Managing Severe Right Shoulder Pain: Treatment Options and Specialist Guidance

I have severe pain in my right shoulder, to the point that I can't sleep well?

Hello, I have severe pain in my right shoulder.
It hurts whether I lie on my side or on my back at night, making it difficult to sleep.
I have a history of hypertension, hyperlipidemia, and diabetes.
Below is my right shoulder MRI report.

Magnetic Resonance Imaging of Right Shoulder Without Enhancement Shows:
Rotator Cuff:
- Complete tear of the rotator cuff involving the supraspinatus and infraspinatus tendon portions, with a large gap and local fluid collection.
- Subacromial-subdeltoid bursitis changes with fluid collection.
Bone and Joints:
- No significant abnormality of the labrum.
- Minimal amount of glenohumeral joint effusion.
- No bony pathology.
- No evident fracture could be identified.
- AC joint osteoarthrosis changes, which may be associated with impingement syndrome clinically.
Impression: Consistent with a complete tear of the rotator cuff involving the supraspinatus and infraspinatus tendon portions and associated subacromial-subdeltoid bursitis changes; rule out impingement syndrome clinically.
Suggest clinical check-up and follow-up.
My orthopedic doctor mentioned that the shoulder ligaments are severely damaged and cannot be found, and he does not recommend surgery due to poor outcomes.
He suggested waiting until the bone deteriorates before considering surgery.
However, the pain is unbearable; even using a spoon to feed my grandchild is difficult, and I can't sleep at night.
1.
What treatment options are available to help restore normal function to my shoulder?
2.
As a layperson, can I consult a neurosurgeon for surgery, or is it better to stick with an orthopedic specialist?
Thank you for your response.

Gan Ku Lang, 60~69 year old female. Ask Date: 2022/06/04

Dr. Shi Guozheng reply Orthopedics

Rotator cuff tears in the shoulder are often very painful.
Rehabilitation can help alleviate the pain, and corticosteroid injections into the shoulder joint or the use of anti-inflammatory pain medications can also provide relief.
If there is no improvement, it is advisable to consult an orthopedic specialist.

Reply Date: 2022/06/04

More Info

Managing severe right shoulder pain, especially following a complete tear of the rotator cuff, can be quite challenging. Your MRI report indicates significant damage to the supraspinatus and infraspinatus tendons, which are crucial components of the rotator cuff. The presence of bursitis and associated pain complicates the situation further. Here’s a comprehensive approach to managing your condition.

Treatment Options
1. Physical Therapy: Engaging in a structured physical therapy program is essential. A physical therapist can guide you through exercises designed to strengthen the muscles around the shoulder, improve range of motion, and reduce pain. Focus on gentle stretching and strengthening exercises that do not exacerbate your pain.
2. Pain Management: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and inflammation. However, since you have a history of hypertension and other conditions, consult your physician before starting any medication.

3. Corticosteroid Injections: If pain persists despite physical therapy and NSAIDs, corticosteroid injections into the shoulder joint may provide relief. These injections can reduce inflammation and pain, allowing you to engage more effectively in physical therapy.

4. Activity Modification: Avoid activities that exacerbate your shoulder pain. This includes heavy lifting or overhead movements. Modifying your daily activities can help prevent further injury and allow your shoulder to heal.

5. Surgical Options: Given your orthopedic surgeon's assessment that surgery may not be beneficial at this stage, it’s crucial to weigh the risks and benefits. Surgery is typically considered when conservative treatments fail, and the pain significantly impacts your quality of life. If your pain continues to be unbearable, seeking a second opinion from another orthopedic surgeon or a shoulder specialist may be warranted. They can provide insight into whether surgical intervention, such as rotator cuff repair or shoulder arthroscopy, is appropriate.

6. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture or massage therapy. These methods can help alleviate pain and improve function, although they should complement, not replace, conventional treatments.

Specialist Guidance
- Orthopedic Surgeon: Since your injury involves the rotator cuff, an orthopedic surgeon specializing in shoulder injuries is your best option. They can provide a thorough evaluation and discuss potential surgical options if conservative treatments fail.

- Pain Management Specialist: If pain remains unmanageable, consulting a pain management specialist can provide additional strategies, including advanced pain relief techniques.

- Physical Therapist: A physical therapist can create a personalized rehabilitation program tailored to your specific needs, focusing on strengthening and improving the function of your shoulder.

Conclusion
In summary, managing severe right shoulder pain due to a complete rotator cuff tear requires a multifaceted approach. Start with conservative treatments such as physical therapy and pain management, and consider surgical options only if these methods do not provide relief. Always consult with your healthcare providers to tailor a treatment plan that considers your overall health, including your history of hypertension and other conditions. Regular follow-ups with your orthopedic surgeon will also help monitor your progress and make necessary adjustments to your treatment plan.

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