Q & A: How Should I Treat Shoulder Pain and Impingement?

Q I suspect I have a left rotator cuff tear.  I have severe pain especially when I move my arm outwards.  It feels like a knife stabbing my left deltoid area with spasms.  There is no swelling or bruising.  The area is tender to touch.  I have trouble lying on my left side at night due to discomfort.  If I don’t move my arm, there is no pain.  Ibuprofen is not effective.  I have been applying ice.  I haven’t seen my MD yet.  When I raise my arm when I perform range of motion (ROM), I hear a cracking sound.  It has been six weeks.  Please advise, Dr. Ben! -Linda

A.  Thanks for your question, Linda!  Unfortunately, this is a fairly common scenario.  Shoulder pain can be one of worst most intense pains a person can experience.  It can be completely debilitating–rendering an arm almost useless in some cases.  The shoulder is vital for any movement of the arm which includes the hand.  It can even affect a person’s ability to utilize a computer mouse.

Linda doesn’t mention any specific causative factor which is common in these cases.  She also mentions pain at night and pain with movement.  Another very common symptom is where she describes the stabbing pain in the deltoid.  The pain is almost always located down the arm into the deltoid area.  Typically, it is located at the insertion point of the deltoid muscle.  It can migrate even further to the elbow or hand.

IMG_3759_RGB_4x6_Deltoid

In a situation like Linda’s, the source of the pain is rarely the deltoid and almost always the rotator cuff.  The rotator cuff tends to “refer pain” into this region.  Referred pain is a common phenomenon which occurs when the pain is being caused in one area of the body, but the pain is felt somewhere else.  (An example of referred pain would be left arm pain or jaw pain which is present during a heart attack.)

Linda states that the pain is present when she raises her arm.  This implies that she still has the ability to raise her arm, which tends to (but not always) rule out a full rotator cuff tear.  Typically with a full tear, the person loses the ability to raise his/her arm.  The level of pain on a full tear will vary depending on how acute or recent the tear.

To accurately diagnose Linda’s condition, I encourage her to seek treatment from her medical physician or physical therapist.  Based on her reported symptoms, she is likely experiencing either a partial rotator cuff tear or shoulder impingement.  Shoulder impingement can lead to an actual rotator cuff tear if it remains untreated.  The key to treatment (with either a partial rotator cuff tear or an impingement) is to first address the pain and inflammation.  Then the mechanical cause or causes which led to the injury must be addressed.

My Top Tips & Recommendations to Treat Shoulder Pain & Impingement include:

Reduce the Inflammation:

  • Use ice on the affected area (not directly on the skin) for 20 minutes per hour. Watch the skin carefully. If it looks white or blue and is non-blanching, then discontinue the use of ice. It is possible to frost bite your skin.
  • Rest the affected area. Stop or reduce any activities which tend to aggravate the area. This is typically overhead activities or repetitive activities.
  • When sleeping, try not to lie on the affected side. Hug a small pillow for comfort. This also promotes optimal blood flow to the shoulder area.
  • Try Capra Flex by Mt. Capra (http://amzn.to/1pF936I). Mt. Capra, an organic goat farm in eastern Washington State, offers superior quality products primarily utilizing goat based products. Capra Flex is the best bone and joint supplement I have found. It is a blend of natural herbs and spices along with glucosamine and chondroitin. The herbal and spice formulation is designed to naturally decrease inflammation and support healing. I recommend it to anyone recovering from an injury or attempting to prevent injury when performing at a very high level. I personally use it, and in my practice, it has helped clients recover faster and prevent injury. It can interfere with some blood thinning medication, so if you are on this type of medication, please check with your physician.

Address the Mechanical Causes:

  • A slouched posture with a forward head and rounded shoulders can be associated with this condition. Try to keep a good postural alignment with your shoulders under your ears and the shoulder blades set in a back and down position. This is particularly important when performing any activity while using the shoulder.
  • Improve thoracic (upper back) mobility. The more mobility your upper back has, the less likely your shoulder will impinge when moving. Your upper back, shoulder blade, and arm must work together when moving. Tightness in the upper back will throw this system off.
  • For a complete list of My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain, subscribe to my e-mail list by entering your e-mail address and first name. http://www.thephysicaltherapyadvisor.com/?p=118 You will automatically gain access to this FREE resource. Download the .pdf file, which is full of photos and exercise instructions, to get started!

Strengthen the Rotator Cuff:

  • The rotator cuff is a critical component to shoulder mobility. It is made up of four different muscles whose job is to make sure that the ball of the humerus (arm bone) rotates and slides properly in the socket, which is made up of the scapula. The rotator cuff allows the other major muscles of the arm, such as the deltoid and Latissimus dorsi (lats), to properly perform. When there is weakness or dysfunction, it will cause rubbing of the muscle tendon on the bone–leading to impingement or eventually fraying and tearing.
  • Here are my recommended Rotator Cuff Exercises  using an exercise band.

Shoulder impingement or a partial rotator cuff tear can be very painful and may take many weeks to recover.  My tips and recommendations are the first steps for treating and preventing shoulder impingement and pain.  Many different causative factors can lead to these conditions.  In most cases, shoulder impingement (or even small partial tears) can be completely rehabilitated and should (when treated properly) leave no residual effects once a person has recovered.

If your symptoms continue to worsen or you don’t improve, I highly recommend that you seek further medical treatment.  Many times, a person will require medical intervention, which could include anti-inflammatory medications either orally or through an injection.  A person may also need hands-on treatment from a qualified physical therapist to address other mobility issues in the shoulder, thoracic or cervical regions which are causing or contributing to the pain.  Sometimes, surgical intervention is needed to repair a fraying tendon or an acromion which is hooked and causing the impingement.

Good luck, Linda!  I hope you find the information to be helpful and provide some relief from the pain you’re experiencing.  If you have a question that you would like featured in an upcoming blog post, please e-mail contact@thephysicaltherapyadvisor.com.

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.