercising and took medicines for 15 days, and I thought the issues had completely healed as I did not experience any pain. But again, I experienced pinching pain while exercising. Then, I consulted another orthopedic specialist, who suggested not exercising for ten days, and prescribed medicines for ten days. After taking medications and resting, the pain stopped, and I thought the issue was completely resolved. But again, I experienced pinching pain while exercising. In addition, I also observed the pain to become severe if I lifted heavy bags. So again, I consulted with the same orthopedic specialist who prescribed me medicine for five days but suggested undergoing an MRI of the shoulder in the first place. I underwent the MRI test, and the reports were normal. I have attached the MRI report for your reference. Then I took the medicine prescribed by the orthopedic surgeon for five days, and the cycle repeated. So now I have stopped exercising for the past ten days. However, I experience frequent mild pain when I move the shoulder at different angles. I thought I would not have pain if I did not exercise. I do all my daily routine without any hindrance. However, I am concerned that I cannot exercise at all. Please give your suggestions.

Answered by Dr. Anuj Nigam

Hi,

Welcome to icliniq.com.

I went through your query and understood your concern. Can you please send me a picture marking the area of the shoulder where you feel the pain exactly? And your MRI (magnetic resonance imaging) reports reveal nothing abnormal about the shoulder (attachment removed to protect the patient's identity). However, similar pain also arises in several cases where the actual problem is not in the shoulder but elsewhere. So kindly attach a picture marking the exact site of pain. Also, let me know if your pain is going downward in your arms. And, have you felt any weakness in your left arm in the last eight months, like while holding objects? I hope this helps. Kindly follow up with the answers.

Patient's Query

Hi doctor,

Thank you for your reply.

I have attached a picture of the painful area. It is difficult for me to locate the exact location of the pain as it arises from the inside of the back of the upper limb from the shoulder to the elbow. There is no swelling or pain on external pressure. However, I have pain while moving the arm sideways from the shoulder or the elbow. And, yes, pain seems to be going downwards to the elbow. And there is no weakness while holding objects. But while lifting an object like a bag, I experience pain or weakness in the upper limb. Is it possible that a muscle tear can cause this pain? As I have been doing weight training exercises. In addition, the pain has become severe in the last eight days. Please suggest a solution to this.

Answered by Dr. Anuj Nigam

Hi,

Welcome back to icliniq.com.

Your shoulder is absolutely normal. What you are experiencing is most likely due to a pinched nerve in your neck. They are referred to as cervical spondylitis, cervical myelopathy, or cervical neuropathy. The nerve supplying to that part of your shoulder and arm is getting pinched in your neck. Whenever you exert stress, like lifting weights, heavy objects, or even pushing or pulling something, you will experience similar discomfort. The causes are most likely due to jerky movements to the spine, mostly while swimming or lifting heavy weights. An MRI (magnetic resonance imaging) of the cervical spine will reveal the exact location of the nerve involvement. So, I suggest you to undergo physiotherapy for your neck and exercises and limitations of certain activities that can stress your cervical spine. And I will be suggesting some medicines for the same. But before that, I need to know a few more things,

  1. What kind of job do you do?
  2. What is your daily routine?
  3. Do you drive a two or a four-wheeler?
  4. Are you allergic to any medicines?

Kindly follow up with the answers.

I hope this helps you.

Thank you.

Patient's Query

Hi doctor,

Thank you for your reply.

  1. I do my office works mainly on a computer. I am on office tours 7 to 10 days a month and usually travel by train.
  2. I drive both two and four-wheelers but less frequently as I mostly prefer public transport or walking. However, I go on long drives in my car once in a half year for 500 km.
  3. I am not allergic to any drugs.
Answered by Dr. Anuj Nigam

Hi,

Welcome back to icliniq.com.

A job involving working on a computer or laptop mainly adds up to the problem. I suggest you to mount your screen or adjust the angulation so that your neck is straight and your eyes are looking forward 90 degrees to the screen. You should avoid flexing, that is, forward bending of your neck, and change your neck posture. Also, I will share some good neck exercises with you.

I hope this was helpful.

Take care.

Patient's Query

Hi doctor,

Thank you for your advice.

I will keep that in mind.

Thank you.

Answered by Dr. Anuj Nigam

Hi,

Welcome back to icliniq.com.

I have sent you a chart that contains some simple exercises, and I suggest you to follow them for a week. Also, you may require an MRI cervical spine in the future. Kindly follow up after three days if there are any improvements, changes, or any issues.

I hope this has helped you.

Thank you.

Patient's Query

Hi doctor,

Thank you for the reply,

Actually, I purposely not stretching my hand too much, but when I work on it, I can say that I not experiencing pinching or any pain anymore.

Answered by Dr. Anuj Nigam

Hello,

Welcome back to icliniq.com.

Good to hear that you have some relief. Here are the answers to your queries:

  1. Your X-ray does not reveal any bony abnormalities. However, there is stiffness due to neck muscles spasm.
  2. The relief you are experiencing is a combination of pain medicines and your selective activity.
  3. Please tell me more about the pinching pain and weakness in the arm and hand, which you mentioned previously is it the same or lower or increased? A cervical collar is used mostly when there is pinching pain and weakness.
  4. Any tingling or numbness, or weakness if you are experiencing, then an MRI (magnetic resonance imaging) cervical spine is recommended for acute diagnosis.
  5. We will lower the painkiller and add up light muscle relaxants for the next five days for your neck muscle spasm, as evidenced by an X-ray.
  6. You should continue doing exercises as you are now comfortable with them. Avoid lifting weights till the end of three weeks.

Kindly reply.

Patient's Query

Hi doctor,

Thank you for the reply.

Actually, I am avoiding stretching or moving the arm extremely, but I can say that I not experiencing any pain or pinching anymore.

Answered by Dr. Anuj Nigam

Hi,

Welcome back to icliniq.com.

We can wait for MRI (magnetic resonance imaging) for a week. After a week, start regular work, including stretching. If symptoms persist, only we will get MRI.

I will send an updated prescription tomorrow morning.

Patient's Query

Hi doctor,

Thank you for the reply,

Please refer to our earlier conversations and your prescriptions.

These are observations after first follow-up:

  1. On the first day, I started to take tablet Zerodol TH 8 with prescribed medicines, hot water bag fomentation over my shoulder, and application of ointment Myolaxin D gel. I did neck exercises. There was fine till the time. However, unknowingly, I stretched my left hand vertically. Then the pain started again. So then, I avoided doing any work from my left arm as much as possible I could.
  2. On the second and third days, there was still a pain in the left arm. So I avoided doing even neck exercises and any major work from the left arm as much as possible.
  3. On the fourth and fifth days, the pain stopped. Hence I started neck exercises again. No pain was observed. However, I avoided stretching the hand extremely.
  4. The tablet Zerodol TH 8 was finished on the sixth and seventh days. I continued neck exercises. No pain was observed. However, I avoided extreme stretching my hand.
  5. On the eighth day, as the pain was absent and seemed completely stopped for a few days, I did hand stretching exercises from downward to upward. However, after the exercise, the arm starts to feel little paining.
  6. On the ninth day, as I woke up, I found no pain in my arm. I have done all exercises with stretching. I experienced little pain after the exercises. But after some time, I found the pain had gone.

Hence, it can be concluded that I can do neck exercises, but the pain starts after the arm is stretched right upwards. But this time, the pain remains for only some time then it recovers. As you suggested earlier, I am ready to go MRI cervical spine for further diagnosis. Any suggestions?

Answered by Dr. Anuj Nigam

Hello,

Welcome back to icliniq.com.

It is good to hear that you are recovering fast. However, pain in the arm stretching still keeps us in a dilemma, so yes, we should go for an MRI (magnetic resonance imaging) cervical spine this time. Do carry your previous MRI shoulder report and films to the MRI center so that the radiologist can compare, and it will be easy for him to comment on any new changes in the shoulder region as well. Keep continuing the neck exercises and avoid heavy weight lifting until MRI results. I will send you the prescription for MRI scan and cutting down the medicines (especially painkillers) by tomorrow morning. You can make the appointment for the MRI cervical spine scan at any diagnostic center of choice for tomorrow or the day after tomorrow, whichever suits you best.

Thanks for the timely follow-up and detailed description.

Patient's Query

Hi sir,

Thank you for the reply,

Noted sir.

Answered by Dr. Anuj Nigam

Hi,

Welcome back to icliniq.com.

Ok.

Patient's Query

Hi sir,

Thank you for the reply,

Please find attached the MRI report of the cervical spine. During the test, the lab technician mentioned that difference between the present condition of the shoulder and the previous report could not be analyzed as they would only scan the cervical spine. I am doing all exercises, including hand stretching. Now no significant pain there in hand. Please suggest according to my report.

Answered by Dr. Anuj Nigam

Hi,

Welcome back to icliniq.com.

I have seen your reports (attachment removed to protect the patient's identity).

I need to see the MRI (magnetic resonance imaging) films. Please send me pictures of the MRI.

(place film on a blank white background, a blank page on a computer (MS word), or a white wall) (Please ensure the background is clear of any wall hangings or furniture).

Patient's Query

Hi doctor,

Thank you for the reply,

Sure sir. I will.

Answered by Dr. Anuj Nigam

Hi,

Welcome back to icliniq.com.

The reports are suggesting slip disc-like features which are compressing the nerves causing pain in the shoulder region as I had expected from day 1. I need to see the films to check the exact amount of discs coming out to finalize my decision. You have cervical myelopathy, and the discs between your cervical vertebrae are pushing out and compressing the spinal cord, that are causing you the current symptoms. You need to put on a neck collar. It is called the cervical collar. Put it for at least ten days full-time, even sleeping. And avoid rotation movements of the neck. Rest all is fine. I have added a muscle relaxant and a low-dose pain med similar to the first prescription but a lower dose. Keep on doing the current exercises. You are improving well. I recommend undergoing a Physiotherapy session for the cervical and shoulder regions with specialized machines. You need daily sessions of Interference therapy (IFT) & Ultrasound therapy (UST) under the guidance of a physiotherapist.

I hope this has helped you.

Thank you.

Patient's Query

Hi doctor,

Thank you for the reply.

I will follow the steps.

  1. But as I have already started my office tour for three days, Can I start physiotherapy?
  2. I have one more office tour next week for three days. Can I skip the therapy for these days?
  3. How much serious is this myelopathy?
  4. How much time will it take to recover?
  5. Can I ever start my weight training, and approximately when?
  6. Did it occur due to weight training?

Sir, these are the questions that I may find inconvenient but please answer if possible.

Thanks for the exact diagnosis.

Answered by Dr. Anuj Nigam

Hi,

Welcome back to icliniq.com.

  1. Yes, you can start therapy after your tour, but please keep in mind to avoid jerky movements to the neck. Better to wear the cervical collar. Keep on doing previous exercises and hot water bag fomentations at night during rest.
  2. It is not serious at the present situation (3/10), but it is an alarming sign that you have to correct your routine and posture as if this disc comes out more outwards, it may cause serious effects in the future.
  3. With adequate exercise, precautions, and rest, these discs will eventually heal by themselves and stop the progression. It may take three months to six months to normalize. Every nerve pain takes time to heal. You have to continue Neurobion (Riboflavin) and Pregabid (Pregabalin) for a few months. But being at a young age, you will recover soon.
  4. We can try weight training. By the time you can continue cardio and leg presses (lower body training).
  5. There are multiple causes for these. However, the two contributors are your job (sitting over computer screens) and heavy-weight training.

You need to remind yourself to do it (the job and the gym) the right way and do regular exercises to keep your neck muscles relaxed.

I am always happy to help.

We, as a doctor, are lucky to have you as a patient who gives detailed follow-ups.

Wishing you the best health.

Patient's Query

Hi doctor,

Thank you for the reply,

Shall I even continue ointment Myolaxin D gel and tablet Enzoflam?

Answered by Dr. Anuj Nigam

Hi,

Welcome back to icliniq.com.

Continue the ointment. As you are on tour, switch to today's prescription of tablet Ultracet semi (Tramadol and Paracetamol) (If you were not on tour, I would have advised taking Enzoflam (Diclofenac, Paracetamol, and Serratiopeptidase) until your strip or stock gets over and then start tablet Ultracet). Take tablet Enzoflam only SOS (it is a very light painkiller and can be used for any pain).

Patient's Query

Hello doctor,

Thank you doctor for the reply.

I have been using the cervical collar belt since the last month. I am doing exercises as you mentioned. But at the extreme end movement at the top, I feel discomfort at the shoulder with no pain. It is the same symptom that I experienced initially. I am undertaking therapies under a physiotherapist. The physiotherapist also guides me with some extra exercises to gain muscle strength. Moreover, the physiotherapist recommended that I buy a flexible band to do these exercises at home. I am taking Pantop DSR, Mioril, CCM, Uprise (weekly), Neurobion Forte, Pregabid NT, and Ointment Myolaxin D gel. I stopped taking Ultracet Semi or Enzoflam for a month. I am doing hot water bag fomentation over the shoulder and neck. Additionally, I visited my regular orthopedician. He checked me physically and also saw the cervical MRI films. He mentioned that the illness is not severe and the treatment suggested by you is correct.

Present condition: There is no pain as such in the left arm. But I do feel weakness in my left arm. So I avoided lifting any weight with it as far as possible. Also, as I mentioned, I feel slight discomfort in the shoulder during movement of the left arm. It is the symptom I had observed initially while doing exercises under the guidance of a physiotherapist too.

  1. Shall I stop using the collar, as I have continuously used it for 11 days?
  2. Shall I start exercises recommended by the physiotherapist at home? I feel quite comfortable now with these exercises too.
  3. You mentioned that our treatment aims to stop the further progression of the illness. However, is it possible to reverse it completely?
Answered by Dr. Anuj Nigam

Hello,

Welcome back to iclinq.com.

Reading your replies with an accurate description of improvement and current ailments is always a pleasure. For any nerve pinching and muscle stretch symptoms, it takes two to three weeks for the complete settlement of symptoms and may take two to three months for reversal. Please continue using the collar belt for ten more days. You may also follow up with your physiotherapist and start at-home exercises. Getting relief from the pain and difficulty in hand movements is the prime target. Reversing the nerve pinch and disc symptoms at a young age is possible but may take time. Do continue the same medications for next week.

Patient's Query

Hi doctor,

Thank you doctor for the reply.

Shall I continue taking the tablet Pantop DSR, Mioril, CCM, Uprise (weekly), Neurobion Forte, Pregabid NT, and ointment Myolaxin D gel till the next month?

Answered by Dr. Anuj Nigam

Hi,

Welcome back to icliniq.com.

Yes, I suggest you continue taking the medications. We will taper it within one or two months.

Patient's Query

Hello doctor,

Thank you again for your time; I greatly appreciate it.

You mentioned last time about the reminder. The condition is the same as earlier, as I informed you. The only change is that, as per the physiotherapist's advice, I started sessions with a two-day gap instead of daily. One important update I want to provide is that I have been experiencing a continuously mild ringing bell-like noise (tinnitus) in my right ear for around 6 days. I visited an ENT specialist, who suggested some blood tests. The report of which is attached herewith. According to the report, my B12 level is low at 197 pg/ml. The specialist mentioned that low B12 levels might be the cause of tinnitus. Hence, he prescribed me some medicines and Nervijen plus injection (2 ml) to be taken with a 2-day gap. My queries are as follows:

  1. Should I stop using the collar since I used it continuously for 18 days? Moreover, I have reduced the frequency of using the collar. I now only use it during travel, but I avoid jerky neck motions.
  2. How does the low B12 level impact cervical myelopathy and arm pain?
  3. When should I stop the US & IFT treatment?

Please provide further treatment or suggestions.

Answered by Dr. Anuj Nigam

Hello,

Welcome back to icliniq.com.

There can be a number of causes for tinnitus, so it is good that you consulted an ENT specialist. Your vitamin B12 levels are low but are just borderline. The tablet Neurobion (Thiamine disulfide 100 mg, Pyridoxine hydrochloride 200 mg, Cyanocobalamin 200 mcg) you were already taking on my previous prescription will eventually help to normalize it. However, I really appreciate the treatment of an ENT (ear, nose, and throat) specialist for injection Nervijen as it helps to alleviate the symptoms very fast, which is recommended in tinnitus. Now, as per your queries.

  1. You can stop collar use and do wear it while traveling in any vehicle.
  2. B12 is an important factor for nerve regeneration and helps in developing stronger nerves, and is important for any type of pain in any part of the spine. You were already prescribed for tablet Neurobion by me to be taken for two to three months. You have to continue that. Pain, however, gets subsided by painkillers and does not exactly relate to the B12 levels, but the pain caused due to pinched nerves, like in myelopathy and radiculopathies, do have shown good response on prolonged treatments.
  3. For IFT (interferential therapy) and UST (therapeutic ultrasound), three weeks is the maximum period in one stretch and should be given breaks in between the therapies. Follow you, physiotherapist, accordingly. It is good to know you are in good hands.
  4. I will provide you further plan of treatment as soon as possible.

Please send me the last prescription as an attachment. Also, I would like to know these as well:

  1. Any difficulty in routine work?
  2. Any pains during rest?
  3. Any weakness felt to grip objects?
  4. Any dizziness or vertigo?

Awaiting your response.

Thank you.

Patient's Query

Hi doctor,

Thank you for the reply.

  1. I do not find any difficulty in routine work.
  2. I have no pain during rest.
  3. I have no weakness felt to grip the object.
  4. I also have no dizziness or vertigo.

I have attached the last prescription.

Answered by Dr. Anuj Nigam

Hi,

Welcome back to icliniq.com.

Thank you for the details.

Patient's Query

Hi doctor,

Thank you for the reply.

I am doing well and following your instructions. Here I want your suggestion on different issue. As I mentioned earlier, I started experiencing tinnitus issue in my right ear since last 15 days. I consulted one ENT. He checked the ear. He prescribed medicines. And he also prescribed me steroid tablet Ivepred (8 mg) initially twice a day for 5 days then once in day for next 5 days. As I know, steroid has permanent side effect like AVN. Here I want to clarify that my brother has AVN issue since almost one year. The reason of AVN might be the steroid injections taken during corona treatment.Please suggest, is there any possibility of AVN in the future if I take steroids as mentioned above?

Answered by Dr. Anuj Nigam

Hi,

Welcome back to icliniq.com.

It makes me happy to know that you are in good health. Yes, steroids during the COVID era have been found to be disastrous in many patients due to the risk of AVN. However, these adverse effects were associated with very high doses and prolonged treatment periods. Please be assured that low-dose steroids, as in your case, are necessary for your treatment. The risk of AVN (avascular necrosis) is primarily associated with heavy doses of steroids over extended periods, and there is a direct relationship between the use of steroids and the development of AVN, as per the literature, typically requiring at least a month of high-dose treatment. You can continue your tinnitus treatment with your ENT specialist without any concerns, especially if they plan to gradually reduce the dosage in the future. Additionally, please continue taking the calcium and vitamin D3 supplements I previously prescribed, as they will help maintain healthy joints and reduce the risk of AVN.

I hope I have explained this clearly. Feel free to contact me for any further concerns or questions.

I would also be happy to assist your brother if he needs any help.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

I will contact you within a day. I am doing absolutely fine, and the physician has added more exercises to my routine. I am performing them with ease. However, I still feel that my left hand is relatively weaker compared to my right. The physician is working on helping my left hand gain more strength. It is worth noting that I can perform all my daily tasks with ease. I have not started any gym workouts yet. I have completed all the medicines you prescribed. Currently, I am taking tablet Neurobion Forte, CCM, and Uprise. So, please offer your suggestions.

Answered by Dr. Anuj Nigam

Hi,

Welcome back to icliniq.com.

Happy to know that you are doing well. I hope you are not experiencing any pain, as you have not mentioned taking any painkillers. Your arm strength will eventually return soon. Please find the time to send me my last prescription. Additionally, if there is a prescription from the physiotherapist regarding the exercises or therapy you are currently receiving, I would appreciate knowing about it as well. Let us follow up on Tuesday evening. I will not be available as I have emergency surgeries scheduled until Tuesday morning.

Have a nice day.

Thank you.

Patient's Query

Hello doctor,

Thank you again for your time; I greatly appreciate it.

I am not taking painkillers as there is no pain. Following are last prescription and prescription of the physio.

Answered by Dr. Anuj Nigam

Hello,

Welcome back to icliniq.com.

I have reviewed the physiotherapy protocol, and it looks good. I would like to request the addition of ultrasound therapy or interferential therapy if your physiotherapist has not already recommended it. It is great to hear that you are free from pain and not taking any painkillers; this is a significant achievement. Now, could you please provide me with the following information:

  1. How many days ago did you stop taking Pregabid NT?
  2. Did you experience any weakness, numbness, or tingling after discontinuing Pregabid NT?
  3. Did you feel better in terms of strength or weakness in your arms and shoulders while you were taking Pregabid NT, or did you notice improvement after stopping it, or did you observe no change?
  4. Have you returned to regular work? Are there any difficulties in lifting office bags or laptop bags?
  5. Do you experience any neck, shoulder, or arm pain when traveling on a two-wheeler or four-wheeler?
  6. Do you have any issues with extreme shoulder stretching?
  7. Is there anything else you think I should know?

Awaiting your response. Thanks for timely follow up.

Patient's Query

Hello doctor,

Thank you for your prompt reply.

Ultrasound therapy and interferential therapy have both been completed. Here are my responses to your questions:

  1. I stopped taking Pregabid NT 20 days ago.
  2. I cannot say that I noticed any changes while I was on Pregabid NT or after stopping it.
  3. I can perform all regular tasks, and I have no difficulty lifting any bags.
  4. I do not experience any neck, shoulder, or arm pain when traveling on both two and four-wheelers.
  5. I have no issues with extreme shoulder stretching.
  6. The only thing I notice is some weakness in my shoulder compared to my right arm.
Answered by Dr. Anuj Nigam

Hi,

Thank you for providing the details.

Here are my recommendations:

  1. You can continue taking Neurobion tablets for 15 more days, after which you should stop. There is no need to restart the Pregabalin course.
  2. Please continue following the physiotherapy protocol as advised by your physiotherapist.
  3. The weakness in your shoulder should improve by the end of your physiotherapy protocol.
  4. You will find more details in my prescription.
  5. I will send you an updated prescription shortly.

I hope this has helped you.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Anuj Nigam
Dr. Anuj Nigam

Orthopedician and Traumatology

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