Why does my shoulder hurt?
August 1, 2019 8:43 PM Subscribe
I am having moderate to severe shoulder pain, particularly when I move my arm in a certain way, as described below. Please help me understand what the problem might be, and how to deal with it.
You're statistically unlikely to be my doctor, but let's pretend you are.
I walk into your office and tell you that my right shoulder hurts intermittently. You ask what sort of motion makes the pain worse, so I extend the arm out to my side, parallel to the ground, but with the palm of my hand facing toward you. I then, without bending my elbow, move my arm up and down, grimacing with pain in my shoulder, mostly on the "down" strokes. I then rotate my forearm 90 degrees, so that my palm is facing down, and flap the same arm violently up and down in the same motion, but with no pain whatsoever.
What am I likely dealing with here? Rotator cuff tear? Nerve impingement? Bursitis? Is this kind of thing likely to go away on its own after a while, or do I need to get in to see a doctor soon? I'm in my early 40s, so things don't heal as quickly as they used to.
When I did a search of AskMe, I thought this question might be relevant, since I often sleep in the same position as the poster of that question, with my arm hanging off of the bed. (I know this isn't a great sleeping position, but nothing else is comfortable, and even if I manage to fall asleep in another position, I tend to end up in the "bad" position at some point during the night.) My symptoms are similar, but not the same -- reaching behind my back doesn't bother me.
Assuming this is about my bad sleeping position, what can I do to avoid rolling into that position in my sleep, considering I'm, you know, asleep?
You're statistically unlikely to be my doctor, but let's pretend you are.
I walk into your office and tell you that my right shoulder hurts intermittently. You ask what sort of motion makes the pain worse, so I extend the arm out to my side, parallel to the ground, but with the palm of my hand facing toward you. I then, without bending my elbow, move my arm up and down, grimacing with pain in my shoulder, mostly on the "down" strokes. I then rotate my forearm 90 degrees, so that my palm is facing down, and flap the same arm violently up and down in the same motion, but with no pain whatsoever.
What am I likely dealing with here? Rotator cuff tear? Nerve impingement? Bursitis? Is this kind of thing likely to go away on its own after a while, or do I need to get in to see a doctor soon? I'm in my early 40s, so things don't heal as quickly as they used to.
When I did a search of AskMe, I thought this question might be relevant, since I often sleep in the same position as the poster of that question, with my arm hanging off of the bed. (I know this isn't a great sleeping position, but nothing else is comfortable, and even if I manage to fall asleep in another position, I tend to end up in the "bad" position at some point during the night.) My symptoms are similar, but not the same -- reaching behind my back doesn't bother me.
Assuming this is about my bad sleeping position, what can I do to avoid rolling into that position in my sleep, considering I'm, you know, asleep?
I have a shoulder pain similar to that. And it’s a nerve impingement at the shoulder. I thought it was a rotator cuff injury at first, but it didn’t get better with rest and I had no muscle mobility issues. I went to a doc and PT and they diagnosed it right away as an impingement at the shoulder. Not sure what caused it, I sleep on my side and I work out a lot. But PT helps, specifically strengthening the little muscles everywhere in the shoulder, doing arm and pec stretches, work with the bands like rows, and when my PT works on the shoulder it feels a lot better.
posted by katypickle at 9:09 PM on August 1, 2019 [2 favorites]
posted by katypickle at 9:09 PM on August 1, 2019 [2 favorites]
unfortunately, all the basic upper-extremity movement tests/signs that look fairly simple if you look them up (Neer, Hawkins, etc.) do not reliably produce the same results when you do them on your own as when a doctor or PT manipulates the limb for you, even when it seems like there should be no difference. (There is one where you bend your head to the side while pressing down on the top of your head, and pain in the bendy side of the neck means something bad. It felt completely fine when I did this to myself experimentally, but elicited a textbook sharp pain when a doctor did it to me.) so the sensations you can get when moving under your own power are not as easy to match up to specific issues.
a more reliable source of information can be whether ice or heat make it feel better. for a problem that didn't just start in the last few days, it's probably a good sign if heat helps more. it's not good if what helps keeps changing with no apparent relation to what you do.
if you have a nerve issue, either it will resolve itself with PT or benign neglect or else sooner or later it will progress to an indescribable burning scraping itching sensation. you become inescapably aware that a nerve is basically a long string of pain and some evil toothed creature is gnawing on it. it can take a very long time to get to that point, but on the plus side, once you have that feeling you can't ever mistake it for anything else.
rotator cuff issues/tendinitis are more likely, and may also resolve themselves if you don't aggravate the injury with excessive motion without skilled PT guidance.
I am not a doctor but have had surgery for a full-thickness rotator cuff tear in the last year and also have a pinched nerve or three. so I can tell you that doctors absolutely can mistake symptoms of one for the other, and, if you have more than one issue, be catastrophically wrong about which injury is causing the pain you have and which one requires intervention. if it gets worse, get multiple tests and opinions before believing anybody. however, if someone offers you a steroid injection, I advise saying yes.
posted by queenofbithynia at 11:34 PM on August 1, 2019 [3 favorites]
a more reliable source of information can be whether ice or heat make it feel better. for a problem that didn't just start in the last few days, it's probably a good sign if heat helps more. it's not good if what helps keeps changing with no apparent relation to what you do.
if you have a nerve issue, either it will resolve itself with PT or benign neglect or else sooner or later it will progress to an indescribable burning scraping itching sensation. you become inescapably aware that a nerve is basically a long string of pain and some evil toothed creature is gnawing on it. it can take a very long time to get to that point, but on the plus side, once you have that feeling you can't ever mistake it for anything else.
rotator cuff issues/tendinitis are more likely, and may also resolve themselves if you don't aggravate the injury with excessive motion without skilled PT guidance.
I am not a doctor but have had surgery for a full-thickness rotator cuff tear in the last year and also have a pinched nerve or three. so I can tell you that doctors absolutely can mistake symptoms of one for the other, and, if you have more than one issue, be catastrophically wrong about which injury is causing the pain you have and which one requires intervention. if it gets worse, get multiple tests and opinions before believing anybody. however, if someone offers you a steroid injection, I advise saying yes.
posted by queenofbithynia at 11:34 PM on August 1, 2019 [3 favorites]
Will all the relevant caveats, you may consider looking into trigger points/trigger point therapy. This book helped me a lot.
posted by 2 cats in the yard at 4:45 AM on August 2, 2019 [1 favorite]
posted by 2 cats in the yard at 4:45 AM on August 2, 2019 [1 favorite]
IANYD, IANY, IANYPT but.....you're nearly me, perhaps!
Your profile says you're a software developer, and I am a sysadmin; we both sit in chairs for like forty hours a week.
My shoulder pain got to the point where I asked my PA about it, and he agreed that it was likely a tear in the rotator cuff. The first treatment is physical therapy, though, because the recovery from rotator cuff surgery is like 18 months of PT appointments, according to my therapist! My therapist agreed that I do have a small tear in one of the four ligaments that comprise the "rotator cuff"; I went to weekly appointments with her for a summer to learn strengthening exercises (which I do to this day, largely thanks to a note from dancestoblue), and the pain faded as the shoulder got stronger.
But at least as important as those exercises is my posture. The therapist pointed out that my posture sucks, both sitting and tanding. I have made very conscious efforts to sit up straighter in my chair, and I was very fortunate to come into a different used car (2011 Outback) around this time after I realized that my beater 2005 Camry was forcing me into a really bad position when I drove to work. I also keep a little lumbar pillow in the car now. Sitting up and standing up has really helped!
With the pain much reduced, I continue doing the exercises. If the pain comes back, then they might consider surgery, but the recovery takes for-damn-ever and I really need to consider what quality of life is...which kind of sucks, but it's better than it was.
So got to your doctor to get a note for PT, then go to PT and have your shoulder massaged and to learn the exercises. Do your exercises...AND SIT UP STRAIGHT.
posted by wenestvedt at 5:33 AM on August 2, 2019 [3 favorites]
Your profile says you're a software developer, and I am a sysadmin; we both sit in chairs for like forty hours a week.
My shoulder pain got to the point where I asked my PA about it, and he agreed that it was likely a tear in the rotator cuff. The first treatment is physical therapy, though, because the recovery from rotator cuff surgery is like 18 months of PT appointments, according to my therapist! My therapist agreed that I do have a small tear in one of the four ligaments that comprise the "rotator cuff"; I went to weekly appointments with her for a summer to learn strengthening exercises (which I do to this day, largely thanks to a note from dancestoblue), and the pain faded as the shoulder got stronger.
But at least as important as those exercises is my posture. The therapist pointed out that my posture sucks, both sitting and tanding. I have made very conscious efforts to sit up straighter in my chair, and I was very fortunate to come into a different used car (2011 Outback) around this time after I realized that my beater 2005 Camry was forcing me into a really bad position when I drove to work. I also keep a little lumbar pillow in the car now. Sitting up and standing up has really helped!
With the pain much reduced, I continue doing the exercises. If the pain comes back, then they might consider surgery, but the recovery takes for-damn-ever and I really need to consider what quality of life is...which kind of sucks, but it's better than it was.
So got to your doctor to get a note for PT, then go to PT and have your shoulder massaged and to learn the exercises. Do your exercises...AND SIT UP STRAIGHT.
posted by wenestvedt at 5:33 AM on August 2, 2019 [3 favorites]
I had the similar but opposite (palm down was extremely painful, palm up was stiff but manageable) and the diagnosis was bursitis. I went to a bunch of PT sessions (weights and stretching exercises + ultrasound therapy) which weren't entirely successful, so then I got a cortisone injection into my shoulder which hurt like hell but was a magic bullet.
Other things to consider: do you use a messenger bag or backpack on one shoulder? That became a no-no for me in maintaining better shoulder health since that incident.
posted by TwoStride at 5:38 AM on August 2, 2019 [2 favorites]
Other things to consider: do you use a messenger bag or backpack on one shoulder? That became a no-no for me in maintaining better shoulder health since that incident.
posted by TwoStride at 5:38 AM on August 2, 2019 [2 favorites]
I also have had similar issues and it was impingement. For me, the number one cause was sleeping on my side. I have been trying to train myself to sleep in a different position (not totally on my back, but not putting all my weight on my shoulder). I also don't lay on the couch leaning on my arm or shoulder. Stretching and exercises help, but I only do them after the pain subsides as a preventative measure.
posted by jraz at 5:56 AM on August 2, 2019 [2 favorites]
posted by jraz at 5:56 AM on August 2, 2019 [2 favorites]
I had a similar issue and the problem was a serious muscle imbalance between my left and right sides. I went for a number of sessions of PT where they gave my some basic exercises to strengthen my left side, and I continued on from there. It would come back if I lapsed in my exercises but it's pretty much gone now that I've been going to the gym regularly and have balanced everything out pretty much.
posted by thebots at 7:24 AM on August 2, 2019 [2 favorites]
posted by thebots at 7:24 AM on August 2, 2019 [2 favorites]
When I had similar pain I was diagnosed with frozen shoulder. A steroid injection helped quite a bit.
posted by Clustercuss at 8:56 AM on August 2, 2019 [1 favorite]
posted by Clustercuss at 8:56 AM on August 2, 2019 [1 favorite]
I was recently diagnosed with impingement. My symptoms are/were most pronounced when I try to reach behind me. (And taking off a t-shirt became torture.) I am also a side sleeper. The physical therapist gave me exercises and they seem to be helping, but honestly, I haven't been sleeping in my bed much due to travel and I wonder if that's part of it too.
posted by roger ackroyd at 9:07 AM on August 2, 2019 [1 favorite]
posted by roger ackroyd at 9:07 AM on August 2, 2019 [1 favorite]
I had a similar problem. After several physical therapy sessions, it became clear that they were doing trial and error and my shoulder injury was getting much worse. Went to a sports medicine doctor, who used an ultrasound to diagnose bursitis in about five minutes, and assigned appropriate exercises. Months later, it is slowly improving.
posted by qxntpqbbbqxl at 5:19 PM on August 2, 2019 [1 favorite]
posted by qxntpqbbbqxl at 5:19 PM on August 2, 2019 [1 favorite]
Symptoms suggest tendonitis, probably of the calcific variety.
Some past damage, normal (non-injury exercise related) or traumatic injury can trigger the formation of scar tissue. The phenomenon may arise months or even years after the initial insult.
Sometimes the scar cells mess up and accumulate too much calcium and have to deal with it somehow and it manifests as crusty calcific buildups.
The diagnosis is simple, fast, and non-invasive: surface ultrasound scan. Takes a few minutes (plus a few to scan the other shoulder as a negative control).
The prescription is usually "physiotherapy" - but my experience is that it's pretty much useless other than learning compensatory or alternate routines. In severe cases there are surgical options, but when it's that bad the damage is already done and if it wasn't too bad, there's too much risk of damaging healthy tissue.
It sucks, but can wax and wane in intensity, and one gets used to such things as we age and try to compensate.
posted by porpoise at 9:51 PM on August 2, 2019 [2 favorites]
Some past damage, normal (non-injury exercise related) or traumatic injury can trigger the formation of scar tissue. The phenomenon may arise months or even years after the initial insult.
Sometimes the scar cells mess up and accumulate too much calcium and have to deal with it somehow and it manifests as crusty calcific buildups.
The diagnosis is simple, fast, and non-invasive: surface ultrasound scan. Takes a few minutes (plus a few to scan the other shoulder as a negative control).
The prescription is usually "physiotherapy" - but my experience is that it's pretty much useless other than learning compensatory or alternate routines. In severe cases there are surgical options, but when it's that bad the damage is already done and if it wasn't too bad, there's too much risk of damaging healthy tissue.
It sucks, but can wax and wane in intensity, and one gets used to such things as we age and try to compensate.
posted by porpoise at 9:51 PM on August 2, 2019 [2 favorites]
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