Shoulder and Elbow Pain After an Injury: What to Do Next

Help with shoulder and elbow issues?

Dear Dr.:
I can speak and read in Chinese.
Please reply in Chinese if it’s easier.
Here comes my X-ray report:
Right shoulder: No fracture or soft tissue calcification is seen.
A bone island is noted in the humeral head.
The glenohumeral and acromioclavicular joint spaces are preserved.
A small opacity is seen in the right mid zone of the lung field suggestive of a small granuloma.
Right elbow: No fracture is seen.
Bony alignment is preserved.
Even more than a month has passed, I still can’t straighten my elbow and I feel pain in my shoulder and elbow.
I feel more pain if I try to lift or use any force.
Please let me know what needs to be noted.
I will visit a doctor on August 16th and I don’t know if I need to go to the ER again.
I am afraid a more serious problem will develop if this is not treated now.
Thanks for your attention.
Henry.
I had a car accident in June.
I was involved in a head-on/side collision and I didn’t wear a seat belt.
My forehead, right shoulder, and left leg were hurt, but I didn’t have any broken bones (X-rayed).
However, my right shoulder still feels weak and I experience minor pain when I try to lift sideways.
I can swing my arm forward and backward without any problem.
However, I do feel uneasy and a little pain if I try to sleep on my stomach.
I have been putting weight on my injured shoulder while sleeping.
In early July, things got more complicated.
My right elbow suddenly started to hurt and I can’t straighten it after carrying some luggage during traveling.
I went to a clinic and had another X-ray.
The bone is fine.
I also went to the ER.
I received treatment for pain and muscle spasms.
I have also been using BenGay Ultra to soothe my arm.
However, I still can’t straighten my arm and I can’t lift things as usual.
Please tell me what’s happening and what needs to be done? I can’t come to you since I am away from home.
I don’t know if I am at major risk and if my arm will recover after all! Please help!
Henry
Response from the physician: Orthopedic, Dr.
Ching-Nien Yeh suggests: INJURY OF RIGHT SHOULDER WITHOUT BONY FRACTURE AND WEAKNESS OF MOVEMENT OF RIGHT SHOULDER.
RUPTURE OF ROTATOR CUFF AND TENDINITIS IS SUSPECTED.
PLEASE CHECK MRI.
IT CAN BE DIAGNOSTIC.
CHING-NIEN YEH

henry, 30~39 year old female. Ask Date: 2004/08/01

Dr. Shi Guozheng reply Orthopedics

Based on your description, it is likely a soft tissue injury, which could cause pain and weakness in your shoulder and elbow joints.
If you are unable to raise your shoulder above ninety degrees, it may indicate a rotator cuff injury.
An MRI examination would be necessary to assess this condition.
Therefore, I recommend that you keep your appointment with a physician to explore any specific treatment options.
In the meantime, pain management with medication is advised.

Reply Date: 2004/08/01

More Info

Dear Henry,
Thank you for sharing your concerns regarding your shoulder and elbow pain following your car accident. Based on your description and the X-ray report, it appears that you are experiencing significant discomfort and functional limitations in your right shoulder and elbow. Let's break down the situation and discuss what steps you can take next.

Understanding Your Condition
1. Shoulder Pain: The X-ray report indicates no fractures or significant soft tissue calcifications in your right shoulder, but it does mention a "bone island" in the humeral head. This is generally a benign finding and may not be related to your pain. However, the weakness and pain you are experiencing could be indicative of a rotator cuff injury or tendinitis, which are common after trauma. The rotator cuff is a group of muscles and tendons that stabilize the shoulder and allow for a wide range of motion. If these structures are injured, it can lead to pain, weakness, and difficulty lifting your arm.

2. Elbow Pain: Your inability to fully extend your elbow and the pain you feel when trying to lift objects suggest that there may be soft tissue damage or inflammation in the elbow joint. Since the X-ray did not show any fractures, it is possible that you are dealing with a condition such as tendinitis or a strain of the muscles and tendons around the elbow.

Recommended Next Steps
1. Consult a Specialist: Since you have an appointment scheduled for August 16th, it is crucial to keep that appointment. A specialist, particularly an orthopedic surgeon or a sports medicine physician, can provide a more thorough evaluation. They may recommend an MRI to assess the soft tissues in your shoulder and elbow, which can help confirm any suspected injuries like a rotator cuff tear or tendinitis.

2. Physical Therapy: Engaging in physical therapy can be highly beneficial. A physical therapist can design a rehabilitation program tailored to your specific needs, focusing on strengthening the shoulder and elbow, improving range of motion, and reducing pain. They may use modalities such as ultrasound, electrical stimulation, or manual therapy to aid in your recovery.

3. Pain Management: Continue using over-the-counter pain relief medications as needed, such as NSAIDs (e.g., ibuprofen or naproxen), to help manage pain and inflammation. However, be cautious about prolonged use and consult with your doctor regarding the appropriate dosage and duration.

4. Activity Modification: Avoid activities that exacerbate your pain, especially lifting or carrying heavy objects. It’s essential to give your body time to heal. If you experience significant pain during certain movements, it’s a sign that you should modify those activities.

5. Monitor Symptoms: Keep track of your symptoms, including any changes in pain levels, range of motion, or functional abilities. If you notice worsening symptoms or new symptoms, such as numbness or tingling, it may warrant an earlier visit to the emergency room or your doctor.

Conclusion
While it is understandable to be concerned about the potential for more serious issues, many shoulder and elbow injuries can improve with appropriate management and rehabilitation. It is essential to follow up with your healthcare provider, adhere to any recommended treatments, and participate in physical therapy to facilitate your recovery. Remember, healing takes time, and being patient with your body is crucial.

I hope this information helps clarify your situation and provides a pathway for your recovery. Please take care, and I wish you a speedy return to full function.

Best regards,
Doctor Q&A Teams

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