Tuesday, December 02, 2008Shoulder Pain That Won't Go Away?
A very nice lady came to my office one day hoping that I could help her get rid of her shoulder pain. Shoulder problem? No, problem. At least usually they are no problem. I told her that I would check it out and let her know what I thought was wrong and whether or not I could fix it.
When she told me her history I found that she had had this pain for two years or so. She had not done anything to cause the problem. She could not remember any falls, slips, trips, bumps or car wrecks. It had just started and it would get worse at times but not better. She had been to other doctors, to her MD to physical therapy, through x-rays all to no avail.
I then examined her shoulder. I could not find any particular muscle trigger points that seemed to reproduce or increase the pain in her shoulder. She could not actually point to one specific place that the pain was coming from. I also checked her neck because the nerves to the shoulder come from the neck. Again, nothing about her neck seemed to be causing the shoulder problem. I pushed on whatever tight muscle bundles that I could feel, but nothing sent any pain sensations to the right shoulder. Once I had completed the exam, I had to conclude that the shoulder problem did not seem to be in the shoulder.
Still, I believed her. I did not think that she was making this up. I have found that most of the time patients are telling the truth about their symptoms. The shame of medicine is that when a doctor cannot find the cause of the problem he is often quick to dismiss the patient's complaints and say, "It's all in your head." In this case, the shoulder pain was coming from a place that her other doctors overlooked. In fact her shoulder pain was all in her gall bladder.
One of the classic sign of a gall bladder problem is pain on the lower tip of the right shoulder blade. It may seem odd, but there really is a connection. However, sometimes instead of the classic sign a patient may just have general right shoulder pain. Infrequently, it will even show up as pain in the left shoulder.
So I asked her:
Do you get indigestion? Yes.
Do you get it an hour or two after eating? Yes.
Is it worse after eating a greasy or oily food? Yes.
Now we were getting somewhere. I then had her lie down and examined her stomach and found tenderness in the gall bladder area. I also examined her hand for another sign of gall bladder problems and the sign was present.
At last I told her that she did not have a shoulder problem, she had a gall bladder problem that was causing her shoulder to hurt. I gave her a treatment plan and some home instructions and a date for a follow-up appointment.
I never heard from her again . . . at least not for two months. She missed her appointment and did not respond to a phone follow-up.
But one Monday morning, I got a call and the caller said, "Dr. Payne, I just wanted to tell you that you are a miracle worker!" "Excuse me, but who is this?" I asked. She reminded me of her case and that she had been to the clinic two months previously. She confessed that after she left, she did not believe what I said. No way, she thought, could all of the problems and pain etc. be caused by a gall bladder. How come no one else had told her that, she wondered? Now, here's this chiropractor! telling me I have a gall bladder problem and he has given me a home remedy that he says will fix two and a half years of pain and medical bills? No surgery? No drugs? "Ridiculous!" she thought.
"Well," she continued, "two weeks ago my shoulder hurt so bad that I thought, 'What have I got to lose?'" She followed the procedure that I had given her and Sunday, the day before she called me, she said, "I woke up for the first time in two and a half years without pain. I just wanted to thank you."
This story is not unique. If you have unresolved pain, it may be coming from over-looked cause. Contact me and together we will try to get to the bottom of what is causing the problem.
I wish that all such stories had such a happy ending. Many stories can end happily if the cause of the problem is found. Once we know the cause then we can often find a cure.
Yours in good health,
Dr. Neill H. Payne,