Q. I have chronic shoulder pain with bony protrusion in the right shoulder. Kindly help.

Answered by
Dr. Renjit George Marcus
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Sep 07, 2020

Hello doctor,

I have chronic shoulder pain on both shoulders but more frequently on the right shoulder. I can feel a small protrusion of bone on my right shoulder when I touch, and it pains only sometimes when I touch that area. I have more pain while lying down, and when I am doing work or lifting any weight I am having more pain. I tried hot and cold fermentation, but it did not help in the long run. This shoulder pain is affecting my day to day activities.

I am currently on Glycomet-GP2 twice daily for type 2 diabetes mellitus, Thyronorm 25 mcg for thyroid problem, and Insulin 12 units at night (fasting blood sugar is ranging from 120-150 mg/dL).



Welcome to icliniq.com.

I am sorry to hear about your pain. Since your pain started after a trauma it is mostly related to that. It can be due to a problem with your shoulder or your cervical spine. But the MRI (magnetic resonance imaging) of your cervical spine is not showing any neurological compression. So it is mostly the shoulder that is involved. Do you have an x-ray of the shoulder? Since you can feel a prominence on the shoulder it could be an acromioclavicular joint subluxation or dislocation, which can be seen in an x-ray.

How is the movement of your shoulder? Can you lift your arms up completely? Can you reach the center of your back with your fingers? Does your pain radiate down the shoulder? Is there any paresthesia or weakness? Kindly answer these questions and get back to me with an x-ray of the shoulder if possible.

If it is a joint dislocation, you will mostly need surgery. If it is a muscle injury treatment depends on if it is a partial or complete injury for which I need to know the answers to the above question.

Thank you doctor,

No, I have not done the x-ray. I will get it done tomorrow. My shoulder movement is normal. I am unable to lift my arms up completely, but unable to reach the center of my back with my fingers for both the hands. The pain radiates down the shoulder upto my biceps. Weakness is present.



Welcome back to icliniq.com.

Based on what you said, you have a condition called peri arthritis shoulder. It is a condition common in diabetics due to contraction of the muscles and capsule around the shoulder joint, which in your case was initiated by the trauma. Attempted movement against a contracted muscle causes pain. Lack of movement for a long time increases the stiffiness and pain at night.

Treatment is that you have to get the contracted muscles stretched by exercises. You can search youtube for peri arthritis shoulder exercise or frozen shoulder and do them. It will take time to stretch it out completely and the process is a little painful. You can also go to a physiotherapist for the exercises. Once stretched out pain will disappear. Apply a little heat before the exercise. That will make it easier. Keep a pillow below your shoulder while sleeping.

Another option for a quicker result is to give you anesthesia and stretch it out in a single sitting. Once stretched, you are cured.

Thank you doctor,

I have attached the x-ray film. Please let me know if it is normal.



Welcome back to icliniq.com.

The x-ray shows (attachment removed to protect patient identity), mild subluxation of the AC joint on the right side, but it is only mild and does not require any surgery. The shoulder exercises I described would be enough. Kindly do it for three weeks for the left side and four weeks for the right. It is better to avoid activities involving lifting the right arm above the shoulder level for one week, which also involves exercises above the shoulder level.

Take Zerodol TH 4 (Aceclofenac and Thiocolchicoside) twice daily for one week, tablet Gabaneuron (Gabapentin and Mecobalamine) 300 mg at night at 7 PM for one week. After that, you can do all exercises, including those above the shoulder level. You should be fine in four weeks.

Thank you doctor,

Should I take Zerodol after food one morning and one night? And do I have to take Gabaneuron at 7 PM after dinner?



Welcome back to icliniq.com.

Take Zerodol after food. Gabaneuron can be taken before or after food, but take at 7 PM, or else you may feel drowsy in the morning.

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