Possible strained armpit muscle--looking for advice on care/diagnosis/prognosis and other options

October 10, 2008 11:56 PM

I'm a 26 yr old male and suspect I have strained my right teres major muscle. Is it worth seeing a general practitioner/family doctor first (I suspect they will just toss me painkillers and tell me about R.I.C.E.)? If not a GP, what are ways I can find somebody in sports medicine or physical therapy (do they have hundred dollar new patient processing fees, etc too?) apart from references from acquaintances? Also, any relevant suggestions on what else I can do are also greatly appreciated. I am relatively inexperienced with dealing with doctors/doctor's offices but am interested in how I can become a more informed patient.

I feel swelling in rear of my right armpit like there's a crumpled wad of paper wedged in that area and there is soreness not unlike soreness experienced in the days following a rigorous workout, only 50% greater in magnitude. I think I sustained it while attempting to do dips on non-immobilized push-cart w/out proper warming up, etc. while bored at work in a misguided effort to start rectifying a muscle imbalance (tight chest muscles, overly weak back muscles) and not having had regularly lifted weights in a considerable amount of time, though this was at least a couple of days before I was aware of the pain & I did not have an "oh crap, I think I pulled something" moment typically associated with strains.

Onset of pain was approx 5 days ago & I suspect I have been making it progressively worse in attempting to stretch it (the thought did not yet occur to me this pain was a muscle strain until only the recent few days) with attempting to practice yoga every other day (3 classes since then). While I did feel resistance and pain at the beginning of class, after warming up, the discomfort only was very mild/barely noticeable during downward dog/sun salutations.

Initially I was able to reach up and to the right and only experience mild discomfort; now, motion is restricted such that I feel pain when attempting to raise my elbow more than 45 degrees. Additionally, this is my primary mousing arm and and I have also been experiencing RSI-like symptoms for the past two years. I have been coping via [attempting to] reduce/reducing my computer use, making efforts to improve my posture, yoga, and meditation (still a n00b at the meditating) since my insurance currently does not cover specialist visits due to a pre-existing waiting period).

posted by weakcore to health & fitness (9 answers total)

IANAD.

But I know what MeFi's doctors would say.

Go to a doctor.

Yeah, on glance, it sounds like a pulled muscle. Or a torn ligament. Or bursitis. Or gnomes mining muscle tissue. Okay, that last one is rare.

However, you're dealing with the shoulder -- a very complicated (and not well built) joint that loves to get injured, swell, and then find that it can't move because the swelling has trapped ligaments, tendons and muscles. Look up "impingement" If this happens, it is very hard to heal on its own, because every time you move it, you, in effect, reinjure it.

Don't screw with shoulders. Get to a doc, they'll make you flap your arms in funny ways (to find out exactly what's free to move, what's constrained and what's damaged) and then will treat appropriately.

You're right that the first step often is RICE, but if you have a doctor tell you this, you now have that important documentation so that when you file the claim on the more expensive 2nd and 3rd steps, the insurance company will pay it.
posted by eriko at 5:48 AM on October 11, 2008

You can look at WebMD, MedlinePlus and Family Dr.org, but they'll basically all say the same thing: if you do not have improvement within 24 hours, or if pain continues to worsen, you should see a doctor. My guess is that s/he will proscribe anti-inflammatories and show you which movements you should avoid while healing.

You don't need to start with a specialist, and if you explain that you can't go to one on your insurance, your doctor will have advice.
posted by gesamtkunstwerk at 6:17 AM on October 11, 2008

IANAD, yada yada.

Nobody in AskMe will answer this without recommending that you consult with a doctor, but after the consultation, be sure to research any treatments and medications on the Internet before plunging in. Some doctors will overprescribe addictive pain meds and recommend unnecessary surgery for injuries that may cure themselves over time.

I've been chemically dependent on barbituate-based pain meds for migraines off and on, and believe me, this is a road you don't want to travel down.
posted by Gordion Knott at 6:22 AM on October 11, 2008

Go see a doctor. It may be a pulled muscle. It may be a rotator cuff injury. Either one, untreated, can lead to major trouble. Don't let them give you pain meds, except maybe as a "last resort so you can sleep" -- all they do is mask the pain. Anti-inflammatory meds are useful here.

Shoulder pain is insidious, and it could be caused by anything. The smallest thing going wrong or shifting out of place can cause big trouble. I pulled a teres minor when my toddler was 2, which led to some very odd impingements and bursitis. By the time I actually did something about it (which was, admittedly, three months later), it hurt to brush my teeth.
posted by jlkr at 6:57 AM on October 11, 2008

Shoulder injuries need to be attended to early or else you are looking at really prolonged healing times when you finally get care. I strained the same area this summer, but less dramatically, yet avoided going to the doctor for months because I was busy, it would cost money, I was afraid I would be told to stop cycling, yadda. So when I finally got care over two months later, I had some adhesions and impingement that needed some real work to start healing.

You have what seems to be an acute injury, but you have also been dealing with some RSI symptoms. In addition, you seem to be almost haphazardly trying to increase your fitness in ways that turn out to be counterproductive. In short, you are me, but with a much shorter posting history. Don't be me in this area. It's stupid.

Call sports medicine clinics and find out what the fees are for a doctor consult, a physiotherapist's first consult, and standard treatments by a physiotherapist. You should also find out if they take people off the street or if you need a GP referral. Ask your insurance company if they would cover the sports med treatment or exclude it.

If insurance will cover little or nothing of this, I would still strongly recommend budgeting for at least an initial consult and a few office visits. Tell the physiotherapist (or sensible chiropractor, if you can find one) that money is an issue and you really need to be able to stretch appropriately and do rehab exercises at home to supplement office treatment. They should try their best to figure out a program that works for you.

Stopping the workouts and home stretches that aggravated my injury and the sheer passage of time helped me, obviously, but getting a correct diagnosis, correctly prescribed home exercises to do, and some intense but incredibly useful office treatments were also part of the mix as they loosened the stubborn adhesions and got my shoulder back to a full range of movement. So don't delay treating your acute and painful injury: make some phone calls, know the costs and limits, then do something ASAP.
posted by maudlin at 7:01 AM on October 11, 2008

It's unlikely you just tore teres minor, you could be feeling subscapularis, teres minor and infraspinatus as well.

See an orthopaedic surgeon who specializes in shoulder surgery, insist on having an MRI of your shoulder. It will allow you to rule out any tearing of any cartilage/ligaments/tendons and to establish exactly what was injured.

The surgeon should perform a series of tests on your shoulder to give a general idea of what's wrong.

Insist on getting a script for physical therapy, as the surgeon who they consider the best physical therapist in the area. Also ask them aside from themselves, who they consider the best shoulder surgeon in the area, not in their practice. Call that person up and ask who they use for physical therapy. See both physical therapists if your insurance allows it, otherwise pick the one who has the most experience with athletes.

Avoid advil and the other cox-2 inhibitors, as there is recent question as to whether they impair healing in humans or not

Instead take Tylenol, or consider cissus quadrangularis a plant commonly used in asian and african medicine show to speed fracture healing times

Lick your wounds, get more sleep, give it a few days off, don't stretch it to the point it hurts, eat lots of fish.
posted by zentrification at 12:22 PM on October 11, 2008

Thank you all for the advice ... I apologize that my initial question was ambiguous or unclear ... I had been planning to see a doctor already (for the suspected muscle strain, the RSI is more complicated b/c my insurance doesn't cover it, but I am getting advice from my massage therapist and perhaps going to a chiropractor after doing more research), but uncertain about the best route to take, since I have read that most GP's are not as good at treating soft tissue injuries (is it worth it to see a GP first?). I am primary looking to get this acute injury resolved, but if I am able to get an opinion on RSI as an ancillary benefit from the visit, it would be nice.

My health insurance is a PPO (under blue cross blue shield) and I believe that with PPOs, you normally don't need a referral from a GP/family doc, so I was considering going to a physiotherapist. What benefits might seeing an orthopaedic surgeon have over a physiotherapist (or vice versa?).

Does it look better on paper if I go see a GP and ask for a referral, but more importantly, is there a way to gauge the competency of a doctor prior to going to setting an appointment (i.e. asking the receptionist various questions--if so, what sorts of questions--useful web resources welcome!)? Do those sites where you pay fees to get 'background' checks on doctors actually work?

I'd like to avoid going to the doctor, having him give me a 5 minute exam, and then sending me on my way none the better (I experienced this when seeing a doctor for RSI, but could it just be because RSI isn't as well known/established as an actual medical problem?). I realize that part of the problem with said visit is that I didn't have my questions written down beforehand and I consider myself a shy person when it comes to advocating for myself, so more often than not I usually end up kicking myself for not having had asked something driving home from the doctor because I hadn't thought to ask.
posted by weakcore at 1:28 PM on October 11, 2008

I'm going to get hammered for saying this, but many specialists have absolute tunnel vision when it comes to treatments. A surgeon will explore whether or not surgery is the best treatment, but he or she will not necessarily explore all the options. Seeing an absolutely incredible surgeon isn't necessarily a good thing if what you really need is physical therapy.

A good GP has common sense, and some good contacts for referrals. I would go there first. You may only need some extra-strength anti-inflammatories.
posted by gesamtkunstwerk at 7:47 PM on October 11, 2008 [1 favorite]

FYI: As it turns out, I was totally wrong about the strained muscle .... the swelling under my armpit turned out to be an enlarged lymph node from a case of cat scratch fever/disease (the GP I went to see noticed a pimple/wart-like looking bump on my wrist and asked about it and when I told him I had cats it kind of narrowed it down for him), which makes perfect sense after the fact. I had just never thought much of the thing on my wrist as a big deal.

He gave me a script for azithromycin and hopefully it will clear up in a few days. I guess it just goes to show the little I know is really little and it isn't even what I think I know. Another lesson in humility for me, though my gratitude still goes out to the hive mind for the informative suggestions.

Moral of the story for me: general practitioners are useful for gaining some context/perspective on your symptom, what you think something might be could turn out to be something totally different. It saved me a possibly needless visit to a sports therapist to go see the GP first.
posted by weakcore at 9:39 PM on October 12, 2008