YANMD: When to get concerned about rotator cuff and elbow joint pain
August 8, 2015 5:58 AM Subscribe
I'm a manual wheelchair user. It's getting more common that I have rotator cuff pain (or what I imagine is from my rotator cuff) and elbow joint pain after long bouts of wheeling. The pain is not life-altering and goes away after a day or so. It doesn't bother me but for the fact that I realize that this is a sign of things to come. Can you help me decide whether to pursue therapy/doctor intervention?
My uncle is a champion fencer, and his fencing into his seventies resulted in rotator cuff surgery on both sides. I would like to avoid this fate. However, I don't want to fall into a whole series of invasive medical procedures if this is just some 'what happens when shit gets old' edition.
I've been in a chair for going on fifteen years now, very very active.
I'm trying to get my shit together medically, and have a number of things I need to follow up with medically, but I guess I don't how to prioritize this one. Is this more important than the xyz procedure one doctor recommended a year ago but I haven't followed up on and really should because I'm a woman of a certain age?
Maybe more to the point, the idea of surgery to my arms fills me with terror. My legs are paralyzed but I swing around the house like a lemur, but I can't do that shit one-armed. How do I beat back the terror so I can act like a grown-ass human and do what needs to be done for my darn body?
My uncle is a champion fencer, and his fencing into his seventies resulted in rotator cuff surgery on both sides. I would like to avoid this fate. However, I don't want to fall into a whole series of invasive medical procedures if this is just some 'what happens when shit gets old' edition.
I've been in a chair for going on fifteen years now, very very active.
I'm trying to get my shit together medically, and have a number of things I need to follow up with medically, but I guess I don't how to prioritize this one. Is this more important than the xyz procedure one doctor recommended a year ago but I haven't followed up on and really should because I'm a woman of a certain age?
Maybe more to the point, the idea of surgery to my arms fills me with terror. My legs are paralyzed but I swing around the house like a lemur, but I can't do that shit one-armed. How do I beat back the terror so I can act like a grown-ass human and do what needs to be done for my darn body?
I just bought these two books to help with rotator cuff pain based solely on their good Amazon reviews. I don't know yet if they'll help. But maybe that's a good place to start, by reading up on the issue and trying to identify proven techniques/exercises to address it yourself.
posted by mono blanco at 6:20 AM on August 8, 2015 [2 favorites]
posted by mono blanco at 6:20 AM on August 8, 2015 [2 favorites]
Surgery is more likely to be your only option once you've pushed through the pain avoiding seeing somebody. A PT or sport med doctor will probably have rehab exercises to help sort things out if it's still early days (and possibly even if it's not).
posted by hollyholly at 6:50 AM on August 8, 2015 [1 favorite]
posted by hollyholly at 6:50 AM on August 8, 2015 [1 favorite]
Definitely don't delay consulting a doctor because of fear of surgery. Whether you know you have a problem or not doesn't change the existence of the problem. The sooner you inquire, the greater your likelihood of avoiding surgery.
Anecdotally, I had rotator cuff pain and it was treated very successfully with 12 weeks of physical therapy after consulting with a physiatrist (PM&R doctor). If I had ignored the pain and continued with what I was doing (in short my problems were caused by a muscular imbalance in the rotator cuff), I could have ended up needing surgery. As it stands there's no reason to believe I will ever need surgery.
There are a lot of interventions in between doing nothing and going under the knife. They are, for the most part, specifically designed to avoid subjecting you to surgery.
Good luck!
posted by telegraph at 6:51 AM on August 8, 2015 [10 favorites]
Anecdotally, I had rotator cuff pain and it was treated very successfully with 12 weeks of physical therapy after consulting with a physiatrist (PM&R doctor). If I had ignored the pain and continued with what I was doing (in short my problems were caused by a muscular imbalance in the rotator cuff), I could have ended up needing surgery. As it stands there's no reason to believe I will ever need surgery.
There are a lot of interventions in between doing nothing and going under the knife. They are, for the most part, specifically designed to avoid subjecting you to surgery.
Good luck!
posted by telegraph at 6:51 AM on August 8, 2015 [10 favorites]
You're getting ahead of yourself a bit. You can't make an informed decision about surgery or anything else until you know what you're dealing with. Maybe this is something that can be helped with physical therapy or anti-inflammatory medication. You don't know. Find out before it gets worse and then you can decide about surgery. Your uncle's situation sounds very different from yours. Knowledge is power, as they say. Empower yourself and find out what's going on. Then go from there, armed (haha) with facts, not fear of the unknown.
posted by Kangaroo at 6:54 AM on August 8, 2015
posted by Kangaroo at 6:54 AM on August 8, 2015
Also keep in mind that, even if the doctor thinks you need surgery, they can't make you have it unless you want it. If you go in for a consultation, they're not going to knock you out in the examining room and drag you back for surgery that day.
That sounds kind of insultingly simplistic, but it's honestly something I have to remind myself of sometimes when I'm avoiding a doctor visit because I'm scared of what they'll recommend. That first visit is just about getting information; what I choose to do with it from there is still up to me, and I haven't committed to anything just by going to the appointment.
posted by katemonster at 7:33 AM on August 8, 2015 [5 favorites]
That sounds kind of insultingly simplistic, but it's honestly something I have to remind myself of sometimes when I'm avoiding a doctor visit because I'm scared of what they'll recommend. That first visit is just about getting information; what I choose to do with it from there is still up to me, and I haven't committed to anything just by going to the appointment.
posted by katemonster at 7:33 AM on August 8, 2015 [5 favorites]
I have treated injures in the same address successfully with exercises I got from a physical therapist I was referred to after seeing a doctor. Add to that some recommendations from my therapies about ways to perform activities that put less strain on my joints, and I have gone from almost constant pain to just an occasional twinge without surgery. Explain to your doctor your very reasonable fears and let them build a treatment plan to help you now before surgery becomes the only option.
posted by wwax at 8:09 AM on August 8, 2015
posted by wwax at 8:09 AM on August 8, 2015
N'thing much of the above (you have options) with a couple of caveats:
Nothing good will come from waiting and this really is your friendy neighborhood PT's bread and butter.
posted by mce at 8:13 AM on August 8, 2015 [3 favorites]
- a) you walk on your hands
- b) you need shoulders to self transfer
Nothing good will come from waiting and this really is your friendy neighborhood PT's bread and butter.
posted by mce at 8:13 AM on August 8, 2015 [3 favorites]
Read about treatment options, for sure. Don't try to treat it yourself, though - get the best PT you can find and afford (get recommendations). They can make a world of difference.
(Read a bit, though, about rotator cuff and elbow tendinopathies specifically, to ensure you're getting the right kind of treatment. Some practitioners are still using outdated models and therapies, and unless you can recognize these when you see them, you might waste healing time. There are two approaches to tendinopathies, based on different conceptions of what happens. One sees them as a kind of chronic inflammation [hence "tendonitis"]. The other sees them as failed collagen healing; this is the view supported by current research (good overview here). A lot of [especially PT] treatments wind up being the same, but there may be some differences. Personally, I would avoid cortisone shots if they're offered (they wouldn't be offered by a PT, only a med). Shots reduce pain in the short term, but ultimately contribute to further degeneration. Right now, while you're figuring out who to see, rest is probably the best thing you can do for your shoulder and elbow. I don't know how possible that is for you, though :/ do you have access to a motorized wheelchair?)
Also - tendons and ligaments can take a long time to improve, compared to other kinds of tissues. But they do often improve, especially with the right help (i.e. from a PT).
posted by cotton dress sock at 8:20 AM on August 8, 2015
(Read a bit, though, about rotator cuff and elbow tendinopathies specifically, to ensure you're getting the right kind of treatment. Some practitioners are still using outdated models and therapies, and unless you can recognize these when you see them, you might waste healing time. There are two approaches to tendinopathies, based on different conceptions of what happens. One sees them as a kind of chronic inflammation [hence "tendonitis"]. The other sees them as failed collagen healing; this is the view supported by current research (good overview here). A lot of [especially PT] treatments wind up being the same, but there may be some differences. Personally, I would avoid cortisone shots if they're offered (they wouldn't be offered by a PT, only a med). Shots reduce pain in the short term, but ultimately contribute to further degeneration. Right now, while you're figuring out who to see, rest is probably the best thing you can do for your shoulder and elbow. I don't know how possible that is for you, though :/ do you have access to a motorized wheelchair?)
Also - tendons and ligaments can take a long time to improve, compared to other kinds of tissues. But they do often improve, especially with the right help (i.e. from a PT).
posted by cotton dress sock at 8:20 AM on August 8, 2015
Be sure you sleep with your head to an inside wall. If you live in a cold climate sleeping with your head and neck up to an outside wall can give you neck and shoulder stiffness. If you have to, then wear a turtleneck at night, cut one off so just your arms shoulders and neck are covered if the whole thing is too hot. You can always take just one little anti-inflammatory 200 mg dose of ibuprofen before bed with a meal, and let that soothe you. The Yogis make something called golden milk, which is simmered turmeric, milk, honey, ginger if you like, for the anti-inflammatory properties.
There are surgeons and there are surgeons. I had three rotator cuff injuries, which I endured for decades before the mother of all injuries made surgery a necessity. We all face the decline of our mortal prowess, and sometimes just taking it a little easier on our body results in less over all inflammation that makes the weak points last longer in their original state.
I have seen folks who had one rotator tendon repaired, who can not lift their arm above shoulder level, much less run it with fine motor skill. If you are going for the repair, you can not wuss out when it comes to the PT to restore mobility. You have to shop for a surgeon, you have to call PT outfits, and subtly but cloyingly find out whose repairs rehab the best. I did this, and it took some phone work. I had three out of the four rotator tendons ripped off the bone and fully retracted, and the bicep torn off the head, with no head to grow back to. I now have full range of motion with excellent fine motor ability. It took seven months of stretching PT to regain full use. I am pain free, in fact my other arm is feeling the effects of age. I have eleven pete screws in this shoulder, which I am wondering about, but if you worry it can't be fixed, well it can. But, easing your use, pattern of use, and being nicer to it might give you some more time with it. You will need a motorized chair after, for recovery time, because you will blow out your other shoulder compensating.
A couple of weeks after surgery I started taking glucosamine with chondroitin and MSM, I could feel that work to soothe on a cellular level. I avoided Calcium supplementation for several months so the nerves could heal, with less chance of Calcium attraction to injured nerves I developed no arthritis with relation to this injury.
posted by Oyéah at 8:45 AM on August 8, 2015 [1 favorite]
There are surgeons and there are surgeons. I had three rotator cuff injuries, which I endured for decades before the mother of all injuries made surgery a necessity. We all face the decline of our mortal prowess, and sometimes just taking it a little easier on our body results in less over all inflammation that makes the weak points last longer in their original state.
I have seen folks who had one rotator tendon repaired, who can not lift their arm above shoulder level, much less run it with fine motor skill. If you are going for the repair, you can not wuss out when it comes to the PT to restore mobility. You have to shop for a surgeon, you have to call PT outfits, and subtly but cloyingly find out whose repairs rehab the best. I did this, and it took some phone work. I had three out of the four rotator tendons ripped off the bone and fully retracted, and the bicep torn off the head, with no head to grow back to. I now have full range of motion with excellent fine motor ability. It took seven months of stretching PT to regain full use. I am pain free, in fact my other arm is feeling the effects of age. I have eleven pete screws in this shoulder, which I am wondering about, but if you worry it can't be fixed, well it can. But, easing your use, pattern of use, and being nicer to it might give you some more time with it. You will need a motorized chair after, for recovery time, because you will blow out your other shoulder compensating.
A couple of weeks after surgery I started taking glucosamine with chondroitin and MSM, I could feel that work to soothe on a cellular level. I avoided Calcium supplementation for several months so the nerves could heal, with less chance of Calcium attraction to injured nerves I developed no arthritis with relation to this injury.
posted by Oyéah at 8:45 AM on August 8, 2015 [1 favorite]
I'm trying to get my shit together medically, and have a number of things I need to follow up with medically, but I guess I don't how to prioritize this one. Is this more important than the xyz procedure one doctor recommended a year ago but I haven't followed up on and really should because I'm a woman of a certain age?
This is your mobility. It is high priority.
It sounds like this could be related to balancing how you move. For example, because you rely on your arms, if you're right-handed you probably prefer your right side. Identifying muscle imbalances and learning to move more ambidextrously may be part of the solution. There is a whole range of conservative care options here to explore.
I see a chiropractor who does Active Release Therapy and exercise therapy for rotator cuff issues. If you are looking for a manual therapist, I would recommend one who does ART. They take more time with you and must customize treatment for you. It's a good filter.
posted by heatherann at 9:27 AM on August 8, 2015 [1 favorite]
This is your mobility. It is high priority.
It sounds like this could be related to balancing how you move. For example, because you rely on your arms, if you're right-handed you probably prefer your right side. Identifying muscle imbalances and learning to move more ambidextrously may be part of the solution. There is a whole range of conservative care options here to explore.
I see a chiropractor who does Active Release Therapy and exercise therapy for rotator cuff issues. If you are looking for a manual therapist, I would recommend one who does ART. They take more time with you and must customize treatment for you. It's a good filter.
posted by heatherann at 9:27 AM on August 8, 2015 [1 favorite]
Response by poster: Thanks everybody. I've scheduled an appointment with my physician, so I can get referrals to the appropriate people. I feel silly for being such a scaredy-cat about it. Thanks again.
posted by angrycat at 7:11 AM on August 19, 2015
posted by angrycat at 7:11 AM on August 19, 2015
This thread is closed to new comments.
posted by myselfasme at 6:04 AM on August 8, 2015 [3 favorites]