Shoulder injury / inflammation / strain?
November 11, 2010 | 30,00 EUR | answered by Dr. med. Olaf Stephan
I injured both shoulders while exercising a specific exercise.
The exercise: push-ups, then transitioning into a one-arm push-up with the other arm stretched out "around the body" rotating 180 degrees, rotating the torso with it (the arm then points towards the ceiling, the head follows), then back, performing a push-up (with both arms), coming back up, then repeating the movement with the other arm.
I performed this exercise (I hope it's understandable) in 4 sets of 12 repetitions. It went without any problems, no pain, pulling, cracking, etc. while performing the exercise. However, I hadn't done this exercise in a long time (last time was about two years ago).
Two and a half days later (after the exercise), I woke up at night with extreme pain in both shoulders. The pain was not clearly localized, it simply hurt the entire shoulder area up to the upper arms and the shoulder muscle (trapezius muscle?) ("dull" pain), it hurt sharply in the shoulder at various points during movements.
I then took a Voltaren Resinat (75mg Diclofenac) daily. The pain in the right shoulder has mostly gone away (4 days after the first night of pain), with a slight to moderate restriction in movement still present (reaching overhead and forward, e.g. putting dishes in a kitchen cabinet).
The left shoulder calms down during the day (only slight to moderate pain, moderate restriction in movement), but the pain increases at night. This seems to happen due to lying down: I fall asleep (currently with little pain), wake up after about 4 hours of sleep with strong pain in the shoulder and then have to get up. After some time of walking / standing / sitting, the pain subsides. I may "doze off" a bit (lying down), but the pain increases again, so I get up and end the night very early. In the right shoulder, there is only a slight pulling at night during movements.
I continue to take 1 Voltaren Resinat 75mg Diclofenac (now for a week) in the evening (to have an effect during the night).
I am currently abroad for a few weeks and do not have the opportunity to see a specialist.
I would be very grateful for an assessment and advice.
Dear Inquirer,
according to your above description of the physical exercise, you have subjected the shoulder-neck area to a very complex load, which has certainly overstrained muscles and ligaments. Although you describe your symptoms very extensively and in detail, a thorough clinical examination with testing of joint mobility, pain points, and muscular status would be necessary for an accurate diagnosis. Since this is apparently not currently possible, I will try to be as helpful as possible remotely. From your description, it can be concluded that there are initially no bone injuries such as fractures or joint injuries such as dislocations, as the symptoms are improving and there is apparently only slightly reduced mobility. Furthermore, the ligament apparatus also seems to be intact. Due to the nature of the load, an injury to the so-called rotator cuff of the shoulder is also possible, but in that case you would not be able to lift your arm sideways above the horizontal. Most likely, the symptoms you described are simply a "normal" muscle soreness, possibly accompanied by muscle fiber tears. Additionally, a moderate overstretching of the ligament apparatus is also possible. Therefore, it is very likely that these are completely reversible damages, which, although quite painful, will gradually heal over time. Apparently, there has been a significant improvement in the last few days. Therapeutically, you should rest physically until the pain disappears and refrain from any sports activities in the next few days. You can increase the dose of Voltaren to 2 x 75 mg daily, as the tablets only work for about 12 hours, which may explain the increasing nighttime symptoms as the medication is already largely eliminated from the body. Voltaren (= Diclofenac) also has an anti-inflammatory effect, which should accelerate the healing process overall. The side effects of Voltaren mainly affect the stomach (stomach pain to gastric ulcer), so you should pay attention to tolerance and not take the tablets on an empty stomach. It is very likely that the pain will decrease in the next few days. I wish you a speedy recovery. Best regards, O. Stephan.
