Right Shoulder Pain and Swelling Near the Clavicle

Pain from the right jaw to the shoulder, along with swelling at the anterior end of the right clavicle?

Hello Doctor:
1.
About three to four months ago, I started experiencing pain in my right shoulder and right upper back, which has progressively extended to my right jaw and neck.
2.
This morning, I noticed that the anterior end of my right clavicle is more prominent than the left, visibly noticeable and feels hard to the touch, without tenderness, as if "the clavicle bone has enlarged" (not around the clavicle, but feels like the clavicle itself).
3.
There is a painful point located about 7 centimeters below the right clavicle, connecting the right shoulder and right neck, but I cannot feel a tumor upon manual examination.
4.
When I sleep on my right side, I have a foreign body sensation in my neck, and there is pain in the areas mentioned in points 1, 2, and 3.
I would like to ask the doctor:
1.
What could be the likely cause of the above symptoms?
2.
Is there a possibility that this is related to a malignant tumor? (I have seen reports linking enlarged clavicular lymph nodes to cancer.)
3.
Which specialty should I consult? Or, which department should I start with to find the cause? (The main pain points are in the right shoulder and right upper back, but the swelling is in the clavicle, and there is also pain in the neck and chest, so I am unsure which specialty to approach.)
Thank you for taking the time to respond, I greatly appreciate it.

Xiao Lin, 40~49 year old female. Ask Date: 2023/06/23

Dr. Zheng Jueyi reply Otolaryngology

Hello, it is recommended to visit an otolaryngologist to check for any issues with the cervical or supraclavicular lymph nodes.
If there are no problems, it is advisable to consult an orthopedic specialist or a rehabilitation physician to evaluate whether it is related to muscular or skeletal issues.

Reply Date: 2023/06/23

More Info

Hello,
Thank you for your detailed description of your symptoms. Based on what you've shared, it seems that you are experiencing a complex set of issues involving your right shoulder, clavicle, and surrounding areas. Let's break down your concerns and address them systematically.

1. Symptoms Overview: You mentioned that the pain started three to four months ago and has progressively extended to your right jaw and neck. The noticeable protrusion of the right clavicle, which feels hard but is not tender to touch, is particularly concerning. Additionally, you have a painful point on your chest near the shoulder and neck, along with a sensation of something being stuck in your throat when lying on your right side.

2. Possible Causes: The symptoms you describe could be indicative of several conditions:
- Shoulder Impingement or Rotator Cuff Injury: Given the pain radiating from your shoulder to your neck and jaw, it is possible that you have a shoulder impingement or a rotator cuff injury. These conditions can cause referred pain in the neck and upper back.

- Clavicular Issues: The protrusion of the clavicle could suggest a possible acromioclavicular joint issue or even a previous injury that may have led to a change in the bone structure or alignment.

- Cervical Spine Issues: Given the pain extending to your neck and jaw, cervical spine problems such as herniated discs or degenerative changes could be contributing to your symptoms.

- Muscle Strain or Myofascial Pain: Chronic pain in the shoulder and neck area can also be due to muscle strain or myofascial pain syndrome, especially if you have been using your shoulder in a way that puts stress on these muscles.

3. Concern for Malignancy: You expressed concern about the possibility of a malignant tumor, especially given the association of swollen lymph nodes with cancer. While it is important to consider this, the absence of tenderness and the specific nature of the protrusion may suggest a different issue. However, any new or unusual growth should be evaluated by a healthcare professional to rule out malignancy.

4. Recommended Specialists: Given the complexity of your symptoms, it would be prudent to start with a visit to an orthopedic specialist who focuses on shoulder and upper extremity issues. They can perform a thorough physical examination and may recommend imaging studies such as X-rays or MRI to assess the shoulder joint, clavicle, and cervical spine. If there are indications of nerve involvement or if the orthopedic evaluation suggests a need for further investigation, a referral to a neurologist or rheumatologist may also be warranted.

5. Next Steps: I recommend scheduling an appointment with an orthopedic specialist as soon as possible. Be sure to bring any previous imaging studies or medical records that may be relevant. In the meantime, consider applying ice to the painful areas to help reduce inflammation and taking over-the-counter anti-inflammatory medications, if appropriate for you, to manage pain.

In summary, your symptoms could stem from a variety of musculoskeletal issues, and while malignancy is a concern that should not be dismissed, it is likely that a more benign condition is at play. Early evaluation and appropriate imaging will be key in determining the exact cause of your symptoms and guiding effective treatment.

Wishing you a speedy recovery and relief from your pain. Please do not hesitate to reach out if you have further questions or need additional information.

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