Shoulder pain of 9 months.

Patient: About 9 months ago I started suddenly getting sharp pain down my left arm when I moved my arm outward or backward. When this did not go away, I went for physio and had about 4 months of treatment, mostly to free up the muscles in the shoulder area. This eased the pain a lot and it is now much milder and far less restrictive, but it has not gone away and gets worse with cold air. What else can I try?

Doctor: There are so many causes of shoulder pain, the most common in all age groups are the lesions of the rotator cuff, they r epresent 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 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.