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shoulder pain

I used to play tennis 6 days a week. On December 15th I was returning serves that were about 80mph  (I am 5'4 about 110lbs) and swung back too far with my racket before contacting the tennis ball.  I recall feeling the impact on my arm but it was not severe.  My arm hurt a little the next day and over the course of a week the pain increased.  I took three weeks off tennis and took NSAIDS.  On January 5th I tried to play but had to stop because of pain on the upper outside of my arm all the way down to my elbow and pain on the front side of the armpit area.  On January 7th I picked up a 3 year old and felt it 10X worse in those same areas.  I saw the orthopedist and he thought it was a labral tear.  I went in for an MRI Arthrogram and the results came back stating everything is intact.  I started PT and have been doing shoulder strengthening exercises but when I reach my arm out to the side to get something, have it on a slightly elevated desk trying to type or try to wash my other shoulder I have shooting pains down the outside of my arm.  The pain in the armpit area has lessened a little since I started PT and is now more of an achy sensation when it does hurt.  Occassionally my scapula hurts but that is only when the pain on the arm pit is present.  I am taking tramadol (once a day) and vicodine (when the pain is severe), as well as Diclofenac for inflammation.  Does anyone have any ideas what it could be if the MRI did not show anything?
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Avatar universal
Hi,
How are you feeling now?
Any patient who comes with query of shoulder pain, the differential diagnosis of common causes includes the following four entities:
1. Impingement syndrome and rotator cuff disease. 2. Rotator cuff calcific tendonitis.
3. Biceps tendonitis. 4. Superior labral anterior posterior (SLAP) lesions,
Before I proceed I would like to know few things.
Where is your pain actually if you have to show with index fingers? What movements, if any, exacerbate your pain?
Does your shoulder ever give way? Did your shoulder previously have pain, but is now only stiff?
How long have you had your shoulder pain and have you tried anything to help it?
Shooting arm pain may be termed radicular pain. Radicular pain is lancinating or electric in nature. Radicular pain radiates deeply in a narrow, characteristic, band-like pattern. The pathological mechanism of radicular pain is compression of a dorsal root ganglion or inflammation of a nerve root. Radicular pain and radiculopathy often (though not always) coexist. Radiculopathy is a neurological condition of loss—a sensory radiculopathy results in loss of sensation (numbness or tingling); a motor radiculopathy results in loss of strength (weakness).
I think you should be consulting another orthopaedician or sports medicine specialist for further evaluation.
Bye.
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Avatar universal
To answer thequestions  in order from last to first:
I have had severe shoulder pain since January 7th but the pain initially started as mildly intense on December 15th.   I have gone to 6 physical therapy session and have done range of motion exercises as well as external and internal strengthening exercises with a theraband.  The pain seemed to decrease then, last week the PT added new exercises (passive stretching of the posterior cuff and pulleys overhead) and it returned to its previous level of pain from that PT session on.  Today when I went to PT I mentioned it, so she has me doing isometric strengthening internally and externally and stopped all other exercises. She previously did ultrasound and it made it feel better but today when she did ultrasound at level 1.0 it hurt so bad that she switched to pulse only.  Ice and strong pain meds are the only thing that relieve the pain.  At night I sleep on my stomach and if my arm is above my head, my hand swells to the point of not being able to bend my fingers.  I have to hang it over the bed for a while for the swelling to go down.

My shoulder on two occassions has popped and felt slightly unstable but not like it was out of socket or anything.  I  have never had shoulder pain before and initially it was stiff but with the PT exercises and decrease of some inflammation I have full range of motion now...albeit not pain free.

The pain is primarily from the outside top of my shoulder down my bicep tendon and some into the front of the armpit.  Reaching out to the side and across the front of my body bring on the pain severely.  Also, swinging a tennis racket (not even hitting a ball) and throwing a dart at a dart board are next to impossible at this time.  The PT said today that it seems like there is something going on with the bicep.  I have another appointment for Friday with the sports medicine orthopedist.  (of note...I developed Chronic Exertional Compartment Syndrome in my leg two years ago and he preformed a fasciotomy and a year later removed a nerve that was cut during the first surgery and had to take the vein at that point to.  I also developed severe allergies and asthma over the past year.  Previous to all of this, I had never been sick a day in my life).  Any ideas why my shoulder is still screwed up on top of all these other maladies over the past two years?
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Avatar universal
Hi,
I am sorry that I was not able to post you soon.
Your pain symptoms in the area you have described suggest that you might have bicipital tendonitis.
Patients with Bicipital tendonitis will point slightly more distal along their arm over the bicipital sheath.
Your other symptom of impossibility to throw a dart or swing a tennis racket also suggests that it could be due to Bicipital Tendonitis.
Patients with biceps tendonitis, rotator cuff tendonitis, or rotator cuff calcific tendonitis all complain of pain exacerbated by overhead movements.
So finally you might be having what is called as Bicipital Tendonitis.
You should be getting X-rays, including AP and lateral views of the shoulder in internal and external rotation, scapular outlet view, and axillary view.
Treatment for Bicipital tendonitis would include conservative treatment which is usually successful and includes rest, NSAIDs, physical therapy, and/or a bicipital sheath injection of corticosteroid and anesthetic.
Keep me posted if you have any queries.
Bye.
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Avatar universal
When this initially happened I had x-rays done (I believe they did two) and they did an MRI a few weeks later.  Neither showed anything significant.  Last Thursday I went back to PT (the PT is also an athletic trainer) and after doing a progress note she stated that it seemed like Supraspinatus impingment and tendonitis.  The next day I went back to the Ortho and saw his physician assistant.  He moved my arm a couple of different positions and thought bicep tendonitis and sent me back to PT.  At this point the PT said we will try a few more sessions before she starts putting pressure on the ortho to do something.  I have been doing conservative treatment (PT, Ice, resting the arm and at home stabalization exercises) but nothing seems to be helping. The pain decreases for a while then it flares up again by doing simple things like reaching across the car to get into the glove box.  I don't want to be impatient but I don't want to let this drag on like they did with my leg and let things get so bad that the damage is ireversible. How long would you expect either supraspinatus impingment/tendonitis or bicep tendonitis would take to heal?  
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Avatar universal
Hi,
Prognosis is usually good. Recovery depends up on physical therapy, any other associated condition etc.
It would take 3 weeks before you start on physical therapy.
Hope this helps.
Bye.
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Avatar universal
I have seen the ortho five times and had about 17 PT sessions at this point and I keep hearing something different everytime I see the two people.  The pain down the front of my arm is doing better but my arm pit area still hurts and it still hurts to move my arm across the front of my body.  At one point a month ago I lost feeling in my outer fingers for two days and with some traction work at PT the feeling came back.  They started new strengthening exercises at PT and now my scapula area is hurting...not just sore but also painful to lay flat on.  The ortho said I could try tennis and it was still painful and my arm does not have as much strength as it used to.  They have thrown around terms like "hypermobility in the joint, stretched capsule, suprasinatus tendonitis, thoracic outlet syndrome" but no one has been able to tell me what is what.  Is this typical that after all these appointments one would be no closer to knowing what is going on?
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Avatar universal
hi all, I have trouble with restricted strength in hands, upper arms and shoulders, M.R.I. Scan revealed c7 slipped disc in neck, had pain relief and injection, just wondering what will the surgeon do when I see him/her? many thanx sharon
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