What's wrong with my shoulder?

[Lehman300]

I have been having problems with my shoulder for 3 months. I think it is my rotator cuff (subscapularis tendon, to be specific). Hoping to get some insight on here, as I cannot see a doctor for this matter due to COVID.

I am in my late 30s, physically active, no major health problems. I did not have any traumatic injury to my shoulder, nor do I participate in any throwing or racket sports. I do weight lift regularly though.

I have 90% of my range of motion pain free, and I can live my daily life just fine. I can even do exercises like push ups, bicep curls, and dips with minimal pain. Weighted overhead movements hurt though, as do a few other weighted movements. I have a painless clicking feeling when I laterally raise my arm - it seems to happen less frequently now, than it did 2 weeks ago.

I looked online, and it seems that the 3 tests for subscapularis are the bear hug test, the lift off test, and the belly press test. I can also do the bear hug test just fine, and I can do the lift off test without resistance. If you add resistance to the lift off test, it hurts a little, but I can still do it. It's the belly press test that hurts to do. Sometimes it hurts more than other times. The pain seems to be at the back of my shoulder joint. It also seems like there is a muscle back there that is extremely tight.

Can anyone help me shed light on this, since I won't be able to go to an ortho for at least another 6 weeks? Also, do MRIs of the shoulder typically involve contrast?

[Barb135]

You might want to think about possibly having adhesive capsulitis - otherwise known as "frozen shoulder".  I've had this in both of my shoulders and it's quite painful once the shoulders get completely frozen, but when it first started, it sounds similar to what you're experiencing.  

I was sent to physical therapy when it happened to my right shoulder and my doctor also gave me a cortisone shot in the shoulder.  It took 3 months worth of PT and about 18 months total to get movement back into my shoulder.  Before the right shoulder was back to normal, I was beginning to get it in my left shoulder.  Because I'd already been to PT with the right one, I simply did the same exercises I'd been taught, which did a world of good.  I struggled with it though for almost a year and still ended up getting a cortisone shot in that shoulder also.  Once I got the cortisone shot, it didn't take long for the pain to go away and I've not had any trouble with either shoulder.  

There are 3 stages to frozen shoulder - the freezing, the frozen and the thawing.  Each stage can take months to get through.  It took approximately 2.5 yrs to get through mine.   As Paxiled said: "I'm old and you're not" so maybe it took me longer than it might someone younger.

As everyone else has said - you'll need to see a doctor to find out for sure.

[CHIN_C]

Regarding your question about the appropriate imaging test for atraumatic shoulder pain, the American College of Radiology (ACR) offers the following evidence-based recommendations: https://acsearch.acr.org/docs/3101482/Narrative/

[Sara_MHModerator]

Hello Lehman300.  Welcome to the forum!  We're glad you found us.  The good news is that this seems to painful or uncomfortable only during specific movements, correct?  You are not in a chronic state of pain at this point but just when you are lifting, you have the rotator cuff pain?  It's difficult to know exactly what is going on without examination but it could possibly be a tear.  While these can happen due to a trauma, they can also be attritional. Some doctors are taking phone calls and practicing virtual medicine.  I suggest you call and talk to your doctor about the pain.  But you will likely need imaging done when we are able to get back into regular life again which will be sooner for some parts than others of the US.  In patients with lower functional demands, rehabilitation therapy, including range of motion and strengthening exercises is often effective.  But of course, we don't know your particular situation.  Here's some ideas of things you can do at home for rotator cuff pain.  https://www.healthline.com/health/rotator-cuff-injury-stretches#doorway-stretch  The article also suggests the RICE method of relief as well, rest, ice, compression and elevation.  But really, your best bet is that in the near future you can have this evaluated by your physician.  

[Lehman300]

Thank you for the warm welcome and your response.  This is helpful information, and good to know that it's good news that I'm not in a constant state of pain.  Your interpretation is correct.  Most non-weighted movements bring no pain at all.  Even when I'm lifting I can do many movements with no pain, and I can do push ups with only minimal pain.  I think I can do most of the movements without pain in the link you posted, except the first one.  In the chest stretch, it hurts my affected shoulder slightly.  I also used to get a clicking sensation with certain movements of my shoulder, but that seems to have mostly disappeared over the past 10 days.  Does this tell you anything?

[Paxiled]

This happened to me, and the MRIs I got did not involve contrast.  They were actually more interested in my neck because that hurt a lot but it was the pain in my arms that got to the point I had to stop lifting and that happened twice more including now, where I haven't been able to go to the gym for a couple of years.  Some of that was making a mistake by having my chiropractor try to change my physical therapy, which I was just doing too much of because I also had a bad knee and a bad lower back that happened at the same time, and then I got plantar fasciitis and, well, I'm old and you're not.  What I was told was that everyone gets rotator problems as they age, and the older we get the more we get them if we use our arms in our lives.  Doesn't mean you need surgery.  I was sent to physical therapy for everything, and ended up a couple years ago just hurting everywhere.  So it might not be the rotator cuff, it wasn't for me at the time.  Could be from the neck.  Could be you're not lifting with proper form.  Could be you're lifting too much weight for who you were genetically made to be.  Remember, those huge guys are huge guys and are probably taking steroids.  My advice for now is, until you see your orthopod, is to not do any exercise that hurts.  Sounds simple, but if you force things your body will not like you very much. as I found out.  Make sure you eat well, have plenty of electrolytes, be careful about overdoing protein because those who do don't eat enough plant food and the plant food supplies the antioxidants that prevent inflammation.  Hope it goes well.

[Lehman300]

Thank you for your response.  This is very helpful.  If you don't mind, can you tell me a little more about the pain patterns you experienced?  Did you have pain every time you moved your arms?  Even without weights?  Pain at night?  I do not have any neck pain, but I am curious about what you went through.

[Paxiled]

It started at the gym doing dumb bells on a bench.  I toughed it out and then one day I just couldn't lift anymore.  But it's very hard for me to help you specifically because unfortunately at the same time this happened I also hurt my knee and my lower back, so ended up with lots of pictures and a ton of physical therapy.  The PT worked, but as it turned out, only because they stopped me from doing anything that hurt.  My whole workout became the elliptical machine and hours of PT.  Seemed to work.  My arms, which by then were hurting all the time, stopped hurting, everything stopped hurting, and then I got plantar fasciitis on the darned elliptical machine.  More PT, and I was left having to resume doing the things that had hurt me before.  To my regret, despite all that PT I just ended up eventually hurting everything again.  Then I had surgery for something completely different and was forced to rest everything for a few weeks, and all the pain went away, only to come back again eventually when I resumed workouts.  But that's me, not you.  Most likely my problems are due to a combination of an old auto accident, lots of playground basketball, lots of martial arts, lots of running, and a medication that destroyed my ability to sleep or relax.  You don't have what I had.  You will get over this.  When you can, get it checked out, and I'm sure you'll find yourself back in action again.  And as Barb confirmed, I'm old, you're not.