Shoulder Syndrome - A Pain in the …

'Doc, I just can't stand it anymore! I've tried everything but now it's so bad I can't even sleep.' The subject, not surprisingly is pain.

But what kind of pain makes you feel like that? On the top of the list is - from a musculoskeletal point of view - back pain and all its nasty cousins. Next in line is shoulder pain.

For anyone who hasn't suffered from this remarkably debilitating disorder, it's hard to grasp how troubling it can be. Nearly everyone has had back problems, for instance, and nearly everyone understands how people can be really 'laid up' when back pain acts up. But shoulder pain?

Amazingly, the first two sentences above are the most common presenting complaints I hear from people grinding it out with shoulder pain.

This pain is not the sort that's associated with acute trauma - like tumbling off your ATV, or dislocating your shoulder in a wrestling tournament, or having your arm yanked sideways and backwards from a water-ski rope [actual injury stories]. This is nagging pain, night after night.

Of course, there IS often some kind of injury story from the past, but it certainly doesn't come readily to mind. Most patients say that they have no idea what or how is causing their pain.

Careful review almost always elicits the clue. It might be something as simple as the repetitive reaching for a book or notepad near a telephone, or reaching back in the car to retrieve some item annoyingly clutched between the seat cushions, or stopping an infant from falling out of a high chair, or … a bad golf swing. The variety is endless. The pain isn't. It's consistent, and a drag.

WHAT'S THE CAUSE?

Rotator Cuff Syndrome: stretch, strain and/or partial tears of the muscle- tendons deep in the shoulder. To simplify, these are the muscle-tendons that connect the arm bone to the shoulder bone. They control fine motions associated with moving your arm in all its complicated directions [think baseball pitcher]. There are lots of pain fibers embedded in the rotator cuff and they let you know when they're irritated.

You may not notice when you first annoy your rotator cuff, as in the examples above, but once the pain starts, the most likely next thing is that you stop using your arm. That makes a lot of sense, but it only makes things worse, because not using your shoulder/arm for very long – meaning a couple of weeks or so - can lead to 'frozen shoulder syndrome', which is just more pain. Ever notice how you ache after a really long car or plane ride? That's pain associated with disuse. ARRRRGGGH! What to do?

WHAT YOU CAN DO FOR RELIEF

Try heat, capsaizin creams, hot water towels, sleeping with a pillow under your arm, and over-the-counter analgesics that are safe for you. Most people have already done all of these before they come to me. It's not that these things are wrong or bad - they're just insufficient. So try adding these simple, gentle, isometric and flexibility exercises [see diagrams].

1. The side press - Stand sideways near a wall with arms hanging down by your side. With your involved arm [the one that's bugging you] press the back of your hand out against the wall. Your arm should make about a 30-40 degree angle with your body. Hold this position with constant tension for 10-15 seconds.

2. The 'V' Press - Stand with your back flat against a wall. The goal in this one is to have your arms outstretched, palms FORWARD, making a 'V'. This one uses more of the muscles of the rotator cuff and it make take some time - meaning days to weeks - to get your arms in a full 'V'. But the point is to start at the range you can manage and then build from there. Hold this position with constant tension for 10-15 seconds.

3. The 'Hang Stretch' - This is best performed with something that loops around your wrist - in the manner of a dog leash - and is suspended from overhead. You could use an accessible tree limb in your back yard, a rafter in the garage, monkey bars, or anything that allows you to suspend a rope or strap over it. The goal is to be able to have both arms extend straight up and overhead so that your arms are very close to your ears. THAT is full range of normal motion! Hold this position with constant tension for 10-15 seconds.

HOW HARD, HOW OFTEN?

All of these exercises should be done at the position you can tolerate with a LITTLE ache. That's OK. Do not push to the point of pain. That's not OK. It's not the amount of force you generate that's important, just activating the system that promotes rehabilitation.

Repetition is vital. Muscle-tendon units respond best to low stretch-strain that's constantly repeated. This understanding is at the core of why patients are placed in 'continuous passive motion' machines after many kinds of joint surgery.

How repetitive? Make the goal to do these 3 exercises one time for every hour of your day. That's right. Once per hour.

WHAT ABOUT SURGERY?

Surgery is likely the best [or only] approach to traumatic or acute injuries of the shoulder. True impingement of a part of the shoulder blade [the acromion] on the movement of the arm also responds well to a fairly simple procedure of shaving the end of this bone.

However, a lot and perhaps most chronic shoulder pain will respond to these exercises and to well placed injections. The injections are supposed to cure the problem, but they can definitely calm things down [like pain] so you can get started on your rehab.

SPORTS MED, PHYSICAL MED OR ORTHO?

These are the docs most likely to have lots of experience in managing shoulder problems. Patient - meaning person to person - reference may be the best.