Dear Ask The Doctor: About twelve years ago I worked for moving company. After awhile a pain devoloped in my shoulder. There was a dull ache in my right arm and when I raised my arm to ninety degrees, particulalry to the right, the was a sharp pain in my shoulder. There was no obvious inury accompanied by the onset of this pain and it subsided after a few months. The past two weeks this pain has returned. This morning I woke up with a sharp pain in my wrist as well. It feels like a bad sprain but again there was no obvious injury. It particularly hurts when I put pressure on it and seems to have gotten worse since this morning. Any idea what this may be? Thank you.
Dear R.: Amonst the 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.
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.