Shoulder pain for 7 months

Patient

Q: I have been having shoulder pain for 7 months now after doing a lot of heavy lifting and throwing at my job. I have had cortizone injections which did not help. I ice it often, take pain killers...I have also done 5 months of physical therapy where it started to feel a little better until we added resistance, then it always went back to severely painful and we had to start over. The MRI and arthrogram all came back negative for a tear and now the doctor is saying he just doesn't know what's causing my pain. The pain is mostly in the front and then straight through to the back...sometimes going down my arm a bit. And now it's spreading up into my neck. I am at a loss as to what to do now. The pain never goes away and it worsens with movement. It has completely changed the way I am able to live my life and I am terrified the doctor won't be able to figure out what is wrong. What other ideas do you have? Thank you for your time

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 to the description that you have 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 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) and local corticosteroid injection. The healing time is variable and depends on the severity of the initial injury and each person in particular. I suggest that you continue physical therapy and avoid completely any movement or activities that may cause the pain get worse.Try to 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.

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