Most Severe Shoulder Pain Can be Treated

Posted on Wed., Aug. 01, 2007

By Dr. Stephen J. Daniels

"MY SHOULDER keeps me awake all night, doctor," said Tina, with a wince. "I can barely lift my arm. It's been hurting for weeks."

Tina couldn't remember injuring her shoulder, which is common with shoulder pain. Pain at night when lying on the shoulder or turning over is also common, as is the inability to raise the arm above horizontal. Many patients come in because they can no longer raise their arms to comb or brush their hair.

In my practice, shoulder tendonitis (inflamed tendon) is the most common cause of shoulder pain, although arthritis and a rotator cuff tear may also be involved. Often it takes an MRI to determine the cause.

Tendons are the nylon-like bands that connect muscles to bone. Often the tendons, ligaments (nylon-like bands that connect bones to each other) and cartilage (the joint lining) are all inflamed.

Shoulder pain produces a worsening cycle. It hurts to raise the arm, so the person doesn't do it. Without movement, the shoulder becomes stiffer and stiffer, producing more and more pain.

Most shoulder pain can be treated conservatively, without surgery.

The first treatment involves physical therapy. If you don't have access to a professional physical therapist, you can perform some useful therapy at home by gentle "passive" stretching of the shoulder.

Research suggests that gently stretching torn ligaments and tendons can help them heal more effectively. It is important to not use the shoulder muscles to lift the arm when stretching. This hurts, and can lead to greater inflammation. Rather, use other muscles to lift the arm.

One way to stretch the shoulder correctly is to sit in a chair with the painful-side elbow resting on a table. (The table should be to your side, not in front of you.)

Gently slide the elbow on the table away from your body. You'll have to lean sideways toward the table as the elbow slides away. (Put something under the elbow so it will slide easily.)

Slide the elbow out until the shoulder begins to hurt. Hold it in a mildly uncomfortable, but not painful, position for 30 to 40 seconds. Then slide it back.

Repeat this for 15 minutes at least twice a day, trying gradually to extend the elbow further and further, until (after weeks or months) you can lean sideways and touch your ear to the upper arm extended out sideways over the table (elbow bent or straight).

The next effective treatment for shoulder pain is anti-inflammatory medicines, such as Motrin, Advil, Aleve and others available by prescription.

If the pain persists for a month or more, a cortisone injection directly into the joint or around the tendon can be most helpful.

This is relatively painless if the doctor uses a 27-gauge needle (thinner than the customary 25-gauge needle). And, if the doctor injects bupivacaine along with the cortisone, there is rapid pain relief lasting six to eight hours.

Be prepared for greater pain the next day, as the needle and cortisone may irritate the tissues temporarily. But, long-lasting, even permanent, relief usually comes after three to four days. In some cases, periodic or regular use of narcotic pain relievers (codeine, Vicodin, Norco) may be needed.

Shoulder pain that persists despite these treatments may need surgery.

Stephen Daniels practices family medicine at the Pittsburg and Concord Health Centers, part of the county Health Services Department.