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Dr. Chip
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 23434
Experience:  Over 20 yrs of Family Practice
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What causes bursitis flare-ups, & how can one prevent th

Customer Question

What causes bursitis flare-ups, & how can one prevent them? I get them in knees, hips, and shoulders. Thanks. (oh, and what's the best treatment for flare-ups? Especially hoping for treatment suggestions that don't involve NSAID meds. Thx.)
Submitted: 4 years ago.
Category: Health
Expert:  Dr. Chip replied 4 years ago.

Multiple recurrences of bursitis would be a very unusual condition--are you sure about the diagnosis?

Customer: replied 4 years ago.
Hi. Every time I complain about the pain the Dx is always "bursitis". Last visit doc touched my knees at the sore site and I about nearly leaped off the exam table. The pain is a real "!!YIKES!!" pain to the touch. In my shoulder it limits my range of motion quite a bit, to the point where I sometimes need assistance just to get dressed. In my hip, it sometimes leaves me unable to walk.
Expert:  Dr. Chip replied 4 years ago.
Have any studies--X-Rays of MRI's--been done? Have you been checked for gout and rheumatoid arthritis?
Customer: replied 4 years ago.
Hi. With the very first flare-up of my knee one doc ordered an MRI and found nothing of note. It was the orthopedist who Dxed bursitis in the knee. That was the only MRI or any test other than diagnosis by touch ("touch-n-yelp"). My brother had gouty arthritis. Does that run in families? Thanks.
Expert:  Dr. Chip replied 4 years ago.
Before I answer, can you describe what goes on in the affected joints--any swelling, warmth, or redness?
Customer: replied 4 years ago.
Hi. No visible anything. No swelling, warmth, or redness. Just pain. Not an ache-all-the-time-and-make-you-nutty kind of pain. Just a YIKES-to-the-touch pain, and pain on movement. With the latest knee flare-up, it didn't limit my ability to walk. It was only a "don't-let-anything-touch-my-leg" pain. (Previous knee flare-ups have left me unable to bear weight on the affected knee.) Hip flare-ups nearly always require me to resort to crutches. Shoulder flare-ups just limit my ability to move my arm; does not affect strength, elbow, wrist, or fingers in any way.
Expert:  Dr. Chip replied 4 years ago.
And, when this happens, is it a gradual thing, or do you just suddenly go into an extreme flare up?
Customer: replied 4 years ago.
Hi. With knees and hips it's definitely sudden. One day - fine. Next day - OUCH. With the shoulder I'm not so clear on the answer. Seems like it might be fine one day, next day a little weird, and then a full blown flare.

[Right now it's my shoulder I'd like to heal! Hard to put on a T-shirt, let alone a long-sleeved shirt! (A long sleeved shirt is nearly impossible to maneuver my arm into.) Good thing it's too hot for long sleeved shirts. Embarassed But I'd like to be able to don a jacket if I need to attend a business event.]

You know, one really shouldn't think about body parts too much. I mean, I *never* think about my little pinkie toe unless I stub it on a door frame or a piece of furniture. Body parts just shouldn't normally call attention to themselves in any way. With my shoulder (or knees or hip), I'm not thinking about the body parts and then all of a sudden --- blammo --- they consume all of my attention. How can I reach for that salt shaker with that arm? How can I put on that dress? How can I ... x, y, or z? It really shouldn't be that way. I should be able to put on apparel with equal ease on any given day. Not reserve certain items of clothing for good-shoulder days versus bad-shoulder days!

Thank you for your thoughts.

It honestly didn't occur to me that this was anything out of the ordinary. I just figured it was a fact of life. And I hoped there might be some easy way to prevent it or mitigate it, like "stop climbing stairs on your knees" (which I don't do, by the way) or "eat more chopped liver" (which I also don't do, by the way!)

I watch my children on the swim team... four kids on the swim team... they do Butterfly or Breast Stroke and all I can think is "Wow, I can't get my arm to do that move ONCE let alone over and over and over again for 200 meters!"

Expert:  Dr. Chip replied 4 years ago.
Yours is an interesting condition, I must say. Let me continue on this line--bursitis usually only occurs in one or maybe two joints from time to time, like one knee or one shoulder. There's pain--usually not suddenly severe-- and it usually subsides in a few days. Although painful, there's usually full range of motion if you push through the pain. There may or may not be swelling, and plain X-Rays may or may not suggest soft tissue swelling. Since most of the bursae are somewhat deep, there may be tenderness, but if there's, say, extreme point tenderness, it may be more of a tendonitis than a bursitis, but, then, again, I haven't had a patient with "migrating" tendonitis before. Does any of this sound as if we might not be dealing with either bursitis or tendonitis?
Customer: replied 4 years ago.
I am prone to tendonitis in both forearms from a work injury 20 years ago. I can get a flare-up of that pain if I carry something too heavy (like carrying too many groceries in sacks instead of just taking and using a stupid little cart), or if I bear weight on my hands in a way that irritates the fingers (think push-ups).

The shoulder pain is similar to that in the sense that the shoulder pain is not an ache-all-the-time pain like a burn is, and it's not a shooting-on-fire pain like nerve pain is. The forearm tendonitis and the shoulder pain are similar in that they only hurt on certain movements. I *know* what triggers the forearm tendonitis (thank goodness) and can usually avoid it. (Sometimes, however, I stupidly don't know too-heavy or too-straining until too-late. Bummer. I pay the price for trying to carry just one more gallon of milk with only my ring finger available....)

When the knee bursitis was at its worst I could neither walk nor even wiggle my toes. The current shoulder pain isn't as severe as that. I can certainly type without pain, so I can wiggle all ten fingers! When the hip bursitis was at its worst I'd get "stuck" in weird places. For instance, I'd walk to the mailbox across the street from my home and then be unable to walk all the way back up the driveway to the house. My leg simply would not take one more step without SCREAMING AGONY in my hip. I would be immobilized and have to get someone to fetch crutches so I could take all weight off my hip.

With the current shoulder issue, it's only don't-touch-that-shoulder and don't-move-that-way. I can reach up over my head if I go straight forward and up. I cannot lift my arm up to the side like a penguin-wing-flap. (I hope you can picture what I'm talking about!) I couldn't do the ever-so-popular "Chicken Dance" at a wedding today, for instance. And Butterfly or Breast Stroke would be RIGHT OUT.

OK, now that I re-read what you typed... I *CAN* actually move my arm for the chicken dance wing flapping but it hurts like crazy to move my arm that way, & still hurts (throbbing) after I bring my arm to my side. The touch-tenderness is absent if my elbow is at my waist, but if I move my elbow out from my waist (chicken dance move) even as little as a few inches the touch tenderness is BACK. The totally sore touch point feels to me to be right where bone-meets-bone where the shoulder meets the arm. (I'm an engineer by trade, not an orthopedist! So I hope I'm not misleading you by careless terminology.)





Expert:  Dr. Chip replied 4 years ago.
OK--and your terminology is fine--at least I can understand your explanations clearly. Let's get back to the beginning. Except for one MRI of a knee, you've had no other MRI's, no X-Rays of anything, and you haven't, to your knowledge, been screened for gout or autoimmune disorders? And, except for bursitis, no doctor has ever considered any other diagnosis?
Customer: replied 4 years ago.
Knee - one MRI moons ago... otherwise only diagnosed by touch-and-yelp.
Hip - "Huh, that's odd". No tests. No advice.
Shoulder - guess I haven't complained about it to the doc lately. No tests.

What would a gout screen involve? Would it should up on BMP or other common tests?

I have auto-immune issues. I have celiac disease. I'm also a T2 diabetic (diet only - no meds).

I had a full physical in March. The blood tests then revealed nothing unusual. (And my A1C was fine. Happy news!)

I took a bad fall in 2003 and broke the sacrum bone. So I expect hip/pelvic issues from that but the only consequence from that falls seems to be occasional nerve pain shooting down my leg and the fact that I can't feel my skin on certain parts of my leg. The hip issue predates the fall by at least a year.

I've had four babies, all of them good sized. With the hip thing happening frequently in pregnancy they just wrote it off as "sciatica due to pregnancy". But this pain isn't like the nerve pain I know too well. This pain is definitely more muscular/skeletal and not nerve-like. I would think sciatica would be more nerve-like since, after all, it involves a nerve!

Thank you for your time. I hope your family isn't waiting for you to have a summer cook-out while you puzzle my "Can't-do-the-chicken-dance issue".
Expert:  Dr. Chip replied 4 years ago.
Don't worry--the family is patiently waiting so I can join them in our weekly Fox Trot After Grits And Hog Jowls Repast. First off, I guess this could be just "migrating bursitis/tendonitis," and, if that's the case, there is not treatment beyond antiinflammatories, rest, splinting or bracing when deemed necessary, and the occasional cortisone shot. Gout is usually caused by abnormally high uric acid levels in the blood and treated with antiinflammatories and colchicine intially and with Allopurinol to lower the uric acid after the acute attack. An autoimmune disorder like rheumatoid arthritis could explain this, and blood work is needed to rule that out. Celiac disease, while being somewhat autoimmune, wouldn't likely be in play here. I would get a battery of X-Rays and MRI's just to see if there's anything those might add to coming up with a legitimate diagnosis. Often in the practice of medicine, one can only consider the differential diagnosis and take steps to rule out the disorders on the list one by one. Lastly--can you give me detailed instructions on how to do the "Chicken Dance?" We might try it out in an hour or so............
Customer: replied 4 years ago.
Glad to be of service!
http://www.wikihow.com/Do-the-Chicken-Dance
Customer: replied 4 years ago.
I had typed a note about my risk factors for gout. It seemed to have vanished. Bummer.

Is there a simple blood test for gout? Or does it involve removing fluid from joint?

Is there a specific test for auto-immune?

Would x-ray be the first thing to do?

I see Doc again in September, barring accident or illness before then.
Expert:  Dr. Chip replied 4 years ago.
Uric acid levels may or may not be included in a standard chemistry panel. If they're not elevated, gout is unlikely, but pseudogout could still be a cause, and, then, it'd take aspiration of inflammed joint fluid to make the diagnosis. Standard screening for autoimmune disorders: Antinuclear antiboidy (ANA), Rheumatoid Factor (RF), and Erythrocyte Sedimentation Rate (ESR), but there are some of these disorders that take further testing by a rheumatologist to fully rule them in or out. I'd start with the blood work and X-Rays of the affected areas, and go on from there. In the meantime, I'd advise you continue with the chicken dance between flare ups, and, when you have them, if only your upper body is affected, you can do the Two-Step or the Flamenco or the Irish River Dance without a problem. If it's your hip and knee, stick to knitting in a rocking chair with a shawl on your legs and a long-tailed cat by your side--just be sure the rockers on the chair don't run over the cat's tail, unless you want to try the joint aspiration at home via cat claws.
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 23434
Experience: Over 20 yrs of Family Practice
Dr. Chip and 9 other Health Specialists are ready to help you
Customer: replied 4 years ago.
Ha! How did you know I'm an accomplished (even published) knitter?! Allergic to cats so no worry about the tail or claws. Thank you for your help. I will ask more questions of my doc in September when next I go. Have fun learning the chicken dance. If you weren't already familiar with it then I gather there aren't many Polish people in your area! Enjoy the rest of your weekend.
Expert:  Dr. Chip replied 4 years ago.
OK--let me know if a diagnosis is determined. Knit one, pearl (I think that's how it's spelled) two, and, "First, you put your two knees close up tight, then you swing 'em to the left, and you swing 'em to the right. Waltz around the floor kinda nice n light.........." You get the picture. And, Ballin' the Jack is not a medical term for something I shouldn't mention!
Customer: replied 4 years ago.
Thank you for the laughs! You're a "purl". :-)
Expert:  Dr. Chip replied 4 years ago.
Somehow I thought I was wrong about the spelling! Time to pig out and trip the light fantastic.......
Customer: replied 4 years ago.
ps --- if it were bursitis, does pushing thru the pain cause any damage? do bursae ever break? thx
no go enjoy dinner!
Expert:  Dr. Chip replied 4 years ago.
Damn it!!! I'll have to start the Conga line at the end again!!! I should charge you for this big time. OOPS--sorry, dear esteemed customer. I hope I can still help you to the best of my abilities and that you will again accept the following answer and add a bonus so I can pay for much needed dance lessons. Thank you. Bursae don't break, but, as with tendonitis, rest is the key, since motion only increases the inflammation. But, then seeing as how my supper is cold, and half my guests are already passed out on the floor from drinking too much apple jack--GO RIGHT AHEAD AND PUSH IT TO THE LIMIT AND I HOPE YOU SUFFER AS MUCH AS YOU'VE MADE ME SUFFER TODAY!!!!!!!!
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 23434
Experience: Over 20 yrs of Family Practice
Dr. Chip and 9 other Health Specialists are ready to help you
Customer: replied 4 years ago.
Ah, but the still-standing guests are the REALLY fun ones! Thanks!
(I confess that I don't really understand how this JA web site works. I will press the GREEN button again. I hope they pay you double for being so obliging.)
Expert:  Dr. Chip replied 4 years ago.
Thanks--you did it just fine. Seriously--let me know what happens, and you don't have to pay for any more humor from me. AND--I think taking advantage (hee, hee) of the ones that are already down and can't complain is much more to my liking. I can take the lead and go anywhere with it I want! Have a good night..........
Customer: replied 4 years ago.
Hi. My doc's NP ordered blood tests for gout, but suspects my shoulder pain and hip pain are not gout because I don't have any significant redness. The NP ordered LYME DISEASE Titres, too, suspecting that since I live in Lyme-Central (and get mice in the house (ugh)) that Lyme is more likely than gout. I should know soon. Thank you for the input, Doc Chip.
Expert:  Dr. Chip replied 4 years ago.
Lyme's a possibility--let me know the test results.
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 23434
Experience: Over 20 yrs of Family Practice
Dr. Chip and 9 other Health Specialists are ready to help you
Customer: replied 2 years ago.
Hi. Can I bring this ancient conversation to your mind & ask you new ?s based on two yeats of additional info?
Expert:  Dr. Chip replied 2 years ago.
Good to hear from you again--what's up Tiger Lily?
Customer: replied 2 years ago.
You're already making me smile!

Ok... Two years have gone by & I am still messed up w/ multiple bouts of bursitis or bursitis-like problems.

Multiple blood tests for gout - nothing found
Multiple blood tests for Lyme - nothing found

Noticed that when my asthma is worst, so too can the joints be at their worst. Noticed that Prednisone ir Medrol for the asthma makes my joints say "AHHHHHHH! THAT'S HAPPINESS!"

List of bothered joints, CCW around body:
Left third toe - has been really bad, but lately OK
Left knee - has been OK lately but definitely bursitis in March
Lower back - if I sit too long I cannkt walk easily
Left ring finger - swells and hurts often, mainly at night. Often have to remove wedding ring.
Left thumb - swells and hurts often. Feels better w SalonPas or TugerBalm usually
Right shoulder - biggest mess of all. Cry getting drressed.
Right middle finger - 2nd biggest mess. Swells like crazy. Stiff. Severe pain. Even skin cannot handle being touched by a breeze. Should I bump the hand (eg grocery shopping), I see stars and nearly faint from pain.
Right hip - keeps spazzing out. Severe pain. Cannot walk. Cannnot lift or move leg. Only fix is laying on the hip until it feels bwtter. Multiple episodes of this happening from Friday thru Sunday last.
.
Primary doc sent me to rheum when left foot and right hand at worst. Rheum has tested for RA, Lupus, gout & more. Nothing.

Rheum has sent me to PT for back, hand, shoulder. Back & hand doing better. Shoulder is a huge mess. Shoulder makes me cry often. PT this week was severely painful.

I will finally get an mri of the shoulder next week.

Meanwhile, derm doc has DXed psoriasis. (I have had a miserable belly rash for at least five years that every doc thought was yeast. Derm doc says its psoriasis.

So.... Rheum doc wonders, but is not cinvinced, that I have psoriatic arthritis. The physical therapist says he's never seen arthritis look & behave like my case, so he thinks I have sboulder impingement, rotator cuff injury, bursitis, or perbaps labrum injury.

No doc wants to rx steroids - I am diabetic.
We must limit NSAIDs - I have colitis and sensitive asthma.

Latest list of meds:
Labetol - hypertension
Celexa & wellbutrin - depression
Asthma inhaler prn
Tylenol 3 and fiorocet - prn
Lotrisone, dovonex, protopic & clobetasol shampoo for psoriasis in multiple places
I haven't started the protopic or clobetasol yet - they are new (and scare me) - but i have them

I think that's all the news. Oh, and basal cell skin cancer - excised.

I look forward to your thoughts. Thanks!
Expert:  Dr. Chip replied 2 years ago.
OK--remind me--have you had all the x-rays and/or MRI's needed to look at all the problem joints?
Customer: replied 2 years ago.
Recently -
Hand xray within last few minths shows swelling
Prior hand xray last september showed nithing

Shoulder xray recently showed nithing

Back xray recently showed only a kidney stone

Left foot xray last fall showed nithing

Will get shoukder mri on Monday

Forgive typos - doing ja on phone is hard
Expert:  Dr. Chip replied 2 years ago.
Doing JA on phone--if someone read that and new nothing about it, sounds a bit kinky. The rheumatologist--why is he unsure about psoriatic arthritis?
Customer: replied 2 years ago.
Hmmmm..... Why is rheum unsure about PsA? Good question... Let me try to piece that together.

I think ... And I could be mistaken... It's a combo of the followinv:
- no xrays showing definitive "this is PsA!" Signs
- whatever bood tests he ordered didn't shout "this is PsA" either
He only sees swelling in one finger.... Although that swelling is classic sausage. The foot swelling in toes was gone when he saw me altbough foot can still be tender to the touch.

I don't think he's convinced that the derm is correct about psoriasis, either.

Mind you - the belly rash i have had for YEARS. (at least 6 years) doesn't sbout "this is psoriasis" either. Derm doc dxed psoriasis based on scalp. Primary care doc not convinced scalp is psoriasis either.

Wish I had a way to get them all in one room to talk: primary, his NP, derm doc, rheum, PT and you!

Doin' the kinky JA on the phone with you.... :-)

Expert:  Dr. Chip replied 2 years ago.
Gout was ruled out? Your sed rate and C reactive protein levels were normal?
Customer: replied 2 years ago.
Gout tests have been blood only, not joint aspiration (via.cat claw or needle ot other).bno high uric acid levels in blood.

If CRP is a lupus test the those were all normal. Sed rate was normal too.

Sometimes i wonder if MY normal is a normal-normal, if you know what I mean.

JA on a ohone - you can't see what you type! When you prevuew your reponse & spot the typos, you cannot click on them to go back & fix them. Sigh. It's kinky, for sure!
Expert:  Dr. Chip replied 2 years ago.
Well, as to the normal/normal, usually all tests are normal with PA.
Customer: replied 2 years ago.
So I guess the rheum doc is unconvinced about PsA because nothing "shouts" 'this is PsA'. I guess everything is harder to diagnose in the earliest days, eh? Whatever is going on I guess I must be still "sub-clinical"?

Two days ago at PT, the therapist didn't even have me do my normal routine. I was yelping to the touch on Monday. His massage/stretching made me queasy & cry. So all we did was heat & TENS, shoulder bike, pullies, over-the-head reach, massage & stretches, and then LOTS of ice.

The PT pretends he's a sadist so I got to "make" his whole week by crying at 7 AM on a Monday!
Expert:  Dr. Chip replied 2 years ago.
A masochist looks pleadingly at a sadist and says, "Hit me!! Please hit me!!" The sadist raises his clenched fist, draws back his are, hesitates, then grins, puts down his fist and says, "No." What was so painful on Monday?
Customer: replied 2 years ago.

Funny!
Monday & Sunday EVERYTHING was painful about the shoulder. I was late because I couldn't get my foundation garment and T shirt on. Touching my shoulder to put on the TENS pads hurt. Oh, after TENS he did ultrasound. That didn't hurt. Shoulder bike was among the longest 6 minutes of my life other than perhaps giving birth. Pulleys: I couldn't reach far up my back for the "towel pull" stretch. Just doing fifteen of those took all my will. Reaching up over my head for the other pulley exercise also took a heroic act of will. Then laying on the table to have my left arm pull my right arm up over my head (straight arm lifts) nearly made me ouke from pain. I onky managed ten arm lifts and it probably took ten minutes to do it. Tgen tge PT did his magic massage and his wacky pull-the-arm-away-from-thenshoulder thing. I donct know to explain that one. Hope you know what it is. That too nearly made me puke. Tgen he massaged in Biofreeze and out ice Ice ICE on. I sat with ice for a long time and then was done. The whole thing was awful, but productuve. I was definitely better yesterday & today. Today I didn't even cry.putting on a shirt! Thatcs progress!

But overall, the PT hasn't improved my shoulder in a lasting way. He has taight me some tricks to make reaching or carrying things easier. But I am not healed.

The pt has improved my hand and lower back a lot.

The hand thwrapy has includex iontopheresis with dexamethasone. I tbink we have done that four.or five times.

Expert:  Dr. Chip replied 2 years ago.
So your shoulder is the biggest problem right now?
Customer: replied 2 years ago.
Shoukder and right middle finger are top two at the moment.
Time to drive. Won't be back to ja for a while.
Expert:  Dr. Chip replied 2 years ago.
OK--let me know when you're back--there's more to talk about here.
Customer: replied 2 years ago.
I am back. For about an hour. Then I have to take a kid to work.

Yes, the shoulder is the worst complaint for the last few days.

Tomorrow could be different. :-)

Today is much better than Sunday/Monday.

What kinds of things cause Migrating Misery... Today one joint, tomorrow a different joint, the next day multiple joints, etc?
Expert:  Dr. Chip replied 2 years ago.
OK--were you screened for Lyme disease and was fibromyalgia considered?
Customer: replied 2 years ago.
Been tested several times for Lyme. No indicators of that in blood. (Thank goodness. I have two friends whose lives have been turned upside down because of Lyme.)

Only the rheum doc has ever said the fibro word.

How does that get diagnosed? And is it even real? Seems very controversial.

Expert:  Dr. Chip replied 2 years ago.
No, it's real but there are no diagnostic tests for it except if all other possibilities have been checked for with tests and those are negative, it's a real consideration. So, so far, none of the docs have come up with an idea except perhaps PA?
Customer: replied 2 years ago.
Right - the onky idea on the table from dics at the moment seems to be PsA.

The physical therapist (admittedly, not an MD) says: impingement, bursitis, rotator cuff injury or maybe (less likely) a labrum injury.

Why dies the electrical stim machine help so much? Wish I could sit there in the PT office all day with that electricity blasting through my shoulder.

Does my love of the Stim machine give any additiinal hints?

Would fibro make entire digits swell like sausages?

Coukd fibro exist coincidentally with PsA?

Expert:  Dr. Chip replied 2 years ago.
Both can coexist and if the TENS unit helps that would seem to indicate fibromyalgia.
Customer: replied 2 years ago.
Interesting. I love that electricity machine.
I hope the mri on monday will give more info.
What coukd an mri reveal?
Expert:  Dr. Chip replied 2 years ago.
Of your shoulder?
Customer: replied 2 years ago.
Yup. It took a while but finally will gey an mri of the shoulder.
It wouldn't reveal fibro, i.presume.
Expert:  Dr. Chip replied 2 years ago.
No, and you may have a rotator cuff problem like impingement syndrome or a partially torn ligament or maybe a labral tear--the cartilage inside the joint--but no scans reveal FM.
Customer: replied 2 years ago.
I am very grateful for all of this info. I will keep you posted if you wish to know what, if anything, the mri reveals.

I looked at the Mayo Clinic web page for fibro. I guess now I know why docs keep pressing on my elbows, neck, chest....

I don't know if I really fit the pattern Mayo lists in thie document. I am definitely not symmetric. My other shoulder is fine... Other foot is fine... Etc.

But I will ask more ?s at next rheum appt. I have to call them to schedule that now that I have an MRI date.

Expert:  Dr. Chip replied 2 years ago.
Well, you can have fibro and still have different problems with specific joints like the shoulder. Next time, don't wait nearly two years to get back to me Tiger Lily
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 23434
Experience: Over 20 yrs of Family Practice
Dr. Chip and 9 other Health Specialists are ready to help you
Customer: replied 2 years ago.
:-)

I will keep you posted then!
Customer: replied 2 years ago.
Additional data - Yesterday we had big storms with lightning & hail and nearly tornado. (Just rotation... No tornado formed.) Today my shoulder is nearly normal! I got dressed, I brushed my teeth... All that normal stuff someone with a working shoulder doesn't even notice!

Had to cut the PT session short this AM. I was doing the shoulder pullies and behind-the-back stretches when the world turned dark, my BP dropped, I nearly fainted, and I had to lay down. I wonder if it's because I did a Double Reds blood donation on Tuesday. Normally I have hypertension. The PT took my BP when I was lying down w feet elevated. It was 102/72. Gosh I can't remember the last time I heard numbers like that.

All the news that's fit to print.
Expert:  Dr. Chip replied 2 years ago.
News flash from the New York Times, eh? Have you ever had a near fainting experience before? Was there a lot of pain going on during the PT session?
Customer: replied 2 years ago.
Just call me "Queen of the TMI", but I like Tiger Lily better. PT hurts like crazy and frequently makes me nauseated. But this was my first near-faint at PT. I'm all too familiar with fainting, luckily. I knew immediately to sit down and lower my head. I was shocked my bp was so low. Fret not - I am safely home and nearly feeling normal. Don't need to drive anywhere for 2 1/2 hours...
Expert:  Dr. Chip replied 2 years ago.
OK. Probably a vasovagal episode--stimulation of the vagus nerve slows heart rate and lowers blood pressure--like when someone faints at the sight of blood. Can happen with straining at the stool, pain, etc. Not really serious in and of itself but I don't think it was because you donated blood.
Customer: replied 2 years ago.
:-)
I am a very experienced donor.... Like maybe 90 donations. Seriously. Regularly for 25 years or so. But it was my first successful double-reds. A very strange experience. I will look up vasovagal & learn more. I have heard that term a couple of times but know nothing beyond the familiarity of the term.
Expert:  Dr. Chip replied 2 years ago.
http://www.mayoclinic.com/health/vasovagal-syncope/DS00806 Straight from the Mayo Times--all the medicine that's fit to print.
Customer: replied 2 years ago.
But what does The Mustard Times have to say about it? Wonder what the evolutionary usefulness of this pesky nerve is. I mean, how does it save Cave Man from being eaten by tigers if he faints at the sight of blood when the tiger eats his neighbor? Does fainting trick tigers? Ok I will let you do your REAL job now.
More news after the MRI next week.
Expert:  Dr. Chip replied 2 years ago.
Vagus comes from the Latin for wanderer because it wanders so many places. It is intimately involved in small bowel function too so without it the tiger couldn't enjoy the Pygmi Parmesan or the Watusi wrap.
Customer: replied 2 years ago.
You are too funny!
Expert:  Dr. Chip replied 2 years ago.
Not when I take my medicine properly, but if I do I just sit in a corner and suck my thumb.
Customer: replied 2 years ago.
:-)
Expert:  Dr. Chip replied 2 years ago.
Later
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 23434
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Customer: replied 2 years ago.
Grateful if you could put this a bit into English!

Here's what the MRI says without and with contrast (please forgive typos):

Most notable change is amorphous increased T2 with enhancement involving the ventral deltoid ligament and muscle at its insertion on the distal acromion. There is adjacent subcutaneous edema. Appearance is consistent with strain/partial tear. Note is also made of edema and enhancement involving the chronic navicular joint consistent with sprain.

There is mild focal tendinosis superior tendon of subscapularis. There is no evidence for synovitis. Glenoid labrum and biceps tendon are unremarkable. There is no rotator cuff tear. The femoral head has normal signal and morphology.

Impression: Partial-tear versus high grade strain ventral deltoid muscle and tendon at its attachment on distal acromion with adjacent subcutaneous soft tissue edema. Small subacromial effusion. Edema consistent with sprain at the acromioclavicular joint. Mild tendinosis anterior suprasinatus tendon and superior fibers of the subscapularis tendon.
Expert:  Dr. Chip replied 2 years ago.
King's English or guttersnipe English? Remind me about your shoulder symptoms?
Customer: replied 2 years ago.
Shoulder has hurt like crazy for YEARS. Years. Reaching over my head, getting dressed, brushing teeth, opening trunk, etc., are all every day movements I'd far prefer to avoid. However, to be socially acceptable, I MUST do most of them.

So the primary doc sent me to the rheum who sent me to PT. I've been doing PT since May. The PT has helped my hand (psoriatic arthritis perhaps) and my lower back (not as bothersome as hand and shoulder) but hasn't helped with the shoulder much. Heat and electric muscle stim are great. I can do the shoulder bike. The rest of the exercises hurt like crazy, often to the point of making me queasy from the pain.

So, I finally got an MRI last week. And above is what the report says. The PT said it means lots and lots of inflammation, and we won't do as much exercising for now. So today was heat, stim, shoulder bike, a little exercise, and then ice. Lots of pain.

Thanks for your input.
Expert:  Dr. Chip replied 2 years ago.
Well, actually, it's not as significant as I would have thought. The tendon of the deltoid may have a partial tear or it may just be a chronic tendonitis and the supraspinatus and subcapsularis tendons--part of the rotator cuff--are a bit inflamed. So no labral tear (cartilage of the joint) and no arthrosis/arthritis.
Customer: replied 2 years ago.
So I'm just a big baby? Is there something that can be done?
Expert:  Dr. Chip replied 2 years ago.
Not a big baby but remind me--have you seen an orthopedic surgeon about this?
Customer: replied 2 years ago.
nope. Only primary care doc, rheum, and PT.
Expert:  Dr. Chip replied 2 years ago.
And the PT has only been painful?
Customer: replied 2 years ago.
If I could sit with the heat and electrical muscle stim all day, it'd be wonderful. Mainly the PT is painful. The shoulder bike wears me out, and I can go neither really fast nor with great tension on the wheel, but I can do it. But all the other stuff hurts. Pulling rubber resistance bands or using pulleys, raising my arm, shoulder rolls, lifting a wand with two hands over my head.... hurts. Sometimes he'll do pulls on my shoulder and I'm supposed to avoid resisting at all. Passive exercises, I think these are called. Ugh. Those REALLY make me queasy. Massage of the shoulder hurts. Heat, electrical stim, shoulder bike, and ice. Those are the only things that don't hurt.
Expert:  Dr. Chip replied 2 years ago.
Well, I don't really see anything in the report that smacks of a surgical problem--at least, something that might improve things with surgery. If you haven't had them up to now, cortisone injections might help but if you've been at the PT for a few weeks and all that happens is pain, I don't think you can expect that to help any further.
Customer: replied 2 years ago.
So the "partial tear" thing isn't a surgery thing? Would immobilization for a while help? (Can one *truly* immobilize a shoulder?) People are loathe to give me cortisone because I'm diabetic. Well-controlled diet-only T2 (a1c 5.5), but diabetic nonetheless. (Also, courses of steroids for asthma or whatnot makes me NUTTY.) Would a cortisone injection in the shoulder make my BGs go haywire, or make my emotions go haywire? Or would it just knock down the inflammation, give me big relief, with little on the side-effect ends of things?
Expert:  Dr. Chip replied 2 years ago.
The partial tear could be considered surgical, although there doesn't seem to be much in the way of inflammation there. Unfortunately, the cortisone injection could mess with your mind--the blood glucose elevation wouldn't be much of a problem. But, then the shot wouldn't cure anything. Yes, the shoulder can be fully immobilized with a sling and swath bandage or brace.
Customer: replied 2 years ago.
I will see the rheum next week. perhaps he'll say "go back to primary doc and get sent to an ortho". Think immobilization would help?
Expert:  Dr. Chip replied 2 years ago.
If done for no more than a week or two, yes it could. Longer than that and you run the risk of developing a frozen shoulder from disuse
Customer: replied 2 years ago.
ick. frozen shoulder would be worse.
This conversation started two YEARS ago, and the stupid shoulder had been bothering me LONG before that. So I guess it's time to get more serious and more aggressively try to find an answer.
Thanks a lot for all your help.

just a few more ?s -
could the inflammation be hiding anything the mri couldn't see?
does any of this sound like psoriatic arthritis?
does any of this still sound like fibro?

Thanks!!!
Expert:  Dr. Chip replied 2 years ago.
No to the psoriatic arthritis and to the fibro, and yes to the fact that I have seen more than one occasion where direct surgical observation in the OR surprised the surgeon because the visual didn't match the MRI report.
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Expert:  Dr. Chip replied 2 years ago.
Hey--by the way, don't stay away so long again if you have more medical questions for me
Customer: replied 2 years ago.
I get embarrassingly silly when I chat with you.
Expert:  Dr. Chip replied 2 years ago.
I tend to make people do that

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