Discomfort in the Shoulder Post-Sleeping
I am a 27-year-old man, standing at 6 feet 5 inches and weighing 270 pounds. I do not smoke and the only medication I take is tenofovir (for PREP). I have no known medical conditions or health issues. Recently, I've found myself in a peculiar sleeping situation that I hope will resolve soon. As a side sleeper, I position myself against the wall on one side of the bed, often switching sides during the night. For the past few weeks, I have been awakening with discomfort in my right shoulder. The intensity of the pain varies – at times it's just mild, but on other occasions, it can become quite severe and linger for days. Typically, I sleep with my left shoulder facing the side of the bed adjacent to the wall. I’ve observed a crackling and popping noise from my right shoulder during movement, particularly when I attempt to stretch it. Additionally, I’ve noticed that the position of my neck may influence when and how the pain occurs, whether at rest or during certain movements. While my range of motion remains intact, some actions involving my right arm can cause discomfort. Should I be concerned about this issue? Are there any particular stretches or techniques that could help relieve this pain?
Answers (1)
8/21/2025, 3:12:06 PM
OpenHealth AI
You’re experiencing discomfort in your right shoulder, particularly after sleeping, which may be associated with your sleeping position or shoulder mechanics. While it's good to know that your range of motion is intact, persistent pain shouldn't be ignored. Let’s explore possible causes and actionable steps you can take to relieve the discomfort.
Explanation
Several factors could contribute to your shoulder pain, including:
- Sleeping Position: Side sleeping against a wall may put pressure on the shoulder joint and surrounding muscles, leading to discomfort and potential strain.
- Muscle Strain or Impingement: The shoulder's structure may become irritated or strained, especially if your arm is in an awkward position during sleep.
- Tendinitis or Bursitis: Inflammation of the tendons or bursae can occur due to repetitive movements or positions that stress the shoulder over time.
The crackling and popping sounds, known as crepitus, can be common and are often due to air bubbles in the joint or movement of tendons over bony structures, especially if they are not accompanied by pain.
Actionable Steps
Here are prioritized actions to help alleviate your shoulder pain:
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Adjust Your Sleeping Position:
- Experiment with different positions or use a supportive pillow that keeps your neck aligned with your spine. If possible, avoid sleeping against the wall, as this may limit mobility and put extra pressure on your shoulder.
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Gentle Stretches and Exercises:
- Shoulder Stretch: Stand or sit up straight. Slowly bring your right arm across your body at shoulder height and use your left arm to gently pull it closer for a stretch. Hold for 15-30 seconds and repeat a few times.
- Neck Stretch: Tilt your head towards your left shoulder for a gentle stretch on the right side of your neck. Hold for 15-30 seconds and repeat a few times.
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Strengthening Exercises:
- Scapular Retraction: Sit or stand with your arms at your sides. Squeeze your shoulder blades together without raising your shoulders for 10 seconds. Repeat 10-15 times to strengthen upper back muscles.
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Ice Application:
- If the pain is severe, you can apply an ice pack to the shoulder for 15-20 minutes a few times a day to reduce inflammation.
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Avoid Painful Activities:
- Try to avoid any movements that cause discomfort, especially overhead activities that might strain your shoulder.
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Monitor Symptoms:
- Keep track of when the pain occurs and any new symptoms. If your discomfort persists or worsens, or if you experience significant swelling, numbness, or weakness, it may be necessary to seek further evaluation.
By focusing on these steps, you should be able to find some relief and assess whether your shoulder discomfort improves over time. Let me know if you need any further assistance!
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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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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.