Imobilise or Exercise?

[cavanuk]

Hi,

I'm hoping someone might give me some advice concerning a problem I have with my own health. Any such advice or information would be much appreciated. I do have appointments scheduled with physiotherapist and hospital consultant but not for one and two months respectively. I wondered if anyone could advise me what to do while I'm waiting. Pain and restricted movement are making life difficult for me.

I have a problems with many joints and tendons - restricted movement and pain. The worst is my right shoulder. For about 4 months now I have had severe pain upon moving in certain ways and when sleeping. In fact I don't get a great deal of sleep because of pain. Basically, I can't raise my right arm either to the side or in front. Physically, the arm is extremely stiff and weak, plus I get intense pain just before I reach about 90 degrees from my trunk. The pain is on the top edge and the front of the shoulder. I also get pain radiating down my arm into the front of the elbow. When reaching out towards something - whether above or below horizontal - I get pain in the front top of the shoulder and just before the elbow. Additionally, I get intense stinging pain in the biceps.

I don't know a great deal about medicine but from looking on-line I would say the condition that most matches my experience is Impingement Syndrome\Painful arc. Many activities in which I have to lift my arm are causing me a great deal of pain and the lack of sleep is really getting to me.

I'm currently using heat and an Ibuprofen gel on the arm, two or three times a day, and taking two 500mg Naproxen a day. I haven't been given a diagnosis but referred, by my GP, for physio in a months time and an appointment with an RA consultant in two months time. I haven't had any tests on the shoulder but ultra sound examination of both Achilles, which are both very tender and often have little lumps on them, revealed accumulations of fluid.

Some sports sites say to rest the shoulder - including using a sling\support. Other sites say keep moving. Does anyone have any advice as to what I should do while I wait?

Any advice would be very gratefully received.

Many thanks.

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[gcoe]

As you have multiple sites of pain and restricted movement it is most likely that the shoulder is just a manifestation of a systemic disease. It is good that you have an appointment with a rheumaologist. RA is just one of a number of rheumatic diseases that can give you theses symptoms so it is time to get this cheked out properly before proceeding with treatment of any kind.

Thebfact that you have pain at night while resting implies a likely inflammatory disease. A common problem that can givyou that sort of pain is adhesive capsulitis. But this is just localised to the shoulder.

I would see what you can do to fast track the appointment wih thespecialist.

[cavanuk]

Thank you GCoe. I shall see what I can do about getting seen sooner.

[gcoe]

Hi cavanuk. Hope you manage to get an earlier appt. Sorr for not giving any ex or advice but it is best to know what os going on before proceeding with such matters

[Vanc_WA_PT]

hi all - my first thought was a systemic issue as well gcoe, but since we have time to banter this around before the appointment cavanuk i was wondering what your activity level was like over say the past year? Very strenuous, or minimally? Have you had episodes of shoulder and achilles tendon pain in the past but to a lesser degree? My only suggestion at this point is to try sleeping supine with pillows under each arm to keep them slightly elevated, though with sleep being a big problem i'm sure you've tried just about every position possible...

[cavanuk]

Hello Vanc_WA_PT

Thank you for the reply. I've had Achilles pain for well over a year now and also episodes of "flare-ups" where my joints swell and feel oddly 'squishy' is the only way I can explain it. It's as if they are filled with cotton-wool. I get mild pain in all my joints virtually all the time and constantly click and crack between the flare-ups. I'm also getting more noticeable pain in my knees and tops of my legs. In fact virtually all my joints and muscles - or the tendons, I don't know anatomy well enough to know - ache, have pain and feel tender to some extent.

I've been to my doc a number of times and he's given me anti-inflammatories but not a great deal else. It was only after I visited him during an active flare-up that he agreed to refer me to a consultant and physio. He did send off bloods but they came back negative for C reactive protein. I have had some more blood taken for "immune response tests" but don't yet know the results.

So I've been putting up with things until the recent, worsening problems with my shoulder. That pain has become unbearable at times and it's mainly that that stops me sleeping. I've been taking the Naproxen regularly for over a month now and that does seem to be helping. I'm also using Ibuprofen gel three times a day.

Rest helps, at the weekend it's much easier than when I'm working - sedentary work on a computer with arm rests and wrist support. Although the pain bothers me in the night, once I get moving in the morning from the initial stiffness and I have the gel on, the pain fades but activity makes my whole arm hurt by early afternoon with the main focus of pain being as previously described.

As for activity, even during the worst pain of the Achilles, I've kept moving. I don't drive and walk about 5 miles round trip to and from work. Sometimes normally, sometimes extremely slowly. I also shop on foot and carry heavy bags. Having the weight hanging from my arm doesn't bother it. However, lifting even a cup toward my face causes pain and shaking in the arm. It's lifting the arm that is most painful. I can over-come the pain to raise my arm slowly over my head but it is very difficult. Not only is it painful but it feels as if there is something physically resisting my arm moving and my arm is weak. I'm also getting spasms in the muscles when at rest.

So, as you may be able to tell, I refuse to be beaten but wonder if I'm doing more harm than good by keeping moving so much. I am a little worried that, during the last week, I have started to get twinges in my left arm and my hips. I'm also nervous about undergoing physio without even having had a scan or X-rays of the shoulder.

I haven't been too happy with my own Dr and so I've made an appointment to see a different one this coming Tuesday.

[Vanc_WA_PT]

Yikes. Well, best to get to the bottom of things first like gcoe said. Hope the new doc meets your needs.

[cavanuk]

Thanks for the reply "Yikes" is not very reassuring!

I shall try your suggested sleeping position.

Thanks again