Neck and Shoulder Pain: A Guide to Symptoms and Specialist Referrals

Neck and shoulder pain?

Hello Doctor: Recently, I have been experiencing many symptoms and have consulted various doctors in different hospitals without finding a diagnosis.
Could you please help explain the following symptoms?
1.
I have sharp pain in the left rear part of my head, accompanied by muscle spasms, dizziness, itchy ears, occasional pain, and nausea.
Recently, I have been experiencing increased vomiting when lying down.

2.
My eyes feel sore, and I also have pain in my neck, shoulders, and back, with occasional numbness in my left hand.

3.
I recently visited an endocrinologist due to swelling near the left side of my neck close to the carotid artery.
An irregular image was detected, measuring about 1.5-1.6 cm in diameter.
The doctor suggested surgery for further testing to determine if it is benign or malignant.
However, regarding the first two issues, I was advised to see a neurologist or an ENT specialist, as the thyroid issue should not cause those symptoms.

4.
These symptoms have persisted for two months, but the hand numbness has been intermittent for the past one to two years.

5.
Which specialty should I consult for these symptoms, and is a CT scan necessary? Please provide a detailed explanation so I can understand which department to seek for examination.
Thank you very much.

angela, 30~39 year old female. Ask Date: 2009/03/28

Dr. Zheng Zhong reply Neurosurgery

It is recommended to first consult a neurosurgeon to rule out any brain or cervical spine lesions.
My clinic hours are: Monday afternoons and Wednesday mornings.
Best wishes, Dr.
Zheng.

Reply Date: 2009/03/28

More Info

Understanding neck and shoulder pain can be quite complex, especially when multiple symptoms are involved. Based on the symptoms you’ve described, it seems that you are experiencing a combination of neurological, muscular, and possibly vascular issues. Let's break down your symptoms and discuss the appropriate specialist referrals and potential diagnostic tests.

Symptoms Breakdown
1. Left Occipital Pain and Dizziness: The stabbing pain in the left back of your head, accompanied by dizziness and nausea, could indicate several issues. This may be related to tension headaches, migraines, or even cervical spine issues. The fact that you feel dizzy and nauseous, especially when lying down, suggests that there may be some vestibular involvement or increased intracranial pressure.

2. Eye Strain and Shoulder Pain: The strain in your eyes, along with pain in your neck, shoulders, and back, could be due to muscle tension or poor posture, especially if you spend long hours in front of a computer. This is often referred to as "computer vision syndrome" and can lead to a cycle of discomfort and pain.

3. Numbness in the Left Hand: Numbness in the left hand could indicate nerve compression, possibly from cervical radiculopathy, which occurs when a nerve in the neck is compressed or irritated. This can lead to symptoms radiating down the arm.

4. Thyroid Concerns: The irregular imaging near your carotid artery and the recommendation for surgery raises concerns that should not be overlooked. Thyroid nodules can sometimes cause pressure symptoms, but they typically do not cause neurological symptoms like those you are experiencing.

Specialist Referrals
Given the complexity of your symptoms, a multidisciplinary approach may be beneficial. Here are the specialists you should consider consulting:
1. Neurologist: Since you are experiencing neurological symptoms such as headaches, dizziness, and numbness, a neurologist can perform a thorough evaluation. They may recommend imaging studies like an MRI of the brain and cervical spine to rule out any structural issues or neurological conditions.

2. Otolaryngologist (ENT): If your symptoms include ear discomfort and dizziness, an ENT specialist can evaluate for any inner ear issues or other related conditions.

3. Endocrinologist: Since you have concerns regarding your thyroid, it would be wise to follow up with an endocrinologist who can assess the nodule and its potential impact on your overall health.

4. Physical Therapist: A physical therapist can help address muscle tension and postural issues contributing to your neck and shoulder pain. They can provide exercises tailored to your specific needs.

Diagnostic Tests
- MRI or CT Scan: Given your symptoms, an MRI of the cervical spine and possibly a CT scan of the head may be warranted to assess for any structural abnormalities, such as herniated discs or other issues that could be pressing on nerves.

- Ultrasound: For the thyroid nodule, an ultrasound can help characterize the nodule and guide further management.

- Electromyography (EMG) and Nerve Conduction Studies: These tests can help determine if there is any nerve damage or compression that could explain the numbness in your hand.

Conclusion
Your symptoms are multifaceted, and it is crucial to approach them systematically. Start with a visit to a neurologist to address the neurological symptoms, and concurrently follow up with an endocrinologist regarding your thyroid concerns. A referral to an ENT may also be beneficial based on your ear symptoms. Lastly, consider physical therapy for muscle tension and posture correction.
By taking these steps, you can work towards a clearer diagnosis and effective treatment plan. Remember to keep a detailed record of your symptoms, as this will aid your healthcare providers in making informed decisions about your care.

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