Chronic Shoulder and Neck Pain: Finding the Right Specialist for Relief

Shoulder and neck pain?

Hello, I have been experiencing pain in my left shoulder and neck for 4-5 years.
I have consulted many doctors, but the cause of my pain has not been identified, and I have not received effective treatment.
I have seen an orthopedic specialist (who said there are no fractures and that the shoulder and neck cannot be X-rayed), a rehabilitation specialist (who provided acupuncture and massage), another rehabilitation specialist (who performed cervical traction and nerve conduction studies), a pain management specialist (who prescribed painkillers and muscle relaxants, which I do not take), and a neurosurgeon (who administered muscle relaxant injections).
I have trouble sleeping at night, and I have to elevate my left arm.
When I rotate my left arm from front to back, I hear a "crackling" sound.
Each doctor has asked about my work (computer-related), but I experience this dull pain even when I am not working at home.
I am unsure which specialty I should consult to truly identify the cause of my pain and receive treatment.
Thank you.

Qing, 30~39 year old female. Ask Date: 2008/05/27

Dr. Pan Yingda reply Rehabilitation

Are you just asking me which department to consult? Of course, I would say that rehabilitation medicine is sometimes not just about which specialty to see, but about finding the right person.
I think you've already seen the appropriate specialists, and since you're still relatively young, there's no reason you shouldn't improve.
Physical issues are manageable (it's either a cervical spine problem compressing nerves, or shoulder tendonitis, and then there are more complex conditions like myofascial pain syndrome).
We also need to consider psychosomatic factors: personality, worries, and stress.
If you've seen multiple doctors without improvement, this definitely needs to be taken into account.
Additionally, there's the issue of energy, which is a perspective from Western medicine; we won't delve into that direction! If you happen to come to Taitung, you can come and let me take a look, but don't have too high expectations (so there's no need to make a special trip), and I won't sugarcoat things for patients.

Reply Date: 2008/05/27

More Info

Chronic shoulder and neck pain can be incredibly frustrating, especially when you've seen multiple specialists without finding a definitive diagnosis or effective treatment. Given your symptoms and the extensive history of consultations, it’s important to approach this issue systematically.

First, let’s summarize your situation: you have been experiencing persistent pain in your left shoulder and neck for 4-5 years, with various specialists unable to provide a clear diagnosis or effective treatment. You've consulted orthopedic surgeons, rehabilitation specialists (both traditional Chinese medicine and Western medicine), pain management specialists, and neurosurgeons, yet the pain persists, particularly affecting your sleep and daily activities.

Understanding Your Symptoms
The symptoms you describe, including the "clicking" sound when moving your shoulder, pain that radiates down your arm, and difficulty sleeping, suggest a few possibilities:
1. Rotator Cuff Injury: This is common in individuals who perform repetitive overhead activities, such as typing or using a computer. Even if X-rays show no fractures, soft tissue injuries may not be visible on X-rays. An MRI could help identify any tears or inflammation in the rotator cuff.

2. Cervical Radiculopathy: Given your neck pain and the radiation of pain into your arm, there may be nerve compression in your cervical spine. This could be due to degenerative changes, herniated discs, or other spinal issues. A cervical spine MRI would provide more insight into this.

3. Myofascial Pain Syndrome: This condition involves trigger points in the muscles that can cause referred pain in other areas. It often occurs in individuals with chronic pain and can be exacerbated by stress or poor posture.

4. Tendinitis or Bursitis: Inflammation of the tendons or bursae around the shoulder joint can lead to pain and restricted movement. This is often seen in individuals with repetitive shoulder use.

Recommendations for Finding the Right Specialist
1. Revisit Imaging: If you haven’t had an MRI of your shoulder and cervical spine, this should be a priority. An MRI can reveal soft tissue injuries, disc herniations, or other abnormalities that X-rays cannot.

2. Consult a Sports Medicine Specialist: These physicians specialize in musculoskeletal injuries and may have a more comprehensive approach to diagnosing and treating chronic pain. They can also coordinate care among different specialists.

3. Physical Medicine and Rehabilitation (PM&R): A physiatrist can help develop a comprehensive rehabilitation plan that includes physical therapy, pain management techniques, and possibly injections if necessary.

4. Pain Management Specialist: Since you mentioned not wanting to take muscle relaxants or pain medications, consider discussing alternative pain management strategies, such as physical therapy, acupuncture, or cognitive behavioral therapy (CBT) for pain management.

5. Consider a Multidisciplinary Approach: Sometimes, a team approach involving a physical therapist, occupational therapist, and psychologist can provide a more holistic treatment plan. This can address not only the physical aspects of your pain but also any psychological factors contributing to your discomfort.

6. Lifestyle Modifications: Ergonomic adjustments to your workspace, regular breaks during computer use, and gentle stretching exercises can help alleviate some symptoms. A physical therapist can guide you on proper techniques.

Conclusion
Chronic pain can be complex and multifactorial, often requiring a combination of treatments and a multidisciplinary approach. It’s essential to advocate for yourself and continue seeking answers until you find a specialist who can help you understand the underlying causes of your pain and develop an effective treatment plan. Don’t hesitate to seek a second opinion or explore new avenues of care. Your well-being is paramount, and with persistence, you can find relief.

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