Does Your Shoulder Keep You Awake at Night?

Shoulder pain is a relatively common condition. Ordinary strains and sprains produce shoulder discomfort. Most of the time the condition is self-limiting and resolves spontaneously.

Some shoulder pains are recalcitrant and progressive. Pain may or may not follow any specific injury; it may be spontaneous. Patients usually feel stiffness and find themselves experiencing increasing difficulty in performing day to day routine functions. Pain eventually starts to invade periods of rest. Patients wake up several times during the night and find themselves rubbing their shoulders or popping pain medications. Some patients develop weakness and cannot raise their arms to the side or forward. In most cases there is no visible swelling or lump.

It is not uncommon for some people to discount it as arthritis. They think that since there is no lasting cure then they must suffer and learn to live with the problem. NOT TRUE! Most chronic shoulder pains are not arthritic and are relatively easy to cure.

The shoulder is a ball and socket kind of joint. It is surrounded by an envelope of deep muscles called rotator muscles or commonly known as "rotator cuff". The cuff symbolizes an envelope-like configuration. The cuff is further covered by a bony arch which provides shape and an outer configuration to the shoulder. The actual joint sits deeper, right below the bridge.

Due to several reasons, the muscles stan to rub against the bony arch. This rubbing starts to produce irritation of the rotator cuff. If the rubbing continues for a period of time, the cuff starts to erode. The final outcome may be a good size tear in the cuff. The pressure and rubbing is the cause of pain. Night pain indicates probable erosion of the cuff although this is not necessarily the case in each and every patient. This condition is also called "Impingement Syndrome".

A simple office examination usually reveals the problem. X-rays are usually performed to obtain further information. In some patients, special investigations are indicated to verify tears of the cuff. Local anesthetic injection, at times, is applied to confirm the diagnosis of impingement.

Another common cause of shoulder pain is degeneration of a tiny joint above the shoulder, the AC or acromioclavicular joint. Pain from this condition is usually on the top of the shoulder. One can usually feel a tender spot right over the shoulder. True arthritis of the shoulder joint is rather an uncommon cause.

One should always remember certain serious causes of shoulder pain. Fortunately these casues are rare. Bone tumors, serious conditions in the chest or the abdomen can produce vague shoulder pain. Nerve pinching in the neck or TMJ conditions are also relatively common but non-serious causes of shoulder pain.

Treatment of the problem is based upon the cause. Most cases are mild and relatively easily manageable. Medications, simple exercises, and physical therapy are the usual treatments. Most patients benefit from this plan. Some patients require injections, arthroscopy or surgical correction to get rid of the problem. For specific information on this condition, consult your physician.

Most shoulder pain is easily treated. Consult your physician for information!

Article by Shaheer Yousaf, M.D., FACS