Right Shoulder Impingement and pain, facing surgery, nothing has helped

by Ajit Kumar Singh
(Bangalore, Karnataka, India)



Hi Joshua,

Can you please help me out of this pain? Myself Ajit Singh from India, I came to know about you from Internet.

I will explain you my problem, I am right handed and had an accident on 04th Jan 2009 and my right shoulder get injured. Nothing comes in x-ray.

As per the orthopedics I put arm sling for 25 days and take rest almost 6 months but its not really helped me out.

Now my right hand is little bit thinner than left hand and also has some pain while moving my hand in outside or inside 90 degree. Then after 7 months I consult with another orthopedics and done MRI scan as doctor says.

In MRI scan they found some problem, which is mentioned below. Please have a look.

1)TYPE 1 ACROMION PROCESS WITH SMALL OSTEOPHYTIC LIPPING / EBURNATION UNDER SURFACE OF TIP OF THE ACROMION COMPROMISING THE SUPRASPINATOUS OUTLET WITH IMPINGEMENT OF SUPRASPINATOUS TENDON AND MILD TENDINOSIS. NO EVIDENT ROTATOR CUFF TEAR.

2)THIN LAMELLAR FLUID IN SUBACROMIO-SUBDELTOID BURSAL REGION AND IN BICIPITAL GROOVE-POSSIBLE SEQUALAE OF SUPRASPINATOUS IMPINGEMENT.

After that they start my treatment. Treatment & medicine are mentioned below.

1)Avoid lifting, heavy weight.
2)Heat therapy (Nexcare First Aid – 3M) – Warm with water then apply.
3)Hifenac P Tab (1 – 0 –1) After food, 7 days.
4)Pantorite 40 Tab (1 – 0 –1) Before food, 7 days.
5)Dicloran ms 30 gm Gel (10 Days, Local apply)
6)Physiotherapy – VSW/IFT (15 Days)

Than in next visit after 2 weeks they gave some another medicine & Exercise guideline.

1)Hifenac P Tab (1 – 0 –1) After food, 7 days.
2)Rantac 150 MG Tab (1 – 0 –1) Before food, 7 days.
3)Some Exercise. (e.g. – Right hand should pull up and down some movement etc.)

Now, They are telling if this will not cured then we have to do one small surgery. Like one hole in shoulder and they will cut some impingement area. (Not enough idea about the surgery)

Please help me on this. Should I go for surgery or it will be cured after sometime after doing some exercise and heat/cold therapy?
And also let me know what will happen if will not do the surgery? Waiting for your valuable reply and heartily thanks in advance.

Regards,
Ajit Singh




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Joshua Answers:


Hello Ajit.

Thanks for all the details, but I need some more.

1. What was the accident that hurt your arm? How exactly did it happen, what did it look like if I was watching?

2. I don't know what all those meds are. I assume that they are anti-inflammatory medicine, muscle relaxers, and pain killers, yes?

3. Does it hurt to move your arm now? A lot? A little? In what directions or activities?

4. Does it hurt on top of the shoulder, in the armpit area, down in the arm itself?

5. What are all your symptoms? Pain, numbness, tingling, loss of range of motion, etc?

6. Have you have any previous pain, problem, or injury?


Answer those questions and I can offer you better suggestions.


On other topics:

* I personally wouldn't get the surgery. It doesn't sound like they know how to fix your shoulder now, I don't expect they would be able to with surgery either.


* It sounds like you have a shoulder impingement dynamic. The surgery won't fix the actual SOURCE of the problem, but it will injure you more. Read this Shoulder Impingement page.


* Rest won't cure this. Nor will any of the pills you've been prescribed. Nor will time in a sling or brace.


* Ice is your best friend right now. Learn How To Reduce Inflammation.


Answer the questions, and let's go from there.




Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
www.TendonitisExpert.com
















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Dec 15, 2009
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starstarstarstarstar 		PART 2 - Right Shoulder Impingement and pain, facing surgery, nothing has helped
by: Ajit

Hi Joshua,

please have a look on the below queries.


1. What was the accident that hurt your arm? How exactly did it happen, what did it look like if I was watching?

Ajit: - Accident happens with Bike. Actually I was riding and one autorickshaw suddenly stopped in front of my bike and I fell down on my shoulder.


2. I don't know what all those meds are. I assume that they are anti-inflammatory medicine, muscle relaxers, and pain killers, yes?

Ajit: - Yes


3. Does it hurt to move your arm now? A lot? A little? In what directions or activities?

Ajit: - A little.

A) When I trying to pull up my hand straight side of my right ear have some pain.

B) When trying to ache my hand internally or externally on 90 degree then have some little pain.

C) When throwing a ball then its hurt a lot.

D) When trying to move my hand backside on 90 degree then have some little pain.

E) And most important my right biceps are little bit thinner than left biceps.


4. Does it hurt on top of the shoulder, in the armpit area, down in the arm itself?

Ajit: - Yes.


5. What are all your symptoms? Pain, numbness, tingling, loss of range of motion, etc?

Ajit : - Pain, loss of range of motion, little bit tingling also.


6. Have you have any previous pain, problem, or injury?

Ajit : - No


Thanks,
Ajit Singh


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Joshua Comments:

Hmmm.

Well, I don't have a crystal clear picture yet. Maybe there's some language barrier.

So, for clarification.

1. Why do you have limited range of motion? Does pain keep you from moving? Or can you physically not move very far. If that's the case, what do you think is stopping you from moving?

2. It hurts on the top of the shoulder, in the armpit area, and down in the arm and wrist area. Is one worse than the other?

3. You landed on your shoulder while riding a bike. Did you catch yourself with your hand/arm, or just land right on the shoulder?

4. Where does it hurt when you throw a ball?


Answer those, and I think I'll be ready to give you some words of wisdom.


Dec 19, 2009
Rating
starstarstarstarstar 		PART 3 - Right Shoulder Impingement and pain, facing surgery, nothing has helped
by: Ajit

Hi Joshua,

1. Why do you have limited range of motion? Does pain keep you from moving? Or can you physically not move very far. If that's the case, what do you think is stopping you from moving?

Ajit: - Little bit pain feels, while moving my hand freely. And after accident injured hand not moving very far. As per physiotherapist and doctor, earlier I used to do some exercises everyday. But now days I stopped. Everyday I used to compare my both hand, wrist, shoulder, biceps, and chest. And it seems little bit thinner or weaker than other one. Please help me I very much worried about this.

One more important thing when I left my hand simply means not move anywhere then little bit pain inside my shoulder/biceps or bone not sure. But it?s paining after 30 minutes. And also when moves my hand anywhere means up, down, ache, 90-degree angle etc than have some sound on my shoulder or shoulder and arm joints.


2. It hurts on the top of the shoulder, in the armpit area, and down in the arm and wrist area. Is one worse than the other?

Ajit: - Yes, it hurts when I used to pull up my hand straight on top. And also when trying to move my hand straight, slowly from down to top then its hurt in armpit area also.


3. You landed on your shoulder while riding a bike. Did you catch yourself with your hand/arm, or just land right on the shoulder?

Ajit: - Just landed right on the shoulder.


4. Where does it hurt when you throw a ball?

Ajit: - I used to play cricket earlier, but after accident I didn't play. One day I was playing with ball and simply thrown with strength. And its badly hurt me. That time my hand was severing.

Thanks,
Ajit Singh


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Joshua Comments:

Hey Ajit.

Well, I'm a little fuzzy on this, I think because of the language barrier.

If there was a good massage therapist around, I'd have him/her work your lats, subscapularis, teres major and minor, and all the shoulder cuff muscles/tendons, along with the scalenes in your neck.

In a Self Care context though, I suggest that you:

1. Start supplementing with Magnesium as described on this page. Magnesium Dosage

2. Reach over and self massage your shoulder, armpit area, forearm front and back repeatedly throughout the day. Like, 30-180 seconds every half hour, or every hour. Squeeze the sponge. Old stuff out, new blood and nutrition in, mobilize all the tissue.

3. Light, easy stretching. Often throughout the day. Push it if it doesn't irritate the problem.

4. Increase your protein intake.

5. Ice your shoulder as much as possible. 5 minutes on, 5 off, 5 on, 5 off.


Ultimately, you want to keep things moving. Push your structures to stay acive and move around. This will keep the strucutures healthy and working as best they can.



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