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- Sun Apr 26, 2009 12:06 pm
Last July, after a period extensive heavy lifting of 50 lb concrete blocks, i noticed a sharp pain in my right dominant shoulder when i moved it in certain ways, and a loss of strength. I had just accepted a teaching position at a Christian school in Nigeria, so I went ahead with the move without seeing a doctor, primarily as a result of the job not offering health insurance and my insurance lapsing the month before. Note: i had never once filed a health insurance claim in my adult life, so I took a chance of not having it [dumb]. During the following months, the shoulder improved in strength and agility, but never completely recovering [I could do pull-ups but not chin ups, for example]. However in December, I reinjured the shoulder in a quick moment of reaching out to catch my balance. Since that event I have lost a range of motion, barely able to touch the top of my head, unable to shift my car into reverse [out and down], can lift outwards/upwards from a relaxed position [abduction] about 45 degrees and no higher. If there is a sudden movement or jarring of the shoulder, as in a sympathetic response to pain, it severly hurts for about 30 seconds. If I sleep with any pressure on it, it wakes me up.
In the middle of June I will return to the U.S. [for approximately one month, but could be extended] with some money in the bank but no health insurance. I am ready to bargain, sign a no-lawsuit clause, get price quotes, whatever it takes, but i do not want government assistance and i cannot afford a huge bill. I may have to go to Mumbai [where doctors advertise online] if I can't get a bill price within my range, which i don't want to do.
What can you tell me or recommend? Thank you for your time and God bless you and what you do.
| Tom Plamondon PA-C
- Mon May 04, 2009 6:33 am
Thanks for writing in.
From your description, there are a few areas in the shoulder which may be causing the pain, loss of motion and strength.
The first area is the rotator cuff (RC). The second is the acromioclavicular joint. The third s the shoulder joint itself i.e. labral tear.
The rotator cuff muscle can be assessed clinically with certain movements and strength testing.
Often MRI is the test of choice for suspected RC tears. We sometimes wait until we are considering surgery before doing MRI.
Full thickness RC tears require surgery. Partial tear can be treated conservatively initially and then operative care if no change or worsening.
The main motion to avoid with RC injury is reaching outward and back (as if to put your hand in the coatsleeve). This places lots of stress on the shoulder.
Range of Motion should be restored as soon as possible to prevent frozen shoulder. Straight plane motions are the best and start with flexion in supine - may use a cane or stick with hands overtop and raise arms overhead with the goal being full flexion overhead without pain. Once this is achieved, ditch the cane and use a light handweight and progress gradually. If painfree for one week then start external rotation strengthening with an elastic band or pulley system. Elbow is bent 90 degrees and held near the thorax. Grab a band or pulley robe and move the hand outward rotating the shoulder while maintaining the elbow position. This is a basic rotator cuff strengthening exercise.
Ice after every exercise session.
Moist heat before every exercise session.
NSAIDS as needed.
Lastly, sometimes subacromial bursitis may cause this. The same basic rehab principles apply however a corticosteroid injection may be helpful.
Without insurance, avoiding the cost of surgery is important so focussed attention to rehab is vital.
If at anytime the shoulder worsens from exercise, stop. Restart in a few days after the pain subsides.
Any questions should be fielded by a physician or physical therapist.
Take care and may the Lord's grace be with you.