Doc, it hurts when I do this...
October 25, 2012 7:33 AM   Subscribe

You know the joke about the man who shows his hyper-extended arm to his doctor, says "doc, it hurts when i do this," and the doc says, "well then don't do that!"? I am now that joke. Help me not be.

For a long time I used to sleep on my side with my right arm straight out, under my pillow, partially supporting my head. Eventually I began to notice that when I hyper-extended this arm at other times, it hurt, quite a lot, around my shoulder joint. I never lost any important range of motion, but i couldn't, for instance, put my hand behind my back and move it as far up my spine as I could the other hand.

I mentioned it to my doctor, she ordered an x-ray, it showed nothing. She prescribed double-strength ibuprofen 3 times a day for 3 weeks; when that didn't help we ruled out swelling. She suggested Physical Therapy but because it seemed so trivial to me, I did nothing.

Eventually, the other arm started to hurt under the same circumstances, though I had not been sleeping on it. I went (for unrelated reasons) through a series of Rolfings, and the right arm started to feel better, but the left arm got worse. This trend continued after the Rolfing sessions ended. The right arm is now fine, but the left arm hurts when i hyper-extend it.

I have tried ordinary massage, and it has no effect. Even if the Rolfing helped, I'm not convinced it could be repeated, so I'm not doing that again (besides, it's really expensive). I had several chiropractic sessions which also did not help. The next step is Physical Therapy, but I still hate to spend so much time and money on something that really isn't stopping me from doing anything. I also tend to think that since the right arm eventually fixed itself, so might the left. Can you suggest some things I could try to hurry that along?

I have one more clue: hot water (like in a shower) applied to the left shoulder joint definitely improves my range of motion for the left arm and makes it hurt less. I was thinking about wrapping it in something warming while I sleep and seeing if that helps. What do you think of this? If you think it might work, do you have any recommendations on what to use to warm it?
posted by ubiquity to Health & Fitness (14 answers total) 3 users marked this as a favorite
I have the exact same problem, for the exact same pillow-related reasons. Damn you pillows!

To be clear, did you stop sleeping that way? I've generally tried to avoid it these days, and on the whole, my shoulder has gotten better. However, I've slept that way for over 30 years, so kicking the habit has been difficult.
posted by Admiral Haddock at 7:39 AM on October 25, 2012

I had the exact problem, compounded by tennis elbow (from actually playing tennis). It was one of the most excruciating conditions I ever had.

I had to give up tennis for a year, and stop sleeping with my arm out. (I was actually extending my arm over the edge of the bed, so gravity was my enemy.) In addition, I went to a sports medicine clinic where I was shown a specific stretching/twisting maneuver which I did several times a day, and which I can't remember, and even if I could it would be impossible to explain. I also wore a neoprene elbow brace.

The next step is Physical Therapy, but I still hate to spend so much time and money on something that really isn't stopping me from doing anything.

I do recommend a sports medicine / orthopedic doctor. In my case, it wasn't week after week of PT, but rather one session, then doing the work on my own.
posted by The Deej at 7:46 AM on October 25, 2012

Like The Deej mentioned, I had similar problems though in my elbow caused by sleeping in that position greatly helped when I flipped over and made sure my arm didn't hang over the side of the bed and was supported, the pull of gravity all night turned out to be the culprit. I suspect a PT session or 2 to learn some exercises that you can do on your own could only help, I got 2 exercises from my GP though and along with making sure my arm was not flopping off the side of the bed at night (and instead was hitting my husband in the back of the head which he bitched about until he got used to it) my pain and lack of movement was gone in a month or so.
posted by wwax at 8:10 AM on October 25, 2012

In my senior year of college, I began having searing pain and numbness in my left arm all the time. This was especially disconcerting for me because at the time, basically my livelihood was programming (it still is!).

I went to a physical therapist. The experience was, in a word, transforming. Over ten years later and I am still typing away with virtually no pain anymore (if I type for a very long time, say I pull an all-nighter, I may start to feel some minor tingling. This rarely happens though).

I can't recommend physical therapy enough for these sorts of problems. The sessions will not be super cheap but they won't be significantly more expensive than massage (which is to say, a session might be twice as expensive, but it will have long-lasting, permanent results). I think I needed a half dozen sessions or so, along with some very simple exercises, and I was completely cured.
posted by Deathalicious at 8:11 AM on October 25, 2012

Just for clarification: the pain in my arm was in my forearm, and appeared to be the precursor to carpal tunnel syndrome (dreaded by all career programmers). Traditionally the remedy for this is surgery. My wife actually got surgery for this (or some related wrist condition) and she still occasionally feels pain or discomfort there while I do not. Physical therapy is also much cheaper than surgery (unless, like my wife, your father is a surgeon).

All in all, if something can be treated with physical therapy, I believe PT is *always* a better alternative than surgery or, worse, doing nothing about the pain.
posted by Deathalicious at 8:15 AM on October 25, 2012

Response by poster: To answer the question the Admiral asked, I am not sleeping that way anymore. I sleep on my sides with my arms folded in front of my chest.

No comments from anyone about the helpfulness of heat?
posted by ubiquity at 8:16 AM on October 25, 2012

3 options for your "warm thing while sleeping"

1. Hot water bottle. Cheap, avaliable at any drug store. Doubles as an ice bag for sprained ankles.
2. Heating pad. Also avaliable most places, They'll often come with velcro to strap on, and sleep timers.
3. A Microwave warm pack like this one from Grampas Garden. Put it in the microwave for a few minutes and you get maybe 30 minutes of a nice weighted warm thing. No cords to tangle with in bed.

I've tried those adhesive warming wraps, but don't really like them. If you wanted to wear it to work under your clothes, that might be an option for you. Otherwise, they're expensive and disposable.

If you're debating between Rolfing massage and PT, which are both expensive, I'd go for PT. If you've never done PT before, a lot of it can be massage. I had tendonitis in my wrist and PT sessions were half doing kinda lame forearm exercises, like pedaling a bike with my hands. (but it helped because apparently I have lame forearms...) and half was a pretty intense massage and TENS session. It was very educational, including learning self-massage techniques in addition to exercises I could do at home with cans of tomatoes and rubber bands and such.
posted by fontophilic at 8:17 AM on October 25, 2012

Oh man, do I ever relate. I have a torn rotator cuff in my right shoulder (from a car accident in 2000). I sleep with my right arm folded so that my hand is by my shoulder, and my head lays on my folded arm (with a pillow between them). I have tried to NOT sleep like this, but I often move into that position in the middle of the night while sleeping. My shoulder is creaky and, often, in a good deal of pain.

I went to a physical therapist and she identified that my shoulder issues were the origin of my upper back/neck issues, and were not helping my lower back issues. One weak part of the frame was throwing everything else off. So I worked with her, twice a week, for four months. I'd say that at the end of it I was 75% better. Our sessions have ended but I still do the exercises when I remember...a few times a week. I know things would be better if I were more diligent about doing them. I highly, highly recommend a visit to a physical therapist. It is worth it.

Still haven't figured out how to stop folding my arm under my head when I sleep...if I could figure that out, perhaps I'd get that final 25% and have a normal shoulder again.
posted by Elly Vortex at 8:19 AM on October 25, 2012

My official diagnosis is medial epicondylitis in both elbows. Started in my right arm when I was like 17 and my left at around age 20. I am now 23, and the chronic pain has been more or less consistent. I used to sleep the exact same way as well (we should probably put out a public service announcement). I have always been pretty active with my arms, played drums and keyboard in a band, video games/guitar hero, lots of cooking etc.

I tried the doctor and physical therapy route several times at first. Got X-Rays and MRI's, prescriped NSAIDS and got cortisone injections. The official answer was always total rest and lots of physical therapy. So I basically did nothing for months, which was awful, and then did physical therapy every morning. Absolutely no improvement. I went through maybe 3 rounds of this with no benefit, and really did have to give up a lot of quality of life in order to keep my arms inactive.

My current system, once I gave up on the doctor route, has actually been pretty decent and I have gone back to the level of activity that I want without too much pain. I sleep on my back now. I work out my arms twice a week while wearing neoprene braces - push ups, pull ups, etc. I do daily stretches whenever I think about it. And I do Hot Yoga once a week - basically yoga in a 104 Degree room. Really helps with flexibility and range of motion, I feel way better coming out of it. So still some chronic pain, but overall very livable. But yea, not a fun problem to have - I feel your pain. Best of luck with it!
posted by cccp47 at 8:26 AM on October 25, 2012

ubiquity, not to sound like a broken record, but please do consider PT as a solution to your problems. 12 years after my therapy, I have had to make literally no changes to any of my behaviors and my pain has gone away. I still use the computer as much or more than I did when I experienced the carpal tunnel symptoms.

It sounds like you have used rolfing, chiropractic, and massage therapies for a solution which calls for physical therapy or, as someone mentioned above, the attention of someone involved in sports medicine. I realize investing more in therapies might feel like throwing good money after bad, but I assure you it is not. For a small investment of a few hundred dollars in sessions, you will have a lifetime free of pain and discomfort.

One note about what fontophillic said about massage above. I did get a form of "massage" from my physical therapist but it was not the relaxing experience of a massage therapist. He specifically focused on the part of my shoulder that was, if I remember correctly, blocking the nerve/blood flow to my arm (I can't remember the details). Point is, even though he was using the flat of his thumb on my muscle, it felt like he was dragging his fingernail through my underarm. So the initial therapy can be uncomfortable. However, the payoff is that it takes away the cause of the pain, not just the symptoms.

Also, I imagine the quality of your physical therapist will really affect your experience. You want to do your research before selecting one, although your GP may have good suggestions.

I notice you are in IT. My carpal tunnel issues stemmed from shoulder issues. I worry that if you don't attack this head on, you will start experiencing issues down your arms and with your wrists. Believe me, you do not want to go through what I went through if you are in IT.
posted by Deathalicious at 8:27 AM on October 25, 2012 [1 favorite]

Have you thought about seeing a good chiropractor? Sometimes you have to get the body retrained, and a good chiropractor can recommend stretches and exercises, as well. (or mine does.)
posted by needlegrrl at 8:28 AM on October 25, 2012

the heat idea is not going to help. go to a good pt, this is exactly what they're for. you have probably screwed up your rotator cuff or caused significant impingement somewhere in the shoulder joint.
posted by facetious at 8:51 AM on October 25, 2012 [1 favorite]

As a veteran of the shoulder wars myself, I would strongly suggest going to a sports medicine specialist, then physiotherapy if required, before going to a family doctor, a Rolfer or anyone else (assuming you have insurance that doesn't make you jump through pointless hoops).

Sleeping is (usually) not a sports injury, but sports medicine docs know a hell of a lot about how various bits of the body fit smoothly together and why they sometimes don't fit smoothly together. Your family doctor chose to give you an x-ray which was a waste of time and resources: this is most likely a soft tissue injury related to your sleeping position or other sources of repetitive strain in your life that you may not even be aware of right now. If you see a sports doctor, they will carefully assess your range of movement and identify any patterns of pain or weakness. (You may be shocked to find out just how weak your bad shoulder is.)

You will probably get ultrasound as a diagnostic, not another x-ray. They may recommend home treatments with ice or heat as well as exercises, but they may also recommend some PT. If cost is an issue, tell them that.

Continued inflammation and pain around a joint can get worse if not treated. If your range of motion is limited because of pain, this could have eventual bad consequences, such as frozen shoulder. Please go to a doctor who knows something about diagnosing and treating this kind of problem.
posted by maudlin at 9:15 AM on October 25, 2012 [1 favorite]

Seconding maudlin's thought re frozen shoulder, AKA adhesive capsulitis of of the shoulder. I sleep the same way you do, and finally self-referred to an orthopedic surgeon who, after examining x-rays and an MRI, gave me that diagnosis.

It will go away on its own, but that may take a year. Physical therapy (or rather the exercises they give you that you can do on your own after you learn them) is the only way you'll ease the pain and increase the limited range of motion you mention with your arm behind your back. I didn't see any benefit from the infrared or electrical stimulation that the physical therapist gave me.

Be advised that the treatment is essentially barbaric - you need to tear those adhesions loose. That's the only way. Long languid stretching exercises that cause excruciating pain in your shoulder, but the immediate pain goes away quickly.

If you do a Google search, you'll soon come across a certain chiropractor that claims to be able to resolve it in a day...for 1200 one of his clinics in Canada, Europe or Hong Kong. No one that I talked to know what that treatment could possible be.
posted by DandyRandy at 12:49 PM on October 25, 2012

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