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!

A couple of months ago I developed pain in my left shoulder and sought out an orthopedic doctor and after X-rays and physical examination was diagnosed with inflamation of my rotator cuff. I had been doing some relatively intense exercises with dumbbells and pushups. The Dr. said we could try two things - a prescription (MOBIC�, i.e. meloxicam) and light weights for my workout or a shot of cortizone in the joint (I hurt just thinking about it). In my case the former worked after a couple of weeks. The Dr. said that really light weights (2-3 lbs) worked in a slow rotational motion was better than complete rest.

Probably you should make sure you don't actually have an injury or bone spurs - might include an MRI and/or surgery. Otherwise, time is the only answer. You could also opt for the cortizone shot.

I had tendonitis in my right elbow a couple of years back and it took 6 months before I finally quit noticing the pain. At first I would cringe everytime I would shake someones hand. Getting older just sucks - and I'm only 36. I now realize why athaletes go downhill in their 30's, the body just doesn't repair itself as quickly anymore.

I'm not a doctor, and haven't even played one on TV; but here goes:

Your injury sounds like some I have had in the past (and one I am dealing with now) that result from repetitive strain (for lack of a better term). Whether the strained tissue is muscle, tendon, ligament, or whatever, is beyond me; all I know is that it hurts and it's usually at a joint, but not always.

I currently have an elbow that is dealing me grief, and I know exactly what caused it: Extensive usage during a concentrated period of time of a cordless drill to drive screws. I was overseeing the building of our new home and doing much of the detail work, like door knobs, cabinet pulls, and some specialty construction myself. Now, when I pick up the drill, I can feel the sensative tissue right down to the index finger which squeezes the power button.

I was also issued one of the new-generation pain killers (akin to Vioxx, and likely just as bad for the heart). It helped some, but not much more than naproxin sodium or asprin.

I'm afraid that the cure is really simple: Quit doing what injured you in the first place (easier said than done, since I'm leaving work early today to go build yet another screw-together project with the very same drill). You're simply going to have to lay off of long strings of repetitive shooting while you give your shoulder a chance to heal (the shooting you do in regular hunting isn't usually enough to aggravate the injury). Once you've fully recovered, you can likely resume reasonably regular shooting without a relapse. It usually takes me the better part of a year to get over a "repetitive strain" injury. Hopefully, you're younger and heal quicker.

Just remember, this advice is likely worth almost as much as you paid for it, but good luck.

There are several dx that may apply to you and there is no rule in the book of 'being human' that says you CANNOT have more than one problem at a time.



First and foremost, there are other questions that need answering.



Is this your first episode of shoulder pain?



Does pain radiate into your upper extremity, down the arm, or into forearm?



Any numbness, tingling, pins-needles feeling anywhere?



Is pain only sharp with certain movements?



Ever had any other history of shoulder trauma?



Age? Any family hx of arthritic joints?





What ranges of motion elicit pain? Are these passive (meaning you relax and the examiner moves your shoulder for you), or active (meaning you do it), or both?



Abduction? Flexion? extension? Internal and external rotation?

Quote:

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

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Your question is not practical. Not seeking a dx but wanting to know what to do, ie. treatment plan.



A proper dx is needed to accurately steer you the right direction.



You've already been given the best advice. Stop the inciting incident or activity for best results. However, most patients, especially men, are NONCOMPLIANT.



Remember, most meds will only mask symptoms, not cure the problem. Dose paks of steroids or local injections are better. Chiropractic and Osteopathic manipulation and physical therapy are good conservative measures to try first. Then injections, which are more invasive. Keep in mind, corticosteroid use is bad on joints overall and not healthy for bones or ligaments, but this is with long term repeated use. Also, your liver has to detoxify every chemical you introduce to your body, ie. meds.



Mild exercises with resistance are better.



There are medical guidelines used here in the US that suggest that 'pain in the same region greater than 3 months is considered complicated.'



You sound like you have a 'repetitive non-traumatic chronic condition'...an OVERUSE syndrome, if you will.



I'd say you have bursitis and perhaps tenosynovitis. Tendonitis itself does not really exist. Tendons do not get inflamed. The sheath around them does, however.



The examiner should also visualize your shoulders without a shirt on to determine if there is a 'step defect' which might mean A-C separation.



weight bearing x-rays should be obtained if the examiner is suspicious of this defect.



A STIR MRI without contrast is what I would order . Open MRI's are fine and you'll be better off in one of those if you are claustrophobic. But I prefer closed MRI. Overall I think it produced better imaging.



You may also have a rotator cuff issue. MRI would rule in or out its existence.



Good Luck.

I agree "Sports Medicine" is a good place to start. I have problems with my arms and shoulders as well. I have messed up tendions in my shoulder and elbow along with a pinched nerve in my neck that affects my shoulder blade area with numbness in my right hand. My sports med doctor has done wonders for me.

I have had similar problems for the past year. I lift weights 4-5 times a week and I'm sure that is the culprit. I have had 2 rounds of physical therapy and two cortizone injections in the shoulder this year. I even quit lifting for several months, still nagging pain and numbness. I'm on my second orthapedic surgeon and he suggested surgery. I'm scheduled to go under the knife in mid Jan., hope to be back in full-swing by turkey season in April. I also took Naproxen, Cataflam, and oral Pretizone. I hope you have better luck than I.

Re: Shoulder problems.

I have knee problems, and the only advise that I can add to Doc's already detailed advise to take the results of the testing (MRI etc) to an Orthopedic Surgeon who specialized in shoulders. In NYC there are two hospitals dedicated to orthopedic issues (Hospital for Special Surgery and the Hospital for Joint Disease) Garantueed these types of hospitals have specialists for shoulders. I had a recurrent problem with my right knee that no one could figure out despite several different views of x-rays and an MRI.

It took Arthroscopy by a surgeon specializing in knees (that is all he does) to find out that I was missing cartilage between the patella and the femur at a small but critical location, which was causing extreme pain during certain activities only. Somehow, even in retrospect it was invisible on MRI. A slab of muscle and tissue was stuffed in the defect and I have been fine (running, skiing name it) ever since (until, ofcourse, the flap too wears out).

You can't give up, especially if the pain is affecting your lifestyle. Many surgeons advised my NOT to participate in activities which cause me pain. For me that was unacceptable. Be persistent, and find a competent physician. Good luck.

Marianne