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Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5299
Experience:  American Board Certified Neurologist, Internal Medicine
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I have tremors and a lot of shoulder pain. I was told it was

Customer Question

I have tremors and a lot of shoulder pain. I was told it was most likely Parkinson's buI have had an MRI done which came back with no abnormal lesions. I've had ultrasounds and X-rays which don't show any tears in the rotator cuff. I don't know where to go from here. I've quit my job as a logging processor operator n am doing low impact work and activities bec I have so much pain in the shoulder
Submitted: 1 year ago.
Category: Neurology
Customer: replied 1 year ago.
I have been to three specialist, neurological, orthopedic, Parkinson's Dr and I don't know what else to do
Expert:  Dr Subbanna MD replied 1 year ago.

Hi, I am an American Board Certified Neurologist and I am very glad to help you with your health concerns.

First I will ask few questions so that I can gather additional information related to your health concerns.

1) Could you describe your tremors – for example are they constant or intermittent? Do they occur while hand is in resting position or do they occur while using the hand or doing some activities?

2) How severe are the tremors? How much the tremor affects your daily life?

3) Do you have other parkinson’s symptoms like bradykinesia (slowing of daily motor activities), rigidity (a type of muscle stiffness) etc?

4) For the shoulder pain what treatments have you tried already (other than acupuncture & physio)? What are your current treatments? And what treatments have you tried for the tremors?

5) Is there any neck pain?

6) The MRI was of which region? Shoulder or neck or brain?

7) What was the final diagnosis by the neurologist and parkinson’s specialist on you? And what was the final diagnosis by the orthopaedist on you?

Best regards,

Neuro Doctor

Customer: replied 1 year ago.
1) They are constant...while hand is resting
2) Tremors are severe...very noticeable
3) well im slower bec of my shoulde pain
4)Those are the only treatments Ive done. Physio Dr. told me to not come anymore bec it would be a waste of my time
I have no current treatments
5) No
6)MRI was on brain
7)Neuroligist informed me my results were great and that there wer abnormalities..
Customer: replied 1 year ago.
were no abnormalities
Expert:  Dr Subbanna MD replied 1 year ago.

Thanks for all these additional information. Okay I am ready and I am posting my answer here. And I am sorry I couldn't reply earlier as I was away from the computer and just returned.

Coming to the discussion;

You have mentioned about 2 major concerns; one is about severe tremors/parkinson’s and the other major concern is about the severe shoulder pain.

Regarding the tremors/parkinson’s;

Please see that you have no sufficient clinical evidence for parkinson’s condition. You have tremors but there should be more than just tremors to suspect parkinson’s. You have some slowing of the motor activities but that appears to be related to shoulder condition rather than due to parkinson’s. To suspect parkinson’s out of 3 classical features (tremors, rigidity & bradykinesia or slowing) one needs at least 2 classical features to make this diagnosis. You seem to have just one feature – which is tremor - so with this much information I cannot consider you are having parkinson’s.

And brain MRI is not going to help to diagnose parkinson’s. For assisting in the diagnosis of parkinson’s you need a special neurological investigation called as DaTscan brain test, which is a special type of SPECT brain scan, this can help telling whether you have any parkinsonian condition or not. If this test is not already done then please ask your neurologist or parkinson’s specialist to arrange this test.

In the meantime you may try one of the following meds to see whether the severe tremors can be brought under control;

Artane

Propranolol

Mysoline

Alprazolam etc

Regarding the severe shoulder pain;

I see that no diagnosis has been made regarding what is causing this severe pain. I am not sure what other investigations were done other than the ones you have mentioned above, if an MRI scan of the shoulder has not been done then you need one which can help in identifying various conditions of the shoulder that causes the pain, so please ask your orthopaedist for an MRI scan of the shoulder.

In the meantime you may try one or more of the following treatment options to control the severe disabling pain you are tortured with;

A) Medication treatment options;

Lidoderm anesthetic pain relieving skin patches

Flector (Diclofenac) anti-inflammatory pain relieving skin patches

Truegevity 024 Pain Relief Towelettes

Capsaicin pain relieving skin cream

Nerve-pain pills that also help with shoulder pain like Gabapentin or Amitriptyline

Specialized injection treatments to the shoulder like PRP (platelet Rich Plasma) injection, or Prolotherapy injections, or Steroid shots etc

Narcotic/opioid pain killers like Oxycontin or Hydrocodone preparations etc.

B) Non-medication treatment options;

Diathermy therapy

Ultrasound therapy

ESWT (Extracorporeal Shock Wave Therapy)

Iontophoresis treatment

Cold Laser therapy

TENS (Transcutaneous Electrical Nerve Stimulation) OR Interferential therapy etc

If you see any of the above treatments you have not yet tried then you may consider trying them to help in relieving the pain as well as the tremors. I am not telling all these above treatments are required in your case, but providing you with a list of several different treatment options that are available for your tremors & pain conditions. In the meanwhile please ask your doctors to arrange for the above mentioned additional investigations that can help in finalizing the precise diagnosis causing your severe tremors and disabling pain.

Please let me know if you have any further questions; and if you feel you have received the answer to your question please rate me so that I can receive credit for the time and effort put by me in answering your question.

Best regards,

Neuro Doctor