What causes pain in the shoulder blade that arises only during the night?

Question

Hi doctor,

I am a 40-year-old male. I do not smoke but drink occasionally. I do not have hypertension or diabetes. I am 5'5 feet in height and weigh 68 kg. I used to work out in the gym a few years back and stopped due to the pandemic. After working out in a park for six months, I think I sprained my right shoulder blade muscle. The impact was not that much at the initial moment. But, after a few weeks and months, I would feel pain when I used to press on my right shoulder blade muscle. On a grade of 1 to 10, the pain was 3. The last month-end, I had been on a motorbike trip of around 1000 km with sufficient break times in between. After returning home from this trip, I started having symptoms such as neck pain during nighttime and right shoulder blade muscle pain at night, which was 9 out of 10. The pain is also on the border of the right scapula muscle and a little on the actual scapula bone muscle. The pain feels like it is occurring internally. I could not sleep at night due to this pain. I have chills but no fever. There is no swelling or redness in that shoulder blade area. Although, I feel a little weakness in the right arm due to this pain. I have no symptoms during the day. I consulted an orthopedic specialist and attached the consultation details. I went through eight physiotherapy sessions with stretching exercises and strengthening machine therapy. What is the diagnosis of my pain? I have never experienced anything like this before. As I used to work out in the gym, I know the post-workout pain, which used to go away after the muscle recovery. But this pain is not going away. I wanted to know if the prescribed treatment plan is correct. Is this a degenerative disease? Will it worsen and leave permanent weakness and pain? Is this a serious health condition that I need to worry about? Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

It is not a serious problem. Your condition can be diagnosed as cervical neuralgia from the history you provided and the attached reports (attachment removed to protect the patient's identity). The nerve from the neck to your shoulder is getting inflamed and could be a little compressed, which could be due to a cervical disc. This is not like the post-workout pain in which the muscle is involved. In this case, your nerve is involved, and your ongoing physiotherapy is fine. But I suggest you take an X-ray of the neck to look for any degenerative changes. An MRI (magnetic resonance imaging) would be even better, as nerves and discs cannot be seen in an X-ray. A routine blood investigation, including total count and ESR (erythrocyte sedimentation rate), is advisable as you are having chills and more pain at night that points to the possibility of having an infection. However, it can be a simple inflammation also. Also, some lifestyle modifications are required, like avoiding two-wheeler, using a cervical pillow, and avoiding lifting weights. Whether it is a degenerative problem, it can be assessed by seeing the X-ray only. It is unlikely to worsen if the pain is only up to the shoulder and not radiating down to your arms and fingers. If it starts radiating down, or if there is numbness, you will need an MRI to check for further diagnosis.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

It will usually take about a month. Chiropractors are unlikely to help your condition.

Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

As the counts are normal, infection is unlikely. So antibiotics are not needed. The lipid profile is not significant as it was not on an empty stomach. However, vitamin B12 is low, and you will need medicine. Take tablet Meganeuron once daily morning for one month and Neurokind G at night for two weeks. Consult your specialist, talk with them, and take medications with their consent.

Thank you.

Answer 4

Hello,

Welcome back to icliniq.com.

1. Alkaline phosphatase is not raised much, and you need not do anything about it. You can stop using alcohol if you use it. CRP of that level is not significant with a normal ESR and counts.

2. You have to take them with the present medicines, preferably after an X-ray.

Thank you.

Answer 5

Hello,

Welcome back to icliniq.com.

The images (attachments removed to protect the patient's identity) are not clear, and an MRI of the cervical spine would have been better the images you sent do not show the relevant information.

Thank you.

Answer 6

Hello,

Welcome back to icliniq.com.

Pain in the shoulder can occur due to a problem at the shoulder or due to compression of the nerve to your shoulder. From your description, it appeared to be the second one. But you have not taken even an X-ray of your neck as the nerves to your shoulder come from the neck. Whether it is, a neuro problem can be identified only by an MRI or at least an X-ray of the cervical spine. The MRI of the shoulder does not have any serious issues, and for that, the treatment prescribed is enough. But I am unsure if that will relieve your pain if the problem is with the nerves, which will need an evaluation of your cervical spine.

Thank you.