Ask a doctor on the topic of Orthopedics

Shoulder, rotator cuff

March 21, 2011 | 30,00 EUR | answered by Christian Klein

Here is a longer story (including background information for which I have already received hints). It would be very helpful if a specialist in this field would comment on this topic (or someone who actually has experience here).

I am currently abroad and do not have access to a specialist.

Here is the background information that I posted here and to which I already received a response (on 01.11.2010):

"I injured both shoulders during a specific exercise at sports.

The exercise: Push-ups, after coming up then into a one-armed push-up, while stretching the other arm "around the body" by rotating 180 degrees, turning the torso as well (the arm then points towards the ceiling, the head follows), then back, performing a push-up (both arms), coming up again, then repeating the movement with the other arm.

I performed this exercise (I hope it is understandable) in 4 sets of 12 repetitions. It went without any problems, no pain, pulling, cracking, etc. while performing the exercise. However, I haven't done this exercise in a long time (last time about two years ago).

Two and a half days after the exercise, I woke up in the middle of the night with extreme pain in both shoulders. The pain was not clearly localized, it simply hurt the entire shoulder area down to the upper arms and the shoulder muscle (trapezius muscle?) ("dull" pain), it hurt stabbing in the shoulder at various points when moving.

I then took a Voltaren Resinat (75mg Diclofenac) daily. The pain in the right shoulder is largely gone (4 days after the first night pain), there is still a slight to moderate restriction of movement (reaching a plate into a kitchen cabinet over the head, for example).

The left shoulder calms down during the day (only slight to moderate pain, moderate restriction of 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 then subsides. I may "doze off" a bit (lying down), but the pain increases again, causing me to get up and end the night very early. In the right shoulder, there is only a slight pulling during movements at night.

I continue to take 1 Voltaren Resinat 75mg Diclofenac (now for a week) in the evening (to have an effect at night).

I am currently abroad for a few weeks and do not have the opportunity to see a specialist here.

I would be very grateful for an assessment and advice."

I saw a physiotherapist who treated me with massages, magnets, and electrotherapy. Over time, the symptoms improved.

I can now do push-ups again and have no

Christian Klein

Hello,

Based on what you have described here, I also assume that there is no serious injury or major tear of the rotator cuff. However, you have performed a very strenuous exercise for the shoulders, which has either led to muscular overuse of the entire shoulder girdle resulting in severe muscle soreness without visible signs of injury, or there has been an inflammation in the area of the shoulder roof.

Since similar complaints occur after similar exercises and a period of about 6 months with alternating complaints has already been fulfilled, and considering the fact that the first time raising your arm to the kitchen cabinet caused pain, I assume that you probably have an impingement syndrome with resulting inflammation of the subacromial bursa, i.e. the sliding layer between the bony shoulder roof and the shoulder head. Another possibility could be irritation or wear of the shoulder joint.

To diagnose an impingement syndrome, the easiest way is to perform an X-ray examination of the shoulder with a so-called y-view, as the often congenital "unfavorable" hook shape of the acromion, i.e. the shoulder roof, can be seen there. An ultrasound examination in the acute state is also very informative to determine the bursa irritation and the condition of the rotator cuff.

If you have access to an MRI abroad, this is certainly the most modern and safest method for diagnosis. However, a true impingement syndrome with bursitis, i.e. bursa irritation, should lead to rapid and significant improvement after an injection under the shoulder roof (not into the joint!) with a local anesthetic and cortisone.

Therefore, the fastest and easiest therapy for impingement syndrome is mentioned, otherwise, conservative methods such as physical therapy, Voltaren tablets (not suitable for long-term therapy for kidneys, stomach, and liver!), and possibly acupuncture should be tried for at least 6 months to manage the symptoms.

Without sustained improvement, in the presence of impingement, the recommendation is for arthroscopic shoulder surgery to remove the inflamed bursa and remove the hook-shaped bony protrusion using a mill.

I hope this explanation has helped you.

Best regards,
Dr. Ch. Klein