Never Ignore Shoulder Pain, Experts Warn

Never Ignore Pain in This One Body Part, Experts Warn

Any type of sudden, unexplained pain in your body deserves your attention ...

Lauren Gray

Fri, December 24, 2021, 8:09 PM·4 min read

Any type of sudden, unexplained pain in your body deserves your attention, but experts say there's one location for discomfort that stands apart from the rest. If your trouble spot is in this place it can have a particularly wide range of underlying causes—many of them related to serious organ problems that you may not suspect. In fact, one diagnosis for sudden pain in this area is considered a serious medical emergency, and experts say you may have reason to call 911 if you notice it. They urge you to never ignore pain in this part of your body, and say it's crucial to learn the signs that indicate it may be something serious. Read on to find out what to look out for, and how to determine if your symptom means you're in immediate danger.

You should never ignore unexplained pain in your shoulder blade, experts say.

According to experts from the University of Michigan Health System (UMHS), you should never ignore sudden, unexplained shoulder pain—especially if it occurs with symptoms elsewhere in your body, such as in your abdomen or chest. This is because the source of your discomfort may actually be "referred shoulder pain," meaning "a problem exists somewhere else in the body other than where you feel the pain."

UMHS experts warn that there are several conditions capable of causing this type of referred pain. They say you may need to be screened for abdominal problems such as gallstones or pancreatitis, pelvic problems such as ovarian cysts, lung problems such as pneumonia, and other health issues including shingles, Paget's disease, thoracic outlet syndrome, or complications from past surgery.

Sudden, unexplained left shoulder pain can be caused by a heart attack.

If your unexplained shoulder pain happens to be on the left side, it's even more crucial that you call for medical assistance. Experts from UMHS explain that this type of pain can be a symptom of heart attack, blood vessel problems, or inflammation around the heart.

If you do suspect a heart attack, don't wait to call for help. According to the Cleveland Clinic, you should dial 911 if you notice any chest pain or discomfort along with pain in the arms, left shoulder, back, neck, jaw, or stomach that lasts for more than five minutes.

The cause for your shoulder pain could also be orthopedic.

Of course, another possible cause for your shoulder pain is orthopedic injury, and these types of injuries are somewhat common given the shoulder's frequent motion and use. "The shoulder is the most movable joint in the human body," explains Penn Medicine. "A group of four muscles and their tendons, called the rotator cuff, give the shoulder its wide range of motion. Swelling, damage, or bone changes around the rotator cuff can cause shoulder pain. You may have pain when lifting the arm above your head or moving it forward or behind your back," their experts add.

Additionally, your shoulder pain may be caused by arthritis, bone spurs, bursitis, a broken bone, joint dislocation or separation, overuse, shoulder tear, or poor posture. If your pain does not resolve on its own and you suspect localized injury, seek help from an orthopedic specialist who can pinpoint the problem.

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How to tell the difference between localized and referred pain.

If you find that your shoulder is in sudden pain with no known explanation, it may be hard to distinguish between a localized injury and referred pain from something potentially more serious. Experts from Penn Medicine say there's one way to recognize referred pain that can help you quickly assess the problem. In the event that an organ is the underlying cause, they say "there is usually pain at rest and no worsening of pain when moving the shoulder."

And of course, it's always better to be safe than sorry. Speak with your doctor if you notice shoulder pain of any kind that may be cause for concern.

RELATED: If You Notice This on Your Fingers or Toes, Have Your Lungs Checked.

RELATED: If This Body Part Hurts You at Night, See Your Doctor.

RELATED: If You Notice This When Your Heat Turns On, Call Your Doctor Immediately.

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Change Your Sleep Position...

May 1, 2013

To relieve pain, acid reflux, snoring and more.

 

When you slip into bed at night, you probably go straight to your favorite sleep position—perhaps on your side or on your back. But sleep positions can sometimes be tricky. Certain positions can help—or worsen—common health problems.

 

The best—and worst—sleep positions for seven common ailments...

 

SHOULDER PAIN

 

Sleeping on your back is often a good option if you have shoulder pain. To avoid compressing shoulder nerves, tendons and/or joints, make sure that your head, neck and shoulders are in a neutral position. Put a small pillow under your head (with a rolled-up towel under your neck, if needed). You may even want to put a small towel roll or pillow under your shoulder to give it more support, if needed.

 

Should you sleep on your side when your shoulder hurts? And if so, which side? It depends on the cause of your shoulder pain.

 

For sprains and rotator-cuff injuries: When opting for side-sleeping, most people with this type of shoulder pain are most comfortable hugging a pillow with the painful shoulder up.

 

Some people, however, are more comfortable—and hurt less in the morning—if they sleep with the painful side down. The joint will be supported by the mattress, and your weight will keep the affected shoulder from moving. Just be sure to place a pillow in front of your chest and under the painful shoulder for support.

 

For arthritis: The irritation and inflammation can worsen if you sleep on the painful shoulder. Keep pressure off the affected joint by lying on your back or on the other side with the arm supported by hugging a pillow.

 

KNEE PAIN

 

Do not lie on your stomach if you have knee pain—whether it’s from arthritis, an injury or a surgical procedure. The pressure on the kneecap can be painful. Also, people who sleep on their stomachs often stretch out the back of the knee joint. This can cause an overextension of the hamstring and the knee joint, leading to pain in the knee or hamstring.

 

Better: Sleep on your side with a pillow between your knees. The pillow should be thick enough so that the top leg remains in alignment with the hip. This prevents the top hip from dropping down, which can stress the leg and the spine. The pillow reduces friction and pressure on the knees and keeps the legs in proper alignment.

 

Another choice: Sleep on your back. You may want to sometimes use a small pillow or towel roll under your knees. Caution: If you have arthritis or any acute injury and use a pillow in this way often, it can increase swelling in your knees and limit the knees’ range of motion. For this reason, you might need to alternate between side-lying and sleeping on your back throughout the night or on different nights.

 

BACK PAIN

 

Back-sleeping is a good position for people with back pain. However, if you’re lying flat on your back, you may feel more comfortable with a pillow under your knees. This will keep your back in a more natural position and eliminate an excessive arch between your lower back and the mattress.

 

Self-test: If you can easily slip your hand into an open space between your lower back and the mattress, raise your knees a little more. Your lower back should be flat against your hand.

 

For back pain, you may also find it comfortable to sleep on your side with a pillow between your legs.

 

NECK PAIN

 

If your neck is tight and/or painful, do not sleep on your stomach. Reason: Unless you sleep with your face pressed into the mattress, you’ll need to turn your head to the side. This puts a lot of stress on the neck joints as well as the muscles and soft tissues in the neck and upper back.

 

Better: Sleep on your side with a pillow under your neck. The pillow should fill the distance between your neck and shoulder. You can use a special pillow for side- sleeping with more support for your neck and a cutout for your head (available online or from home-goods stores). Alternately, you can use a rolled-up towel to give your neck more support. You also can sleep on your back as long as you don’t prop up your head too high, which will strain your neck. (Usually one pillow is enough.)

 

FOOT PAIN

 

If you have extreme pain on the sole of your foot, you may have plantar fasciitis. This condition causes painful inflammation of the tissues on the bottom of the foot. If you have plantar fasciitis, it will likely worsen if you sleep on your stomach. Reason: You generally point your feet when you’re on your stomach. This shortens the muscles of the calf and soles of the feet and can cause painful cramps.

 

You will do better if you sleep on your back or side using a pillow between the legs. If you must sleep on your stomach, at least hang your feet over the end of the bed so that your feet and ankles are in a more neutral position.

 

SNORING AND SLEEP APNEA

 

Even people who do not usually snore will often do so when they sleep on their backs. Gravity pulls downward on the tongue and other structures in the throat, partially blocking airflow and causing snoring.

 

Sleeping on your back also can cause obstructive sleep apnea, in which breathing intermittently stops and starts during sleep. If you’ve been diagnosed with sleep apnea or if your partner reports that you gasp, snore or snort during sleep, try sleeping on your side or stomach. If you are on your side but tend to flip onto your back during the night, place a pillow or two behind you. This will stop you from rolling onto your back.

 

ACID REFLUX

 

If you suffer from heartburn, also known as acid reflux, how you sleep can determine whether you’re comfortable or suffering from that unpleasant “burning” sensation. Lying flat on your back makes it easier for stomach acid to surge upward into the esophagus—the cause of heartburn.

 

You’ll feel better if you elevate the upper half of your body with a wedge pillow, often made of foam.

 

There are also special pillows that slip between the box spring and mattress (or under the mattress on a platform bed) to elevate the head of the bed. Risers for the head of the bed also can be used.

 

If you have heartburn: Sleeping on your left side often is advised. In this position, the esophagus is higher than the stomach to help prevent the backwash of stomach acid.

 

HOW TO CHANGE HOW YOU SLEEP

 

Suppose that you are a side-sleeper, but you know that you should be sleeping on your back. Before you go to sleep, think about the position that you want to maintain and start in that position. Remind yourself of this whenever you happen to wake up and return to the desired position.

 

It may take a few weeks (or even months), but the mental reminders and time in the desired position will eventually change the way that you sleep most of the time.

 

IS IT TIME TO REPLACE YOUR MATTRESS?

 

If you can’t remember when you bought your mattress, you’re probably due for a new one.

Mattresses start to sag and lose their support after about eight or 10 years.

 

Choose a mattress that’s on the firm side or firm, but with some cushioning on top, such as a plush-top mattress. About every three months, rotate the mattress. Flip it over if it has two sleep sides.

 

Also: Invest in more pillows. You can use them in different ways when you need more support or padding—for example, between your legs, for hugging and under your knees. Depending on the size of the pillows, two to four will generally be enough to provide added support for your body.

 

Source: Mary Ann Wilmarth, PT, DPT, chief of physical therapy at Harvard University in Cambridge, Massachusetts, and former director of the Doctor of Physical Therapy (DPT) Program at Northeastern University, where she was the assistant dean for the College of Professional Studies. She is also the founder and CEO of Back2Back Physical Therapy, a private practice based in Andover, Massachusetts. www.Back2BackPT.com

 

http://www.bottomlinepublications.com/content/article/health-a-healing/change-your-sleep-position#at_pco=cfd-1.0

Sore Shoulder?

June 1, 2008

 

It could be a torn rotator cuff

 

 

When you hear the words “rotator cuff injury,” you probably think of professional baseball pitchers and tennis players. It’s true that this injury frequently affects athletes whose sports require an overarm motion. The rotator cuff—the broad tendon and muscle that surrounds the “ball” part of the “ball and socket” shoulder joint—helps stabilize the shoulder and is involved in lifting and rotating the arm.

 

What you may not know: It’s also easy for nonathletes to tear a rotator cuff, and you can even do so without realizing it. If you’ve noticed decreased strength and mobility or recurrent pain in your shoulder, you may have torn your rotator cuff. Studies suggest that up to 70% of people age 80 and older have a tear in one or both rotator cuffs. Among people in their 60s and 70s, more than 50% have rotator cuff tears.

 

One reason these tears are so common in older people is that even under the best of conditions, the shoulder joint gets a limited supply of blood. As we age, the shoulder’s blood supply diminishes even further, causing tendons to become less elastic—and more prone to damage. A single traumatic event such as a fall can cause a rotator cuff injury, but most are the long-term result of everyday wear and tear.

 

IS IT TORN?

 

Do you experience weakness when lifting or rotating your arm…a crackling sensation in your shoulder…and/or pain in the front and outside of your shoulder? The pain may be constant or intermittent, and it may feel worse when you lean on your elbow, reach up for something or lie on the affected shoulder at night.

 

These are all indicators of a torn rotator cuff, and you should see an orthopedic surgeon, who can diagnose the problem. Other possible causes of shoulder pain include arthritis, tendonitis (inflammation of the rotator cuff tendon) and bursitis (inflammation of the bursa, a pad of soft tissue inside the shoulder joint).

 

When I examine someone with a shoulder ailment, I check for shoulder weakness by having the patient lift his/her arm away from the body at a 90-degree angle while resisting my downward pressure. If there’s no weakness, the pain is most likely due simply to inflammation. In that case, I generally recommend that the patient try to avoid exacerbating activities (overhead sports, reaching, sleeping with that arm extended over the head) for two to three weeks, take anti-inflammatory medication, such as ibuprofen or naproxen (possibly including a cortisone shot in the affected joint), and perform shoulder-strengthening exercises (see below) once the pain subsides.

 

But if my test reveals shoulder weakness, that usually indicates a tear in the rotator cuff tendon, which requires much more aggressive treatment. The next step is to do an MRI or ultrasound scan of the shoulder to check for a tendon tear.

 

TREATING AN INJURY

 

No rotator cuff tear, big or small, will ever heal on its own. If the tear is small and the patient is over 65, I’ll usually recommend two weeks of anti-inflammatory medication along with physical therapy to see if strengthening the remaining rotator cuff muscles will compensate for the small tear. In younger patients—who tend to be more active and who have more years ahead of them during which the tear will increase and become more symptomatic and difficult to repair—surgery is recommended.

 

Helpful exercises involve working the four muscles around the shoulder joint using a TheraBand (an elastic band that provides resistance when you pull it, available at sporting-goods and fitness supply stores), or light (one- or two-pound) weights.

 

Examples: Tie the TheraBand to a doorknob. Stand with your affected shoulder away from the door, holding one end of the band with that same hand. Pulling the band for resistance, extend your arm out to the side (keeping your elbow against your body). Repeat 10 to 15 times.

 

Next, stand with the affected shoulder toward the door, hold the band with the same hand and pull your arm across your body 10 to 15 times (again keeping your elbow in).

 

Finally, stand with the front of your body facing the door. Holding the band, lift the affected arm with the palm up and the elbow straight 10 to 15 times.

 

Do three sets of these exercises every other day. By the tenth lift, the arm should be tired.

 

WHEN SURGERY IS NECESSARY

 

If a patient’s pain continues, or if the rotator cuff tear is large, I generally recommend surgery to repair the tendon. Reason: As already mentioned, tears tend to get worse over time—especially large ones. In the worst cases, the attached muscles lose function and start to atrophy.

 

For this same reason, I’ll also periodically reevaluate patients with small tears to make sure that the tears haven’t progressed to where surgery is required. In these follow-up exams, I check not just the affected shoulder but also the other shoulder. Reason: Many people also have tears on their “good” side. In a recent ultrasound study of nearly 600 patients with shoulder pain, researchers found that one-third had tears in both rotator cuffs—even though most had pain in just one shoulder.

 

Today, rotator cuff surgery is usually done arthroscopically, using a scope and cutting tool that are inserted through two or three tiny incisions. The surgeon typically removes a spur of bone from the top of the shoulder joint to make more space for the rotator cuff and trims away any chronically inflamed tendon tissue. The tear is sewn up and, usually, reattached to the top of the humerus bone using a small anchor made of metal or of a bioabsorbable material that looks like plastic.

 

The procedure is generally very successful provided the patient does shoulder-strengthening exercises under the guidance of a physical therapist during recovery. It typically takes six weeks for the tendon to heal, but can take up to 12 months to regain maximum strength. Return of strength is far less predictable than pain relief.

 

Once a patient has completed physical therapy, the shoulder will be reassessed to determine the need for any restrictions. Most patients return to full activity.

 

Future hope: Two promising medications may speed healing. Early studies indicate that application of certain healing substances derived from blood platelets or engineered in a laboratory promotes earlier absorption of diseased tissue and replacement by strong tendon. Other promising techniques include use of platelets isolated from the patient’s own blood to deliver growth factors to a tendon repair site…and pulsed ultrasound, which speeds healing by improving local blood circulation.

 

Source: Sabrina Strickland, MD, sports medicine specialist, Hospital for Special Surgery, New York City, where she treats orthopedic conditions of the shoulder, knee, elbow and ankle. She is also chief of orthopedics at the James J. Peters VA Medical Center, Bronx, New York, and a clinical instructor at Weill Medical College of Cornell University, New York City.

Listing Details

Publication                                       Bottom Line Tomorrow

Original publication date                 June 1, 2008

http://www.bottomlinepublications.com/content/article/health-a-healing/sore-shoulder

Sore Shoulder?

It could be a torn rotator cuff

 

When you hear the words “rotator cuff injury,” you probably think of professional baseball pitchers and tennis players. It’s true that this injury frequently affects athletes whose sports require an overarm motion. The rotator cuff—the broad tendon and muscle that surrounds the “ball” part of the “ball and socket” shoulder joint—helps stabilize the shoulder and is involved in lifting and rotating the arm.

What you may not know: It’s also easy for nonathletes to tear a rotator cuff, and you can even do so without realizing it. If you’ve noticed decreased strength and mobility or recurrent pain in your shoulder, you may have torn your rotator cuff. Studies suggest that up to 70% of people age 80 and older have a tear in one or both rotator cuffs. Among people in their 60s and 70s, more than 50% have rotator cuff tears.

One reason these tears are so common in older people is that even under the best of conditions, the shoulder joint gets a limited supply of blood. As we age, the shoulder’s blood supply diminishes even further, causing tendons to become less elastic—and more prone to damage. A single traumatic event such as a fall can cause a rotator cuff injury, but most are the long-term result of everyday wear and tear.

 

IS IT TORN?

Do you experience weakness when lifting or rotating your arm…a crackling sensation in your shoulder…and/or pain in the front and outside of your shoulder? The pain may be constant or intermittent, and it may feel worse when you lean on your elbow, reach up for something or lie on the affected shoulder at night.

These are all indicators of a torn rotator cuff, and you should see an orthopedic surgeon, who can diagnose the problem. Other possible causes of shoulder pain include arthritis, tendonitis (inflammation of the rotator cuff tendon) and bursitis (inflammation of the bursa, a pad of soft tissue inside the shoulder joint).

When I examine someone with a shoulder ailment, I check for shoulder weakness by having the patient lift his/her arm away from the body at a 90-degree angle while resisting my downward pressure. If there’s no weakness, the pain is most likely due simply to inflammation. In that case, I generally recommend that the patient try to avoid exacerbating activities (overhead sports, reaching, sleeping with that arm extended over the head) for two to three weeks, take anti-inflammatory medication, such as ibuprofen or naproxen (possibly including a cortisone shot in the affected joint), and perform shoulder-strengthening exercises (see below) once the pain subsides.

But if my test reveals shoulder weakness, that usually indicates a tear in the rotator cuff tendon, which requires much more aggressive treatment. The next step is to do an MRI or ultrasound scan of the shoulder to check for a tendon tear.

 

TREATING AN INJURY

No rotator cuff tear, big or small, will ever heal on its own. If the tear is small and the patient is over 65, I’ll usually recommend two weeks of anti-inflammatory medication along with physical therapy to see if strengthening the remaining rotator cuff muscles will compensate for the small tear. In younger patients—who tend to be more active and who have more years ahead of them during which the tear will increase and become more symptomatic and difficult to repair—surgery is recommended.

Helpful exercises involve working the four muscles around the shoulder joint using a TheraBand (an elastic band that provides resistance when you pull it, available at sporting-goods and fitness supply stores), or light (one- or two-pound) weights.

Examples: Tie the TheraBand to a doorknob. Stand with your affected shoulder away from the door, holding one end of the band with that same hand. Pulling the band for resistance, extend your arm out to the side (keeping your elbow against your body). Repeat 10 to 15 times.

Next, stand with the affected shoulder toward the door, hold the band with the same hand and pull your arm across your body 10 to 15 times (again keeping your elbow in).

Finally, stand with the front of your body facing the door. Holding the band, lift the affected arm with the palm up and the elbow straight 10 to 15 times.

Do three sets of these exercises every other day. By the tenth lift, the arm should be tired.

 

WHEN SURGERY IS NECESSARY

If a patient’s pain continues, or if the rotator cuff tear is large, I generally recommend surgery to repair the tendon. Reason: As already mentioned, tears tend to get worse over time—especially large ones. In the worst cases, the attached muscles lose function and start to atrophy.

For this same reason, I’ll also periodically reevaluate patients with small tears to make sure that the tears haven’t progressed to where surgery is required. In these follow-up exams, I check not just the affected shoulder but also the other shoulder. Reason: Many people also have tears on their “good” side. In a recent ultrasound study of nearly 600 patients with shoulder pain, researchers found that one-third had tears in both rotator cuffs—even though most had pain in just one shoulder.

Today, rotator cuff surgery is usually done arthroscopically, using a scope and cutting tool that are inserted through two or three tiny incisions. The surgeon typically removes a spur of bone from the top of the shoulder joint to make more space for the rotator cuff and trims away any chronically inflamed tendon tissue. The tear is sewn up and, usually, reattached to the top of the humerus bone using a small anchor made of metal or of a bioabsorbable material that looks like plastic.

The procedure is generally very successful provided the patient does shoulder-strengthening exercises under the guidance of a physical therapist during recovery. It typically takes six weeks for the tendon to heal, but can take up to 12 months to regain maximum strength. Return of strength is far less predictable than pain relief.

Once a patient has completed physical therapy, the shoulder will be reassessed to determine the need for any restrictions. Most patients return to full activity.

Future hope: Two promising medications may speed healing. Early studies indicate that application of certain healing substances derived from blood platelets or engineered in a laboratory promotes earlier absorption of diseased tissue and replacement by strong tendon. Other promising techniques include use of platelets isolated from the patient’s own blood to deliver growth factors to a tendon repair site…and pulsed ultrasound, which speeds healing by improving local blood circulation.

 

Source: Sabrina Strickland, MD, sports medicine specialist, Hospital for Special Surgery, New York City, where she treats orthopedic conditions of the shoulder, knee, elbow and ankle. She is also chief of orthopedics at the James J. Peters VA Medical Center, Bronx, New York, and a clinical instructor at Weill Medical College of Cornell University, New York City.

 

 

Listing Details

Publication

Bottom Line Tomorrow

Original publication date

June 1, 2008

http://bottomlinepublications.com/content/article/health-a-healing/sore-shoulder