Shoulder pain for 5 years and getting worse

Patient

Q: I have had shoulder pain for the past 5 years, gradually getting worse...its now at the point where I have very limited movement and if I move it the wrong way I almost faint from the excruciating pain. More often than not I have pain down my arm as well which is severe at night and I cannot sleep on the side. It is so bad I cannot scratch my back, take off my bar or lift off a top over my head. What could it be?

Doctor

A:    There are 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, and these are the muscles of the rotator cuff. This type of lesion may become chronic, as in your case. 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 suffer degenerative changes with the aging process.Typically, presents with an activity 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. 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. It is strongly recommended 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 if there is no significant improvement after follow the conservative treatment.

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