Shoulder Pain: Bursitis or rotator cuff tear?

[Snoogans]

ok. So I used to pitch in HS and throw all the time, no big deal. I could throw for 4 straight hours and it wouldnt bother me. Over the past 2 years or so, whenever I would really crank up a throw, even when warmed up, my fingers were start to tingle after for a few seconds. This didn't happen when I threw a pitch with a real pitchers motion, cause you use your legs alot more. But when I would just make a normal hard throw, this would happen. Ever since then, I can still throw, but no matter how much, the back of my shoulder gets alot of pain. Even if I only throw like 4 or 5 throws, about 20 minutes later it will hurt so bad i dont even want to raise it over my head. The pain is in the back of my shoulder, almost above the back of my armpit behind the socket. Is this like possibly rotator cuff or labrum or do you have any idea what else it might be?

edit: This comes up cause I threw a football probably 7 times tonight, not hard at all. And this area of my arm/shoulder is really sore right now.

[Dr Steve]

ok. So I used to pitch in HS and throw all the time, no big deal. I could throw for 4 straight hours and it wouldnt bother me. Over the past 2 years or so, whenever I would really crank up a throw, even when warmed up, my fingers were start to tingle after for a few seconds. This didn't happen when I threw a pitch with a real pitchers motion, cause you use your legs alot more. But when I would just make a normal hard throw, this would happen. Ever since then, I can still throw, but no matter how much, the back of my shoulder gets alot of pain. Even if I only throw like 4 or 5 throws, about 20 minutes later it will hurt so bad i dont even want to raise it over my head. The pain is in the back of my shoulder, almost above the back of my armpit behind the socket. Is this like possibly rotator cuff or labrum or do you have any idea what else it might be?

edit: This comes up cause I threw a football probably 7 times tonight, not hard at all. And this area of my arm/shoulder is really sore right now.

Ortho is my weak suit, but I'll give this a try. If I can get PA John in here (lazy SOB that he is), I'll try to get his opinion on it as well.

You could have one of several things, from rotator cuff or labral tear as you already mentioned, to a bursitis or tendonitis. I'm going to bet on a shoulder bursitis or tendonitis, since it doesn't seem to bother you except when throwing things. When you throw, these tissues get squished between the bones of the shoulder, and can cause a lot of pain and discomfort.

Bursitis happens when a "bursa" (which is a fluid filled lubricating sac found near heavy joints) gets inflammed; this can cause pain that is very similar to that you'd have with a rotator cuff tear, but it's much easier to treat. Your local orthopedist (or experienced family practitioner/internist) may want to inject your shoulder with cortisone at some point. This will decrease or eliminate inflammation in the surrounding tissues, and may fix your problem for good.

http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/8741.jpg

If you have a rotator cuff tear, physical therapy or cortisone injections won't really help, and they'll eventually get an MRI and consider surgery if your symptoms are bad enough.


Hope this helps.


your pal,


steve

[BinaryBimbo]

I have similar pain but it is much more pronouced in my daily activities, (computer).

For a little over a week I have been elevating my mouse arm position as my Dr. told to do, and the pain isn't going away.

You mentioned that a cortisone shot could possibly fix this permanently? I had always heard that although they, (cortisone shots), can eliminate the pain that you still have the injury. Having read your response to the op I am really ready to go seek that shot.

I really need relief as this has gone on for at least 3 months now. I also have severe COPD; so it's a given I didn't do this by physical exertion. I think you cured me Dr.:smile:

[Snoogans]

I try not to fuck with cortizone. Ive had it a few times and I dont like it. it works great, but it almost makes me feel like Im gonna fuck it up worse by not being able to feel it.

[Dr Steve]

I have similar pain but it is much more pronouced in my daily activities, (computer).

For a little over a week I have been elevating my mouse arm position as my Dr. told to do, and the pain isn't going away.

You mentioned that a cortisone shot could possibly fix this permanently? I had always heard that although they, (cortisone shots), can eliminate the pain that you still have the injury. Having read your response to the op I am really ready to go seek that shot.

I really need relief as this has gone on for at least 3 months now. I also have severe COPD; so it's a given I didn't do this by physical exertion. I think you cured me Dr.:smile:


Cortisone shots will make bursitis and tendonitis "go away", by decreasing the inflammation in or around these structures. Most of the time the bursitis especially is an overresponse to minor injury, and calming down the inflammation is actually a good thing.

Inside JOINTS, too many cortisone shots can cause arthritis, though we will use them for acute arthritis episodes. Inside BURSAE, however, cortisone really seems to be well tolerated and helpful.

Cortisone shots will not help surgical knees (like severely torn cartilage), or rotator cuff tears, though they may feel better for a short period of time.

As always, talk this stuff over with your health care provider, and don't do anything you don't feel comfortable with. :smile:

[EliSnow]

I have shoulder pain as well, but it's not as regularly recurring as it is for the others.

Every time I have a really violent sneeze, it feels like someone is shoving spikes right into my shoulders, right in the cuff.

[Snoogans]

Cortisone shots will make bursitis and tendonitis "go away", by decreasing the inflammation in or around these structures. Most of the time the bursitis especially is an overresponse to minor injury, and calming down the inflammation is actually a good thing.

Inside JOINTS, too many cortisone shots can cause arthritis, though we will use them for acute arthritis episodes. Inside BURSAE, however, cortisone really seems to be well tolerated and helpful.

Cortisone shots will not help surgical knees (like severely torn cartilage), or rotator cuff tears, though they may feel better for a short period of time.

As always, talk this stuff over with your health care provider, and don't do anything you don't feel comfortable with. :smile:

Yea I called my doctor and explained to him exactly what it was feeling like, which is alot easier over the phone as it seems. He seems to think I do have a tear, if not a couple. Whats different, at least it seems to me, about this as opposed to regular throwing pain, is that this is an inside pain. It almost feels like its so far inside its in the socket. My Dr. told me that usually means a tear in something connected to the bones, and it really ruined my fuckin day.

[Disaster]

Hey not a Doctor here and wouldn’t ever act like one. With that said I have done more damage to my body over the year and from what you have said I would think tear in one or more of the muscles in the rotator cuff. I had injured my shoulder years ago and the pain you describe is just like how I felt. Finally I went and had it checked I had some damage to the lining of the join with tears in 2 of the 4 muscles in the cuff. One worse then the other and curently ducking surgery doing rehab on that shoulder. Seems to be working since it doesn’t hurt as much but yet to see if they will have to open it up after all. Get an MRI that will clear things up good luck

[stinkbud]

I am a chiropractic physician. Most of the work I do is spinal care but I am trained as a musculoskeletal worker so i have some experience with shoulder pain. The tingling is the key thing here. Without the benefit of imaging and a full examination of the joint in question its hard to give an accurate impression of what is going on, but the tingling can indicate a thoracic outlet syndrome. The structures involved in a throw could be pinching the nerves and blood vessels that feed your arm. It could also be related to the bursa or other things.

The veins/arteries/nerves that supply your arms are contained in a "neuro-vascular bundle" that travels into your arm across the joint. This is what is called the "thoracic outlet". There are several structures that could be compressing this bundle that can create the tingling you feel. The question is what exactly is doing this. There are several simple orthopedic tests that could narrow things down a bit. Imaging can also help. AN MRI will show pretty much exactly whats happening. Diagnostic ultrasound could also turn up whatever is inflamed there.

http://www.thailabonline.com/diseasegeneral1/TOS1.gif

Since it is a "neuro" and "vascular" (i.e. blood supply) bundle, the tingling of thoracic outlet syndrome is also associated with coldness of the hand and a diminished pulse. Have you been noticing anything like hand coldness or swelling?

As far as treatment...it depends on the problem. Simple treatments such as stretching muscles like the anterior scalene or the pectoralis minor (neck and chest muscles) could relieve pressure on the neurovascular bundle and you are okay (I have had some success with this in my practice). The clavicle (collar bone) could also be pinching the bundle. More invasive treatments include cortisone injections, lidocane injections into tight muscles or even shoulder joint manipulation under anesthesia (but that would happen if your problem develops into a frozen shoulder). Even more invasive treatments would start to get into arthroscopic surgery.

Remember, the severity of the treatment depends on the severity of the condition. Get it checked out by a physician, be it a chiropractor, your family doctor a specialist on sports medicine or an orthopedist. Any of these can help or at least get you on the way to the right person to help you. Like Dr. Steve mentioned, if it is a cuff tear then you will need an MRI. Physical therapy has been known to help with tears if they are minor. More serious tears have to be fixed arthroscopically.

Good luck.

[Snoogans]

No swelling tingling goes away after a few seconds

[stinkbud]

The pain makes me think cuff tear and the tingling makes me think thoracic outlet. You are on the right track working with your doctor. Get it checked out as soon as you can.

One thing that is a good orthopedic test for a supraspinatus tear (a very common rotator cuff tear) is to hold the affected arm at 90 degrees with your thumb pointed down. Have someone hit your arm between your shoulder and your elbow. If your arm suddenly drops down with a ratchety motion you are looking at a tear.

A version of the same test is to have your arm up as I mentioned and then slowly try to lower it to your body. If it is either painful or it drops down uncontrollably that is also a positive test for a tear.

[SP1!]

Sorry, new here but had to chime in.

Sounds just like what I had in my throwing shoulder, baseball in HS, then years of improper weight lifting and 10 years of tournament softball gave me a tear even the MRI tech said looked bad. Turns out it was a tear and quite a few bone spurs or burs (I forget) that was on my shoulder and causing numbness during activity or sleep, I quit being very active and the only thing that would fix it, I was told, was cuff repair and the grind down the shoulder.

3 years and two surgeries later I am still in pain, I dont want to go back to my doctor for fear of another surgery and the only thing that will make it go away are Lortabs, I can take advil or aleve but most of the time they dont work and I didnt realize I was taking more than double the dosage of them a day until my GF said something. I wish I could just get a lifetime script to low dose lortabs cause after 1 or even a half my shoulder feels great and I dont think about it for at least a day.

[Raxallove]

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[Snoogans]

I dont ever get numbness or tingling when Im not throwing. And it doesnt happen every throw either. In fact, it NEVER happens with a football, no matter how hard I throw. Mostly not with a baseball, but sometimes. But when I throw a softball it happens alot. I dont know if that means anything.

As far as that arm test, my arm didnt ratchet or buckle or have pain lowering it. Felt fine