Keith Roach, M.D., syndicated columnist

Dear Dr. Roach: I am an 86 year old woman in good health, and I run and walk regularly. I was having intense pain in the area of my right shoulder as well as down my arm on and off.

I sent a note to my doctor and said I thought I had bursitis. He told me to take Mobic, but the pain continued on and off for more than a month after the Mobic wore off. So I looked for information on bursitis and found that my symptoms did not match bursitis’ usual symptoms.

I also have piriformis syndrome and spinal curvatures. With that diagnosis, it took over 30 years to figure that out, but I now have stretches I do to keep it under control. I am wondering if this is a similar situation and if there are stretches that I can do to eliminate the pain. My granddaughter, who is a nurse practitioner, suggested that I see an orthopedic physician. — G.M.H.

ANSWER: It is not always easy to diagnose the cause of pain in the area of the neck and shoulder, because very different conditions may have a similar presentation. Experienced clinicians can often make a reliable diagnosis by physical exam.

Your analogy of piriformis syndrome is apt. Pain in the hip and leg can come from the hip (like with piriformis syndrome) or from the spine. An exam done by an expert helps make the diagnosis. However, even an expert recognizes that sometimes a presumed diagnosis may be incorrect, and when a person doesn’t get better with their treatment, it is time to reconsider the diagnosis and possibly get more information.

Pain in the neck and shoulder radiating down the neck causes more concern for compression of a nerve in the neck than bursitis. It may be appropriate to get imaging of the neck or shoulder.

General physicians have a great deal of knowledge, but it tends to be over a broad range of conditions. We don’t usually know as much as the expert in the field. An orthopedic surgeon is a reasonable choice, as is a physical medicine doctor (physiatrist).