Severe and sudden right shoulder pain that worsens at night: Possible Rotator Cuff Impingement

Patient: I woke up the day after Christmas and got up with my right shoulder stiff and in severe pain. I could not move it. I thought I’d slept on it too long or something and it would resolve in a day or so. It did not. It lasted till January 3rd and got better with taking Aleve. There was no precipitating injury. On January 10th the pain came back, again no injury, and is 75% worse now than at first. It is affecting my work as a Medical Transcriptionist and I am having nighttime pain. Aleve is no longer helping the pain. I have no insurance, can I do anything else? What might this be?

Doctor: One of the most common causes of shoulder pain is the Rotator Cuff tendinitis due to acute trauma or impingement, this last one 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, even daily living activities that involve  repetitive use over a period of time or suffer degenerative changes with the aging process. Typically, the pain worsens at night, a dull ache in the upper outer arm and shoulder, it results from mechanical impingement of the rotator cuff tendon beneath the anteroinferior portion of the acromion (one of the bones of the shoulder joint), causing changes in the distal part of the rotator cuff tendon, which is at risk due to poor blood supply. 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 you show poor or no improvement, then, local corticosteroid injection may be considered.