Shoulder pain going down the arm getting worse when lying in bed

Dear Ask The Doctor:  Hi can you help me pleasei seen a phsio a week ago who told me i had arthritis of the left shoulder they refered me but in the mean time my doctor sent me for a xray when i phooned they said it was normal the sytoms is very bad pain in shoulder going down my arm its worse when iam in bed

Dear Patient:   There are many causes of shoulder-arm pain as you described it, 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, passing by impingement of the tendon for the surrounding bone structures, to massive tears involving the supraspinatus, infraspinatus, and subscapularis, these are the 3 muscles of the rotator cuff. The diagnosis is often made through detailed history and physical examination, and it might be confirmed by imaging studies (MRI). 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”, “motrin”). It has proven to be helpful 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. You should continue the pain control techniques at home, work, or vacation as part of the 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 might be considered to allow further progression of the rehabilitation program. I do not recommend these injections to patients with complete rotator tears, especially if surgery is being considered.

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