I appologize for the slightly off-topic post.

I am not seeking medical diagnosis but just a practical opinion on what my next steps should be, given my situation.

Situation resulting in injury:

I had been shooting sporting clays with 12 and 20 gauge for several months this spring in prep for a bird hunt in Africa. After shooting 500 rounds per weekend for 2-3 months I developed pain in my right shoulder (the arm holding the fore-end of shotgun) when shooting, putting on my seat-belt, doing push-ups etc. This pain gradually worsened until July (when I stopped doing major shooting).

In August, the pain maintained at a below threshold level where it would just bug me, but not enough for me to seek medical attention. As hunting season progressed (Sept.-my activities increased), pain increased to the point of having trouble sleeping at night (as I turned over onto my shoulder, the pain would wake me up).

1st Doctor diagnosis:

In September, I sought medical attention for my right shoulder. The general MD I saw dianosed it as tendonitis and prescribed:

1. Napro - Novo-Napro EC 500 mg 2X day
2. Ratio-Emtec 30 ( 300mg-30 mg combo) 1X night

After two weeks of this treatment, I still had pain in my shoulder and was given an additional 7 days prescription for a total of 21 days supply.

End result: While pain decreased in shoulder during medication, pain returned after treatment.

2nd Doctor Diagnosis:

In late October, I sought a second opinion with my family doctor, general MD. He mentioned that it could be tendonitis but wants me to try the following:

1. Mobicox, 15 mg 1X per day for 30 days.

I have just finished the Mobicox and even during the prescription taking period, I still had bad shoulder pain (sharp burst of pain when actively using it to a dull pain when trying to sleep etc. Keep in mind, that I did not stop hunting and that I maintained an active lifestyle.

Current situation:
Now, I am running out of options?? I have a follow-up with my family doctor in January where he might send me to seek another opinion. His office renewed my prescription for Mobicox for another 30 days. The pharmacist told me that this family of drugs should not be taken long-term as it is similar to Vioxx. I am still in pain and have to wait another month for a medical appointment.

Question:
Given the above, what should be my next steps? Or what type of specialist should I see about my shoulder? Any thoughts would be appreciated.

Big thanks!

Time to go see a sports medicine doctor. A good orthopedist will do an MRI and take a good look for deeper damage. I don't know how old you are, but you may have some arthritis in that shoulder among other things, and only an MRI will really give the full picture so to speak.



I'm not an MD, but I've got screws and things in some joints and have had a handful of sports related surgeries, so I'm kind of going from my experience.



Good luck. It's a bitch getting old.

There was a similar discussion on this topic a short while ago, do a search for pain or shoulder I believe in Big Bores.
I was faced with a similar event in my life which resulted in loss of my tricep for several weeks. In a nut shell if you are experiencing pain their is contact with a nerve which gives off the pain , persistance agrivation or further injury can result in morepain, permanet and or partial damage to the nerve resulting in varying degree of loss of use. My suggestion pursue this with your doctor until they pinpoint the problem . I am no medical doctor but the medications are probably anti-inflamatory and pain killers. This was tried on me and it didnot work from start to finish it took 2 years to figure out the problem and by the time the neuro surgeons and Radiologist came up with a prognosis my herniation healed itself

Canadian lefty,
Sorry to hear about the sore shoulder, tendinitis due to an overuse injury may easily take 6-12 months to resolve because of the low metabolic activity in connective tissue. A Sports Med Doc is a good choice to establish a specific source for the pain (ligament, tendon, nerve or bone), see if there is anything structurally wrong, and to help with exercises to prevent a recurrence. Can you self refer yourself to a specialist in Canada? Meds are more to help you sleep or work than a way to fix the problem. Gentle stretching and mild exercise are always appropriate. A basic principle in orthopedics is that if it hurts to do that, don't do that. I believe the no pain no gain approach applies best to marriages, not injured shoulders.

I am a Doc, but not Sports Med. Good luck, Paul

It does sound like a tendinitis/bursitis problem. See an Orthopedic Surgeon.
Physical Therapy plus/minus a cortisone shot would be a reasonable next step. An Mri may be indicated if that fails.

I hope that it's easier to get in to see an orthopod than it was when I spent a couple months at Sick Kids in Toronto during training in the late '80's....At that point it was a year's wait for an MRI......

I take it your GP's didn't do a full blown physical exam on your shoulder. That is the next step. Someone with a clue can tell a lot with that. There are several possiblities, all of them treatable.
If it is going to take a long time to get in to see an orthopaedic surgeon up there, fly down to Boise and we can tell you what's going on in one day. If surgical intervention is indicated that can be done within 3-4 days. PM me and I'll send up a couple good guides to doing a shoulder exam. If your family doctor has the inclination to read, he/she should be able to narrow it down pretty quickly. IF you have a few boxes of factory .404 Jeffery ammunition I'm sure Alf could get you in pretty quickly.
JCN

Seek out anyone in a professional capacity who will tell you that either the 7mm Mauser or .270 Win. cartridges are perfectly suitable for plainsgame hunting, and get a letter of endorsement from same to at effect............

AD

You may have arthritis in your shoulder. This can result in a bony spur pointing into the soft tissue and causing pain. You might have a torn tendon. You need an MRI of that shoulder and joint, plus an evaluation by a good bone doc,(orthopedic surgeon). Your problem is common and usually easily fixed.
Best wishes and keep us informed!
Jeff in Texas

I�m with Joel C on this one -more likely a tendinitis of the biceps tendom or a bursitis. Doens�t sound like a rotator cuff problem. If you can move your arm freely -painfully but freely- it�s probably an inflammation. Physical therapy, a good anti-inflammatory drug, a regular exercise program (made up for you personally by the PT) and possible a cortisone injection. Acupuncture will also relieve pain and many PT�s in Finland use that along with traditional methods.

D Hunter:

Have you tried the cortisone shots? I had my first African Safari this year and had a bad right shoulder that was killing me, no sleep etc. from years working as a carpenter. They wanted to do the orthoscopic surgery but I opted to try the shots. Two shots a month apart and no more pain and I also have full movement. Just another option. Good luck.

Regards,

Rick L. Webb

Wow!

A big thanks to all of you who responded to me both through this forum or in personal messages.

I value your time and experience and I will now have a greater sense of what I should ask for, look out for and/or what I may have to go through in the coming months.

This forum is truly a great place to share!

I'm only 45 and I've had the same problem for 3 years now. Doc tried anti-inflammatories (Celebrex) but I had an allergic reaction (hives) and any less strong anti-inflammatories caused the same reaction.

I've had 2 shots of cortizone, physiotherapy and I even tried acupuncture, for chrissake. Nothing's worked.

Doc says no more cortizone because extended use is suspected to cause deterioration of the tendons. I've learned to live with it. It's not as severe now. When it first developed, I couldn't even rest my arm at my side. Hurt like Hell at the lower bicep. Doc calls it "referred pain" from the nerve in the shoulder. The only time I got relief was when I was in bed and I slept with my arm over my head. Now, I only occasionally get the "crunch" sound when I lift my shoulder. Dull ache occasionally, but it's tolerable. Not worth taking painkillers for. I do notice a slight weakness in my right arm when lifting, but it hasn't been a problem up to this point.

Only thing that bothers me is that I'm starting to get the same occasional twinge in my left shoulder.

Your problem may be in your neck. You may have a disc herniation at the C-6 level pressing on the nerve roots as they come out of the spinal cord.
JCN

Lefty,
we all relate to your experience.My strict advice is to listen but forget most well meant "advice" as they are based on different experiences and hunches.You had the injury for some time,it is not trivial.Simple anti inflammatory treatement did not succeed.You have to now see somebody that has experience and knowledge,not only good will and opinions.Even then the diagnosis might be a good guess and you will have to stick with the advice of the experienced.going in increments until its solved.
Waste no further time,see a knowledgable orthopedic surgeon for a work up,a sport medicine doc might be better,depends on the person and their experience/attitude.

Good luck

I can ask the doc, but that wouldn't have anything to do with my shoulder joint "crunching" when I lift my arm, would it? The physiotherapist explained that the muscle is supposed to slide under the joint there, but since it's inflamed, it catches. It only happens occasionally now, where it was constant before.

I was in a car accident 20 years ago. No apparent injuries, but I probably had whiplash, and ended with up headaches from a stiff neck occasionally, ever since the accident. I've been going to a chiropractor every six weeks for about 12 years, and that's resolved the stiff neck and headache problems for the most part. Used to be several times a month, now I only get the headaches a couple times a year.

Hi Canadian Lefty,
If your case has been diagnosed as tendonitis and you have an open mind try homeopathy. There is a remedy called Arnica Montana that works really well for tendonitis. Cortezone only masks the symptoms and when it wears off the problem is still there. Go to a store where they sell homeopathic remedies and ask for Arinca Montana 30ch which is the dilution it should cost you a whole $6 to 8 dollars. Don't eat for 20 minutes before or after taking the 3 granules and try it out for 5 to 7 days three times a day.Cut back on coffee if your a big coffee drinker. There are no side effects it's all natural and works well.
Take good care and get well,
Dave

Is the pain down in the belly of your bicep muscle, or up very close to your shoulder?

Shoot me a pm.

JCN

I had an inflamed bicep tendon that was so bad my arm would give out without warning (not great on the dip bars). One shot of cortizone and a lecture from the ortho about how pro quarterbacks get the same thing and it does not hold them back and the condition left both my bicep and my mind.

I got to see the orthopod today. Heat, A shot of cortisone(boy will that get your attention for a minute), Mobic 15 mg, and some excercises. Says mild stretching excercises to free up the capsule around the joint. Possible second shot of cortisone in 4-7 days. Tincture of time. Will report results when better.

Is somebody really recommending homeopathy? That -if anything- is a crock of manure. A recent study showed that homeopathy had no effects on any diseases or ailments -except for placebo effect. Do not waste money on "medicines" that are 100% water or lactose or something else that is totally inert.

Shame on you Mbogo.

Myself and several of my friends used to like to show off on weight lifting benches pumping more iron than we should.

We used to like to see who would shoot the heaviest kicking rifles and claim we had no pain.

We ran chain saws, threw footballs and acted like big kids.

We all developed shoulder pain that every one of our doctors gave a different expensive medicines for or prescribed surgery for.

I had an HMO doctor and they're notorious cheapskates that don't really fix problems by throwing money at them or they'll fall out of favor with the HMO.... Right?

Well... My doctor gave me a quick exam by sticking his thumb in my shoulder (ouch) and moving my arm all over the place and frowning a lot. I was busy telling him that I was almost sure I had a rotator cuff injury or possibly a bone spur.

He told me to be quiet... He was concentrating. I sighed and wondered what he was up to.

Then he went to a plain paper scratch pad and wrote glucosamine sulfate 1000mg on it and handed it to me. I said what's this and he said to go to a health food store and I'd find it in the vitamin section.

I'd been expecting a referral to an orthopedic surgeon or some kinda $50 a pill drug.

He saw the doubt in my face and asked me how long I'd been putting up with the pain. I told him about 2 years. He said... "Give it two weeks and if it still hurts I'll give you what you want and you can have someone cut up your shoulder"... Then he laughed and slapped me on the good shoulder. "Hey" I said... "I didn't know that one hurt too until you hit me"... He said... Of course not... You don't stress it as much. Try the glucosamine and come see me if it doesn't work.

Well I did... I bought it on the way home and took one capsule twice a day for a week and my shoulder pain almost went away. After 2 weeks there was only the faintest twinge once in a while.

I told all my friends with similar problems and every one of them went and bought it and every one of them has had total recovery like me.

This stuff cures arthritis and any other cartlidge related ailment including a lot of "sports injuries".

Doctors won't tell you about it because it'd negatively affect their income.

I've told about 40 more people about it since then and every single one of them experienced almost immediate relief and have all thanked me.

It's now sold at Wal-Mart and Sam's Club and is cheap as dirt.

I know that a LOT of you are going to be in denial, especially those that have had surgery or that are fooled by their medical salesman, er... ah... doctor but this stuff works.

It comes in several forms that cost a lot more money and I've never tried any other form than the sulfate because it works for me just fine and it's cheap.

Go ahead and deny it. These days most everyone that I try to tell about it already knows about it and many of them take it.

Go ahead and deny that it can't work and that it's quackery. It'll make you feel better. Go ahead and let your doctor destroy your liver with expensive drugs. Go ahead and let the surgeons "fix" your joints with expensive surgery and long recovery times.

I spend about 20 bucks a year for my vitamin that helps my body rejuvenate my aging cartlidge and I never even get a stiff neck any more.

Go ahead... Live in denial... It'll make you feel better. But your joints (and wallets) will give you fits.... <grin>

By the way... I now only take one 1000mg capsule a day and like the way they slide down my throat. The tablets at Sams have sharp edges and are a lot harder to swallow.

$bob$

Man is it better! Not all the way. Still when I move certain ways it still talks to me a bit but the language is gentle or at most a little firm. Before it was shouting and screaming every curse word you can think of. I didn't like that cortisone shot much while it was going on but if it flares again you can bet I will be asking for that big needle again.

The best brand is called Cosamin DX.

I have been recommending it since I read the first good studies in 1996-1997. The studies show that it provides the most benefit in the setting of cartilage injuries in the knees.

I do make more money if I inject a shoulder than if I just put someone on Glucosamine & Chondroitin.

The Glucosamine only helps if a patient also ceases and desists with the knuckle-headed behavior.

Glucosamine will not heal a torn rotator cuff.

Glucosamine will not make a sub-acromial spur go away.

Glucosamine will not induce the growth of new cartilage to replace cartilage that is no longer present in a joint (see knuckle-headed behavior above).

Glucosamine does help with cartilage healing. It is not an anti-inflamatory. "Cortisone" and NSAIDs (Motrin, Aleve, Celebrex, Mobic, Relafen, Feldene, Ansaid, etc.) are anti-inflamatory medicines.

Pain in a joint can be due to a cartilage injury, inflamation, a tendon or ligament tear, infection, arthritic destruction or many other causes. Many of these conditions overlap and more than one may be (usually are) present at the same time.

The treatment needs to be matched to the problem(s).

Most of my middle aged joint pain patients in this hardscrabble agricultural and ranching region present well beyond the point where a bottle of glucosamine and a pat on the ass is going to make things right.

JCN

PS Glucosamine works best if a person starts taking it long before there is any problem, but that is a hard sale to make.

It's been interesting watching this topic unfold with everyone's experiences with this common problem. Again, I encourage you all to persist with your Docs until you have a specific diagnosis for the pain (of which there are many possibilities). A first time shoulder injury aften eventually heals on its own. Established pathology in this anatomically complex area may be difficult to cure. If you can't sleep or can't work you go to the front of the list at the Doctor's office. You need to follow through with exercises/therapy/stretching as the pain will always come back after the medications wear off if you don't address the underlying problems. Surgery is the last option and is innapropriate for the majoraty of cases. Glycosamine has been prover effective in clinical trials for knee arthritis and may be helpful in some cases. Cortisone shots are a quick fix that may work dramatically. They can only be repeated a limited number of times, however. Cortisone is good for inflammation but interferes with healing; repeated/prolonged use may damage the tissues and make things worse. Asparin, advil, motrin, etc are all similar in effect and differ mainly in the duration of action. Keep in mind that one new nonsteroidal has been pulled off the market for life threatening complications (beware of new drugs/therapies). Unfortinately, most homeopathic remedies are crap and have not been subjected to controlled prospective studies because there is no scientific merit to the underlying theories.

Paul

Glucosamine is not a homeopathic medicine nor is it a vitamin, it�s an integral part of cartilige and taken regularly is said to alleviate pain in the joints by helping the primary process of healing.

This has been shown to be true in unbiased controls and in Finland Arthryl (as it�s called here) is a registered medicine.

I�ve been on it for the last week now after discussing on this post.

Now homeopathy is another issue -practised by quacks.

"Most of my middle aged joint pain patients in this hardscrabble agricultural and ranching region present well beyond the point where a bottle of glucosamine and a pat on the ass is going to make things right."

That may well be right but 3-4 of the people that I recommended to take it had been under doctors treatment for 20+ years for arthritis and haven't been back to the doctor since. I don't claim to know why but I haven't had someone with joint pain yet that it didn't help significantly.

I've seen people over 70 start taking it and within weeks throw away their arthritis drugs.

The glucosamine I use says that it's derived from shellfish so I assumed it was a "vitamin"... Sorry.. Semantical error.

It works. It works. It works.

I know of two people that supposedly had bone spurs that took it and got relief.

I'm not claiming that it cures everything and I know that it can't cure a bone spur or a torn rotator cuff but I also know that the statistic that 80-90% of the prescribed surgery in this country is totally unwarranted.

I don't trust most doctors. I'm told that most medical school graduates leave that school with a half million in debt from their education alone. Then their homes, cars, and country club memberships ad another million or so...

I guess that SOMEONE has to support them... I just don't want it to be me unless it's truly necessary.

If I ever run across even one person that doesn't get cured by glucosamine I'll maybe think that doctors can help joint injuries or arthritis.

I'm likely to talk to ANYONE. I never met a stranger... I often run into people buying glucosamine while in in the vitamin aisle and ask for their story. Quite often they had a serious joint problem and were under doctors care and often facing surgery and someone, often a chiropractor told them about glucosamine and they were totally cured almost overnight.

Just like aspirin, red wine, weight loss, and walking can prevent almost any cardiovascular problems, glosamine can prevent and even cure joint problems.

I've seen it a LOT of times and have never seen it fail.

$bob$

Hi Cewe
There is that closed mind I was mentioning.
Take care,
Dave

.

Alf,



You list your profession as orthopaedic surgeon in your profile. It appears that I've stepped on your toes.



No... I don't have the scientific studies to back me up. Just everyday experience.



The 80-90% figure came from the AMA Journal a few short years ago and no I can't produce that journal so if you want to call me a liar I'll accept the brand unless I can produce it.



I don't believe that I've stated any fact incorrectly but I'm guilty of talking about something I can't prove. So there you have it...



***EDIT*** Did some quick research. ***



Ok... Doing a quick google under "unnecessary surgery ama journal" I got 90,000 hits



Here are a few of the more notable ones from the first few pages. Some of them are from medical journals and almost all of them refer to multiple medical journal articles.



http://www.mises.org/fullstory.aspx?Id=1547



http://www.newmediaexplorer.org/chris/2003/11/18/medical_armageddon.htm



http://www.dorway.com/jama.html



http://www.mercola.com/2004/jul/24/healthcare_death.htm



http://www.pacifichealthcenter.com/updates/47.asp



There are two sides to EVERY story and there are a lot of very sincere good doctors out there that really want to help people and who would never do anything to hurt a patient. Unfortunately the quacks do so much damage they get a LOT of press.



Once again... I don't know you and this certainly not a reflection on you .



*** Another Edit ***



11,500 hits on "glucosamine ama journal" but here's one from the a search on AMA Journal touting it's benefits.

http://www.healingdaily.com/conditions/glucosamine.htm



$bob$

Alf,
Those 20+ years of school, residency and practice that we've put in and it turns out we have been wasting our time adhering to the scientific method. Since all we seem to be doing is blowing sunshine and bad intentions up our patient's arses what say I put up my vial of depo-medrol and you set aside your arthroscopic equipment. We can go sell glucosamine, tattoos and body piercings in the shopping malls on the weekend, and go hunt during the week.
Prospective, double blinded, and placebo controlled studies my foot. Next thing you'll be trying to tell me that germs cause diseases.
JCN

.

Mbogo: No studies anywhere have shown homepathy to be effective in any cases. And how could it be? The idea of taking a compund and diluting to an extent where not one single molecule can be found in the "medicine" is not just postive thinking it�s lunacy. As are most homeopathic "doctors".



Alf: In Europe glucosamine is -also- sold at pharmacies by reputed drug companies so it�s been analysed and gone through our FDA. Not a miracle cure, maybe not even a cure, but it seems to help when combined with traditional medical practise. It won�t leave us without patients but it might help alleviate post-op pain, joint swelling etc. I really think that we doctors need to keep an open mind and discuss these things with our patients so as not to scare them off to the quacks of the world. I�m "only" a GP so I send my patients with arthrosis to surgeons etc and here quite a few orthopedic surgeons prescibe glucosamine along with surgical correction etc. As a psychotherapist again I treat quite a lot of psychosomatic pain -a different story and often treatable using short term cognitive methods. Wish more surgeons where able to discuss these patients before they sink to deeply into the system.



I�m thinking of trying the shellfish version of glocosamine, we have a supplement her that also contains ginger which is a traditional Chinese remedy for joint pain. It might just help. I�ll also keep up acupuncture -a form of therapy that a few decades ago was frowned upon by Western medicine but is now seen as an effective pain reliever -not a miracle cure though. And I�ll keep in touch with my orthopedic surgeon �cause he�s the one that keeps putting Humpty Dumpty back together again!



But please put me out of my misery the day I visit a homeopathic doctor or when I start hyping Reiki therapy!