What Ails You: Don't wait on shoulder pain help
The shoulder is the most mobile joint in the body.
The round head of the humerus (the upper arm bone) is held in place against the relatively flat “socket” of the scapula by multiple muscles that attach all around the humeral head. Four of these muscles form what is commonly called the rotator cuff. While the front of the shoulder joint is held stable by a complex series of ligaments and tendons, the back of the shoulder is largely controlled by the rotator cuff.
The rotator cuff can be injured relatively easily. While it can be injured in a severe trauma like a hard fall or having a heavy load shift while you are carrying it, it can simply deteriorate over time and, finally, can be injured by something seemingly innocuous like rolling over in bed. Injuries to the rotator cuff can involve a relatively simple and easy to treat tendonitis or can involve complex tears that require surgery to repair.
Variations in the shape of the shoulder joint can cause narrowing of the space between the bridge of bone at the top of the shoulder (the AC joint) and the humerus which can trap the delicate tendon of the supraspinatus muscle. When this happens, you may develop a “painful arc,” you have “pinching” pain in the side of your shoulder when you try to raise your arm overhead especially when it is near shoulder level. With this impingement syndrome, you can get your arm above the pain. While it is painful at or near shoulder level, you have less pain or even no pain when the arm is completely overhead. You may have, but don’t necessarily have, a tear of the muscle causing impingement syndrome. You may be able to escape surgery through physical therapy.
Because small tears in the rotator cuff allow you to maintain quite a bit of function, you are likely to put off getting the care you need. We call these tears “chronic” tears because they occur and persist over very long periods of time. Chronic tears often happen in the dominant arm affecting primarily men over the age of 40. Pain is often worst at night and patients often complain of being unable to sleep. The arm is gradually getting weaker and the pain is getting worse. You are able to use the arm for most activities so long as you keep it below shoulder level and don’t try to raise it high up and in front or out to the side. You’ve probably had the condition for six months or more before you are finally compelled by pain and dysfunction to go to the doctor.
A more significant injury like a fall or heavy lifting can result in an acute tear of the rotator cuff. You will notice that your arm is immediately unusable after the incident. You can no longer lift the arm overhead. If the tear is complete (the muscle and the tendon are completely separated) you may wonder that you have relatively little pain. If, on the other hand, the tendon is badly torn, but not completely ruptured, the pain can be quite severe and becomes even more intense when you try to use the shoulder. If you are under 30, it took one heck of a wallop to injure the cuff. On the other hand, if you are over 50, it may not have taken much force at all.
As we get older, the rotator cuff tends to thin and deteriorate. Overuse can cause tendonitis in the delicate tissues of the cuff. It is no coincidence that the change of seasons with the accompanying flurry of household chores and yard work often bring an influx of patients with tendonitis in the rotator cuff into my clinic. Tendinitis is more common among women 35-50 and is felt as a deep ache at the outside of the upper arm. You can put your finger right on the spot that hurts and it is often out to the side of the arm. You do pretty well with light household tasks, but as the day wears on, as you try to do more and more, the pain intensifies until finally you must stop. By then it is hard to get away from the pain. Tendinitis can become a serious injury if left untreated and can evolve into a chronic tear.
I would be remiss if I didn’t point out the connection between shoulder pain and heart attack. Rotator cuff pain is brought on or worsened by movement. Conversely, if you stop the offending movement, the pain will lessen or completely resolve. If you are having shoulder pain that is unrelenting regardless of movement, you need to call the doctor immediately.
If you have experienced severe trauma and there is an abrupt change in your ability to move your shoulder, you need immediate care. Do not wait hoping that it will bet better.
If you have missed work because of your shoulder pain or if you are unable to reach a shoulder height shelf or cabinet, you need to call the doctor. You must also call the doctor if you find yourself moderating your activities because of pain. Are you declining an invitation to play a game of ball with the guys because of your shoulder pain? Get on the phone and make an appointment now.
Rotator cuff injuries are highly treatable. Physical therapy can, many times, save you having surgery all together. After you have surgery, physical therapy can help you regain all the use of the arm that you can.
ABOUT THE WRITER:
Jackie Randa is a physical therapist who owns Back on Track in Barstow. She can be contacted at jranda@aol.com
