Dear Ask The Doctor: About a week and a half ago, i was getting pain in my upper right arm. It felt like i pulled a muscle? I didn't feel any bones or any lumps. I started to apply ice packs to ease the pain. This was on a Saturday, Monday of last week, i was able to move my right arm in all positions as it felt like it healed. Tuesday of last week, i decided to take a bath. Once i got into my tub, i felt a shooting pain hit from the palm of my right hand directly up to my upper arm. At that point, it felt more worst than what i felt over the weekend. I was so much in pain i could barely move my arm. I ended up going to umc quick care in Las Vegas, where i reside. i met with the doctor, told the doctor what i was feeling, he took my arm and tried bending it and moving it in positions where it was hurting and where i felt like tightening my muscle to not move. The doctor came up with a diagnosis that i have a tendinitis strain. He told me it will heal in time? (wasn't very specific) gave me a prescription for 3 medicines to ease the pain, Tramadol (to reduce the pain, cyclobenzaprine (to ease the pain and stiffness) and naproxen (to reduce the pain). I started using the medicine last Tuesday night. The doctor also told other than taking the 3 medications, is to apply moist heat on my upper arm where the tendon tissue is causing the whole ordeal. I asked him, should i continue with ice packs or ice in a bag? He said no, either get a heating pad where you can apply water on (moist heat, as he was recommending) , or get a wash cloth have it soak in hot water then place that on upper arm or soak arm in the tub with hot water. It has now been 7 days, the medicine has helped vaguely, i don't get much pain, i can move my arm in some positions, but not all, as i feel pinches and pain if not tightness in certain areas of my upper arm. I have been using a heat pad, but it feels like it is not doing what it supposedly doing? So my questions out of what i said are they true? Should i continue using the heat pad? After 7 days, why hasn't the medicine such as the cyclobenzaprine reduce the stiffness of my tendon? The doctor that I saw 7 days ago, do you think he recommended the proper medication, and treatment such as no ice, use heat to reduce the swelling? Since it has been 7 days, and not much has improved what is you recommendation on getting rid of this tendinitis strain? If it is this that I have?
Dear JASON: There are several causes of arm-shoulder pain; one of the most common is the Rotator Cuff tendinitis and this seems to correspond with the description that you made of your pain. The rotator cuff is a group of tendons that support the shoulder. These tendons can be injured during weight lifting, when playing sports with a lot of throwing, after repetitive use over a long time or suffer degenerative changes with the aging process. Typically, presents with an activity related dull ache in the upper outer arm and shoulder. Activity is commonly more difficult and painful above the shoulder level (more than 90 degrees). There is little or no discomfort with below-shoulder-level activities (less than 90 degrees) such as golf, bowling, gardening, writing, or typing. But, tennis, baseball/softball, basketball, swimming, and painting are more problematic and painful. Conservative treatment of the Rotator Cuff tendonitis involves: physical therapy to control pain and keep range of motion of the shoulder, avoidance of painful movements and activities; anti-inflammatory medication (i.e.: “Advil”, “Aleve”). Try to be patient, you are receiving the right treatment; continue the moist and warm compresses, the time for ice is the first 24-36 hours no later, keep taking the anti inflammatory medication and above all avoid extreme or painful movements. If with time you show poor or no improvement, then, local corticosteroid injection may be considered.