Shoulder pain when reaching behind, stretching all the way, worse at waking up

Dear Ask The Doctor:  I have had pain in my left shoulder for about two months. When I reach behind me or stretch my arm all the way the pain is excrutiating. I don't sleep on that side. When I wake up in the morning it seems to be worse. I don't remember injurying it at all. When I rub my shoulder I can't find an exact spot where the pain so is it must be further inside. What could this be from? I don't know what to do.
 

Dear Patient:  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 drugs (i.e.: “Advil”, “Aleve”). If you show poor or no improvement, then, local corticosteroid injection may be considered.

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