Patient: I work as a mechanic/lube tech, I’m also 25 years old. I started having pain in my left shoulder and around my shoulder blade (like a pulled muscle). If anyone tried to massage it, it was like they couldn’t rub hard enough to get it. It progressively got worse. The pain traveled up the left side of my neck so I couldn’t turn my head that way. Even holding it straight hurt, but it didn’t hurt looking right. The pain also traveled to a part of my bicep(under arm) and feels like a severely pulled muscle. Standing up hurts but sitting down or even laying flat hurts worse! I’ve been getting around three hours of sleep at night because I’m in so much pain. I went to the doctor and he said it was more muscular than anything else and gave me two shots around my shoulder blade and sent me home. That didn’t work. Now its even worse and we’re working on over two months now. Now I have a tingle/numbing feeling that runs from my ‘funny’ bone, over the top of my forearm and down to my palm, to my thumb/first/and middle finger. I have NO health insurance and don’t know what to do. Ice packs seem to make the muscles relax when place partly on my shoulder and back. But it doesn’t take it away. I don’t know what else to do. What can this be? I don’t want anymore shots, I think I need an x-ray. But I don’t know what to do.
Doctor: At the beginning, the shoulder pain that you described seemed to be a tendinitis of the shoulder, most likely a rotator cuff tendinitis, maybe work related overuse of the shoulder muscles, you have to keep using them because your work and this does not allow enough time to heal. But now you described other accompanying symptoms and it would be important to rule out a cervical nerve compression (C7-C8), and a inflammation of the peripheral nerves at the level of the arm and hand. In the younger patients, cervical radiculopathy may be a result of a disc herniation or an acute injury causing impingement of an exiting nerve. In the older patient, cervical radiculopathy is often a result of spinal canal narrowing from bone (osteophyte) formation, decreased disc height and degenerative changes due to aging process. The treatment strategy usually includes: physical therapy program aimed to reduce pain and inflammation, and the use of anti-inflammatory drugs (“Motrin”, “Aleve”), also a re-education of habits and posture to improve quality of life. You should be independent in a stretching and strengthening program and continue with these exercises under the periodic supervision of a physical therapist initially and then completely on your own. If your condition fails to improve with a comprehensive rehabilitation program and selective injections you may be presented with a surgical evaluation. Often, patients should show progressive improvement over the first 6-8 weeks with conservative treatment. If there is no significant improvement in this time frame, consider a surgical evaluation.