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Dr. SH
Dr. SH, Board Certified Physician
Category: Medical
Satisfied Customers: 8781
Experience:  Doctor of Medicine
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Thank you the time to read this. I will try

Resolved Question:

Hi,
Thank you for taking the time to read this. I will try to provide as much detail as possible.
I am a 46yo male working full time in a manual job which involves picking up/shelving goods which can weigh anything up to 30 kilos.
Around 3 years ago now, I noticed a pain in my shoulder/upper arm area. I can't be certain of the trigger but believe it may have been caused by sliding a heavy object across a shelf with my arm outstretched using the palm of my hand. The pain would come and go but would seem to be worse when lifting heavier objects. Eventually this pain became more of a persistant ache and remained even after a day or two break from working. I found, that by standing up holding my arm down to my side and making a sharp punching downwards motion would cause my shoulder to click loudly and the pain would subside. This would provide immediate relief, although only temporary and I would have to repeat this process again and again to get any relief. Pain scale is 4/10.
My Gp referred me to hospital where I had xrays and ultrasound of my upper shoulder, but nothing untowards showed up.
After no further action or advice I have carried on living with it, but in the last year I have noticed that the pain has got worse. Although it is hard to pinpoint accurately I believe it is probably more from my upper arm than shoulder and also it now alternates from my shoulder to my lower arm around my elbow. It is either in one place or the other, never both at the same time. The symptoms and pain level are exactly the same whether it is by my shoulder or by my elbow and I can still get relief by doing the punch/click routine. I used to have to punch downwards quite forcefully to get the relief, but now even a mild punch will cause the click. Also the greater the pain, the louder the click. Sometimes I am up and down punching 5 or 6 times an hour to get relief. It can drive me mad!
I have spoke to my GP again, who said that cortisone injections would probably give me some relief but these injections can't be given in the elbow region so he has dismissed that option. The pain can sometimes be at my shoulder for a couple of weeks, then at my elbow for maybe a month. It doesn't alternate regulary, but probably spends more time at my shoulder end than the elbow end. After a couple of weeks break from work I notice a big improvement but it still can creep back once or twice a day.
I really would like an explanation as to what is going on and if there is anything that can be done about it. I now to work using my left arm as little as possible and try to balance loads so the weight is mainly absorbed by my right arm, but I have a real worry that if my right arm was like this as well, I'm not sure how I would be able to work.
I am more than willing to pay for someone to give me an explanation and appreciate your time.
Thanks,
Mark
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. SH replied 1 year ago.
Thank you for your question.I think that x-rays and ultrasounds are not accurate enough for the diagnosis of such kinds of pain.I would like that you should have a MRI done.I think that there is a strong possibility of muscular or tendon tear or damage that is causing your pain which is better picked up by MRI.Also, at times, such pain in the shoulder can be due to a pinched nerve in the neck and MRI of the neck may be indicated as well to have a look at the discs and bones of your neck spine to make sure they are not pressing on nerves causing your pain in the shoulder area.This session is open for any number of further questions that you may have.Please rate me by clicking on one of the rating options at your end as that is the only way I am credited on here for helping you out.Kindest regards
Customer: replied 1 year ago.
Hi Dr SH,
Thank you for your response.
Would muscular or tendon damage not have healed itself during this time, as this has been with me for at least 3 years now?I also I also don't understand how the pain moves from the upper arm to my elbow. It is exactly the same symptom just in a different place. The click sound I am trying to describe is very much like when you get out of bed in the morning and your knee or ankle might click although louder. The click relieves the pain, but it will only ever click if I make the downward punch movement I described earlier. It won't happen just by moving my arm around.I will ask my GP for a MRI referral but up till now he has been reluctant. I am trying to provide myself with as much understanding so I can make a good case to him.Thank you
Expert:  Dr. SH replied 1 year ago.
Muscular or tendon damage would have healed if you gave it appropriate rest of four to eight weeks for it to heal.It may be a persistent tendon or muscular problem still.Pain moving from the upper arm to the elbow is the reason why I wanted you to have your neck investigated as well to be sure that there is no nerve pinch at the neve of the neck causing this pain.For all joints, muscular and neck problems MRI scan is the best test.This session is open for any number of further questions that you may have.Please rate me by clicking on one of the rating options at your end as that is the only way I am credited on here for helping you out.Kindest regards
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Customer: replied 1 year ago.
Thank you Dr SH,I have completed your rating.Could I just ask you if you have any idea what causes it to click like it does? The click is always from the same area as where the pain is. I appreciate that you may not have an answer to this question without further diagnosis.Thank you for your help.Mark
Expert:  Dr. SH replied 1 year ago.
The clicking sound usually happens from tense ligaments and tendons around a joint.When you have not used a muscle or tendon or ligament for sometime it can become tense and painful which can improve on movement which produces a clicking sound. That is what I can think of at the moment.