How to manage shoulder pain and stiffness?

Question

Hello doctor,

I am reaching out regarding my 58-year-old aunt, who has been experiencing right shoulder pain for a few months. Initially, the painkillers provided some relief, but the pain gradually radiated down to her elbow and fingertips. She consulted a GP and received painkiller injections, which offered only temporary relief. Subsequently, she visited an orthopedist, underwent an X-ray, and received an initial diagnosis. Unfortunately, she does not recall the diagnosis, and no prescription is available. She received an injection in her shoulder and some medication, but did not experience significant improvement. She then consulted another orthopedist and had an MRI done. I have attached the MRI report and the prescription she was given. While the medication provided relief during the five to ten days she took it, the pain returned once she stopped. She is also diabetic, with her levels typically around 100 to 110 (fasting) and 140 to 150 (post-prandial) under medication. This pain restricts her daily activity, and it seems there is muscle wastage. Her right shoulder looks dropped and weak. She had the same kind of pain (less severity) on her other side (left) around five years back, and that settled in a month following physio, injection, and medication. Could you kindly review the MRI and suggest an appropriate course of action?

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Nicely structured query. Well, there are two possibilities. One is that she has a shoulder problem which is known as a frozen shoulder. She is a high-risk candidate because she does not have very good control of blood sugar. The second possibility is cervical spine nerve compression. Because the kind of pain you are describing does look like cervical radiculopathy. Though her MRI (magnetic resonance imaging) is not very conclusive, there is one thing you can do for me. Try to rotate her shoulder completely while holding her hand. It should be a full range of motion. You can check from the internet. If this is very painful, then it is a shoulder issue. Second, ask her to keep her hand above her head, if this position gives her relief, then it's a cervical problem. So above are the two tests that can help differentiate shoulder and cervical spine problems. If there was no relief with shoulder injection, then most likely it is a cervical spine problem. You perform these two tests and let me know what you observe. I hope this will help you.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

It is a frozen shoulder. I would suggest you take the intra-articular injection once again. If there is no relief, then go for shoulder manipulation under anesthesia. These are the two best options right now. I would also like to upgrade her medication. I would suggest she take the tablet Ultracet (Tramadol and Paracetamol) thrice daily for seven days and a capsule of Pregabid (Pregabalin) 50 mg twice daily for one month. We cannot give anti-inflammatory medication because her creatinine is high. So, injection is the best option for her.

Also, I would suggest you read about frozen shoulders. The natural history of the disease is like that the pain subsides eventually.

Kindly consult a specialist, talk with them, and take medications with their consent.

I hope this helps you.

Thank you.