Atypical Presentation of Activity-Related Shoulder Pain and Computer-Associated Wrist Symptoms in a Middle Aged Man

Abstract                                                                                                                                 

Musculoskeletal pain in sedentary adults with chronic disease may resemble more serious conditions, including cardiac ischemia. We report the case of a 57-year-old man with Type 2 diabetes and depression who presented with left shoulder discomfort while walking his dog and progressive wrist pain associated with computer use. Although he feared a cardiac cause, the symptom pattern suggested localized musculoskeletal strain and repetitive-use neuropathic irritation. This case highlights the value of a detailed history for distinguishing benign complaints from ischemic equivalents in patients with cardiovascular risk factors.

Introduction

Activity-related shoulder pain and wrist discomfort are common in people with sedentary jobs. Distinguishing routine musculoskeletal pain from potentially serious cardiac symptoms is especially important in patients with risk factors such as Type 2 diabetes, hypertension, and low physical activity. This case involves a patient whose concern about heart disease led to evaluation of left arm pain, showing how a careful history can clarify the cause and highlight lifestyle issues.

Case Presentation

A 57-year-old accountant, Yusuf Khoury, presented with left shoulder and upper-arm discomfort occurring only when dog-walking, as well as continuous left wrist pain associated with prolonged computer use. His past medical history included Type 2 diabetes mellitus, moderate to severe depression, and hypertension. Medications included metformin, glyburide, paroxetine, and enalapril.

Shoulder and Upper Arm Pain

The shoulder ache appeared only during dog-walking and did not worsen with continued walking. It resolved soon after he stopped. He denied chest pain, shortness of breath, jaw pain, palpitations, sweating, or radiation of pain.

Wrist Symptoms

The wrist pain was on the palm side and developed gradually through the workday. He also noticed numbness and tingling in the thumb and index finger, often worse at night. Ibuprofen 400mg offered partial relief.

Lifestyle and Psychosocial Factors

His job required long hours at a computer, and he described himself as “allergic to exercise.” His diet typically included a buttered roll for breakfast, take-out meals for lunch, and frequent sweets at work. Home glucose readings were often 180–200 mg/dL, his fasting glucose was 160 mg/dL, and his A1C was 9.0%. Blood pressure remained below 140/90 on medication. He was hesitant to start insulin despite worsening glucose control.

He lived with his wife but had little social activity, often spending weekends sleeping and staying indoors. Family history included diabetes and prostate cancer in his father, hypertension and stroke in his mother, and macular degeneration in a sibling.

Physical Exam and Vitals BP: 142/86 Pulse: 72 Resp: 16         Temp: 99°F
Height: 5′11.5″      Weight: 190 lb      Waist circumference: 43″

Discussion

This case illustrates the difficulty of assessing arm pain in patients with cardiovascular risk factors. Although left arm pain can signal cardiac ischemia, this patient’s symptoms occurred only during a specific physical activity, resolved quickly afterward, and had no chest or respiratory features. These findings support a musculoskeletal cause rather than a cardiac one.

The wrist pain strongly suggested repetitive-use strain, as it worsened with long computer sessions and improved on non-work days. His poorly controlled diabetes, low physical activity, and depression may have increased his fatigue and anxiety about symptoms. His elevated A1C and dietary habits highlight the need for lifestyle counseling and collaborative diabetes management.

Conclusion

In patients with chronic disease and anxiety about cardiac symptoms, careful characterization of pain patterns is essential. Distinguishing musculoskeletal strain from cardiac etiologies prevents unnecessary alarm. 

Learning Points

• Left arm pain requires thoughtful evaluation, but it is not always heart-related.
• Poor diabetes control and depression may affect symptom perception and lifestyle choices.

References

Morrow D.A. (2022). Chest discomfort. Loscalzo J, & Fauci A, & Kasper D, & Hauser S, & Longo D, & Jameson J(Eds.), Harrison’s Principles of Internal Medicine, 21e. McGraw-Hill Education. https://accessmedicine-mhmedical-com.york.ezproxy.cuny.edu/content.aspx?bookid=3095&sectionid=262789253

Jaffar A (2017). Anatomical structure of the heart. Elmoselhi A(Ed.), Cardiology: An Integrated Approach. McGraw-Hill Education. https://accessmedicine-mhmedical-com.york.ezproxy.cuny.edu/content.aspx?bookid=2224&sectionid=171659604