PainFilter

July 6, 2008 6:04 PM

What have I hurt in my shoulder/arm, and what should I do about it?

I know there are a lot of "shoulder pain" questions on AskMe, and most of them refer to rotator cuff injuries. I'm not sure that's what I have.

On Saturday I did a fair amount of heavy lifting (boxes filled with books). On Sunday the pain in my left arm and shoulder became apparent. I am able to raise my left arm in front of me, to my left, and across my body. I can't move my left arm back behind me and raise it without causing pain, and I can't "pull up" from my side with the left arm without causing pain. "Pulling down" motions also hurt. Moving the left arm from the elbow downwards does not cause any pain.

In terms of everyday activity, I can put on a T-shirt without pain, but pulling up my trousers with my left arm is agonizing. I'm learning to do it one-handed. Lying down on my back in bed also hurts unless I lie absolutely flat.

In terms of the degree of pain, this is the worst pain I have felt in recent years (I have not had sports injuries). It is knife-like and makes me feel sick for a moment.

I am 37, Asian/white, female, reasonably fit, but much stronger in the legs (I walk a lot) than in the upper body. I haven't done any upper-body workouts for several years, aside from housework and minor lifting at work (I am a librarian). I am thin and not very muscular.

Should I try to not use this shoulder and arm for a few days and see if it goes away? I am taking Advil and using a cold pack though I'm not sure where to put it; right now the cold pack is in my armpit so I can type. I would prefer to keep going to work, as long as I don't lift anything.

I have a reference to an orthopedic surgeon, though the patient didn't like him much (I have the impression that nobody likes orthopedic surgeons, since they torture their patients). Is it worth trying to get an appointment? I also have a primary care physician. I will be going on vacation in 2 weeks.

posted by bad grammar to health & fitness (8 comments total)

See your primary care physician, who will most likely give you a prescription to see a physical therapist.
posted by BuddhaInABucket at 6:09 PM on July 6, 2008

IANAD, but...

Most significant injuries occur suddenly- when I tore (partially) my rotator cuff, it was on a specific tennis serve. When I hurt my knee, it was a specific moment.

What you're describing (pain the next day), doesn't seem like these. The first time I squatted, I took the next day off from work b/c the pain was so bad from walking. Sometimes when I lift, I'm really hurting the next day, and it hurts to move.

If I were you, I would go ahead and try to schedule an appt. with your primary care physician for Thursday. If the pain goes away, you can always cancel it. He can refer you to someone more specialized and can also give you pain killers.
posted by unexpected at 6:27 PM on July 6, 2008

In my opinion you should skip your GP and go directly to an orthopedist. Your GP is just going to write you a referral to an orthopedist and charge you for an office visit.

Two years ago I injured my shoulder while cleaning up heavy branches. I had pain and some limited movement for almost a year. Then I reinjured the same shoulder, again tossing branches, and this time I felt the debilitating pain you describe. I would almost pass out when the pain occurred and I found myself limiting my activity to avoid any possibility of feeling that pain again. Range of motion on that shoulder was severely limited and I was pretty sure it would be a rotator cuff injury.

I went to see an orthopedist in Seattle. They injected die into the shoulder joint and ran me through the MRI. I did NOT have a rotator cuff injury, but I had a very constricted joint. The diagnosis was "frozen shoulder", a catch-all diagnosis when there is limited motion and severe pain without obvious injury.

My understanding of frozen shoulder is that the cartilage in the joint will turn rigid in response to injury. The cells literally change their form to be more like bone than cartilage. They will eventually become pliable again whether you do anything or not. Some people go to physical therapy, some don't. I had one appointment with a physical therapist who gave me some exercises which I never did. I also never went back for another appointment.

After 6 months or so, I am almost completely healed. I cannot throw a frisbee or a ball without pain yet, but the sometimes severe ache is long gone and I have pretty good range of motion. So in my case, I feel the money spent on the physical therapist charged with a waste. The MRI was worth it to eliminate more severe diagnosis.

Get an MRI. If it is not a tear, just live with it and in a year it will be better.
posted by csw at 7:56 PM on July 6, 2008

When I hurt my AC joint the doctor was able to identify what part of my shoulder I hurt with just a few range of motion tests. She then said "let pain be my guide" when going back to lifting. I misinterpreted that as, "do it so long as it doesn't hurt too much." Turns out it didn't start getting better until I stopped using it in any manner that caused pain. Also, I started sleeping on my back rather than my side, and this hastened the recovery. This was all a while ago (I even asked a question on it here on AskMe, shoulder injuries are agonizing and debilitating enough that I'm not surprised you did the same), but I still don't have a pain-free full range of motion back in my shoulder, though I definitely have a functional range of motion and can do heavy lifting pain-free.

My advice would be to refrain from doing as much as you can that causes any sort of pain at all, even moderate. You need to give it a good amount of time to get better. Also, doing your best to avoid pressure while you sleep (that's a good 8 or so hours you could be putting consistent pressure on it if you aren't careful) will help the recovery. Physical therapy is another good idea that I recommend. I would avoid talking to surgeon this soon and give it some time to recover. Recovery from surgery would probably be more delicate than recovering without. It will probably take a while, and impatience is probably going to be your biggest hurdle in getting better.
posted by GooseOnTheLoose at 7:56 PM on July 6, 2008

I had a back problem last year, visited a physiotherapist a few times for no improvement, put up with the pain for another month before visiting a GP. The GP identified the problem in about five minutes, and sent me to another physiotherapist who successfully treated the problem. I'm just saying don't rule out the GP, ymmv.

As for my recent rotator cuff injury, rest, specific strengthening exercises, stretching, under the guidance of a physiotherapist, and time. I'd see a doctor and a physiotherapist before thinking about surgery.
posted by Tixylix at 9:07 PM on July 6, 2008

This definitely doesn't sound like "take Advil and suffer through." You need to find out what's happened to you, and it doesn't sound good.

Call your primary care physician first thing tomorrow morning. Your GP may want to see you, or she may refer you to an orthopedist. Either way, you'll know more than you know now.
posted by purpleclover at 11:15 PM on July 6, 2008

I am no doctor, and personally I think it's always best to get a doctor's opinion when something hurts badly. Just to keep you from totally panicking based on the other responses, though... It sounds like the only motions that hurt you are the ones that use the same motions/muscles as carrying heavy boxes did. You might just be really sore from the extra work your poor muscles had to do.
posted by vytae at 6:49 AM on July 7, 2008

Thanks for your advice. After 24 more hours of Advil, cold pack, and being careful not to use my left arm, the pain has subsided and I have regained the ability to "pull up" with this arm.

But I am still going easy on it. I'm thinking of buying either an ergonomic backpack or one of those pullman briefcases for carrying books to and from work. I'll call the doctor tomorrow and ask for a reference to a physical therapist who can show me some strengthening exercises.
posted by bad grammar at 3:45 PM on July 7, 2008