Left Shoulder Pain, Dizziness, and Heart Symptoms

Left shoulder, neck, and back pain, palpitations, and dizziness?

Hello, Doctor: I have been experiencing intermittent pain in my left shoulder, neck, and back for about two years.
My presbyopia has been worsening.
Last year, I suddenly experienced dizziness and went to the emergency room, but no cause was found, which led to a lengthy series of medical examinations.
I consulted specialists in cardiology, pulmonology, neurology, orthopedic spine, gastroenterology, otolaryngology, and even traditional Chinese medicine for acupuncture and massage.
Eventually, I visited a family medicine doctor.
I underwent tests including an EEG, brain MRI, cervical spine MRI, chest X-ray, ECG, echocardiogram, and multiple blood tests, all of which returned normal results, except for gastroesophageal reflux.
As a result, I quit smoking, stopped drinking coffee, switched to tea, and reduced my sugar intake.
After five months, from January 1 to today, January 12, I have been experiencing pain in my left shoulder, neck, and back, similar to a stiff neck, where turning left causes pain.
I also have intermittent chest tightness and tenderness in the upper chest, along with dizziness.
Doctor, what should I do?

Victor, 40~49 year old female. Ask Date: 2016/01/12

Dr. Lan Shengxing reply Neurology

Dear Victor, based on your symptoms, I recommend that you seek treatment from a neurologist and a rehabilitation specialist.
There is a high chance that your condition is related to the cervical spine, and treatment may include medication and physical therapy, among other options.
However, it will require some patience, as six months of pain may not resolve in just a few days.
Wishing you all the best, Blue Saint Star.

Reply Date: 2016/01/12

More Info

Understanding the symptoms you are experiencing, particularly left shoulder pain, dizziness, and heart-related symptoms, requires a comprehensive approach. Given your extensive medical history and the various specialists you have consulted, it seems that you have undergone a thorough evaluation. However, the persistence of your symptoms indicates that further exploration may be necessary.

Possible Causes of Your Symptoms
1. Musculoskeletal Issues: The pain in your left shoulder, neck, and upper back could be related to musculoskeletal problems. Conditions such as cervical radiculopathy, which occurs when a nerve in the neck is compressed or irritated, can lead to pain that radiates to the shoulder and arm. Poor posture, especially if you spend long hours sitting or working on a computer, can exacerbate these issues.
2. Cervical Spine Problems: Given that you have had imaging studies of your cervical spine, it is essential to consider any degenerative changes or disc herniations that might not have been significant enough to warrant immediate treatment but could still cause discomfort and referred pain.

3. Anxiety and Stress: Chronic stress and anxiety can manifest physically, leading to muscle tension and pain, particularly in the neck and shoulders. This tension can also contribute to feelings of dizziness and chest discomfort. It's important to address any psychological factors that may be contributing to your physical symptoms.

4. Gastroesophageal Reflux Disease (GERD): You mentioned having gastroesophageal reflux, which can cause chest discomfort and may mimic cardiac symptoms. It is crucial to manage this condition effectively, as it can lead to significant discomfort and may be mistaken for heart-related issues.

5. Cardiac Concerns: Although you have undergone extensive cardiac evaluations, it is understandable to remain concerned about heart-related issues, especially given the nature of your symptoms. However, the normal results from your echocardiogram, EKG, and other cardiac tests suggest that significant heart disease is less likely.

Recommendations for Management
1. Physical Therapy: Engaging in physical therapy can be beneficial for addressing musculoskeletal pain. A physical therapist can provide exercises to strengthen your neck and shoulder muscles, improve posture, and enhance flexibility, which may alleviate some of your symptoms.

2. Stress Management Techniques: Incorporating stress-reduction techniques such as mindfulness, yoga, or cognitive-behavioral therapy can help manage anxiety and its physical manifestations. Regular exercise can also be a powerful tool for reducing stress and improving overall well-being.

3. Lifestyle Modifications: Continue to focus on lifestyle changes that promote overall health. This includes maintaining a balanced diet, staying hydrated, and avoiding triggers such as caffeine and smoking that can exacerbate both anxiety and GERD symptoms.

4. Follow-Up with Specialists: If symptoms persist or worsen, consider following up with a neurologist or a pain management specialist. They may offer additional insights or treatments that could help alleviate your discomfort.

5. Regular Monitoring: Keep a symptom diary to track when your symptoms occur, their intensity, and any potential triggers. This information can be valuable for your healthcare providers in determining the best course of action.

Conclusion
While your symptoms are concerning, the extensive evaluations you have undergone suggest that serious underlying conditions have been ruled out. It is essential to continue working closely with your healthcare providers to manage your symptoms effectively. By addressing both physical and psychological aspects of your health, you can work towards improving your quality of life and reducing the impact of these symptoms on your daily activities.

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