Post Traumatic Rotator Cuff Injury in a middle age man.
Patient : Dear Doctor: I fell off my bicycle about a year ago and chicken winged my shoulder. I went to the emergency room and they x-rayed it and there was no structural damage. It felt like it was going to pop out of joint when holding arm out to side. Imagine putting arm out to left to brace a fall and that is where the problem was. It seemed to slowly heal and I started working out. I could do bench press as long as my arms were tucked into side. I stopped working out due to laziness and now three months later I have a clicking in the front of my shoulder about inch and a half down from the pointed bone on top of shoulder. down about an inch from the collarbone where it joins. Simple things like opening a bottle with a bottle opener when I move my wrist in a downward way to exert pressure, I feel it pop a little and it's like it grates against a bone and there is short pain and it goes away immediately. Imagine I am at my desk (Computer) and I have my elbow on the best with my phone in my ear. I then move my body a little bit with my elbow on the desk and I feel a twinge and the same clicking. I was thinking of getting like 2 pound weights and doing careful shoulder exercises. I can do this if I hold my right hand on the offending area for support and there is no pain. If I do not support it, I can only imagine what might happen. I have no insurance so I am reluctant to go for help. There is no pain when walking around normally. Just when I move it the wrong way I know it's hard to diagnose something but my guess is the ligaments grating against the bone and is also a little loose in there. It feels weird when doing slow windmill exercise. Could it be the rotator cuff. I can hold my arm out to side at 90 degree angle but If I am resting upright in bed with my hand behind my head, it also hurts sometimes when taking my hand away from the back of my head to put by my side. Thanks and sorry for the long winded question
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 glenoid labrum provides attachments for the shoulder capsule and tendons and ligaments, giving stability to the shoulder by increasing the glenoid surface. The labrum and the rotator cuff tendons might be torn with shoulder dislocations, with activities involving overhead arm movements, especially throwing and bowling, or as you described the fall from your bike with the arm extended, these can stress the shoulder excessively causing tendon or 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”). Have the patient 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. Patients should continue the pain control techniques at home, work, or vacation as part of their 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.
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