Upper arm/shoulder mystery problem - HELP!

[erdooley]

I've had a problem with my shoulder/upper arm since Nov. '08. Not sure how the problem actually started. I've been to an orthopedist who said bicep tendonitis and sent me to a PT for 8 wks. So I did that. The PT said it seemed like an inflamed bursa or impingement syndrome. He used ultrasound, electric stimulation and gave me some isometric and band exercises. I improved, then when I tried some lateral flies w/ 1-2 lb. weights (at the PT's direction), I had a setback. I've not been able to get back to normal. After the 8 wks.of PT, I went back to the dr. and got 2 cortisone shots. Didn't help much. Went back in a month for an MRI. The MRI results were normal. I was so sure I had a tear or something so I was surprised. Are MRI scans are hard to read? I'm hoping to take my scans to a dr. who specializes in shoulders, but the scheduler is out this week so I can't even make an appt. Who knows how long it will be before there's even an availability. In the meantime, I wonder if I just keep doing the PT exercises if eventually they will help. I can do things like bicep curls, and I have pretty good overhead range of motion, but my upper arm tires while washing my hair or simple things like that. I have discomfort (a sort of sharp pain) when I reach certain ways, getting my clothes on and off, particularly a coat (not that I need that anymore...) or reaching behind me in the car to hand my daughter something. The motion that hurts the most is while I'm sitting, if I put my elbows on a dining table and clasp my hands together. I have this nagging pain all in my upper arm, where it seems my muscles attach to the shoulder, kind of on the outside part of the arm. Another thing that hurts is stretching my arm out in front of me and twisting the whole arm, like turning a doorknob, but using the entire arm, not just the wrist and forearm. I'd really appreciate any advice on how to proceed, or what you think the problem might be. I appreciate any advice. Thanks!

[Michael L Gross, MD]

This certainly sounds like a combination of rotator cuff tendonitis, and bursitis.  This is usually known as impingement syndrome, because a common cause is impingment of the cuff tendons and bursa against the acromion adn the coraco-acromial ligament.  Frequently on an xray, one can see a bone spur on the front of the acromion, known as a type III acromion.  On MRI, one will see thickening of the bursa and tendonits or tendonosis within th tendons of the rotator cuff.
Many of these patients respond early on to a program of physical therapy and oral or injected medications.  If this is unsuccessful, an arthroscopic sub-acromial decompression can be done.  This an outpatient procedure with a very high success rate

[Teddybear12988]

This is almost exactly my problem too!  I had played volleyball for 12 years...and recently was forced to quit due to medical issues.  PT did not help, neither did the 2 cortisone shots (one into the bursa and the other the shoulder joint itself).  Pain is almost identical now to yours...although it was more towards the front of the shoulder before.  My MRI came back normal and the orthopedic dr. didn't seem to have a clue...he just pulled on my arms a little then gave me a shot.  PLEASE let me know if you find anything out from your doctors..I will do the same.  Good luck!

[erdooley]

Dr. Gross, thanks for your answer. My MRI and x-ray were supposedly normal. This may be true, or they may have been read incorrectly. If they are in fact normal, could I still have impingement syndrome? Do people have surgery even when their MRIs and X-rays are normal, but then during surgery the problem becomes visible? I'm not sure I want to have surgery for an "invisible" problem. If I'm able to get a second opinion, maybe that will shed some light. If I don't have surgery, will the problem get worse, stay the same, or eventually get better on its own or w/ more PT? I guess I'm not sure when PT is considered "successful." It has helped, but not fixed me.