Dear Ask The Doctor: I hurt my shoulder about a month ago thought to be just a strain. as time goes on the pain persists I have been to the therapist we are working the rotator cuff with light exercise but that is not the problem something is wrong in the ball and socket but I can't get an MRI because of cost to the insurance companies so I am being told. through the exercise and lack of movement the pain subsides but at night in sleep if I roll over on it just wrong we are starting theropy all over again because the pani hurts so much I stop the exercises till the pain goes away. Mark
Dear Mark: There are so many causes of shoulder pain, the most common in all age groups are the lesions of the rotator cuff, they represent a wide array of diseases, from acute reversible tendinitis to massive tears involving the supraspinatus, infraspinatus, and subscapularis, these are the muscles of the rotator cuff. The diagnosis is often made through detailed history and physical examination, and confirm by imaging studies. The imaging studies help to confirm the type of lesion and the term “Labrum Tear”, is a MRI finding. The glenoid labrum provides attachments for the shoulder capsule and tendons and ligaments, giving stability to the shoulder by increasing the glenoid surface. The labrum may be torn with shoulder dislocations, with activities involving overhead arm movements, especially throwing and bowling, these can stress the shoulder excessively and also cause labral injury.
The suggested treatment strategy includes: in the acute phase, pain control and inflammation reduction are initially required to allow progression of healing and initiation of an active rehabilitation program. This can be accomplished with a combination of relative rest, icing (20 min, 3-4 times per day), and anti inflammatory medication (“Aleve”). Have the patient sleep with a pillow between the trunk and arm to decrease tension on the supraspinatus tendon and to prevent blood flow compromise in its watershed region. Patients should continue the pain control techniques at home, work, or vacation as part of their exercise program. The home exercise program builds on itself through each phase of the rehabilitation process, and carry-over should be monitored. Corticosteroids injection locally can be considered to allow further progression of the rehabilitation program. These injections should not be given to patients with complete rotator tears, especially if surgery is being considered.