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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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.