Shoulder Questions and Answers

What a wonderfully informative and helpful site!  Thank you for taking the time to do this. 

 I have a calcium deposit that was described as large and indeed there is a lump on the front, top of my shoulder.  Pain radiates down my outside arm and even into my forearm nearly to my wrist.

 The suggestion of cortisone was made but an injection in 2010 for an L4-5 herniation resulted in sleep deprivation, inflammation and slight fever that delayed surgery.  Oh, pain was lessened for one day.  The burning and pain in my lower right leg was terrible and has left me with nerve damage and a drop foot.  Consequently, I am apprehensive about cortisone and refused the treatment. 

 We are trying an anti-inflammatory, 2,400 mg of ibuprofen and ice packs.  The pain has lessened but so has activity.  Yard work that includes a chain saw and brush trimmer beckons. 

 Is there any possibility that Gloucosamine might help start absorption of the calcium?

 About eight years ago my family physician x-rayed the shoulder and indicated that a calcium deposit was present.  Obviously it has become worse over time and it has indeed limited movement for the entire time.  I have just “put up with” the lack of movement and pain.  Now, however, the situation has become too painful. 

 Thank you again for the site and very helpful comments and suggestions.

Lake Wylie, SC, USA

Hello Dr. de Beer,

I am a 29 year old occupational therapist. My job requires some frequent overhead acts and assisting patients in transfers and during walking. I have been working in this field approx. 8 months. Daily, I carry a heavy backback with charts, lap top, weights. I am right hand dominant. I have never had very good posture and both of my shoulders are rounded forward slightly.

 About 2 months ago I began having sharp pain at my right shoulder, was tender to the touch, and had difficulty sleeping on my right side. I was diagnosed with impingement 4 weeks ago and given a cortisone injection which eliminated the sharp pain.

 Since then, I have been having a dull aching pain in my entire right shoulder and scapula that comes and goes when I am resting and when I am doing things. I have a hard time sleeping on my right because it is uncomfortable. I feel my neck on my right side feel tight sometimes. My biggest problem is that now my entire right arm feels heavy, weak, and tired. Lately I have noticed my right shoulder is significantly lower than my left. My PT verified this, and noted that my right scapula is 1 inch more lateral from my spine than my left, and is significantly depressed as well.

 My current ortho doctor has refused to order me an MRI or EMG, even after I presented to him last week with the new compaints of weakness/fatigue in my entire arm.

 What would you suggest this is? What should I do next? I currently participate in PT and home exercises for strengthening, stabilization.

Thank you so much,

Hello Dr. de Beer,

I am a 29 year old occupational therapist. My job requires some frequent overhead acts and assisting patients in transfers and during walking. I have been working in this field approx. 8 months. Daily, I carry a heavy backback with charts, lap top, weights. I am right hand dominant. I have never had very good posture and both of my shoulders are rounded forward slightly.

 About 2 months ago I began having sharp pain at my right shoulder, was tender to the touch, and had difficulty sleeping on my right side. I was diagnosed with impingement 4 weeks ago and given a cortisone injection which eliminated the sharp pain.

 Since then, I have been having a dull aching pain in my entire right shoulder and scapula that comes and goes when I am resting and when I am doing things. I have a hard time sleeping on my right because it is uncomfortable. I feel my neck on my right side feel tight sometimes. My biggest problem is that now my entire right arm feels heavy, weak, and tired. Lately I have noticed my right shoulder is significantly lower than my left. My PT verified this, and noted that my right scapula is 1 inch more lateral from my spine than my left, and is significantly depressed as well.

 My current ortho doctor has refused to order me an MRI or EMG, even after I presented to him last week with the new compaints of weakness/fatigue in my entire arm.

 What would you suggest this is? What should I do next? I currently participate in PT and home exercises for strengthening, stabilization.

Thank you so much,

Dr De Beer

I broke head head of my humerus at its base in 1988.  It has never been right since.  I am know 47 years old and over the past year have been loosing movement. (I have never since the injury been able to put my hand behind my back). it has got to a point that i am living on pain killers and antinfam. I am suffering form terrible back pain as I can only sleep on my left side.  If i sleep on my back I have to have a pillow under my arm for support. Physio has never really helped me and in the past (few years ago) I went for physio but it just made it worse.  I also broke my coller bone at the same time.  Could you give me your opinion and  recommend a shoulder surgeon in JHB if you can. 

Thank you

Hi Dr. i injured my right shoulder playing tennis (serving) a while ago. Gradually the pain increased, and my mobility decreased. At this point just touching the AC joint area hurts a lot, moving my arm straight across my chest hurts. With a straight arm, lifting sideways and to the front husrts as well. I live in Pinetown (KZN), is there a shoulder specialist in this area i can see?

Regards

GEAGTE DR. DE BEER

EK HET IN FEBRUARIE 2011 VAN MY FIETS GEVAL REG OP MY SKOUER. AANVANKLIK GEEN PROBLEME NIE. MET TYD KON EK DIE ARM AL HOE MINDER GEBRUIK.UITEINDE V.D. SAAK WAS `N SKOUEROPERASIE WAARTYDENS DIE VOLGENDE GEDOEN IS: SHOULDER:ACROMIOPLASTY, ARTHROPLASTY:DEBRIDEMENT LARGE, MUSCLE +TENDON REPAIR:ROTARY, ARTHROPLASTY:EXCISION MEDIAL,ARTHROSCOPY (EXCLUDING AFTER-C, MANIPULATION LARGE JOINT.

EK IS DIE OGGEND GEOPEREER EN HET UIT TEATER GEKOM MET N BO-ARM WAT GESWEL WAS.EK HET MY EERSTE FISIO REEDS DIE AAND GEHAD EN DAARNA OP `N GEREELDE BASIS. EK HET AL N KORTISOONINSPUITING GEHAD. NOG STEEDS IS MY SKOUER GEVRIES. MY GROOT BEKOMMERNIS IS MY BO-ARM WAT NOG STEEDS DIK IS. EK HET AAN DIESELFDE KANT (DOMINANTE KANT) N MASTEKTOMIE GEHAD EN DAAR IS TWEE LIMFKLIERE VERWYDER. PARTYKEER VOEL MY VINGERS STYF EN DIK. EK HET ONTSETTEND PYN V.D. BO-ARM TOT IN MY HAND. EK LEEF VAN PYNPILLE. EKSTERNE ROTASIE 35 GRADE.SKOUER WAS ERG ONTSTEEK MET OPERASIE. EK IS N ONDERWYSERES MAAR EK KAN NOU FEITLIK NIKS MET DIE ARM DOEN NIE DAN VERERGER PYN. SLAAP BAIE SLEG SNAGS EN IS BAIE MOEDELOOS. WAT STEL U VOOR?

Dear Dr. de Beer,

I have a Christmas wish – I wish you could come to PE at the end of January to perform surgery on my shoulder together with Dr. Hurter.

After 20 years of playing highly competitive handball in Slovakia and in Germany it´s time for repairs. Two days ago I was diagnosed with the Supraspinatus tendon tear and SLAP lesion.

At the moment I´m finishing doctoral studies in Industrial Engineering at NMMU and waiting for examiners´ results. I will need my shoulder again in March to finalize the thesis and before we relocate overseas (April/May).

I wish to come on your list in PE.

Have a wonderful Christmas.

Dear Dr. Joe de Beer,

I’m 16 and had surgery to stablize my shoulder almost a year ago today (december 2010). It disloacted quite a few times before surgery but nothing was torn. I did physical therapy before to try a different method but it didnt work. After surgery I started physical therapy on Janurary 5th 2011 and have been going twice a week since then. Also, my middle and ring finger were numb and weak along with the top of my shoulder. The feeling did however come back eventually. 

I still have an incredible amount of pain and a really limited range of motion. My fingers randomly go numb and pins and needles, typically my pinky and pointer. My shoulder blade also gets the pins and needles. I constantly get knots in my bicep all the way up my arm to the top of my shoulder. Whenever i lift my arm up it feels blocked, same with up to the side and rotating out. I get really bad pain whenever i put my shoulder blade back and down in the front and top. My neck is also constantly  tight and in pain. Its VERY tender to the touch in the front of my shoulder (by the incision) and along the under part of my clavicle and down the pec.  Im skipping a lot of other things that cause pain because this is getting a little long.

Now, my muscle is atrophying in the back. My bone is popping out and bruising the skin. When my arm is at my side its like a crater. My shoulder incredibly weak and it just gets more and more painful by the day. My pinky goes numb almost daily. Although my ROM is increasing by a few degrees, my clavicle is extremely painful when i drop my arm down to rest.

I had an MRI of my neck and a nerve conduction test done, which was negative. My physical therapist and I are now stumped. Nothing is adding up and its really starting to cause set backs. 

Please please help,

Hello Dr. De Beer 

I would appreciate if you could take a look at the radiologist findings and please give me your opinion as to what I should do next. I am a keen weight lifter, but currently I am experiencing alot of pain and am not able to lift my arm.

I look forward to your reply.

Goeiedag

My man (SN Swanepoel – 670404 5105 088)het sy skouer by u laat opereer ‘n tyd terug – ek kan nou nie die korrekte datum onthou nie, maar dis nie meer as 5 jaar terug nie).

Hy het sy fisio gedoen, asook al sy oefeninge wat hy moes, maar hy het konstante, erge pyn.  Volgens hom was dit die slegste besluit wat hy ooit geneem het om sy skouer te laat opereer – hy voel die pyn wat hy voor die operasie gehad het, was meer draaglik.

Is daar enige iets wat u kan voorstel wat hy kan doen – fisio, oefeninge, medikasie?  Die kanse dat hy ooit weer aan sy skouer laat sny, is nul.

Ek het geen x-strale by my nie, maar ek is seker dis nog op u stelstel.

Baie dankie.

I am a under paid amateur powerlifter (you’ll probably stop reading after that…) And I recently had a sharp pain in my right shoulder top/front area while warming up with pushups. This was a severe pain that made my arm impossible to lift and extended foward and up, or across my body.  Pain was not as sever moving back or to the side.  After three weeks of absolutely no lifting, I am able to do pulling exercises but not pressing.  Is this something along the line of a labral injury or AC joint injury?  There is a TINY bit of nise (clicking) in the back of my shoulder when moved backwards and forwards.  In the image the pain is along the black lines.

Dear Dr de Beer ,

 What a brilliant site and well done for answering all of these questions .

I have  had a arthroscopic subacromial decompression and biceps tenodesis procedure on the 26/09/2011 – I kept my arm in a sling 24/7 for the first 2 weeks and did a few daily rotations , I then increased these and started using my arm but avoided anything with weight ( used a computer but lifted nothing ) – 5 weeks later I still have this constant feeling which is not acute pain but bad enough to wake me up at night and for me to be aware of it all day

I have avoided pain killers due to the side effects

Is this normal and how long could I expect this feel to last for or should I have it checked out?

Dear Dr,

I am a 53 year old female that was diagnosed with Thoracic Outlet Syndrome on my left side 6 years ago. Surgery was done by a Vascular Surgeon to remove the first rib and the anterior scalene muscle. The surgery helped so much to help relieve that blood flow down to my hand, but ever since the surgery, I have had severe tightness and muscle spasms in the scapula area. My shoulder will have a dull ache and cause my hand to feel achy and heavy. The only relief I get from it is taking muscle relaxants. In fact I have been on Soma for 6 years. I can’t seem to get any answers as to why I experience this. After reading your excellent article about TOS, I am wondering if this the nerves that are causing my pain.

In you experience with TOS, have you seen alot of patients that have TOS surgery have this issue? Should I see a Neuro Surgeon for this or a shoulder specialist?

Thanks for any advice!

My Mother had a shoulder replacement 1 yr ago this month, she is still having alot of pain. She did her therapy has recommoneded and she still is doing the exercises that she needs to do dailey. The pain is there most of the time, it goes down into her had most of the time. She has restricted movement in her shoulder, the doctor tells her that it could be frozen.

My question is if she has aother surgery to help free up the shoulder, I don’t think there is any quraentee that it my not freeze again. Could the constant pain be some nerve damage, and how can that be delt with.

Thank you.

Hello Dr. de Beer

I am a 27 year student from England. I have had shoulder problems constantly for the past five years and in total have undergone five operations (three on my left and two on my right). My injuries occurred as a result of training accidents whilst doing judo.

I was diagnosed as having a posterior-inferior Bankart lesion from 7 o’clock to 8.30 in my LEFT shoulder and type 3 SLAP tear in my RIGHT shoulder.

Unfortunately all of my surgeries failed and I am still left with ill functioning shoulders.

My most recent surgery was a left Bankart repair carried out by a very well respected orthopaedic surgeon. During a consultation post operation, he informed me that whilst on inspection inside my shoulder he observed a bone deficiency in my humeral head and he suspects that this may well have been from birth. To that end he had advised me that a Latarjet procedure may put an end to my problems with my left shoulder.

My right shoulder is currently not being treated but has undergone two failed SLAP repairs. Would you suspect that I might be deficient bone in both of my humeral heads and this is why the repairs do not seem to be working?

Also, what would be your next step in dealing with this problem?

Many thanks and kind regards.

Goeie dag Dr,

Ek is 61 jaar oud en het in April ‘n rotator cuff herstel gehad asook akromioplastie.   Was vir 6 weke met my arm in ‘n draagband en ook ‘n kussing daarby, wat ek na 4 weke afgehaal het agv erge ongemak in die nag.   Op 6 weke is die draagband afgehaal en het ek met fisio begin.   Na 3 weke se fisio het ek op my eie begin oefen aan die hand van ‘n brosjure wat sy my gegee het, maar ek sukkel geweldig.  Met en na die oefeninge het ek geweldig pyn en snags is dit regtig so pynlik dat ek omtrent elke nag pynpille moet drink en hitte moet opsit.   Nou het ek 2 dae gelede gestop met die oefeninge die pyn is merkbaar minder, ek het 2 nagte sonder pyn geslaap, maar my bekommernis is dat my arm nog baie swak is en ek hom nog nie bo-kant my kop kan lig nie, net as ek lê kan ek dit doen.  Ek moet bysê dat ek 8 maande met die besering geloop het voordat ek by die ortopediese chirug uitgekom het.   My huisdokter sê omdat ek redelik artitis het en nie meer so heeltemal jonk is nie en die besering baie oud was, dit baie langer sal neem om totaal te herstel.   My vraag is sou ek die oefeninge heeltemal los en my normale gang gaan en my werk doen en maar my arm gebruik soos ek gewoond was, maw ek moet hom forseer om seker aksies uit te oefen, sal dit ‘n impak hê op die lang duur en sal hy volkome herstel.

 Baie dankie, u kan my maar hier antwoord.

Dear Dr de Beer

Four months ago I had a Mumford procedure on my right shoulder. On September 12 you gave me an injection for lingering mild pain.(you have my x-ray, it is fine) This pain has now gone and the shoulder feels better.

1. Is it ok to start weight training now ?

2. Will exercises like the bench press, shoulder press, parallel bar dips be safe to perform ?

3. Please give some guidelines for safe weight training.

Many Thanks

I had a La tar jet operation in 2007 done by Dr Rory Harvey, I must admit I was inactive and only started gyming again in 2009. I feel that my shoulder is getting stronger however I am feeling alot of discomfort lately (it comes and goes) and I cant link it to any workout I am having, I have full range of motion but I would like to know if this something that I should be concerned about? and if so when can I make an appointment to see you?

Hi Dr de Beer

I’ve had calcified tendonitis in my left shoulder for about 18 months. After a year of medication, and steroid injections every few months, the problem only got worse. So, I finally went for surgery last month. The doctor said he only managed to remove about 70% of the calcification as the remainder is too close to the tendon to remove safely.

In your article (best one on the topic I found on the web BTW) you mentioned there is usually some deposits left after surgery which will get absorbed over time. Is it usually as in my case (20-30%) or does it appear the calcification is still too much to be absorbed?

You also mentioned that it is safe to go back to normal activity after surgery depending on comfort levels. I have been inactive workout wise since the problem began and now am trying to get back into free weights slowly. The pain is still quite severe at times, but not not consistent.  Is it considered safe?

Hi Dr de Beer,

I was in a car accident 9 years ago, amongst a few injuries, I broke my shoulder.  Dr P. Spies in Pretoria was the doctor that operated on me, he had to put in 5 screws and a plate.  I’m 28 now and its been 9 years and I still have the plates and screws in my shoulder. In this 9 years, I only had inflammation in my shoulder once, but after taking pills for it, I was fine again. But a week ago all the muscles around my shoulder, my neck muscels, shoulder muscels and back muscles are hurting and aching and I dont know if its got something to do with my shoulder (the plates and screws)?  So actually doctor my question is to you.  After having the screws and plates in for 9 years, would you think it time for it to come out??  I heard somewhere that they say if it doesn’t bother you, dont take it out??

Thanks,

Dear doctor i was involved in an accident which i was hit from behind by a drunk driver.its been three months and my shoulders are still not healed ive been doing physio.i was hit wile i was stopped and the guy didnt even brake ibroke my steering column with my arms.i cannot put my arms up to the sides or back of me my left arm is longer than my right now.you can tell by looking at my fingers.my collar bones stick out above my shoulders when i used to have competley straight shoulders.what should i expect now.i just had an xray today with weights in my hands after i had shooting pains thru my shoulders.i am worried i may need surgery now what may have happened.one doctor looked at me and said my ligaments looked stretched because of the way my shoulders hang.like i said ivdone physio 3 months already and im scared.im a hairdresser and single mom and i dont know what will happen to my career.

Geagte Dr Joe,

Hoop dit gan goed.  Ekt n concern, ekt verlede jaar januarie, gegaan vir n skouer operasie.  Ek speel indoor en outdoor krieket en is n bowler.  Hulle het met die operasie as ek dit reg het bicept tendosis of iets gedoen, het dit met skroef of iets ingesit.  Ekt voledig ge-rehab en het physio en bionetikus gesien vir 6 maande..en maak hom nog sterk in gym ens. My physio het ook met dry needling baie van die dieper spiere los gemaak..wat verskriklik baie gehelp het om my terug te kry op die veld.  Ekt begin speel en als was fine…  mar onlang het ek weer begin pyn kry wanner ek gooi (van keeper af) en liggies pyn wanner ek bowl.  Ek speel toernoi in september…en worry oor die pyn!!!  Kan dit wees dat hy swak is…of kan dit weer slap tear of geskeurde bicept wees??  Eks meer as bereid om kaap toe te kom na julle vir die beste behandling wat ek kan kry!!  Ek wil nie dit verder beskadig nie…want joh..dai operasie is nogal seer ;-).  My Dr was Dr Tollig by PTA Oos

Groete,

Dear Dr. de Beer, in your opinion, what exactly is the cause of frozen shoulders and why do women between the ages of 44-55 seem to be the most prone for this condition? Most cases seem to resolve themselves (without resorting to surgery) and certain exercises certainly seem to be highly beneficial. Excellent website, btw. SK Gale.

I had a  nasty fall and after xrays at the hospital found no broken bones, the doctor there indicated that I had probably torn the ligaments in my shoulder.  I have had my arm in a sling for 2 weeks (although I can use my hand and lower arm) and now out of a sling for 2 weeks.  The pain is severe everyday – STILL.  I am on 2 prescription painkillers (having been assured by the pharmacist that there is nothing stronger he can give me) but neither of them have ANY effect or relieve the pain.  At first I could not move my arm away from the side of my body more than a cm.  It has now got a lot better in that regard.  However, the scary thing is that  I cannot lift my arm at all.  It is like the muscles/ligaments which do the lifting do not exist.  I am very worried naturally, and am finding the pain debilitating.  I am not sure whether this problem will go away in time or whether I need to see a physician.  I don’t just want to spend more money if someone is just going to tell me to be patient, ie it takes time for it to heal. What is your advice?

I am a musician (I play the tabla, north indian percussion instrument). Since past few days I have been doing some fast repetitive practice for speed and forcing a little bit to gain extra power for the sound.  I haven’t had any pain but I get these random spasms in some ligament or muscle located at the back of the left armpit. If I lift my arm it would happen only the first time around a quick 4-5 times and if I lift the arm again it won’t happen. While playing where the arm stays in the same position, I get these spams randomly. I also feel I am holding the shoulder tight.

I can’t get out of the practice, but I don’t want the spasms to become a problem.  What do you recommend?

These spasms happened last year as well, but I don’t remember how they went away.

 I also do aerobic exercises and some arm exercises 2 -3 times a week.  

Thank you.