Arm and Shoulder Pain: A Comprehensive Guide to Diagnosis and Treatment

Issues between the arm and shoulder, as well as problems with fist clenching?

About three to four months ago, my mother was taking the MRT and was trying to grab something from the overhead compartment when she was bumped by someone due to the crowd, resulting in an injury to her left arm.
Initially, she thought it was just a strain and that it would be fine, but after a week, she noticed that the pain between her left arm and shoulder had not subsided.
She is unable to lift her arm high, only able to raise it about 30 to 40 degrees before experiencing pain.
Additionally, there is a noticeable protrusion in the front area between her left arm and shoulder.

She visited several major hospitals and consulted orthopedic and neurosurgery specialists, undergoing X-rays and other examinations, but no dislocation or inflammation was found.
They prescribed medication, injections, and arranged for physical therapy.
However, after 1 to 2 months of therapy, there was no improvement, and she gradually began to have difficulty lifting her right arm as well.
Feeling very uncomfortable, she decided to try traditional Chinese medicine, but despite weekly acupuncture sessions, there was little progress.

She then discovered that she could not make a fist; she could only bend her fingers to about 180 to 200 degrees before feeling tightness and discomfort.
A friend recommended a Tui Na practitioner, who informed her that her hand was dislocated.
Although there was some improvement, allowing her to lift her arm to about 120 degrees, she still experiences pain and cannot make a fist.
We kindly seek your assistance and advice on how to resolve this issue.
Thank you very much!

Yumi Hsieh, 20~29 year old female. Ask Date: 2016/08/20

Dr. Shi Guozheng reply Orthopedics

It is possible that a bruise has caused bursitis in the shoulder joint.
Continuing rehabilitation may lead to improvement.
If it is a dislocation, X-rays should be able to reveal it.
It is recommended to see a rehabilitation specialist.

Reply Date: 2016/08/20

More Info

Understanding arm and shoulder pain, especially after an injury, can be quite complex. Based on your mother's experience, it seems she has been through a series of evaluations and treatments without significant improvement. This situation is not uncommon, and it highlights the importance of a thorough understanding of potential underlying issues, as well as the need for a comprehensive approach to diagnosis and treatment.

Possible Causes of Pain
1. Soft Tissue Injury: Given that the injury occurred due to a collision while trying to retrieve something, it’s possible that your mother sustained a soft tissue injury, such as a strain or sprain. These injuries can sometimes take longer to heal than expected, especially if the affected area is not given adequate rest.

2. Rotator Cuff Injury: The inability to lift the arm above a certain degree and the presence of pain could indicate a rotator cuff injury. This group of muscles and tendons stabilizes the shoulder and allows for a wide range of motion. Injuries here can lead to pain and limited mobility.

3. Tendinitis or Bursitis: Inflammation of the tendons (tendinitis) or the bursa (bursitis) in the shoulder can also cause pain and restrict movement. These conditions often arise from repetitive motions or trauma.

4. Nerve Impingement: If there is any swelling or structural changes in the shoulder area, it could lead to nerve impingement, which may cause pain radiating down the arm and weakness.

5. Frozen Shoulder (Adhesive Capsulitis): This condition can develop after an injury and is characterized by stiffness and pain in the shoulder joint, making it difficult to move the arm.

Diagnostic Approach
Given that X-rays did not reveal any fractures or dislocations, further imaging may be necessary. An MRI could provide a more detailed view of the soft tissues, including muscles, tendons, and ligaments, and help identify any tears or inflammation. Additionally, a thorough physical examination by an orthopedic specialist or a sports medicine physician could provide insights into the functional limitations and pain patterns.

Treatment Options
1. Physical Therapy: Continuing physical therapy is crucial. A physical therapist can design a tailored rehabilitation program focusing on strengthening the shoulder and improving range of motion. They may also incorporate modalities like ultrasound or electrical stimulation to reduce pain and inflammation.

2. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and reduce inflammation. If over-the-counter options are insufficient, a physician may prescribe stronger medications.

3. Injections: Corticosteroid injections into the shoulder joint can provide temporary relief from inflammation and pain, allowing for more effective participation in physical therapy.

4. Alternative Therapies: While acupuncture and traditional Chinese medicine approaches like tuina (Chinese therapeutic massage) can be beneficial for some, it’s essential to ensure these treatments are performed by qualified practitioners who understand the underlying issues.

5. Surgical Options: If conservative treatments fail and there is a significant structural issue (like a rotator cuff tear), surgery may be considered. This is typically a last resort after all other options have been exhausted.

Conclusion
It’s important for your mother to continue seeking care and to communicate openly with her healthcare providers about her ongoing symptoms. If she feels that her current treatment plan is not effective, she should advocate for further evaluation, possibly seeking a second opinion from a specialist in shoulder injuries. A multidisciplinary approach, including orthopedic care, physical therapy, and possibly pain management, will likely yield the best outcomes. Recovery can take time, and patience is essential, but with the right treatment plan, improvement is possible.

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