ASK THE EXPERT - AUGUST 5, 2011

Question:

Over the last several weeks I have had shoulder pain that wakes me from sleep if I roll onto that side. I have not had any injury that I can remember. What can cause this?
Steven, 46, Richmond Heights

Answer:

Thank you for the question, Steven. You have touched on a very common complaint that brings people to call their doctor. Most people I know will put up with some discomfort during the day with a couple of ibuprofen or a topical sports cream, but when they can no longer sleep, they want RELIEF!

By far the most common diagnoses that cause this pain at rest all end in "it is". Simply put, the suffix "it is" means "inflammation of". In this case we are often discussing bursitis, tendinitis (a better term maybe "tendinosis" which means "degeneration of"), and arthritis.

"Bursitis" refers to the lubricating sacs around the rotator cuff. Inflammation may begin with a mechanical irritation of the rotator cuff tendons due to "bone spurs" on the undersurface of the acromion (the bony prominence on the top of the shoulder). This type of pain, which is often referred to as "impingement" or "impingement syn- drone" usually starts to present in our forties or fifties and is more common in males than females. It often affects the dominant arm first and can be insidious in onset. Overhead activities are common in this inflammation (ie. working out, tennis, golf, pitching little league, trim- ming trees)

"Tendinitis" means inflammation of a tendon. In the shoulder, we are usually referring tom the 4 tendons of the rotator cuff or the long head of the biceps tendon. Usually, however, we are more accurately discussing degeneration of the tendons or "tendinosis".

There is a spectrum of damage to these tendons that range from mild degeneration to partial thickness tearing to full tears/ruptures of the rotator cuff or bicep tendons. This degeneration may also be associated with inflammation and pain at night.

Arthritis about the shoulder relates to the shoulder joint itself (glenohumeral joint) or the acromioclavicular joint or AC joint (the prominence on top of the shoulder where a woman's bra strap rests). Without a specific history of previous trauma, arthritis in the AC joint is a more common culprit in an active 46 year old. Weightlifting, heavy work, sports can often cause wear in this location as well.

A physical exam and plain x rays usually suffice to make these diagnoses. Early treatment consists of rest, icing, anti-inflammatory medications, and home excises. Sometimes cortisone injections or formal physical therapy become helpful in the treatment. A vast majority of people will see a resolution of symptoms in weeks.

Acute weakness, bruising, or persistent symptoms are reasons to be seen by an orthopedic surgeon sooner rather than later.

Hope that helps. View our website www.STLsportsdoc.com for help- flu videos and additional information and links regarding common shoulder conditions.