Best Tests for Shoulder Pain

[Fay A.]

I have had an ultrasound to the right axilla / CT scan and CT-PET Fusion that included the right shoulder and axilla. A shoulder series of xrays. These studies showed several lymph nodes (1 cm and 7 mm) with increased uptake and slight enlargement-give or take a few mm as the scan resolution was 5mm). The pain is excrutiating, is in the upper part of the shoulder, the far edge of the clavicle, the armpit, down the arm and into the hand, dead center to the shoulder blade in the back. This does not feel like any neuropathic pain I have ever experienced, and I've had plenty of that kind of pain over the years. The docs have ruled out a rotator cuff injury, and a heck of a lot of other things. They have now ordered an MRI of the upper arm without including the joint. Since the joint is the center of the worst of the pain (both at the top of the arm and center of the shoulder blade in the back) I am wondering what benefit a study of the upper part of the arm will be. I am in the unenviable position of having to educate myself as to what are the best diagnostics/treatments available, because if I know enough to ask for specific things they will be ordered and authorized. But no one is going to offer me anything without me pushing for it. And it seems to me that it is in my best interest to have the complete study done one time, and not have to keep going back for more studies. I have kidney disease and the contrast dye can be problematic if I have too many scans too close together.

I have multiple heath problems. But my will to live is fierce and grounded in the very real joy I feel every time I open my eyes. It is just plain WRONG that most of the medical providers I encounter make me work this hard for diagnostics and treatment based on the fact that I have Stage IV Lung Cancer.

Since many of us on this site have had to deal with severe shoulder pain-then subjected to tests like those mentioned above (only to be told for long periods of time that the source of the pain cannot be found.) I am hoping that our panel of experts can speak to the most accurate diagnostics so that we can ask for them, and hopefully receive answers for the severe pain so that appropriate treatment for the underlying problem can be identified and implemented.

Thanking you in advance for assistance.

[kimblanchard]

What you are describing would definitely not be caused by some slightly enlarged lymph nodes. CT and PET are good but have a couple pitfalls. PET scans are not very good at seeing cancer involving bone and neither show neurologic details. What you are describing still sounds like neuropathic pain and the best test would be an MRI of the cervical spine and brachial plexus (the bundle of nerves coming out of the spinal cord into the armpit and down the arm). This would show any nerve impingement. It could be something as simple as a slipped disc. I just had to admit a patient to the hospital with very similar very severe pain and his MRI showed a partially ruptured disc, not cancer. Also, have you had a bone scan?

[Fay A.]

Thank you, Dr. Joe. I haven't had a bone scan for quite some time. I had the MRI of my upper arm done yesterday, but I am unsure how usable the scan will be. My shoulder and arm would go into spasms periodically. The Tech tried to repeat some of the shots, but he can't do much if I can't make my body parts remain still.

This didn't feel like my previous experiences with Neuropathy...until yesterday during the scan. There is definite electric shock type pain to go along with the other symptoms as of yesterday.

I'll be checking into bone scans and a MRI of my cervical spine. I can take a lot in the way of pain and keep functioning...but I've officially reached my limit. Thanks again for the info.