My Shoulder Hurts. What Do I Do Now?

Author: Dr. J. Pieter Hommen

GOALS:

1. What can I continue to do?
2. What should I avoid?
3. What medications should I take?
4. What can I do to treat it on my own?
5. When should I see the doctor?
6. When do I need an MRI scan?

Have you ever… woken up to shoulder pain that was not there when you went to bed? Perhaps you did some light activity the day or weekend prior. Maybe you felt a sudden onset of pain during a workout or from an accident. Now the shoulder constantly aches or maybe it is downright painful. Perhaps you feel like you are starting to lose motion in the shoulder. Maybe the pain is worsened at night or with overhead lifting activities. What do you do now?

What can I continue to do:

1. Depends on pain level – If the symptoms are mild or easily improved with low dose over-the-counter anti-inflammatory medications, then you may be able to resume normal activities.
2. Lighten shoulder activities- Consider lowering the weight and repetitions to minimize the amount of physical stress your shoulder experiences.
3. Lower extremity cardiovascular workout – You can add small amounts of resistance to the shoulder. Try standing next to a wall and push lightly against the wall without moving through an arc of shoulder motion.

What should you NOT do:

1. Push through the pain – This may sound intuitive to most, however, this may be difficult for some. If your job requires repetitive shoulder motion, or if you have an important upcoming tennis tournament, you may try to “push” through the pain. If the symptoms are significant enough to awaken you at night or require larger quantities of over-the-counter anti-inflammatory medications, then it is not advisable to push through the pain.
2. Immobilize your shoulder– A temporary period of immobilization in a sling may help for some shoulder pains, however, prolonged immobilization in a shoulder sling may result in significant tightness and muscle atrophy of the shoulder that can last for a long period of time. If your shoulder requires more than 2-3 days in a sling, then consider consultation with an orthopedic surgeon.

What medications should I take:

1. Depends on pain level – if you pain level requires medications, there are several over-the-counter medications you can start with.
2. NSAIDS - you may consider oral or topical anti-inflammatory medications. Make sure you know if you have allergies. Also, check with your internist to see if you are allowed to take these medications due to other medical risks.
3. Tylenol – acetaminophen is an analgesic that can help reduce pain at the shoulder. Patients with liver disorders or who take other medications that are metabolized by the liver should limit their use of acetaminophen.

What can I do to treat it on my own:

1. 1. Depends on pain level – If the symptoms are mild or easily improved with low dose over-the-counter anti-inflammatory medications, then you may be able to resume normal activities.
2. Stretch the shoulder- Gentle stretching of the shoulder can help reduce the risk of tightness. Try the following motions: 1) overhead, 2) away from your side, 3) reach underneath touch your back, and in the 4) throwing position as if cocking your shoulder to throw. Try stretching the shoulder while lying in bed or walk your fingers up the wall while standing close to the wall. You can also slide a towel along a countertop to stretch the shoulder.
3. Gentle resistance – You can add small amounts of resistance to the shoulder. Start with light isometric strengthening by standing next to a wall and pushing lightly against the wall without moving through an arc of shoulder motion. You can also use resistance bands to gently strengthen the shoulder.
4. Shoulder Therapist – A licensed physical or occupational therapist can be a great way to cure most shoulder pains. He or she will be able to implement a stretching and strengthening program catered to you shoulder needs.

When Should I See a Doctor:

1. 1. Persistent shoulder pain.
2. Losing sleep due to shoulder pain.
3. Loss of shoulder motion.
4. Loss of shoulder strength.
5. Not alleviated with medications.
6. Shoulder pain not alleviated with therapy after 4-5 sessions.

When Should I Go to an Urgent Care or Emergency Room:

1. If you experience acute shoulder pain such as after a fall or accident.
2. If the pain is associated with possible heart attack symptoms such as arm pain, chest tightness, shortness of breath, or lightheadedness.

When do I need an X-rays or an MRI scan:

1. X-rays: An x-ray is highly recommended for an acute accident such as a fall to rule out a fracture or dislocation. For persistent shoulder pain, your primary doctor may order an x-ray of the shoulder. If you are seeing your orthopedic surgeon, you will likely undergo an x-ray of the shoulder at your office visit.
2. Ultrasound examination: your orthopedist may recommend an ultrasound examination of the shoulder. Depending on your surgeon, this may be performed in his or her office. An ultrasound is very useful to help determine if there is a musculoskeletal injury such as a rotator cuff tear. Depending on the results, the surgeon can decide if you need an MRI scan.
3. MRI scan may be ordered if there is persistent pain despite conservative treatments:
   a. Therapy is unsuccessful.
   b. Previous shoulder steroid injection without relief.
   c. Medications do not alleviate pain.