Q: I am a 52-year-old man. I have been doing a lot of physically hard work on the farm recently, repairing buildings and fences. The problem is that when I do too much heavy work, I get pains in my shoulder that keep me awake at night. I had an X-ray and there is no sign of arthritis. Do you have any ideas what is causing the pain and what do you suggest I do tocure it?
A: If you do not have any arthritis that is fortunate. You are most likely suffering from bursitis, tendonitis or impingement syndrome of the shoulder joint.
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You may have caused this by repeatedly using the arm for heavy work, such as lifting boards or swinging a hammer. Perhaps you could get away with this at an earlier age, but being over 50, you may have some general wear and tear to the shoulder and the surroundingstructures.
I expect you have pain in the top of the shoulder or the upper third of the arm if you try to raise the arm above your head. Pain at night when you sleep on the affected shoulder is another common symptom.
These conditions are usually diagnosed by a recent history of activity and a physical examination by the doctor, combined with a lack of any bony changes on the X-ray. X-rays will not show inflamed tendons, muscles or ligaments. An MRI might show something, but it is not really worth the long waiting time or the expense of going to a private clinic.
Tendonitis is inflammation and soreness of a tendon. I expect it is the biceps tendon and the rotator cuff in this case. When the rotator cuff tendon becomes swollen and inflamed, it can become trapped under a bony part of the shoulder joint known as the acromion. This leads to more pain and is known as impingement syndrome. Bursitis involves inflammation and swelling of the bursa sac that surrounds and protects the joint. Sometimes this results inexcessive fluid being produced.
Although the physical work may have caused this to happen, you should also ask the doctor to rule out rheumatoid arthritis, which can cause tendonitis and bursitis without any bone changes in the early stages. This is an autoimmunedisease that can also affect other parts of the body.
The most common treatments are rest, application of ice packs and anti-inflammatory medications if they are not contraindicated due to some conditions such as stomach ulcers. Sometimes a physiotherapist or chiropractor will administerultrasound therapy because it increases blood flow to the area and promotes healing.
In rare cases, if there is noimprovement in six to 12 months, more drastic measures such ascortisone injections or surgery may be required.
Clare Rowson is a medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
