Question
Hi jessica. Me and you have talked before. I have alot of medical problems that will probably help you remember me. I am currently at the mayo clinic. They are running a lot of tests. They think I have neuro autonomic disease and also something with my abdomen. The doctor called it an abdomen band which is caused from muscles and other things that radiate to the stomach wall and they think that that is half the battle. But anyway. I stretched my right shoulder the other day. I was lying on the couch and I stretched my shoulders. I felt something crack in my neck and into my shoulder blade. It was more of a crack in my shoulder blade. Now I have a stabbing,spasming pain in my shoulder and it radiates up my shoulder. I have had 3 cortisone shots in my shoulder and neck. I had one in the neck,one in the back shoulder and one in the front. I have a feeling the cortisone shot is wearing off and all it did was mask the pain for awhile. I think I need two more shots and and MRI to see what is going on in the shoulder area. The x rays show nothing which is no surprise. My shoulder always cracks when I raise it. One of the orthopedics thought it was my rotator cuff but I was to sick to test. I think that needs to be looked at. If I get the surgery do you know how long it takes to recover and does it hurt. Also how long before the rotatary cuff goes back to 100%. I have been through therapy 3 time for it. I have used my tensize unit tonight. Even though it was for my back but it worked well. Also do you have any ideas on what I can do to relieve the pain. I am on alot of medicine. Thanks.

Answer
Sean,

As you remember I'm not a doctor so there is only so much I can say or advise. I'm glad you're at Mayo getting tests done.

I'm guessing you've asked about getting a MRI done of your shoulder? I'm sorry to hear that you were  too sick to have your rotator cuff tested. Are they going to try to do that again?

What is the plan the doctors have regarding the cortisone shots? Usually there is a waiting period in between shots, so I'm not sure how rapidly that will be repeated. I'm glad you did get some relief from that, but it must be extremely frustrated that the relief was so short lived. Its also frustrating when scans show nothing. I know that muscle issues often do not show on scans, which obviously doesn't mean that there is nothing going on in the area, just not detected on the scan.

As with any injury or surgery, everyone's recovery time is different. It can take up to 12 weeks for a recovery. It depends upon the damage to the area and also your dedication to the recovery/PT process. Pain wise, its difficult to judge as well since everyone has different pain thresholds. I will say that when talking to clients, it is more painful than generally an arthroscopic surgery on the knee, but once it recovers there is a lot of relief. Some people do have some issues continued after the surgery, but not like prior to it. Maybe some popping or a different range of motion. If surgery is the way you and your treatment team decide to go, be sure to ask your surgeon what to expect afterwards.

I'm glad to hear that the TENS unit is providing some relief. I know it does for quite a lot of people. Regarding other methods of pain relief, since you are on a number of medications, I'd probably stick to topical agents and the TENS unit. They would be the safest. (Is your back doing better? You didn't really mention it this time). Have you been using ice lately? If I recall it did help some previously. I'm not sure I have suggestions beyond what I mentioned previously. Cryoderm (similar to Biofreeze - a menthol based cooling gel, but stronger), emu oil - to help reduce inflammation, O24 (camphor, eucalyptus oil, and peppermint oil) also helps a number of people - usually a little longer acting than the other two. There are some warming topicals that I like, but I wouldn't recommend them at this point. There is a topical cream called MAXXIRUB that might be effective - its not cooling or heating. It has MSM, glucosamine, & condroitin. I find it tends to take the edge off of the pain, might not completely take it away.

One possible suggestion I also might suggest & I thin I might have suggested it before, would be using epsom salts. Baths aren't always easy to get in and out of when people are in pain. & yes I know this would be using heat. However, in an epsom salts bath, the salts can help draw out toxins that may be contributing to the pain & exchange it for magnesium. That might be worth a try. There are some epsom salts lotions/creams. I've only tried one and my colleague has too. We didn't find it to be particularly effective. I'd focus on emersion in an epsom salts bath of some sorts (which yes would be difficult for a shoulder if you can't get it in a bath tub).

Did you try a magnesium supplement for the muscle spasms? That often can help with that & some of the related pain. I do have a preferred brand of that which is highly bioavailable and you can begin to feel the effects pretty quickly after taking it. If that doesn't help, I'd stick to ice and the TENS unit.

I'm familiar with neuro-autonomic disorders. Incidentally, do you happen to have mitral valve prolapse? But I'm not sure I've heard of an "abdomen band." The abdomen is difficult to diagnose with relation to pain due to referral patterns within the abdomen and outside the abdomen. So much goes on in that area be it muscle related or organic. You may want to check out trigger points again - those that refer to the abdomen to see if you get any relief. I'd work slow and not go full force, maybe gradually increase. Its still probably best to have a massage therapist trained in trigger point therapy to do this, but I know both finances and your current location may not make this a viable option.

The book I mentioned previously (The Trigger Point Workbook by Claire Davies) is now available as an ebook. Here's one link to obtain the ebook if you are interested. Its very thorough and covers the entire body, but gives very good instructions. http://www.filecrop.com/trigger-point-manual.html

I hope this information is useful to you. I hope you are gaining a lot of useful information and help at Mayo. Please don't hesitate to contact me with additional updates or questions.

Always,

Jessica