Understanding Chronic Shoulder Conditions
**Patient Background** - Age: 28 - Weight: 70kg - Activity Level: Mostly sedentary - Posture: Generally acceptable **Symptoms and Conditions** The primary issue resides on the right side of the body. The diagnoses include a long-standing case (spanning a decade) of Scapulothoracic Bursitis, Scapular Dyskinesis, and Snapping Scapula Syndrome (SSS). It is unclear which condition initiated the problem, but there may be associated adhesions contributing to the discomfort. The patient experiences persistent, loud, and noticeable crepitations, accompanied by deep pain that extends to the neck region, although there is no radiating tingling in the arm. Leaning the head backward or to the side exacerbates the pain significantly. Additionally, there is a remarked thickening of tissue in the right rhomboid and latissimus dorsi regions. **Diagnostic Imaging** - A CT scan returned normal results. - Requests for an MRI and an Ultrasound were not approved by the physician. **Previous Treatments Tried** - Engaged in daily physiotherapy for several months (results may have been limited due to potential insufficient commitment or an ineffective program). - Completed a 30-day course of NSAIDs. - Received two corticosteroid injections. - Tried acupuncture. - Underwent massage therapy. **Request for Assistance** I am happy to share details about my training regimen if that would be helpful. I am seeking: 1. A fresh opinion on my situation, as I question the reliability of my current orthopedic specialist and physiotherapist. 2. Suggestions for potential treatment approaches. 3. Insight into the inability to secure an MRI or Ultrasound despite repeated requests—my doctor seems convinced it’s bursitis. 4. Personal experiences shared by others who have faced similar issues. 5. Opinions on whether a scapulothoracic bursectomy is considered safe and effective when performed by a skilled surgeon, as the clinics I have consulted advise against it due to perceived risks. Thank you for your support!
Answers (1)
6/27/2025, 8:30:57 AM
OpenHealth AI
Summary: You're dealing with a complex case of chronic shoulder pain involving conditions like scapulothoracic bursitis and snapping scapula syndrome. Since previous treatments have not provided relief, it’s understandable to seek new opinions and potential strategies. Let’s explore actionable steps you can take while addressing your concerns about imaging and surgical options.
1. Understanding Your Conditions:
Scapulothoracic bursitis involves inflammation of the bursa between the scapula and rib cage, which can lead to pain and crepitations. Scapular dyskinesis refers to poor movement of the shoulder blade, which can contribute to discomfort, and snapping scapula syndrome is characterized by a popping sound during shoulder movements. While a CT scan is normal, it's important to communicate with your physician about ongoing symptoms that warrant further imaging.
2. Next Steps:
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Seek a Second Opinion: If you feel uncertain about your current orthopedic specialist, consider consulting another orthopedic surgeon who specializes in shoulder conditions. Bring all previous imaging and documentation to discuss your history and ongoing concerns.
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Physical Therapy Re-Evaluation: If your previous physical therapy was ineffective, it might help to try a new program with a focus on scapular stabilization and specific muscle strengthening. Look for a physical therapist skilled in treating shoulder issues, especially those familiar with the scapulothoracic mechanism.
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Engage in Active Management: Beyond therapy, consider incorporating gentle, prescribed exercises to maintain mobility without exacerbating pain. Focus on posture correction through core and shoulder stability exercises.
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Explore Pain Management Alternatives: Depending on your response to NSAIDs and steroids, consult your doctor about other options such as topical pain relief, alternative anti-inflammatory medications, or even herbal supplements like turmeric (after discussing safety and interactions).
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Imaging Discussion: If your doctor remains resistant to further imaging, express your concerns firmly. Request a detailed explanation of their reasoning and mention specific symptoms that are causing you distress. A collaborative discussion might help in getting the needed referrals.
3. Surgical Considerations:
Regarding the potential for a scapulothoracic bursectomy, this surgical option is indeed performed in certain cases if conservative treatments fail. It generally has a favorable outcome when performed by an experienced surgeon, but it also carries risks like infection and reduced shoulder mobility. Your discussions with multiple clinics will provide insights into varying opinions on this procedure. Make sure to weigh the benefits against the risks and discuss them openly with any orthopedic surgeon you consult.
4. Community and Experience Sharing:
Connecting with patient support groups or forums focused on chronic shoulder conditions can provide you with personal experiences from others who have faced similar issues. Sharing stories could offer you both support and additional strategies that may have worked for them.
You’re not alone in this, and it’s positive that you’re actively seeking solutions. Modify your approach as needed based on feedback and keep monitoring your symptoms as you pursue these steps. If you have any more questions or need further assistance, feel free to ask.
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