shoulder bursitis and chest pain

[paininchest]

Hi all, I am hoping to find a professional or someone who has had experience with this - My shoulder has hurt since car accident 4 yrs ago. Have done tons of PT, deep tissue massage, cortisone injection, trigger point injections and nerve block. MRI of brachial plexus a few years ago showed multiple lymph nodes. A more recent MRI of shoulder shows bursitis and some small amount of fraying.
I have almost constant shoulder pain but pretty much full ROM - I also have chest pain in the armpit area and to the side and under my breast. it is often a dull pain but occasionally gets worse and is sharp pain making me sit down for a moment. it seems to get better if I put pressure on the area.
I have discussed arthroscopic surgery with both my primary and orthopedic and cardiologist. The ortho was hesitant to do surgery as he said it doesn't always help - about 80% of times it does.
Yesterday, I went to ER due to the pain in side of chest - my labs were ok except for my LDH level which was 259 (normal is 65-190). They were going to keep me overnight for observation but since the labs (I didn't know about LDH elevation at the time), EKG, and chest xray were ok, I went home.

What I am wondering, is could the LDH be up because of the muscle tissue injury? Has anyone heard of such chest area pain with a shoulder injury? even if the shoulder has full rom? I am willing to try the surgery, just concerns me that ortho wasn't ready to dive into it - though I know that is good that he is not knife happy. I am wondering what the odds are that the shoulder is the true cause of the chest pain.

Thanks for any advice!

[Dr Vinod]

LDH-1  - in the heart
LDH-2  - in the reticuloendothelial system
LDH-3  - in the lungs
LDH-4  - in the kidneys
LDH-5  - in the liver and striated muscle

A LDH-1 level higher than the LDH-2 level (a "flipped pattern"), suggests myocardial infarction (damage to heart tissues releases heart LDH, which is rich in LDH-1, into the bloodstream.

The use of this phenomenon to diagnose infarction has been largely superseded by the use of Troponin I or T measurement. So we would advice you to go for testing of other indicators for Myocardial Infarction diagnosis. (Eg Troponin & CPK)

LDH IU/L 240 – 480 . It depends from laboratory to laboratory and you have to check your report for normal range and correlate with your physician.

Take care!

[paininchest]

Thank you for your response. I will be seeing my cardiologist tomorrow. I am still slightly confused - am I correct then that an overall elevated LDH indicates only tissue breakdown, but not specifically which tissue(s) - unless they test for LDH1, LDH2, etc...?

How high is 259? moderate? mild?

And, if in my case the increased LDH level does not indicate myocardial infarction, could it indicate damage to the shoulder's skeletal tissue / muscle? or is it more serious damage which it indicates?
Thanks

[Dr Vinod]

Tissue breakdown elevates levels of LDH, and therefore a measure of it indicates e.g. hemolysis.

In medicine, LDH is often used as a marker of tissue breakdown as LDH is abundant in red blood cells and can function as a marker for hemolysis. A blood sample that has been handled incorrectly can show false-positively high levels of LDH due to erythrocyte damage.

It can also be used as a marker of myocardial infarction. Following a myocardial infarction, levels of LDH peak at 3-4 days and remain elevated for up to 10 days. In this way, elevated levels of LDH (where the level of LDH2 is higher than that of LDH1) can be useful for determining if a patient has had a myocardial infarction if they come to doctors several days after an episode of chest pain.

Check it with your Cartdiologist for the reason of increase in LDH.

You always have a choice of second opinion and consult an Orthopaedician who specialises in shoulder surgery.

Take care!