Q: I’ve had pain in my right arm/shoulder for 20 months now. After four weeks of physical therapy, my arm got worse. I went to an orthopedic doctor seven months ago and had an MRI that showed a little wear and tear and some inflammation. He said I may need surgery in the future but this usually gets better on its own. I know two other ladies that had the same thing and their shoulders did get better in 12 to 18 months.
I don’t have full movements in my arm but now my left arm is beginning to hurt a little, like my right arm did in the beginning stage. I’m afraid I’m getting it in the other arm now. I don’t use my arms in ways that would cause this problem, so do you have any idea why I have the problem and what the best treatment for it might be?
A: A shoulder is made up of three bones – the humerus, scapula and clavicle. Our arms are kept in their shoulder sockets by a rotator cuff. Muscles and tendons form a protective covering around the head of the humerus, attaching it to the shoulder blade. A lubricating sac known as a bursa allows your tendons to glide easily when you move your arm. As a person raises his or her arm, the space around the rotator cuff narrows. When tendons become damaged or irritated or the bursa becomes inflamed, pain, impingement and loss of motion results. Tennis players, swimmers, carpenters swinging a hammer all day, those who sustain an injury and individuals who repeatedly raise their arms over their heads are particularly susceptible. Symptoms may be mild at first but can exacerbate to being more intense. Full extension of the arm is either impossible or simply hurts too much to accomplish. The pain may radiate to the side of the arm.
Diagnosis is made through patient history presented to a physician or orthopedic specialist and evaluation of the range of motion allowed without the patient experiencing pain. Because a regular X-ray will not reveal soft tissues, appropriate testing will likely, as you discovered, include an MRI that may indicate inflammation and any fluid buildup or something more serious.
Treatment is geared toward reducing pain and increasing range of motion. Rest, the use of a sling and abstaining from any known triggers is critical. Over-the-counter anti-inflammatories and physical therapy are common. When this fails to provide relief, injected steroids, an arthroscopic approach or acrominoplasty might follow. To my way of thinking, an open surgical procedure would be a last resort because the shoulder impingement should heal on its own. Once the pain has subsided – which may take several months – gentle exercises to re-strengthen muscles and tendons will follow but this should only be accomplished under the guidance of your physician or a trained health care professional.
Adhesive capsulitis (frozen shoulder) is yet another possibility. This occurs when the shoulder’s joint capsule becomes inflamed and the shoulder bones can no longer move freely within the joint. This often results from injury, but may be connected to mastectomy, hyperthyroidism, cervical disc disease, and more. It can also present without any knowledge of why it occurred. The condition is more common in women between the ages of 40 and 70 more so than in men.
Again, diagnosis is made by a physician taking a history and determining the loss of shoulder movement. Treatment follows along the lines of that for impingement. Even if you failed to visit a health care professional, the condition should improve on its own as long as you don’t continue to further irritate the joint. Physical therapy will not prevent recurrence but it can be helpful because it may assist the patient with maintaining his or her full range of motion once the inflammation has subsided. On the downside, it may take up to two years to completely heal.
Whatever your diagnosis, you may choose to use NSAIDs and apply heat now and then. Resting the shoulder is controversial because it may lead to more loss of range of motion. Speak with your orthopedic specialist about the lack of success you had with your initial physical therapy to determine if another round in a different facility might be beneficial. If done properly, you should not have experienced more pain than when you began. Then, if all is said and done and you are still in pain, surgery may be appropriate but only you and your doctor can determine when your quality of life is so compromised that this would be the right choice. Good luck.
