Question
QUESTION: Dr. Durnin,

I am a 50-year-old male. Last year I had BHR for hip arthritis. It was very successful - with doctor's permission I have resumed running up to 12 miles a day, and playing ultimate frisbee.

However, recently both shoulders have developed loud, frequent, and uncomfortable (but not painful) clicking. After a day of ultimate yesterday, the left arm has developed a pain about 1/3 down from the shoulder. I would think it feels like a pulled muscle, but it is a location that has bothered me before, so I wonder if it really is a pulled muscle, or can shoulder arthritis cause that type of pain in this location? I have never had any sort of shoulder injury.

I have not had shoulder x-rays done, but the cause of my hip arthritis was FAI (femoral-acetabular impingement). The left hip will need doing at some time, and my brother and several cousins have the same problem. Is this an issue with shoulder joints as well?

My mother had osteoarthritis, but much of her problem was brought on by her weight, so I am not sure if that indicates a genetic tendency.

Thanks,

Russell

ANSWER: Hi Russel,

No need to worry, there is no genetic predilection for OA and no risk of hip dysplasias spilling into the shoulder. The shoulder problem is most likely a deltoid tendonitis since it is down 1/3 of the arm. Resting and icing is the proper treatment. Expect a few weeks to repair, early return to heavy activities run the risk of developing a tendonosis, a much worse and chronic condition. Pinpoint tenderness should be right at the deltoid insertion, 1/3 of the way down the lateral (outside) of the arm. Icing it here will get the best results. 15 minutes every other hr is ideal.


Good Luck!


Dr. Timothy Durnin

---------- FOLLOW-UP ----------

QUESTION: Dr. Durnin,

Thanks for your earlier answer. The shoulder did indeed clear up in a little over a week, with no other problems.

However, in the last month I have had 2 other joint problems. One is my right ankle. After a run one day I noticed it was slightly swollen, and the next day after frisbee practice it was badly swollen, as if after a sprain. However, I did not injure it either day, and there has been no pain, just (of course) stiffness because the joint is so swollen. I have never had any sort of ankle injury previously.

I saw a doctor, who said to do conservative treatment, presure, elevation and icing and antiinflamatories. This was a month ago, the swelling is not as bad it was, but is still there (with no pain).

A week ago, also with no injury, the right elbow became stiff and painful. It does not straighten out all the way, or bend fully. The pain that stops it is mainly on the inside of the elbow, the base of the biceps - actually a little rotated from the inside, if I hold my arm out with the palm down it is just above the elbow, about 45 degrees up. It feels like a muscle pain rather than joint - but I had no injury or overuse at the time, in fact not even my usual activity, since I have not resumed full activity because of the ankle.

If the elbow does not improve in the next few days I will see a doctor again. But, in 35 years of athletics I have very rarely been injured. I am wondering if this is a spell of bad luck, the result of aging, or if there is perhaps something systemic that could be contributing to this rash of joint problems.

Thanks,

russell

ANSWER: Hi Russel,

This is going to require more than an Internet correspondence, give me a call at 708-466-9994 and I can guild you more appropriately as to what to do.

Dr. Tim

---------- FOLLOW-UP ----------

QUESTION: Dr. Tim, Thanks for your quick reply. Things are a little complicated because I live in China - that is why I don't have a good orthopedist I can refer to here. Is there a good time to call? Or can you say that it is something that I should try to follow up with my orthopedist next time he comes to China?

Thanks,

russell

Answer
Yes Russell,

This is definitely something that needs direct examination and contact with your Ortho, it is much to difficult to advise you otherwise with confidence since I can't examine you directly. The Ortho should be able to handle this with ease, especially in China. I wish I could be of more help but with this multilayer problem, something important could be overlooked. This is one instance where a good Ortho work-up is necessary. As far as joint issues go, review past answers from me with related conditions for some safe approaches until your Ortho visit.

Take Care and Good Luck!

Dr. Timothy Durnin