Pain in the shoulder with arm extension above 90 degrees

Patient

Q: When I extend my right arm I have pain right above the bicept. My massage therapist told me it was the deltoid muscle. I have been doing physical therepy exercises that I found on the Internet. This started in January, and is getting worse, not better. I am not doing any excercises that hurt. If it hurts, I don't do it. Sometimes I reach up and the pain is quite severe. Massage is not helping. I live overseas, and in January I returned from the holidays and had to drag my suitcases up four flights of stairs. Question, if I have pulled the deltoid muscle, is there anything I can do? I do NOT want surgery.

Doctor

A:    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 simply suffer degenerative changes with the aging process. Typically, presents with an activity or not 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 medication (i.e.: “Advil”, “Aleve”). If there is  poor or no improvement, then, local corticosteroid injection may be considered.

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