upper arm pain

[lilwe]

not sure if you can help.  I was having soreness in both upper arms 6wks after my hysto.  I still exercised, but when it seemed the discomfort was getting worse i stopped.  my right upper outer arm feels like it is swollen.  It has a round nodule/swelling.  It gets worse when I use that arm alot.  my ortho doc took mri said it was normal.  I had a bone scan and it said  periarticular increase is seen in the right glenohumeral articulatory region.  It became hard to move and my doc said it was adhesive/incapulitus and wanted to put me under and manipulate it.  I declined and went home and did therapy which helped greatly.  I can move it alot better, however it still feels swollen and achy.  I have heard of where and I don't know if this applies that sometimes this needs to be aspirated and a biospy done on this.  My left arm has gotten better and hardly hurts.  This has come 6 wks as I stated before after my hysto, I have hadmany pelvic surgeries and weird things have been happening to me.   This being one of them.  I know that trauma can bring on autoimmune type disease.  I did have blood work done all normal except a slightly elevated RA factor, I believe it was a 24.  I am going to go see a rheumatoid doctor, but I am just wondering if I should get this biopsied and who would do that?  Its as if my body over the past 6 months is turning on me and I desperately need to know whats going on.  Should I get this aspirated?  I think it would relieve the pressure.

[Kevin Pho, MD]

Hello - thanks for asking your question.

Without seeing the lesion, it is impossible for me to say what it is.  

If the lesion has been enlarging, then it may be reasonable to biopsy and see what it is.  If it is located in the joint area, then asipration of the fluid would be helpful in diagnosis.

If the mass is located on the muscle, then the most definitive test would be the biopsy.  Given the fact that it has enlarged over the past 6 weeks, this would be an option I would consider.  

Another consideration, especially with an elevated RA factor, would be a rheumatoid nodule.  This is a skin manifestation of rheumatoid arthritis.  They can present on any skin surface.

Again, without seeing the lesion or examining you, I cannot be more specific.  A rheumatology referral is an appropriate next step.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[lilwe]

Thank you doctor for your response.  Forgot to ask you what is a high reading for the RA factor?  Is 24 considered anything substantial?

Thank you

[kevinmd]

Hello,
Normally rheumatoid factor is less than 20.  

Thanks,
Kevin, M.D.