Please help me diagnose source of pain in shoulder and back.

March 17, 2009 12:17 PM

What is the most thorough and effective test, or series of tests, I can go through in order to determine exactly what is wrong with my lower back and shoulder?

I have had 'issues' with my right shoulder and lower back for 20 and 11 years, respectively. Nobody has ever been able to tell me conclusively what is, or was, wrong with them (the initial trauma to the shoulder was never treated, there was no trauma with my back) and I seem to go through a cycle where I do exercises that work for a while, but eventually new pains and stiffness arise in the vicinity and the nature and severity of the problem changes, from day to day as well as from month to month and year to year.

I'm sick of it and I want to know what the hell is actually wrong in there. Once I know that I, at least, won't have to go through the whole history of the problem(s) every time I see a new physio or doctor or acupuncturist etc. (With everyone coming up with different theories as to what may have gone wrong initially, what's happened since, and what this latest bout of pain is likely due to.)

Is there a test that can thoroughly and accurately look at these specific parts of my body and determine what the actual problem is, both mechanically/structurally, and (as a bonus) in terms of the pain associated with it?

(Please note that I have ultrasounds of my shoulder and x-rays of my back as well as extensive movement tests by various physios, all of which have been inconclusive.)

Many thanks,
G.

posted by gwpcasey to health & fitness (8 answers total)

IANAD but I understand MRI scans give the most information when it comes to back problems (that's how I found out I had ruptured a disc).
posted by mirileh at 12:22 PM on March 17, 2009

Have you had an MRI? That's probably the industry standard. (IANAD)
posted by jennyb at 12:23 PM on March 17, 2009

Preview is good...
posted by jennyb at 12:23 PM on March 17, 2009

Nthing the MRI. Rather than dealing with a primary care doctor, try to go straight to an orthopedic specialist if you can.

This sounds a lot like what I've recently gone through - years of chiropractors, physical therapy, etc. only to finally learn that I have cervical spondylosis - in other words, common arthritis of the neck.
posted by chez shoes at 1:11 PM on March 17, 2009

IANAD. Xrays only look at the bones and how they're aligned. If those were inconclusive (back *and* shoulder), the next step is something that shows softer tissues, like an MRI or fluoroscopy (xray with contrast agent). However, if it's a muscle imbalance, that won't show up on anything, unless there's been actual damage to the muscle that has left scar tissue.

In addition, there's the fact that shoulders are badly built for how humans use them, and once there is any kind of problem, it will never just 'go away'. It may not always be the same thing hurting, so 'inconclusive' results doesn't mean anything -- it may just mean that there were different things wrong each time.

The lower back and shoulder are closely connected. I ruptured two discs in my lower back 25 years ago, which led to extra stress on the latissimus dorsi, which led to an otherwise innocuous movement partially tearing the teres minor under my right shoulder blade. Since I tore that muscle 12 years ago, I have had three rounds of tendinitis and one of bursitis. It will never 'go away'.
posted by jlkr at 1:20 PM on March 17, 2009

You need more than just tests: you need one or several professional (doctor or therapist) who know how to read the tests with knowledge of related data in your anatomy. I have a great therapist who can read the state of every muscle and tendon in my shoulder during a one hour examination better than any Xray or doctor reading Xrays, and treat them accordingly.

I was also treated for weeks for lower back pain until I was asked if I had my feet checked by an orthopedic therapist. I didn't. So I went to a specialist, I had my feet videoed while walking on a treadmill. I have new soles and no more back pain.

People with experience and knowledge are more important than tests. Ask around.
posted by bru at 7:11 PM on March 17, 2009

You are actually describing the kinds of problems I have been suffering for a few years. I am only 22, but discovered last year that I had a ruptured disc in my lower back (people who share this experience tend to be thirty years older than me). I think the MRI is a good idea, since the people treating me were able to interpret the data, come up with a plausible diagnosis, and act on it effectively. I am nthing that idea.

But I also think you should listen to jlkr and really scale back any expectation of working out once and for all what it is, and then finding a magic bullet that solves it. I pretty much know what is physically wrong with me (it's the disc), but I don't know how exactly it causes a problem - why it hurt some days, not others, why it suddenly went away for ages and then came back, why exercises and my physiotherapist's manipulation helps ("it stretches the nerve", "it rubs the nerve against the disc and breaks off the protruding material", "it forces the material back into the disc", "it relaxes the muscles that constrict the nerve"). When it comes to diagnosis, don't expect a full picture of what is happening. Your friend might tell you an anecdote about what worked for them, but remember that you are not them - your pain is different, your physio is not their physio. Be sceptical of any specialists who claim to know everything, or who tell you the pain is still there because you 'aren't doing the exercises right' etc... These people are dealing in the same bullshit as reflexologists and faith healers.

I personally saw a few physios and a neurosurgeon. The physios all called themselves the same thing, but they had very different ideas and did very different things; the neurosurgeon spent most of his time shrugging and saying that it was impossible to tell what was going wrong. But he was still a great practitioner because he was honest and practical. The important thing, as he taught me, is pain management. Control it so you can get on with your life. This means seeing plenty of specialists - give them a few weeks to make improvements. If nothing gets better, find someone else with a different method. I changed physios till I found one who made a real difference, and I am happy I did. Remember that you are paying them for a service - don't feel intimidated by your doctor or specialist. Because the pain is so variable, be even more sceptical - it might go for a bit, but that doesn't mean that whoever treated you can get the credit for that, or that the pain won't be back. It certainly doesn't mean what works for you would work for someone else. After a while I started to get angry because my parents' friends, most of them doctors, most of them suffering similar problems, would give me conflicting advice, call it gospel, and expect me to follow it just because they went to medical school and sat through a single lecture in their second year. 'But you're an oncologist/dermatologist/plastic surgeon', I would say. 'Why the hell should I listen to you?'

Don't have surgery unless you can't physically walk, it isn't worth it. And despite all of this, don't despair. Remember that you don't need a full picture, just results.Once you stop expecting a 'cure', you might be pleasantly surprised at how easy it is to get on with your life. That's what I found, anyway.

(Sorry for length of this rant).
posted by marmaduke_yaverland at 5:46 AM on March 18, 2009 [1 favorite]

Thanks all for your suggestions and answers.

jlkr and marmaduke_yaverland - thanks for your thoughts, I understand and appreciate your perspective and the long rant was quite helpful. I think I've already resigned myself to the fact that it will never go away and you both make an excellent point that I need to start managing that rather than looking for any kind of magic bullet.

That said, the reason why my post wasn't a question about the specifics of my pain ("help diagnose this pain!!") was because I don't think that works but it would be nice to know one thing about it for certain and to feel somewhat "armed" when I go to see the next specialist. I do need to stop feeling intimidated though: the last physio I went to see spent the entire 40 mins of our first consult talking to his intern about me, rather than to me. They weren't speaking in English either so I had very little idea what they were saying. It took me another 5 consults before I decided this wasn't the guy for me.

I suppose I feel that if I can go in and say "I ruptured the disc between L4 and L5 about 10 years ago, help me deal with it" rather than my generic moaning about the pain, that I'll get moving quicker. But I accept that I could be deluding myself.

bru - you're totally right, unfortunately for me I live somewhere with a very limited choice of medical professionals and my only chance to shop around is while I'm traveling. I have a great physio in the UK but I'm only there twice a year so she can only give me limited help.

Thanks again.
posted by gwpcasey at 6:30 AM on March 18, 2009