I have shoulder pain and a pinching sensation in my armpit, with a history of shoulder dislocation, and I'm experiencing tingling and numbness in my fingers, what could be causing these symptoms?

Shoulder Pain with History of Dislocation and Neurological Symptoms

Your symptoms suggest a potential brachial plexus injury or nerve compression related to your previous shoulder dislocation, requiring prompt medical evaluation rather than a steroid injection.

Clinical Assessment of Your Symptoms

Your presentation includes several concerning features:

• Shoulder pain with history of previous dislocation
• Pain extending into the armpit
• Tingling and numbness in fingers
• Pinching sensation in the armpit

These symptoms strongly suggest potential nerve involvement, which requires proper diagnosis before treatment.

Likely Diagnoses to Consider

1. Brachial Plexus Injury

   • Common after shoulder dislocations, especially in older patients 1
   • Can cause radiating pain and neurological symptoms in the arm and fingers
   • Often mistaken for simple shoulder pain

2. Rotator Cuff Tear

   • Frequently occurs with shoulder dislocations (present in 100% of middle-aged/elderly patients in some studies) 2
   • Can coexist with nerve injuries
   • May contribute to shoulder instability and pain

3. Axillary Nerve Injury

   • Common nerve injury after shoulder dislocation
   • Can cause numbness and tingling in the lateral shoulder and arm

Recommended Diagnostic Approach

1. Plain Radiographs (First Step)

   • Standard shoulder series including AP, Grashey, axillary, and scapular Y views 3
   • Essential to rule out fractures and assess joint alignment

2. MRI Without Contrast

   • Recommended as the next step if radiographs are normal or indeterminate 3
   • Excellent for evaluating soft tissue injuries including rotator cuff tears and labral injuries
   • Can help identify nerve compression

3. Electromyography (EMG)

   • Should be considered if neurological symptoms persist
   • Helps differentiate between nerve injury and rotator cuff tear 2

Treatment Recommendations

Immediate Management

1. Avoid Steroid Injection

   • Not recommended as first-line treatment without proper diagnosis 4
   • Could mask symptoms of serious underlying pathology
   • Particularly inappropriate with neurological symptoms present

2. Pain Management

   • Acetaminophen (up to 4g/day) as first-line analgesic 4
   • NSAIDs at lowest effective dose if acetaminophen is inadequate
   • Gabapentin may be appropriate for neuropathic symptoms 4

3. Activity Modification

   • Relative rest and avoidance of painful movements 4
   • Protect the shoulder from further trauma
   • Avoid overhead activities that could worsen symptoms

Follow-up Care

1. Physical Therapy

   • After proper diagnosis and initial pain control
   • Focus on gentle range of motion exercises
   • Gradually progress to strengthening exercises 4

2. Specialist Referral

   • Orthopedic or neurology consultation recommended
   • Surgical evaluation may be necessary if significant rotator cuff tear or nerve compression is identified

Important Considerations

• Nerve injuries are often missed in patients with shoulder dislocations, especially in older patients 1, 5
• Rotator cuff tears can mimic nerve palsies and require careful evaluation 1
• Untreated injuries can lead to chronic pain, weakness, and potentially dislocation arthropathy 6
• Recurrent dislocations after previous injury may require surgical intervention 7

Caution

• Do not self-administer steroid injections - this could worsen your condition
• Seek prompt medical evaluation for proper diagnosis
• Neurological symptoms (numbness, tingling) require thorough investigation
• Delayed diagnosis and treatment can lead to permanent functional impairment

Your symptoms suggest a potentially serious condition requiring proper medical evaluation rather than self-treatment with steroid injections.