Dear Ask The Doctor: I am a 22 year old man and i have day to day pain in the right shoulder. When i was 13 i dislocated it and then i did it again at 16. It feels like a constant throbbing pain. When i move it in different ways it also feels like something is grinding against eachother. My entire right arm will go tingly about every 5 days as well. What do you think is wrong with it?
Dear Sean: 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 that you might have . In persons like you that have previous history of dislocation the glenoid labrum may be affected , this is a structure that 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”). You can 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 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.