Shoulder problems resulted in 1.6 million emergency visits in 2006, the last year with complete statistics. How many of those visits and the subsequent visits to the care provider could have been prevented, is unknown. Hopefully, a more informed person with a shoulder problem could self-treat and eliminate the need for some of those visits. I will go through the common causes and the relatively easy solutions, followed by what to look for that might point to a more serious problem that would require professional help.
The most common problem that most people are able to self-diagnosis is the simple muscle sprain. Weekend athletes are commonly the injured party and they know that in a few days of TLC (tender loving care) is all that is needed. The trouble begins when there is no obvious injury and the shoulder begins to hurt. This is the type of shoulder problem that I see most commonly. Repetitive activities with the arms extended, eg., window washing may not be felt as an injury, but a tendinitis is frequently the end result. When an obvious cause is not forthcoming the patient becomes worried that something serious is occurring. Generally this is a tendinitis and rest of the extremity (this does not mean a sling usually), cold compresses or low heat pad settings along with an over-the-counter anti-inflammatory is the initial treatment. It frequently comes on as the person awakens and hurts at rest as well as while being used, though using it aggravates the discomfort even more. It presents in the front and top of shoulder and can even refer discomfort down to approximately half way to the elbow. Caught early and treated aggressively with OTC anti-inflammatories and daily range-of-motion (ROMs) exercises, these modalities will usually resolve the problem within a week. ROMs are necessary for a few minutes a day to lower the likelihood of a frozen shoulder. That discussion will be later in the post. Throughout these articles my common theme when it comes to taking OTC anti-inflammatories is this: I recommend aleve over ibuprofen due to the amount necessary to resolve inflammatory problems like tendinitis. The amount required is more than the label will recommend. The OTCs’s recommendations are based on what it takes for temporary relief of pain, not the resolution of inflammation. That takes more and with aleve 2 tablets 3 times a day with meals is the appropriate dose. With ibuprofen it is 12-16 tablets divided into 4 doses with food. At this dose unacceptable side-effects, besides stomach irritation, can occur and ringing in the ears is possible and that may be permanent. The 6 aleve though not without similar side effects are not as likely to be permanent and the 6 aleve is not as close to its toxic dose as 12-16 ibuprofen is. Whatever you choose, it needs to be taken routinely until the pain has resolved. Think of inflammation as a fire and you will more likely take the medication correctly. Of course, if active intestinal bleeding or active ulcer disease is present, then one should not be taking any anti-inflammatory with the possible exception of Celebrex, but this requires a care provider seeing, diagnosing and determining if anti-inflammatories are appropriate before the Celebrex can be prescribed and it may require special reports to be filled out by your care provider to have the insurance company accept its need.
More serious problems that will likely require the expertise of an orthopedist is a long lasting pain problem that started with a defined injury. It is significant if a pop and the sudden loss of ability to lift the arm occurs. Again, if the pain is in immediate area of the shoulder, again usually anterior, this may be a injury to the rotator cuff, the conjoined tendon from four different shoulder muscles that are responsible for all shoulder motion and this requires the orthopedist’s expertise.
If there is any associated numbness or tingling into the arm below the elbow and especially into the hand, this implies a problem with the nerves coming out of the neck and again an expert evaluation is required.
A less common, but equally devastating problem is frozen shoulder/adhesive capsulitis (our term). Usually it starts as a tendinitis, but instead of a return to normal after a short time, a stiffness sets in the shoulder and there is a progressive loss of motion and as one tries to move the shoulder more pain ensues and less motion is the conscious result by the patient to reduce the pain, thus more adhesions and resultant stiffness. Though unknown as to why, diabetics are particularly prone to this malady. This requires an accurate diagnosis by usually the orthopedist and an aggressive physical therapist and the patient’s knowledge that this is one of those problems that fit into the old adage “no pain no gain”.
An uncommon cause of referred pain to the shoulder, besides neck problems, which can directly effect the shoulder by disrupting the appropriate nerve impulses, is gall bladder disease. This can cause shoulder pain, but it has no effect on the use or strength of the shoulder and acts as a dull ache in the right shoulder only. If you can move the uncomfortable right shoulder without adverse effect and especially if you should have abdominal problems at the same time, then the gall bladder needs to be evaluated. The left shoulder can’t be involved due to the position of the gall bladder on the right side of the upper abdomen under the liver.
For more information about shoulder exercises you can do at home, view this post.
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