Chronic Neck and Shoulder Pain: Diagnosis and Treatment Options

Shoulder and neck pain (2)

I previously inquired about my shoulder and neck pain, but the doctor's response seemed somewhat off-target.
Could you please clarify the issues I raised? Additionally, when the doctor mentioned, "If you can't afford the tests, it might be worth trying to improve your habits; you might save several thousand dollars in testing fees," does that imply that there is actually no serious issue and that habit improvement is more of a temporary solution? I've been experiencing shoulder and neck pain for at least 10 years.
During a visit to the pain clinic, the doctor performed an ultrasound on my right shoulder and found a small bone that was slightly different from the left side.
He prescribed a topical ointment and said that would resolve the issue.
Is there a problem with this treatment? I've also consulted orthopedic and rehabilitation specialists who took X-rays but did not perform an ultrasound, and they all said it was simply a muscle issue.
Should I still consider getting an ultrasound and a cervical MRI? Do rehabilitation therapies, electrical stimulation, and herbal teas really help? I don't have high blood pressure; could it possibly be a vascular blockage issue? Should I see a neurologist? Thank you!

Ni, 30~39 year old female. Ask Date: 2021/04/25

Dr. Chen Bochen reply Orthopedics

I have been experiencing shoulder and neck pain for at least 10 years.
Once, I visited a pain management specialist who performed an ultrasound on my right shoulder and found a small bone that was different from the left side.
The doctor prescribed a topical ointment, saying that would resolve the issue.
Is there a problem with this treatment? I don't understand the consultation process, so I can't comment on whether the treatment was appropriate.
I have also seen orthopedic and rehabilitation specialists; they took X-rays but did not perform an ultrasound, and they all said it was simply a muscle issue.
Should I get an ultrasound and a cervical spine MRI? I strongly recommend that you consider paying out of pocket for an MRI and ultrasound, as health is invaluable.
If any issues are found, they can be addressed early; if not, you can have peace of mind.
Do rehabilitation therapies, electrical stimulation, and herbal teas really work? Each treatment can have different responses for different individuals.
It might be worth trying the physician's recommendations, as your own feelings about their effectiveness are the most accurate.
I don't have high blood pressure; could it possibly be a vascular blockage issue? Should I see a neurologist? Thank you! Anything is possible; even young people can experience strokes, vascular blockages, or myocardial infarctions.
If you have related symptoms, consult a physician and cooperate with examinations and treatments as much as possible.

Reply Date: 2021/04/25

More Info

Chronic neck and shoulder pain can be a complex issue, often requiring a multifaceted approach to diagnosis and treatment. Your experience of persistent pain for over a decade, coupled with the various medical evaluations you've undergone, suggests that there may be underlying factors contributing to your discomfort. Let's break down your concerns and explore potential avenues for relief.

Understanding Your Symptoms
Chronic neck and shoulder pain can stem from several causes, including muscular strain, cervical spine issues, nerve compression, or even referred pain from other areas. Given that you've had imaging studies like X-rays and an ultrasound, it's essential to consider what these tests reveal. The ultrasound indicating a small bone irregularity could suggest a structural issue, but it’s crucial to correlate this with your symptoms.

Importance of Comprehensive Evaluation
While your previous doctors have suggested that your pain is primarily muscular, it might be beneficial to pursue further imaging, such as an MRI of the cervical spine. An MRI can provide detailed images of soft tissues, including discs, nerves, and muscles, which X-rays cannot. This could help identify any disc herniations, nerve root compression, or other abnormalities that might not have been visible on previous tests.

Habitual Factors and Lifestyle Modifications
The suggestion to improve your habits is indeed a valid approach. Poor posture, repetitive strain from activities like prolonged computer use, and inadequate ergonomic setups can exacerbate neck and shoulder pain. Simple changes, such as adjusting your workstation, taking regular breaks, and incorporating stretching exercises, can significantly alleviate symptoms. These lifestyle modifications can sometimes be as effective as medical interventions, particularly in cases where structural issues are not severe.

Treatment Options
1. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around your neck and shoulders, improve flexibility, and address any postural issues. Therapists can also provide modalities like ultrasound or electrical stimulation that may help reduce pain.

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

3. Alternative Therapies: Treatments like acupuncture, chiropractic care, or even herbal remedies may provide relief for some individuals. However, it's essential to consult with a healthcare provider before starting any alternative therapies to ensure they are safe and appropriate for your condition.

4. Injections: If conservative treatments fail, corticosteroid injections into the affected area may provide temporary relief by reducing inflammation.

5. Surgery: In rare cases where there is significant structural damage or nerve compression, surgical intervention may be necessary. This is typically considered only after conservative measures have been exhausted.

Addressing Vascular Concerns
Regarding your concern about potential vascular issues, while chronic pain can sometimes be associated with vascular problems, it is less common. If you have symptoms like numbness, tingling, or weakness in your arms or hands, it may warrant further evaluation by a neurologist or vascular specialist. Blood tests, including D-dimer levels, can help assess for clotting issues, but these should be discussed with your healthcare provider based on your specific symptoms.

Conclusion
In summary, while improving your habits can be a significant first step in managing chronic neck and shoulder pain, further evaluation through imaging like an MRI may be warranted to rule out any underlying structural issues. Engaging with a multidisciplinary team, including physical therapists and possibly neurologists, can provide a comprehensive approach to your treatment. Remember, chronic pain management often requires patience and persistence, but with the right strategies, you can find relief and improve your quality of life.

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