OpenHealth Q&A

Choosing Between a Neurologist and an Orthopedic Specialist

I am a 33-year-old male, standing at 180 cm and weighing 87 kg. Recently, I sought help from a physiotherapist due to persistent tightness in my left armpit and discomfort around my chest near the 4th rib, located a few centimeters left of my nipple. This issue has plagued me for about 3 to 4 years, coinciding with my transition to an office job. While stretching alleviates the pain somewhat, it can become quite severe while lying on my side, especially if I shift into an awkward position. Occasionally, I experience muscle spasms in that area, described as brief, flapping sensations that can linger for a while. I find relief using topical treatments like Bengay. Initially, I disregarded the problem, focusing instead on maintaining a better sleep posture, improving my desk ergonomics, and ensuring I don’t over-exert myself physically. During my physiotherapy session, the professional quickly observed that my left shoulder is noticeably elevated. In a spine X-ray conducted last year, everything appeared normal. Although I exhibit good overall mobility, several points arose during the assessment: - There’s a small abnormal tissue growth above my 4th rib on the left side, which caused pain during the examination. It was determined that this tissue is not muscle, as it did not contract during the tests. - I possess additional tissue beneath my left armpit, which feels more pronounced compared to the right. Occasionally, it becomes uncomfortable when I wear tighter garments. While it is not substantial, it certainly feels unsettling. - When my arm was manipulated into specific positions and pressure was applied, I felt a slight stretching sensation in my left forearm, although my other limbs responded normally to the same tests. The physiotherapist indicated that this isn’t a significant concern. Reflecting on past shoulder complications from roughly 13 to 15 years ago, I realize they may have been more severe than I initially thought. I experienced intense pain along with a winged left scapula, which resolved within about three months following a gym session. The physiotherapist suggested this could have related to a nerve dysfunction affecting the serratus anterior muscle, and assured me that currently this muscle is functioning correctly based on the examination. Following the session, I was referred for an ultrasound, which is scheduled for Monday, and the physiotherapist mentioned that he can’t assist further. Considering the possibility that my symptoms are linked to the past nerve issue and my body might be compensating for the raised shoulder as suggested by the physiotherapist, should I consult a neurologist, or would it be more prudent to see an orthopedic specialist instead?

Answers (1)

3/29/2025, 12:50:39 PM

OpenHealth AI

It's understandable to feel uncertain when dealing with ongoing discomfort, especially given your complex symptoms and medical history. Based on the information you've provided, it seems that both neurological and orthopedic components could be at play in your situation. Here's a structured approach to help clarify your next steps.

Key Considerations

1. Persistent Symptoms: You've experienced tightness and discomfort for several years, possibly related to previous shoulder issues.
2. Physical Assessment: The physiotherapist noted an elevated shoulder and additional tissue growth, which may indicate either a structural or a nerve-related issue.
3. Scheduled Ultrasound: This could provide valuable information, especially regarding the abnormal tissue above your 4th rib.

Explanation

Given that your symptoms involve muscle spasms, tissue growth, and historical shoulder issues, the source of your discomfort could stem from muscular, skeletal, or neurological origins.

• An orthopedic specialist focuses on bone and joint health, helping assess and treat any structural issues in your shoulder, rib area, and surrounding tissues.
• A neurologist specializes in nerve function and could provide insight if your symptoms indicate nerve involvement, especially considering your past shoulder issues and current muscle spasms.

Recommended Next Steps

1. Complete the Scheduled Ultrasound: This will help assess the abnormal tissue and provide clarity about the nature of the growth and any potential implications for nerve or muscle function.

2. Evaluate the Results: After your ultrasound, gather and review the results carefully. If the tissue growth shows signs of compression on nearby nerves or structures, it may influence your next specialist choice.

3. Consult an Orthopedic Specialist: Given the physical nature of your symptoms and historical problems, an orthopedic evaluation will help determine if there’s a structural reason for your discomfort—including potential treatments such as physical therapy, injections, or, in rare cases, surgery if indicated.

4. Follow Up with a Neurologist if Needed: If the ultrasound suggests nerve involvement or if your symptoms do not improve with orthopedic treatment, seeking a neurologist's opinion would be prudent.

Additional Tips

• Continue your stretching exercises, as they seem to provide some relief.
• Pay attention to posture during daily activities and consider simple ergonomic adjustments to your workspace.
• Track your symptoms regularly (pain levels, frequency of spasms, and any changes) to provide comprehensive information to your healthcare providers.

Your proactive approach to managing these symptoms is commendable, and taking these steps should help clarify the best path forward for your health.