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Upper arm ache at night: Waking Up With Arm Pain – AIRROSTI


Waking Up With Arm Pain – AIRROSTI

This blog was written by John Cybulski, DC. He discusses some common causes of arm pain while sharing a few tips to keep your arms healthy and pain free.

Have you been waking up with arm pain lately? Does the pain appear as you’re waking up, or does the pain cause you to wake up?

If your arm pain is so severe that it wakes you up many times during the night, consult your doctor right away. However, if you’re like many people who struggle with arm pain in the morning, you may deal with an overuse injury.

Why Does My Arm Hurt?

Our bodies have limits. The body’s heart can only beat so fast, and lungs can only hold so much air. Fortunately, our bodies set up safeguards that help keep us from breaking our limits. The question then becomes, if you’re in pain, which anatomical limits are you pushing?

Poor Circulation

Your muscles do more than just move your bones. One of the primary jobs of muscles is to help pump blood through your body. Sometimes, arm pain can be a symptom of a blood clot or a cardiac problem. If you’ve already ruled out these medical conditions with your doctor, it’s time to turn your attention to the other functions of the muscular system.

The question then remains, what muscular or joint dysfunctions might contribute to your arm pain?

Muscle Weakness and Overcompensation

Do you have tension and pain in your upper shoulders and neck? Do your hands, wrists, or elbows bother you after a long day at work?

If you answered yes to the above questions, then it’s very possible there are underlying muscular imbalances that are causing your arm pain. You may overuse your stronger muscles to compensate for weakness in other muscles. By overcompensating for your body’s lack of strength, you put undue stress on those muscles and risk developing a painful strain or tear.

Referred Pain

Do you have pain in areas near your arm that could lead to waking up with arm pain?

Many people don’t consider their neck or shoulder problems may contribute to their arm pain since it’s a distinct part of the body. We often call this “referred pain,” as pain from previous injuries will subtly radiate to nearby areas of the body as we sleep. Sometimes the referred pain may appear to be a separate injury.

How to Fix Your Arm Pain Fast

Your muscles are capable of many things, from running and jumping to throwing and lifting. However, even the strongest muscles can occasionally move beyond their limits. Understanding and consciously abiding by your own body’s limits is an important step in avoiding injuries that can lead to pain. Learning how to correct muscular imbalances as they appear is crucial to swift and effective pain relief.

Fortunately, the best solutions are often the simplest. If you know a muscle is holding too much tension, you can stretch it. Or, if you notice some muscles are weaker than others, you can do exercises to strengthen them.

As a Doctor of Chiropractic, I believe in finding and fixing the cause of pain, rather than simply treating the symptoms. If you wake up with arm pain that’s too much to bear, I encourage you to seek your nearest Airrosti provider. Our providers seek to resolve injuries like arm pain at the source to help bring fast, effective relief. We also provide tools and resources to help you address problem areas as they appear, so you can keep doing the things you love pain free.

Prefer to connect virtually? We also offer remote telehealth appointments in addition to in-clinic visits. Call us at (800) 404-6050 or click the button below to schedule your appointment today.

Read our Medical Disclaimer here.

Stiff and Sore? Your Sleep Position May Be To Blame

If you are reading this, it means that you have been waking up with joint or muscle pain. Incorrect sleep habits over time can cause consistent pain and even physical injuries to your body. These injuries are more common in the shoulders, neck and back due to certain sleep tendencies that a lot of us can fall into. Below are three of the most common areas of injury caused by poor sleeping positions – and how to fix them.

1. Shoulder Pain
This seems to be one of the most common areas that are affected by poor sleeping habits typically due to people placing their arm underneath their head as a pillow or placing their bottom arm underneath a pillow. This position leaves the arm imprisoned under all of your body weight and, can pinch your rotator cuff tendon between the shoulder and the acromion bone above it. The result is often a feeling of the shoulder “locking” or pain when you go to straighten your arm. This can exacerbate shoulder bursitis or injuries to the rotator cuff tendon such as tendinosis, partial tears and full thickness tendon tears.

Shoulder Bursitis
Bursitis is defined as the “inflammation of the bursa”. The bursa is a fluid-filled sac that cushions the joint so that your muscles and tendons are not painfully scraping over the joint during a movement. Lifting heavy objects, overuse, and direct trauma can inflame the bursa sac and aggravate the injury even further.

This injury can also be caused from sleeping on one side and it is important to understand not to create the same predicament on the other shoulder while you avoid sleeping on the already-injured shoulder.

Rotator Cuff Tendonitis
Tendonitis means “inflammation of the tendons” and occurs in the tendons and muscles outside of the shoulder joint. Tendonitis most commonly happens from overusing the muscles and tendons. Symptoms of shoulder and arm pain occur when you lift your arm up, down, or behind your back.  To avoid rotator cuff tendonitis it is best to sleeping on your back so that no excess weight is placed on the shoulders.

2. Neck Pain
Many neck injuries stem from poor sleeping habits or exacerbating an existing neck injury with an imposition sleep position.

Sleeping on your stomach can torque your neck as your neck turns to one side as you also hyperextend. This can create tension around the cervical spine and cause impingement on nerve roots or the spinal cord especially if there is underlying arthritis and bone spurs. Trying to find ways to avoid this position is something that should be addressed if you are dealing with consistent neck pain.

Stiff Necks or Neck Strains
If you’ve ever woken up with your head feeling like it weighs 1,000 pounds heavier than it does, or not being able to turn your head without a sharp shooting pain, then you more than likely strained your neck in your sleep.

One of the most common reasons for neck pain after sleeping is the tendency to pile up pillows in an effort to give yourself more support. However, when the cervical spine is elevated too high, the complete opposite is happening. This act can put a strain on the curvature in your spine and neck muscles causing stiffness and soreness.

Acute Torticollis
This condition is not always caused solely by a poor sleeping position, but also leaving a window open and having a breeze on your neck. As the cold air continues to hit your neck throughout the night, it is causing the cervical spine muscles to contract and spasm. This can stop your neck from moving for days at a time! Your neck becomes locked into one position and will not allow any movement whatsoever. This can be a scary occurrence which is why it is important to always to try to maintain proper sleep posture.

3. Back Pain
Back pains are among some of the most common of all sleeping complaints as your posture directly correlates with your spine. If you find yourself with a poor quality mattress, a pillow that does not suit your needs, or are just sleeping incorrectly; then you might want to invest some time into considering a way you can sleep better as you may be leaving yourself susceptible to back pain and discomfort.

Some common injuries that correlate with poor sleep are sciatica, bulging disc and herniated discs.

Bulging Disc
The discs of the spine act as cushions that sit in between your vertebrae and each one of these is made up of a gelatinous fluid substance surrounded by cartilage.   However, if you sleep on your stomach a mattress can push against the natural S curvature which can cause the discs to degenerate over time. This degeneration can result in a bulging of the disc with symptoms such as localized pain, muscle spasms and sciatica.

To treat this at home, first try ice/heat therapy and rest your back for a couple days. Also, sleep on your back with a rolled towel under your knees. If this does not provide relief after several days, it is best to consult a spine specialist.

For those already suffering from Sciatica, the pain is often worse at night and the reason for this is pretty simple. The spinal discs are filled with fluid and depending upon the position in which you are lying, gravity will push the fluid in these discs in that direction. If you are lying on the side where the disc bulge or herniation (the underlying cause of Sciatica) is most prominent, the increase in fluid can cause the herniation to become larger and put more pressure on the sciatic nerve. If you are suffering from Sciatica and are finding it difficult to sleep comfortably, it is best to consult with a spine specialist.

If you are suffering from muscle or joint pain, the physicians at Total Orthopedics and Sports Medicine focus on both the surgical and non-surgical treatment of bone and joint injuries and are one of the most innovative orthopedic practices in the area.  Dr. Charles Ruotolo, President of Total Orthopedics and Sports Medicine, has published several peer-reviewed studies on orthopedic care and orthopedic surgery.

Fortunately, many patients can be treated non-surgically with a combination of conservative modalities coordinated by the Total Orthopedics and Sports Medicine Team. If surgery is necessary, the practice uses a multidisciplinary approach to create a treatment plan that focuses on the patient’s lifestyle and activities and helps them get back to those activities quickly and effectively.  Total Orthopedics and Sports Medicine has locations throughout Long Island and Manhattan.

How to treat Shoulder, Elbow & Wrist Pain: Valley Pain Centers: Interventional Pain Management Specialists

Upper extremity pain is a very common issue among many people at some point in their lives.. The shoulder is one of the most vulnerable joints as it has such a wide range of motion, which opens it up to various injuries and problems. Elbows are the next most vulnerable joint and is usually due to repetitive use. When a shoulder or elbow begins to develop functional or anatomic changes pain usually is first noticed during certain activities  such as lifting a carton of milk or reaching above the head but as it worsens it is felt also at night while in bed or while at rest.  So, why are you experiencing pain and what can you do to find relief? We discuss several treatment options ranging from shoulder stretches to interventional procedures.

Causes of shoulder, elbow and wrist pain

Although many disorders can cause pain, the most common cause of shoulder pain is rotator cuff tendinitis. The most common elbow disorder is epicondylitis (“tennis/golfers elbow”), and common wrist disorder is usually Carpal Tunnel Syndrome. These disorders can be from acute injuries but are more commonly from overuse or repetitive use. These conditions can also include other causes including:

  • Repetitive stress injuries
  • Tears
  • Poor posture
  • Overexertion
  • Aging
  • Osteoarthritis
  • Frozen shoulder

How to relieve pain

Initial home treatment should consist of rest, reduction of activity and ice for a period of 1-2 weeks. If no improvement is noted then a proper examination to determine the cause is best and we recommend patients to see a physician to make a proper diagnosis and for treatment options.

Talk to a pain doctor about interventional therapies

If these natural treatments don’t work to relieve your shoulder pain at night, it may be time to talk to a pain doctor. They can help diagnose the exact cause of your shoulder pain. If your pain isn’t due to an acute injury or fracture, they may suggest interventional treatments.

These treatments may include:

  • Physical therapy/Chiropractic to increase flexibility and reduce pressure of the affected area.
  • A regimen of non-steroidal anti-inflammatory medications
  • Traditional joint injections with corticosteroids
  • Regenerative medicine approaches, including PRP injections, Amnion, and/or Bone marrow concentrate injections.

Some types of shoulder pain such as arthritis can cause permanent damage, which can be mitigated if caught early enough.

If you experience any of the following symptoms, reach out to your doctor immediately:

  • You begin to experience a fever or chills
  • If severe pain is constant for more than 3 days or intermittently for two weeks
  • You start losing weight without reason
  • You have excessive night sweats
  • Excessive stiffness, pain, or swelling in your shoulders
  • Difficulty moving your shoulder, elbow or wrist or performing daily activities due to pain

It is important to have these symptoms checked as soon as possible as these can be symptoms of serious conditions that should be treated immediately.

Contact Valley Pain Centers for a consultation with one of our Board Certified Physicians



Dr Roger Walker
Dr. Walker is originally from San Diego, CA and has been practicing in the Valley for over 25 years. He received his undergraduate degree in Kinesiology from the University of Colorado and his Doctorate from Southern California University of Health Sciences. Dr Walker is licensed and Certified in Manipulation Under Anesthesia (MUAC) and Fellowship trained in Clinical Acupuncture.

Rotator Cuff Tears and Shoulder Pain at Night

Shoulder pain at night is a prevalent and potentially debilitating problem. For some of you, the pain is sharp when you change your sleeping position.  For others, you will complain of a constant dull ache that doesn’t seem to go away.  Sleeping with your arm under your head can be very challenging if you have shoulder pain at night. Most of you eventually find that sleeping on your back, or even in a recliner is the only way to get some sleep.  This post will explore the most common causes of night pain in your shoulder.  We will also review some potential remedies for easing your shoulder pain that worsens at night.  

If you have shoulder pain at night, you know how disruptive it can be! Inflammation within your shoulder and usually in the region of the rotator cuff muscles is a leading cause of night pain.  The specific structure that’s involved is called the subacromial bursa, a fluid-filled sac overlying the rotator cuff.

The 5 most common issues that can affect the rotator cuff and cause shoulder pain at night: 

  1. Subacromial bursitis– inflammation of the tissue around the rotator cuff.
  2. Calcific tendonitis– calcium often forms inside the rotator cuff. When it starts to dissolve, the inflammation can be intense.
  3. Rotator cuff tears- the pain associated with rotator cuff tears is likely due to irritation of the surrounding subacromial bursa.  See the pictures below. 
  4. Rotator cuff tendonitis– Tendonitis of the rotator cuff can occur from an increase in activity that the shoulder is not used to.   
  5. Frozen shoulder: inflammation throughout the shoulder joint, often leading to stiffness of the shoulder.  

As many of you know, no matter which side you try to sleep on, your shoulder pain wakes you up. Eventually, this will start to affect your quality of life and your psychological well-being significantly.

Inflammation of the rotator cuff and shoulder bursitis are probably the most common reasons why you cannot lay down and sleep through the night. The subacromial bursa is a small sack that sits on top of the rotator cuff tendons. A healthy bursa will lubricate the rotator cuff tendons in the shoulder to minimize friction between the rotator cuff and the bones of the shoulder.

The bursa can become inflamed because of various rotator cuff issues. Once angered, the bursa is likely responsible for a significant amount of your night pain.

Down below, we will cover ways to get this bursitis to quiet down.  

The pain from bursitis is often on the outer side, or front of the shoulder. It is not usually on the top of the joint.  Most people will complain of a deep dull ache.  Some of you may feel a grinding or clicking sensation in the shoulder.  The grinding is usually due to inflammation of the bursa and not a bone spur. 

Very few of you will recall an injury that caused your night pain.  Most of the time, there was no readily identifiable injury.   That makes night pain in your shoulder very frustrating.  You cannot identify an activity that caused it.

Most people who simply wake up with shoulder pain one day didn’t do anything wrong per se.  The incidence of shoulder pain increases as we age.  A frozen shoulder is a classic example. A frozen shoulder is a common cause of night pain. When you suffer from a frozen shoulder, you will find it difficult to sleep at night. That is due to intense inflammation within the shoulder joint itself.  We often do not know what causes a frozen shoulder.  The treatment of a frozen shoulder was discussed at length in this post.   

Of course, recent sports injuries or overuse injuries to the rotator cuff can also cause significant pain at night.  Injuries to the rotator cuff can also cause secondary inflammation of the bursa.  Simply stated, if you suffered an injury from a fall and injured your rotator cuff muscle, the bleeding from that injury can cause inflammation in the bursa that abuts the rotator cuff.  

Keep reading down below, and we will cover ways to get more comfortable and hopefully sleep through the night.  

Why Does My Shoulder Hurt At Night?

Here is a list of the most common problems that cause shoulder pain at night.  You can follow the links to read about each diagnosis, or you can keep scrolling down for remedies to try and get the pain to simmer down.   

As you can see above, there are many different types of rotator cuff issues. One of the more common causes of rotator cuff pain is a process we call rotator cuff tendinosis.  This implies that your rotator cuff is starting to wear out, fray, and degenerate.  

If the rotator cuff begins to degenerate enough, it may start to tear. A small tear is referred to as a partial rotator cuff tear. The rough surface of the rotator cuff tendons due to a partial tear can irritate or inflame the bursa sitting on top of the rotator cuff.   Your shoulder might hurt with certain activities too… but it is the night pain that usually makes you call our office.

Some of you have injured yourself or fallen onto your arm, and now your shoulder pain is keeping you up at night.  For those of you with night pain following an injury, a more severe full-thickness rotator cuff tear is possible. You should have your shoulder evaluated sooner rather than later.


What is the Treatment of Severe Shoulder Pain at Night? 

The goal of treating people with severe night pain is to limit the inflammation within the shoulder, and more specifically, within the subacromial bursa. For most of you, this will be a temporary issue.  Short term anti-inflammatory medications, perhaps an injection, and physical therapy, will have you sleeping well again in a few weeks.  For some of you, the pain will persist, despite these often effective modalities. 

It’s the middle of the night, and you’re having a hard time getting to or staying asleep.  A combination of these treatments below can help ease your pain:

A heating pad

Yes, a heating pad.  Used carefully (do not fall asleep with it on), and often, a heating pad can provide a surprising amount of relief.  If your shoulder is not allowing you to sleep and you can’t get in to see your shoulder specialist, this is an excellent place to start.  Many people think that ice is most appropriate for this type of inflammation… but a surprising number of you will feel better with a heating pad. They should be applied for 15 minutes, then taken off for 15 minutes… you can continue 15 minutes on/15 minutes off for as long as needed.  

Sleeping in a reclining chair.

Sleeping in the semi-sitting position can help many people with severe shoulder pain get to sleep. You can also prop yourself up on a couch or in bed with many pillows to get yourself elevated at least 45 degrees. Putting a small rolled-up towel behind your shoulder to push it forward can also help minimize the pain you are experiencing.  


Capsaicin is an over the counter ointment or rub.  It functions as a counter-irritant.  Capsaicin causes a burning sensation. In some people, it can cause an actual burn, so be careful and follow the instructions. When you rub capsaicin in the area where you have the pain, scientists believe that the skin irritation depletes a chemical from your nerves.  By depleting that chemical, it is thought that this will quiet down the nerves around the bursa and the rotator cuff in the shoulder.  

An Ice Compression sleeve:

An ice compression wrap: These ice sleeves seem to be useful at minimizing your pain at night and allowing you to fall asleep.  Many patients have commented over the years that these sleeves have been helpful.  Again, heating pads are useful, as well.  Some people prefer ice, and some prefer heat.  There is little chance of harm, so try both until you find what works best for you.  These ice compression sleeves are also useful and improve your pain following a rotator cuff overuse injury, or surgery. 

Shoulder Injections for Night Pain:

When you are in our office, we will discuss options to improve your night pain. Not being able to sleep is very disturbing, so you may want to consider an injection. Injecting cortisone or a steroid into the bursa can be one of the fastest means of achieving meaningful pain relief.   

Injections into the subacromial bursa, that area above your rotator cuff that tends to become inflamed, can be beneficial in some circumstances.  We know that routine cortisone injections are not the best idea.  Frequent injections near tendons can cause the tendons to degenerate further. 

Injections of cortisone into the bursa, however, can be beneficial in people who are very unhappy because they cannot sleep.   These injections often start working in one day and continue to work for a few weeks to months, so you can begin recovering from your loss of sleep.  

Kinesio Tape: 

Kinesio tape seems to work well with many conditions to calm down the pain that people experience at night and even with certain activities during the day.  The tape likely functions through a complex feedback interaction with the nerves of the spinal cord and brain.  The pattern of taping doesn’t appear to be critical.  Kinesio tape can be purchased online without a prescription.  

Physical therapy:

Physical therapy to address the rotator cuff is beneficial over the long term to help improve your shoulder pain.  For patients without severe night pain, then we start with physical therapy and try to avoid injections.  If the pain at night is severe, then we usually try an injection first to calm things down and follow that soon afterward with a course of physical therapy.  That therapy is generally taken 2-3 times per week for 4-6 weeks. 

Many of you can learn the exercises yourself so you can continue the exercises on your own. Maintaining the activities, even after the physical therapy is done is essential to decrease the risk of the pain coming back.

Medications :

Many patients with severe shoulder pain at night require medications to help get them to sleep.  At least until the pain starts to improve.  Most people will start with NSAIDs like Ibuprofen, Naproxen, and Naprosyn, which are available over the counter. 

Those of you with heart disease, ulcers, kidney disease, asthma, or hypertension will want to speak with your doctor or cardiologist first. Those of you on “blood-thinners” should not be taking anti-inflammatory medications.  

Combining an NSAID with Tylenol can be even more useful.  The two medications together can be very effective at minimizing your pain. The maximum daily dose of Tylenol for a healthy adult with no liver issues is 3000 mg per day.  Taking 1000mg every 8 hours is usually the most effective way to take it.  

Rotator cuff surgery for night pain:

The vast majority of you will not require surgery to alleviate your night pain.  If necessary, surgery has been proven to be effective at helping alleviate the night pain associated with many rotator cuff disorders.

Surgery should be your last choice. But if you do not respond to medications, injections, physical therapy, and changing your sleeping positions, then surgery might be appropriate to consider. 


Surgery for night pain in the shoulder is arthroscopic.  That means that the surgery is performed through small holes with a fiberoptic camera. The procedure we recommend to alleviate night pain is called an arthroscopic decompression.  That name implies that we will be decompressing the space above your rotator cuff by removing the inflammatory tissue.  During the surgery, we remove the inflammation due to the bursa that sits on top of your rotator cuff. 

If necessary, we can also remove calcium from calcific tendonitis; we can release the capsule for a frozen shoulder or repair the rotator cuff if it is torn.  The precise shoulder surgery to alleviate your night pain will ultimately be determined by what we believe is causing your night pain.  

During the arthroscopy, we also inspect and evaluate the rotator cuff.  If the rotator cuff has damage such as a partial tear, then we may consider placing a  biological patch that might help to repair a worn-out rotator cuff. That patch is placed after the inflammation is removed, and the rotator cuff is smoothed out to eliminate the degenerative/frayed tendon, which might be irritating your shoulder. 

Not everyone who has partial tears or fraying of the rotator cuff will require a patch.  Many of us have seen issues in some people after the patch is placed.  There is a chance that you will react to the patch– so we tend to use it in people with certain types of deep partial tears, or if we are repairing a degenerative rotator cuff tear.  

I Tried Therapy, and My Shoulder Still Hurts At Night

Non-surgical treatment of rotator cuff related night pain is very often effective.  Most patients will be able to sleep comfortably after an injection and a course of physical therapy.

A small percentage of people will not respond to non-surgical treatment. I find that people with severe night pain are usually ready to have surgery sooner. They are miserable …as are those who live with them.  Because we have a surgical option proven to diminish or eliminate night pain in your shoulder, it may be a reasonable option for you to consider if you do not respond to non-surgical or conservative treatment. 

Research has shown that surgery on your rotator cuff to repair a rotator cuff tear or to treat tendinosis can dramatically improve or eliminate your night pain.

“Sleep disturbance is common in patients undergoing rotator cuff repair. After surgery, sleep disturbance improves to levels comparable with those of the general public. Preoperative and prolonged postoperative use of narcotic pain medication negatively affects sleep.”

Source: Sleep Disturbance Associated With Rotator Cuff Tear

Surgical options for patients with night pain and injuries to the rotator cuff depend on the type of damage you have. The possible types of injuries we are dealing with include rotator cuff tendinosis, bursitis, a partial rotator cuff tear, or a full-thickness rotator cuff tear.

For those of you who injured your rotator cuff from a fall and have developed weakness, as well as night pain, then a repair of your rotator cuff might be your best option.

For patients with severe night pain due to tendinosis or a partial rotator cuff tear, a promising procedure is where we place a small patch into the shoulder during a shoulder arthroscopy (minimally invasive). Using a camera and other instruments, we place the patch over the area of degeneration or tearing. Then biology should take over and slowly regenerate your rotator cuff over time.  

The patch usually becomes absorbed into your tendon and “induces” the tendon to heal.  Before we place the patch, we will also clear away any inflamed bursa.  Removing the inflamed bursa will ease your discomfort. Reversing or improving the tendinosis and partial tear could give you a good chance of not having to deal with this again in the future.

A fair number of shoulder surgeons are currently utilizing this technology.



Disclaimer:  this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.

Causes, Symptoms and Treatment Options

Medically reviewed by Drugs.com. Last updated on May 31, 2021.

What is a Rotator Cuff Injury?

Four tendons attach muscles from the shoulder blade and ribs to the upper arm bone (humerus). Because these tendons help to rotate the arm within its socket, this sleeve of tendons is called the rotator cuff. 

Tendons in the rotator cuff can be injured easily because they move within a tight space. When the shoulder is turned or lifted at the limit of its natural range of movement, the tendons in this tight space are moved, too. Occasionally, the rotator cuff tendons can bump or rub against a bony knob (the acromion) above them or against a ligament at the front of the shoulder.  

This friction is known as impingement syndrome and causes inflammation in the rotator cuff. Rotator cuff friction is most likely to cause inflammation if your shoulder movement is rough or repetitive. Inflammation can cause three problems:  

  • Rotator cuff tendonitis — Inflammation of a single tendon causes pain only during specific movements, when the muscle that pulls against that tendon is being used or when you are reaching upwards.  
  • Shoulder bursitis, also called subacromial bursitis — Bursitis occurs when inflammation spreads into the pocket of fluid that lubricates the rotator cuff tendons. Pain is often worse at night and occurs when you move your shoulder in almost any direction, particularly if you are reaching upwards.  
  • Rotator cuff tear — The tendon may tear after it has been weakened by inflammation.  

Several types of shoulder use commonly trigger rotator cuff injury:  

  • Pushing off with your arms — People with arthritis of the knee, other painful conditions in the legs, or weak quadriceps muscles in the thighs often compensate by pushing off with their arms when they rise from a chair. The shoulder is not built for this use. During the push off, the shoulder’s socket and humerus function like an upside-down mortar and pestle, crushing and grinding the rotator cuff tendons. Falls onto an outstretched arm, head-on automobile accidents and sports collisions also can crush the tendons.  
  • Repetitive reaching — Overhead arm positions narrow the tight space that the rotator cuff tendons must pass through. Pushups, pitching a baseball, swimming, house painting, filing, building construction, auto mechanic work and other activities can cause injury of the rotator cuff.  
  • Forceful or abrupt overhead arm movements — Tears are particularly common in athletes in throwing sports, racquet sports and wrestling. Abrupt movements, such as pulling to start a lawn mower, can tear a weakened tendon.  

In addition, your shoulder can be injured more easily if it is out of shape. The narrow space that envelops the rotator cuff tendons becomes even narrower if your shoulder muscles are weakened or tight. When this happens, routine shoulder movements are more likely to cause tendon friction. 


Rotator cuff injuries cause pain in your shoulder and upper arm. The pain may be most noticeable when you reach up or out. When you turn your arm as you lift it, the tendons are more likely to rub against surrounding structures. For this reason your shoulder symptoms may be worst when you try to comb your hair or slip your arm into a sleeve. You also may have dull, aching shoulder pain at night. 

Rotator cuff tears that affect a significant portion of the tendon cause weakness of the shoulder, limiting your ability to hold your arm out to one side or to lift an object. Difficulty using the shoulder because of pain does not always mean that there is a tear. Rotator cuff injuries cause pain in your shoulder and upper arm. The pain may be most noticeable when you reach up or out. When you turn your arm as you lift it, the tendons are more likely to rub against surrounding structures. For this reason your shoulder symptoms may be worst when you try to comb your hair or slip your arm into a sleeve. You also may have dull, aching shoulder pain at night. 

Rotator cuff tears that affect a significant portion of the tendon cause weakness of the shoulder, limiting your ability to hold your arm out to one side or to lift an object. Difficulty using the shoulder because of pain does not always mean that there is a tear. 


A rotator cuff injury usually is diagnosed by physical examination. Your doctor will rotate your arm at the shoulder and then will raise your arm. If this type of motion causes pain, the rotator cuff may be inflamed. 

If you have noticeable weakness, you will need further testing to check for a rotator cuff tear. Your doctor may inject a numbing medicine into your shoulder to help distinguish actual weakness of the tendon from your muscle “giving way” because of pain.  

If a tear is suspected, a magnetic resonance imaging (MRI) scan can confirm the diagnosis. An alternative diagnostic test is a shoulder arthrogram. An arthrogram is an X-ray of a joint following injection of dye into the joint. Because MRIs provide excellent pictures without putting a needle into a joint, arthrograms are done less frequently today.

Shoulder X-rays are not always needed, but may be helpful if you have had trauma to the shoulder or if your doctor cannot move your shoulder through its full range of motion. Another reason to do a shoulder X-ray is too look for calcium deposits in or around the shoulder. Calcium deposits form on a persistently inflamed tendon, causing a condition called calcific tendonitis. 

Expected Duration

Without proper treatment, symptoms of a rotator cuff injury or tear can persist for months or years, and usually become worse over time. Most rotator cuff injuries respond to treatment within four to six weeks, especially if an injection is part of the treatment. 


In many cases, a rotator cuff injury can be avoided. To avoid reaching over your head repeatedly, use a step stool or ladder during projects. Avoid using your arms to push off from a chair. For people who are in poor athletic shape or who have arthritis in the knees, exercises to strengthen the quadriceps muscles in the thighs can be very helpful, so that it is not necessary for you to use your arms to get up from sitting. 

Elderly people who are dependent on their arms to rise out of a chair can raise the seat of their favorite chair with a thick folded blanket or a short platform to make it easier to get up.  

Exercises that strengthen the rotator cuff muscles also are an important part of prevention. Some of the rotator cuff muscles pull down on the upper arm bone as they work, widening the space that the tendons travel through. Physical therapy that strengthens the rotator cuff muscles can make your shoulder less vulnerable to injury.  


Tendonitis, bursitis and small rotator cuff tears in the shoulder can be treated effectively with an injection of a corticosteroid medicine followed by physical therapy exercises to restore shoulder movement and strengthen the rotator cuff muscles. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin and others) are useful to decrease pain and inflammation. 

If your doctor determines that you have calcific tendonitis (calcium deposits), other treatments may be helpful. There is some evidence that treatment of the shoulder with ultrasound or a procedure called lithotripsy, which uses powerful ultrasound waves known as shock waves, may help to break up calcium deposits and speed healing. 

Surgery may be necessary for frequently recurring rotator cuff injuries or large tears in a rotator cuff tendon. Either arthroscopy (camera-assisted surgery) or traditional open surgery can be used. 

When To Call A Professional

A doctor should evaluate shoulder symptoms that last for more than one week.


People with a rotator cuff injury typically recover well with treatment. However, it’s common to injure the same shoulder again, especially if you do not change the way you use your shoulder. Elderly people are prone to rotator cuff problems and have a harder time recovering because their shoulders have a less robust blood supply. 

Learn more about Rotator Cuff Injury

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External resources

National Institute of Arthritis and Musculoskeletal and Skin Diseases


National Rehabilitation Information Center (NARIC)


American Academy of Orthopaedic Surgeons (AAOS)


National Athletic Trainers’ Association


American Orthopedic Society for Sports Medicine


Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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Pancoast Tumor Symptoms | Moffitt

A Pancoast tumor develops in the top portion of the lung—known as the apex—and can trigger several uncomfortable and painful symptoms when it invades the chest wall or spine. These symptoms rarely involve the coughing and shortness of breath that are common with other respiratory malignancies, even though a Pancoast tumor is a type of non-small cell lung cancer. Instead, many patients experience sharp shoulder pain, arm pain and muscle weakness as a result of a tumor placing pressure on a nearby nerve. Patients may also experience other neurological symptoms like tingling sensations, impaired hand function and sensation loss.

Is shoulder pain a sign of lung cancer?

Sharp shoulder or scapula (shoulder blade) pain are some of the most common symptoms of a Pancoast tumor, particularly in its early stages. The pain typically develops as the tumor impacts one or more of the nearby structures, such as the:

  • Ribs
  • Neck
  • Ulnar nerve, which runs from the side of the arm to the wrist
  • Branchial plexus, the nerve fibers that run downward from the spine and into the shoulder and arm
  • Parietal pleura, the highly sensitive outer layer of the membrane that lines the chest cavity.
  • Endothoracic fascia, the fibrous tissue that separates the chest wall from the diaphragm and the pleura  

Shoulder pain can be a symptom of other lung cancers besides Pancoast tumors, typically if a lung tumor presses against a particular nerve or if the cancer travels to the tissues or bones near the shoulder joint. 

It’s important to note that shoulder pain is far more likely to be caused by an orthopedic condition, such as osteoarthritis or a rotator cuff injury, than lung cancer. Nevertheless, shoulder pain that persists for more than a few days should be evaluated by a medical professional. Shoulder discomfort that is related to lung cancer may worsen at night, be present while resting or occur without impacting range of motion. Lung cancer that is not classified as a Pancoast tumor may also cause a hacking cough, shortness of breath and wheezing, among other respiratory symptoms.  

Other Pancoast tumor symptoms

As a Pancoast tumor continues to spread, so can the pain. Patients with an advanced Pancoast tumor may feel intense, constant or radiating pain in their arms, around their chest wall, between their shoulder blades or traveling into their upper back. Patients whose tumor has spread into the scalene muscles may also feel pain in their armpit.

In addition to disruptive pain in various areas of the upper body, a Pancoast tumor may cause the following symptoms to develop:

  • Swelling in the upper arm
  • Chest tightness
  • Weakness or loss of coordination in the hand muscles
  • Numbness or tingling sensations in the hand
  • Loss of muscle tissue in the arm or hand
  • Fatigue
  • Unexplained weight loss

If a Pancoast tumor compresses or irritates a nerve in the sympathetic nervous system, which regulates many of the body’s involuntary actions, a patient may experience flushing and/or excessive facial sweating. Physicians occasionally refer to these complications as Pancoast syndrome. These symptoms typically only affect one side of the face—the same side where the tumor is causing the compression—and can develop long before cancerous cells invade nearby tissues.

Some patients also experience a tingling or prickly feeling in their hands. This symptom, sometimes referred to as paresthesias, is also a result of nerve compression. In advanced cases, this compression can lead to permanent sensation loss.

Approximately 40% of patients with a Pancoast tumor also develop the symptoms of Horner’s syndrome. Horner’s syndrome is characterized by several complications of its own, including drooping eyelids, decreased pupil size and an inability to sweat normally. Another possible symptom of Horner’s syndrome is enophthalmos, or displacement of the eyeball.

Pancoast tumor risk factors   

Pancoast tumors and other lung cancers share many of the same risk factors—a characteristic or behavior that may increase the likelihood of developing a certain condition. Established risk factors for Pancoast tumors include:

  • Smoking tobacco
  • Prolonged exposure to secondhand smoke, asbestos or other industrial substances, such as nickel and chromium
  • Being male
  • Being between the ages of 50 and 60

Pancoast tumors can affect anyone, including individuals who do not have any known risk factors for this cancer. Still, people with one or more risk factors should be particularly mindful to seek care for symptoms and receive appropriate treatment.

How common are Pancoast tumors?

Pancoast tumors are rare, making up fewer than 3% to 5% of all lung cancers. This means they can be more challenging to diagnose and treat, as not many doctors have experience with this complex disease. That’s why you should visit a high-volume cancer center, such as Moffitt Cancer Center, for advanced diagnosis and treatment of Pancoast tumors. Our experts possess a unique level of experience with uncommon lung malignancies such as these.

Moffitt Cancer Center’s approach to Pancoast tumors

The multispecialty team in Moffitt Cancer Center’s Thoracic Oncology Program leverages leading-edge technologies and focused expertise to efficiently identify Pancoast tumors and collaborates to create refined treatment plans. As a high-volume cancer center with specialists who focus solely on lung cancers, our team routinely treats Pancoast tumors and spearheads an ambitious clinical trial program to facilitate treatment breakthroughs. A testament to our commitment to research, Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center—the only such cancer center based in Florida.

If you’ve been experiencing possible symptoms of a Pancoast tumor, Moffitt can work with your primary care provider to help you find answers and specialized lung care. Contact us at 1-888-663-3488 or complete a new patient registration form to consult with a Moffitt physician.

Medically Reviewed by Dr. Lary Robinson.

Severe Shoulder Pain After Waking Up: Causes, Relief & Treatment?

Starting your day with severe shoulder pain after waking up isn’t the best way, right?

We agree.

Ah, the joys of a good night’s sleep.

You go to bed fully intending to get a solid 7 hours and wake up refreshed, but instead, you wake up with random shoulder pain severe enough to ring serious alarm bells.

What just happened?

And what can you do about it?

Shoulder pain is very common because the human shoulder is notoriously injury-prone, but that isn’t reassuring when you went to bed just fine the night before and awoke to a mysterious and painful shoulder problem.

Fortunately for most people, there are several relatively clear reasons why this might have occurred, and shoulder pain is treatable – so you can get back on track and take steps to prevent debilitating shoulder pain from striking in the future.

Types of Shoulder Pain

Waking up with severe shoulder pain is no fun at all; the good news for many is that it may subside during waking hours, giving you some breathing room to treat the underlying problem.

It’s helpful to first identify the different types of shoulder pain so you can see which most closely resembles what you may be experiencing upon awakening.

  1. Rotator Cuff Tendinitis – This is perhaps the most common type of shoulder pain that causes severe shoulder pain after waking up. Rotator cuff tendinitis or tendinosis occurs when the rotator cuff tendons break down over time.
  2. Frozen Shoulder – Unfortunately, before the freezing (inability to move the joint due to extreme stiffness) comes the pain – sometimes excruciating pain.
  3. Spinal Stiffness – The thoracic spine was meant to be held erect, not to bend in fixed position as we constantly hunch forward over our phones and computers. All the poor posture (and the normal effects of aging) causes a lack of mobility in our spine and rib cage, making us more prone to shoulder injuries that act up in the morning.
  4. Altered mechanics. Conditions like scapular dyskinesis and old sprains or soft tissue injuries can cause overuse and stretching pain from muscles that were never meant to do this much heavy lifting.
  5. Radiating pain. Sometimes, neck and back pain can radiate to the shoulder, leading patients to believe they have a shoulder problem when they really don’t.

How can you know what type of shoulder pain you are dealing with?

A good start is to come to Integra Health, where you can consult with a multidisciplinary staff of specialists including our expert downtown Toronto Physiotherapists and Chiropractors and get the appropriate diagnosis and treatment plan. After a complete shoulder examination, you’ll know the type(s) of shoulder pain you are personally dealing with and have a concrete plan to end the pain.

Shoulder Pain Causes

If you’re waking up with severe shoulder pain, you obviously want to know how to make it stop. Oddly, simple things that didn’t used to bother your shoulder can suddenly cause severe shoulder pain after waking up. Some of the most common culprits include:

  • Repetitive movements (such as cashiers or shelf-stockers perform at a grocery store)
  • Medical conditions like arthritis and bursitis
  • Sleeping on your arm, or on the same side every night (which pressures and pinches tendons deep in the shoulder, causing them to become inflamed or chafed)
  • Poor shoulder mechanics (such as having weakness or limited range of motion in the back and ribs, and overcompensating with the shoulder)

Much of this relates to the rotator cuff, a ball-and-socket joint that is stabilized with a cuff of muscles and tendons. As with any muscle group, it can sustain injuries in the form of sudden trauma, like an accident, dislocation or fall, or from chronic overuse.

Rotator cuff injuries can take the form of inflammation, full or partial tears.

Golfers, rowers, baseball players and weightlifters, for example, are especially vulnerable to shoulder injuries because of the motions they must complete for their sport.

Shoulder Pain in the Morning Only

Morning is a time when you should be feeling at your body best, not budgeting extra time to pull your shirt on or wash your hair because your stiff, sore shoulders haven’t ‘warmed up’ yet.

When you wake up with shoulder pain that gradually dissipates throughout the day, only to flare up again next morning, you may need to look no further than your bed for the reason – and the solution.

Start with simple changes and monitor shoulder pain each morning as you work your way through this list of shoulder pain relief techniques.

  1. Switch your sleep position. Try sleeping on your back or on the other side – not your stomach.
  2. Remove some pillows. We often sleep propped up to improve breathing and digestion, but having too many pillows can lead to over-pronation of the head, which stretches the muscles and ligaments in the neck and can cause morning shoulder pain.
  3. Add some pillows. If you aren’t using one at all, or just a single flat pillow, try sleeping elevated to take some pressure off your shoulders.
  4. Don’t sleep with your arm under the pillow or your elbow over your head; this squeezes the tendons and can lead to weakness in the arm.
  5. Switch to a cervical support pillow or tear drop shaped specially designed to support the neck during side-sleeping.
  6. Buy a new mattress if you have had yours for many years. Mattresses tend to sag in the middle over time, which puts undue pressure on all the muscles.

Shoulder Pain Relief

What can you do besides switching sleep positions if you are awakening with severe shoulder pain?

It’s important to be mindful of your movements.

Always warm up before you work out or play sports, and don’t make a sudden lunge to get something off a high shelf or an awkward reach back for your wallet; move deliberately and mindfully instead. Set up your workstation to be ergonomic.

Treatment-wise, most physiotherapists recommend rest and ice or heat to start with, but beyond that, an experienced practitioner – whether in sports medicine, arthritis, osteopathy, physiotherapy, chiropractic or acupuncture, depending on your condition and what treatment routes you choose to take – will be able to recommend a course of action.

Shoulder pain relief treatments may include shoulder pain exercises and postural exercises you can do at home, as well as clinical treatments like spinal adjustments, traction, occupational therapy and physiotherapy, to ensure you get the shoulder pain relief you are looking for.

Stop Waking Up with Severe Shoulder Pain

If taking basic preventative steps at home isn’t working, it’s time to visit Integra Health Centre – Financial District’s most modern boutique health clinic, where you’ll find the most comprehensive services under one roof and a diverse team of top-rated professionals who can work together to take care of your shoulder pain.

Book a convenient appointment online!


Before talking about the causes of shoulder pain , it should be noted that the shoulder joint is a unique creation, given its structure and what functions it can perform. If the shoulder joint will perform super-strong or “unusual” physical activity for it, then it can be damaged, which will lead to the occurrence of a local inflammatory process. As a result of this inflammation, the joint swells and effusion occurs.Sometimes the tendons that surround the joint are damaged.

The shoulder joint has its own limit in relation to the wrong loads that are placed on it. When this limit is exhausted, the joint is damaged, inflamed, which is manifested by the appearance of pain.

  • Soreness often has an aching character, physical activity intensifies it.
  • The shoulder joint may ache over a long period of time, with the pain becoming more and more intense, often worsening at night.
  • A person often ceases to perform previously habitual work.
  • Pain can pass from the shoulder to the chest, neck, and shoulder blades.
  • Muscles in the affected area are tense and painful.
  • The areas where the ligaments and tendons are attached can also hurt.
  • Possible swelling.
  • Soreness interferes with sleep or just lying down.

There is a definite classification of shoulder pain.It can be divided, for example, according to the mechanisms of occurrence:

  • The cause of the soreness in the upper shoulder may be a problem with the neck. In this case, soreness will affect the entire arm, and any movement produced by the neck will intensify it, in addition, such pain will be combined with a feeling of “running shivers”, as well as a feeling of numbness. Most often, the essence lies in the presence of a hernia between the cervical vertebrae. If there is damage to the disc located between the vertebrae, then this leads to the fact that it loses its elasticity and flattens, making the space between the vertebrae narrower.The consequence of such a narrowing will be the infringement of the spinal nerve roots, which, naturally, will cause pain. The place of infringement becomes edematous, increasing the manifestations of the pain syndrome.
  • Capsulites. They are characterized by the appearance of soreness, muscle stiffness, affecting the shoulder girdle. A rather rare occurrence that may not bother the patient for a long time due to the slow progression. It is more and more difficult for such patients to withdraw their hand, to raise it; an attempt to place it behind the back is also difficult.If the process is not treated and started, then it becomes even difficult for such a patient to eat, because bringing a spoon or fork to the mouth is a big problem.
  • Shoulder rotatable cuff is also affected. This condition is preceded by movements unusual for the shoulder joint, such as painting ceilings. This condition does not appear immediately, but usually by the next day after carrying out such work and most often when trying to raise your hands up, for example, in order to reach something lying high.In this case, it is important to establish how much the shoulder girdle is damaged and how much movement is limited. When taking X-rays, pathology is often not detected.
  • Tendobursitis. They are characterized by the appearance of an inflammatory process in the bags of the shoulder joint of a reactive nature, which was provoked by the presence of calcifications in the muscle tendons. Such a painful condition usually occurs suddenly, while the ability to perform both active and passive movements is significantly limited.In addition to the shoulder area, the shoulder girdle area, as well as the arm and neck area, can also hurt.

The underlying causes of shoulder pain can be as follows:

  • Tendinitis. This process is an inflammation of the tendons surrounding the shoulder joint. This condition is a consequence of the fact that the shoulder joint “tried” too strong physical exertion on itself, which led to friction of the tendons against the humerus.As a result of such irritation, soreness appears.
  • Tendenitis of the biceps brachii (biceps). This muscle runs along the inside of the shoulder to the elbow area. At the same time, the pain is chronic, and any touch or movement in the affected area aggravates the condition. If the tendon of the biceps muscle of the shoulder is completely torn, then a swollen spherical area is found at the site of this rupture.
  • Bursitis is an inflammation of the bag of the shoulder joint.Most often, this pathology is combined with tendinitis. Soreness in this case, as in tendinitis, is a consequence of physical effort, but in addition, the patient also receives swelling of the bag of the joint.
  • “Collision” syndrome. This syndrome is the result of calcium salts deposited in the joint and often they are deposited on the surface of the tendon, which is located under the collarbone and scapula. This condition is most typical for people over 30 years old, but up to 50. Soreness in this case occurs if the patient wants to take his arm away from the body, while the pain will be strong enough and long-lasting, even constant.In this case, even before the onset of symptoms on the X-ray, calcified areas of the shoulder joint can be detected.
  • Injury. The most common injury that causes damage to the shoulder joint is a fall. With such damage, the hand is displaced relative to the articular cavity and acquires a non-physiological position. People also often stretch or tear tendons when they fall. If this condition is not treated or delayed with treatment, then you can forget about the usefulness of the movements in the shoulder joint.
  • Recurrent shoulder dislocation. Conditions of this kind are typical both for those who have already damaged the joint, and for active young people and athletes. A feature of this pathology is that there is a periodic “loss” of the shoulder from the articular cavity even at low loads. Older people are prone to such dislocations due to the fact that the structures of their shoulder joint gradually age and wear out, as well as osteoporosis occurs in their place as a result of a lack of calcium.
  • Injury to the shoulder in bodybuilders. Due to the fact that bodybuilders significantly overload both the joints and muscles and tendons, they tend to develop pain not only in the shoulders, but also in the knees, lower back and elbows. Those who have injured a joint at least once may in the future face the problem of performing the physical exercises necessary for this sport. In these athletes, the shoulder joint is usually unstable.
  • Hereditary shoulder anomalies and neoplasms are less common but still possible causes of shoulder pain.
  • Diseases of the internal organs. There are diseases of the internal organs, the result of which is soreness in the shoulders. Such diseases include pneumonia, chest tumors, angina pectoris, myocardial infarction, radiculitis of the cervical spine, liver pathology.

It is also worth mentioning diseases such as periarthritis of the shoulder and scapular periarthrosis.

Shoulder-scapular periarthritis is an inflammatory disease localized in the soft tissues outside the joint, which relate directly to the shoulder joint, which is neurodystrophic in nature.
This disease is more typical for right-handers, that is, the right shoulder joint is more often affected. Pain syndrome with periarthritis of the shoulder scapula will be persistent. It is also characterized by the presence of muscle contracture in the affected area. Soreness in the affected joint is constantly present, such a joint aches, it “aches”. In most cases, the pain becomes more intense at night. Certain movements in the shoulder joint also increase the soreness, for example, an attempt to move the arm to the side or put the arm behind the back.
The spread of pain is also characteristic of this condition, while it can migrate to the neck and occiput, as well as to the shoulder blades. The soreness is so intense that it is very difficult in such a situation to lie on the affected side. Movement in the shoulder joint is naturally limited due to both muscle contracture and pain.
Muscles in the affected area are tense and painful. The areas where the ligaments and tendons are attached can also hurt. An experienced physician is also able to detect local nodules and lumps.The anterolateral shoulder region may be edematous.

Shoulder-scapular periarthrosis. Unlike humeral arthritis, arthrosis is characterized by the presence of a degenerative process in the articular cartilage. This ratology is more characteristic of women and manifests itself more often on the one hand.
Symptoms are very similar to those that appear with periarthritis of the shoulder scapula. Very often, people who already have osteochondrosis of the cervical spine, get such a condition as periarthrosis of the shoulder scapula.Changes of a dystrophic nature occur in the tissues adjacent to the shoulder joint, while radicular nerve fibers are significantly damaged. Joint pain is quite intense and can radiate to the neck and arm. The movements increase the soreness, as a result of which the sick person performs a minimum of movements in the joint, up to the complete absence of movements in it, which further damages the damaged joint.
Initially, soreness appears, for which you can perform simple movements in the shoulder joint, or simply raise the arm slightly above 90 °.Soreness gradually becomes more intense and interferes with a person’s work, which is a reason to see a doctor. The pains are usually aching, gnawing, boring. Sometimes this pain goes to the neck or shoulder blade. For humeral-scapular periarthrosis, it is characteristic that in the absence of most of the movements, movements in the form of a “pendulum”, that is, along the body, the hand is able to calmly move forward and backward, remain intact. Untreated shoulder-scapular periarthrosis threatens complete immobilization of the upper arm.

  • Work involving the use of postures that are not physiological for the shoulder joint, for example, painters.
  • Older age.
  • Heavy physical labor.
  • Lack of physical education.
  • Athletes (bodybuilders).
  • Obesity.
  • Hereditary predisposition.
  • History of shoulder injuries.
  • History of spinal diseases.
  • Frequent inflammatory diseases.
  • People with a history of pneumonia, chest tumors, angina pectoris, myocardial infarction, radiculitis of the cervical spine, liver pathology.

Prevention of shoulder pain is included in the complex of prevention of other diseases of the musculoskeletal system.

  • Charge in the morning. It is especially important for the prevention of this disease, because the lack of movement in the shoulder joint negatively affects its usefulness.It takes very little time and ensures a long life for your joint.
  • It is important to monitor your diet. For the full development of the musculoskeletal joints, proper and nutritious nutrition is necessary, which can be provided by the correct selection of foods and diet.
  • Excess weight reduces your mobility, as a result of which joints, muscles, and the entire musculoskeletal system are significantly affected.
  • Try not to overcool your body, because it is harmful to those who are not seasoned.
  • Choose the right modes of rest and sleep, because the physiological work of your musculoskeletal system largely depends on this.
  • Correct working posture. If you are doing work that requires the use of “wrong” and non-physiological positions of the upper limbs (for example, when painting the ceiling), then try, at least, you can take a break more often.
  • It is important to be able to handle weights correctly. At the same time, it is very important to keep an even posture and perform all movements as smoothly as possible.
  • While doing sports, take care of your body and do not do the “impossible”.
  • Treat internal diseases in time.

The most important stage of diagnosis is finding the root cause of the painful condition, and this may require both a specialist consultation and the use of additional examination methods:

  • Stage One – Conversation. At this stage, the doctor in detail (according to the patient) learns about the nature of the pain (characteristics of pain, how it is stopped, and so on) and about the possible cause of its occurrence.
  • Stage two – examination using manual techniques. Palpation (palpation) can detect muscle soreness, tension, possible edema, and also study the usefulness of performing movements in the shoulder joint.
  • Stage three – the results of additional research methods. These include: computed tomography (CT), magnetic resonance imaging (MRI), radiography, and some others.

The basis of treatment is the elimination of the root cause, which causes pain symptoms.

Our pride – Non-traumatic method of non-surgical treatment of diseases of the spine and joints. This is a special technique, created by the specialists of our center, that allows, in the shortest possible time, with minimal discomfort and for a long time, to get rid of both the symptoms of the disease and its causes.

The method includes the most effective modern and ancient methods. Among them I would like to highlight the following: manual therapy (in the face of osteopathy and chiropractic), therapeutic massages, physiotherapy, exercise therapy (physiotherapy exercises).If necessary, the doctor will offer a fixation brace, as well as select the necessary drug therapy.

During the first three sessions (often after the first), the patient’s condition improves significantly. The entire course of non-surgical treatment for shoulder pain at our Center usually consists of 10-15 sessions.

Essential massage oils used for massage always become a pleasant surprise for our clients. They are based on grape seeds, and the aroma is given by extracts of vanilla, lemongrass, rose, pine, lavender, etc.


Before starting treatment, during treatment, as well as for some time after the completion of the course, it is important to give the spine a rest and not to load it.

Arthrosis of the shoulder. What are the first symptoms of the disease? | Healthy life | Health

I was in no hurry to see the doctor

“My shoulder ached, but at first I didn’t pay attention to it. I worked as a painter for half my life, at that time I also worked – I thought, I just worked my hands for a shift, ”- Galina Ivanovna shares her case history.Now she is 56 years old, she was diagnosed with arthrosis of the shoulder joint three years ago. She says she was in no hurry to see the doctor, hoping that it would hurt and it would pass: “I only went because I could not sleep. The pain in the shoulder intensified towards night. You lie down and look for a position for a long time in which it hurts less. It was generally impossible to lie on the side of the sore shoulder. ”

After examination, the doctor sent Galina Ivanovna for an x-ray. The picture showed that the cartilage in the shoulder joint was noticeably worn out. “I thought I’d take a sick leave, quickly drink some medicine, and then go back to work,” the patient recalls.“But the doctor scared me. He said that if you continue to overload the joint, the treatment will not give the desired effect. Like, at such a pace I will not be able to raise my hands, and it will hurt all the time. I had to “retrain as a house manager” – fortunately, we managed to find a place for a concierge. ”

Catch early

The doctor told the truth. If arthrosis is not treated, and the diseased joint is not protected, the cartilage will continue to deteriorate. This, in turn, will lead to increased pain. It can spread to the area of ​​the scapula – it becomes more pronounced and does not go away even at rest.At the same time, the mobility of the hand decreases: it becomes difficult to lift it up and especially to take it back. At a later stage, a person can sometimes only shake it slightly and tries to constantly keep it in the position that causes the least pain.

To avoid such a development of events, you need to unload the problem joint as much as possible and be sure to take medications. The main group of drugs used for any type of arthrosis is chondroprotectors. They contain components such as chondroitin sulfate and glucosamine, which normalize the metabolism in cartilage tissue, help stop its destruction, make it more hydrated, firm and elastic.To feel better, you need to take chondroprotectors for a long course, for several months, and periodically repeat the treatment.

Practice shows: the earlier the treatment begins, the greater the effect it gives. To date, there are no tools to restore damaged cartilage to its original, healthy state. Therefore, the faster the process of its destruction is stopped, the better. If you have shoulder pain, see your doctor right away. Pain can arise for various reasons, including trifling ones – they slept on an uncomfortable mattress, sat in an uncomfortable position for a long time … But nevertheless, arthrosis of the shoulder joint is a fairly common cause of such ailment, and in this case it is impossible to delay treatment.

In special danger

Signs of arthrosis of the knee and hip joint in old age can be found in many people. As we age, the metabolism of all cartilage in the body changes. These joints are supporting, they experience a constant heavy load, and the cartilage tissue in them wears out faster than in others.

The shoulder joint is very mobile, but it does not have to support the weight of almost the entire body, so arthrosis is much less common in it.However, there are risk factors that increase the likelihood of facing it.

Constant physical work in which the hands are heavily loaded. Painter, builder, plasterer, miner, loader are typical patients with shoulder arthrosis.

Injuries – shoulder arthrosis often develops after a dislocation, fracture, or just an unsuccessful fall on the arm.

Excessive training with heavy barbells, lifting dumbbells.

If you are susceptible to these risk factors, you need to see a doctor even with the slightest discomfort in the shoulder.

See also:

90,000 Shoulder pain – causes and treatment of severe and aching pain in the shoulder joint and shoulder muscles at night

Let’s get rid of back and joint pains without surgery!


Chief vertebrologist, rehabilitation the “Active Center” Kiev


Orthopedist, vertebrologist g.Kiev

Updated: 08/11/2021

Shoulder pain is a symptom that ranges from simple discomfort to inability to move without pain. Pain can begin in the shoulder (joints, muscles, tendons) and radiate along the entire upper limb, extending to the neck and chest.

Symptom – pain in the muscles of the shoulder – characteristic of diseases, conditions and disorders:

  • rheumatoid arthritis – chronic systemic inflammatory disease of the connective tissue;
  • arthritis – an inflammatory disease of the joints;
  • gout – an inflammatory metabolic process with the deposition of salts in the joints;
  • osteoarthritis is a non-inflammatory chronic disease, cartilage deformities, as well as changes in the joint capsule;
  • cervical arthrosis – destruction of cartilaginous articular tissue, dystrophic degenerative processes;
  • bursitis – inflammation of the bursa, accumulation of fluid in its cavity;
  • frozen shoulder or capsulitis of the shoulder joint – damage to the capsule of the shoulder joint;
  • cervical spondylosis – osteoarthritis of the cervical vertebrae;
  • cervical stenosis – narrowing of the cervical canal;
  • spinal stenosis – wear and tear of the spine;
  • tendonitis – inflammation of the tendon at the site of the bone attachment.

Shoulder pain can also be a symptom common to other conditions not listed above.

The causes of shoulder pain are varied, here are some of the most common. The most common cause of shoulder pain is tendonitis, which arises primarily from acute trauma, chronic strains, and anatomical factors. This is an inflammation of the tendons that occurs where the tendon attaches to the bone and spreads to the muscles.Expressed as aching pain in the shoulder joint or shoulders.

This symptom also occurs in cranio-brachial periarthritis, an inflammatory process that affects the tendons and soft parts of the shoulder, characterized predominantly by pulling pain in the shoulder joint at night, localized to the articulation and deltoid muscle, and radiates to the arm. A feature of this disease is nocturnal pain in the shoulder in the shoulder joint and in the muscles of the shoulder at complete rest and when trying to move the hand.The disease is very difficult to treat, exacerbations can last for months. In other cases, the occurrence due to more or less severe traumatic injuries, such as bursitis, inflammation of the bursa.

Tendon rupture. Due to injuries, it is important to consider fractures of the humerus, collarbone and scapula. It is expressed in severe pain in the shoulder, swelling, inflammation.

Also calcifying tendinitis, an acute idiopathic disorder of self-limiting that usually affects the shoulder tendons, is associated with severe pain, severe tenderness, and a characteristic radiographic manifestation.

Cellular capsulitis (also known as “frozen shoulder”) is a painful condition characterized by severe narrowing of the joints in all directions. This disorder often occurs after prolonged immobility, but it can also begin without a specific cause.

On the other hand, inflammatory arthritis of the shoulder joint is characteristic of polymyalgia rheumatica – an inflammatory disease of unknown etiology, people are more exposed to older age.But this disease in the form of Juvenile arthritis has been confirmed in children under 16 years of age. It is characterized by pain and stiffness of the shoulder girdle, swelling, pain in the shoulder joint, and sometimes its destruction.

Shoulder pain can result from degenerative processes of the articular surfaces (osteoarthritis) or autoimmune diseases (rheumatoid arthritis). In some cases, this symptom is a consequence of neurological phenomena (stroke, cervical radiculopathy, etc.), metastatic disease (cancer), cholecystitis, and myocardial infarction.

Gout, the big toe suffers, but as the disease progresses, the shoulder joint also suffers.

Before starting treatment, it is necessary to establish the cause, undergo diagnostics, take tests and only then decide on the treatment. So that the pain does not bother you, the specialist will recommend medication and tell you how to relieve pain in the shoulder joint.

  1. Medical history: The patient reports a condition that is causing pain to the doctor.
  2. Physical examination: The doctor examines the patient looking for signs of injury, movement restrictions, location of pain, and degree of instability.
  3. Diagnosis: The doctor can prescribe one or more diagnostic methods to make an accurate diagnosis. The data will help determine the cause of shoulder pain.

Diagnostics can be:

  • Radiography: A family procedure in which a part of the body is exposed to low levels of radiation to create an image called an X-ray.X-rays are useful for diagnosing fractures or other bone problems. Soft tissues such as muscles or tendons are not visible with X-rays.
  • Arthrogram: X-ray taken after injection of contrast agent into the shoulder joint to highlight structures. There are diseases or injuries in which this contrast agent can reach areas where it does not normally enter, indicating a rupture or opening, or does not spread to areas where it should normally have access.
  • Ultrasonography (US): Non-invasive, well-tolerated procedure in which a small probe is placed on the skin of the shoulder.
  • MRI (Magnetic Resonance Imaging): A non-invasive procedure in which a device with a strong magnetic field transmits force into the body to create a series of transverse images of the shoulder.

Other diagnostic methods, such as those that require injection of anesthetic into and around the shoulder joint.

The doctor prescribes the treatment of shoulder pain on the basis of all the data obtained about the disease and, after the diagnosis is made, forms a treatment plan.Depending on the severity of the disease, it is recommended:

  • Physical rehabilitation is a change in physical activity. It will help relieve pain, remove stiffness, and restore mobility.
  • Drug treatment. Depending on the reason, warming (cooling) ointments are used to improve blood flow, anesthetic effect, relieve inflammation, and swelling of tissues.
  • Surgical intervention – used if conservative methods do not help.

Active Center offers treatment for shoulder pain in Kiev, treatment of pain in the buttock that radiates to the leg and other diseases of the musculoskeletal system and applies the most effective methods in the treatment of this disease. The use of several methods in a complex manner allows you to relieve pain syndrome, stop the development of the disease, improve well-being, correct posture and save the patient from the disease without medication, operations. The team of experienced specialists of the Active Center will provide a safe option and treatment for pain in the muscles of the shoulder, relieving the condition without surgical treatment.

From diagnosis to treatment Your health is our top priority!

  • At the first consultation, a specialist will carefully assess your medical history, symptoms and physical condition.
  • If necessary, will send for additional research.
  • Assess and diagnose the condition of the legs and feet, an important support for the spine and the whole body.
  • Will clearly determine the cause and develop an individual treatment plan that will meet all the specifics of the problem.
  • Will give recommendations on further prevention of the disease, healthy lifestyle, nutrition.
  • Our clients with this problem feel better after the first week of classes with a rehabilitation therapist.

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This blog is not intended to provide diagnosis, treatment, or medical advice. The content of the blog on the resource active-center.com.ua is intended for informational purposes only. Please consult a doctor or other healthcare professional regarding any medical or health-related diagnosis or treatment options. Self-medication can be hazardous to your health.

90,000 GBUZ SO “Togliatti City Clinical Hospital No. 5”

Almost everyone has experienced shoulder pain at least once in their life. Such pain is usually accompanied by additional symptoms: the mobility and function of the shoulder joint is limited, the pain radiates to the arms or back, and the mobility of the hands and fingers decreases. The reasons may be bruises, overload or age-related wear and tear of the joints, but in some cases, such pain is associated with violations of the organs of the chest and upper abdomen, sometimes very dangerous.

Doctors distinguish between acute and chronic, that is, lasting more than three months, shoulder pain; these types of pain are caused by various factors.

The most common causes of acute shoulder pain are:

Dislocation. It often occurs in sports or car accidents, with an unsuccessful fall. If nothing has been broken, and the joint capsule has not suffered, it will not be difficult to repair the shoulder.

Fracture of the clavicle. Sometimes a light blow is enough to break the collarbone, and this is especially true in children and adolescents. This fracture can be recognized, in addition to pain, by swelling in the clavicle, pain and limited mobility.

The following disorders can lurk behind chronic shoulder pain:

Bursitis is an inflammatory disease of the periarticular bag of the shoulder joint, accompanied by edema. Many inflammatory phenomena, including influenza and SARS, are capable of provoking bursitis.Also among its possible reasons are excessive loads on the musculoskeletal system, hard physical work, excess weight.

Arthrosis of the shoulder. As a rule, it is he who contributes to age-related wear of the cartilage in the shoulder joint. But also shoulder arthrosis can develop after accidents of untreated shoulder disease.

Shock Syndrome. With this disorder, pain occurs due to joint mobility, as a rule, when moving the arms. The syndrome often develops in people who overload the shoulder with frequent overhead movements of the arms, such as volleyball players or artists.

Rupture of the rotator cuff. The rotator cuff is a muscular sheath that stabilizes the shoulder joint and participates in the rotational movements of the shoulder. Rotor cuff rupture can be caused by shock to the shoulder syndrome, arthrosis of the shoulder joint, or injuries caused by, for example, falling onto an outstretched arm or intense strength training.

Tendonitis is an inflammation of tendons. The most common is inflammation of the supraspinatus tendon over the shoulder joint and the biceps tendon.With tendinitis, most often pain occurs when the arm or shoulder is moved, but with an old and untreated disorder, pain can occur in the shoulder already and at rest, at night.

Frozen shoulder. Frozen shoulder syndrome occurs when the capsule of the shoulder joint is damaged, which severely restricts its mobility. Frozen shoulder can develop in connection with diabetes mellitus or hyperthyroidism, as well as after accidents, surgery, or for no apparent external reason.

Pain in the left shoulder: possible a heart attack. It is good to know that a heart attack is not only caused by chest pain on the left side. The pain can also spread to the left arm and left shoulder, so do not ignore these symptoms, it is better to seek medical help.

Pain from the upper abdomen to the left shoulder may indicate an injury to the spleen. Severe pain in the upper abdomen, radiating to the right shoulder, is a possible symptom of biliary colic.

Shoulder pain (shoulder pain)

The shoulder is one of the most difficult joints in the human body. If the shoulder begins to hurt, it almost always means the presence of pathology. People who are faced with pain in the shoulder joint already know how much this pain interferes with a full life and rest – after all, it is unlikely that it will be possible to sleep normally with such a problem. Many people often look for an answer to the question “my shoulder hurts, I can’t sleep, what should I do?” What is the best way to sleep if your shoulder is worried? And what do you need to know about shoulder pain? We will tell you in this article.

What pain can be

There can be several types of shoulder pain. The fact is that the shoulder is a rather multifunctional joint, and it takes the most varied load. The shoulder may have been damaged from too much physical activity, such as exercising in the gym or rearranging furniture, or from repairs such as painting the ceiling.

Shoulder can lie down while sleeping or chill if not dressed for the weather. Shoulder pain can also be the result of an ongoing illness.In all these cases, the pain will be different, therefore, in order to successfully diagnose the cause of the pain, you need to establish its nature.

Pain in the arm and shoulder

If the arm is also numb with pain in the shoulder, it may be an intervertebral hernia. If the shoulder has been subjected to unusual stress, inflammation of the shoulder tendons is possible. When the right arm and shoulder joint hurts, especially when lifting or moving to the side, we can talk about the deposition of salts in the body. Shoulder-scapular periarthrosis is a common cause of shoulder and arm pain that gets worse at night.

Shoulder and neck pain

With such pain, the skin may change in color, general weakness may appear, and swelling may be felt. Pain in the shoulder and neck appears with diseases such as:

  • osteochondrosis;
  • arthritis;
  • myalgia;
  • plexitis of the shoulder joint;
  • arthrosis.

Also, such pain can occur against the background of a curved posture, with a rupture of muscles or ligaments in this area, with malignant and benign formations.Shoulder and neck pain can occur due to stress, an uncomfortable sleeping position, or severe muscle overload.

Shoulder pain

Osteoarthritis is a degradation of the shoulder cartilage. The patient practically does not feel discomfort, the pain only makes itself felt after physical exertion. The course of the disease passes imperceptibly. Over time, arthrosis can lead to deformation of the shoulder joint and, as a result, disability.

Arthritis is an inflammation of the shoulder joint.The pain is pronounced, especially when moving, which increases with time. It hurts to touch the shoulder, the patient cannot do basic things – take a shower on his own, comb his hair or reach for an object on the upper shelf. A clicking sound may occur when the shoulder is rotated. Pain interferes with sleep at night.

Pain in the muscles of the shoulder

Myalgia is a dull, aching pain in the shoulder muscle. It occurs after an injury, sprain, hypothermia, or a viral infection. Pain is felt when the shoulder is moved or a muscle is pressed.

Myalgia goes away on its own along with the elimination of the primary source, because of which it appeared, you just need to keep your shoulder at rest. Anti-inflammatory and pain relieving ointments can help relieve pain.

Pain of a different nature, radiating to the shoulder

Often, with certain conditions or diseases, pain radiates to the right or left shoulder. If the pain radiates to the left shoulder, it may be heart disease, myocardial infarction, or an attack of angina pectoris. It is very important to establish the cause of the pain in time in order to have time to save a person’s life.

If the pain radiates to the right shoulder, the person may have problems with the kidneys, spleen, pneumonia, or tumors in the chest. Both shoulders can give off pain due to damage and rupture of ligaments or tendons.

Shoulder pain at night

Often, patients complain of exclusively nocturnal pains. Indeed, shoulder pain can worsen at night, making it difficult for the patient to rest normally. Shoulder-scapular periarthritis makes itself felt at night – the patient cannot fall asleep due to severe, piercing pain, it is impossible to lie on the disturbing shoulder, headache, neck discomfort, depression, atrophy of the muscles of the diseased shoulder may be added.

Bursitis is an inflammation of the joint capsule, in which there is swelling. Sharp pain can interfere with sleep, arm movements are very painful.

Tendonitis is an inflammation of a tendon. The pain is worse at night and subside during the day. Most often found in athletes and movers.

How to treat

First you need to establish the exact reason. Ointments, analgesics and cooling compresses are used to relieve symptoms. For temporary pain relief, you can take a paracetamol-based pain reliever – ibuprofen, for example.Before visiting a doctor, you can take some measures to reduce pain:

  • Limit the movement of the sore shoulder, keep the arm at rest, do not perform any physical activity;
  • Sleep on a hard mattress;
  • Ointments will help for minor injuries or sprains – first, cooling, relieving inflammation and pain, and after a few days warming up;
  • Immediately after injury, it is advisable to apply ice to the damaged area through a bandage or gauze;

It is better not to engage in self-medication.The doctor should examine you, if necessary, make an X-ray or ultrasound of the damaged joint and only then prescribe an individual treatment. Immediately before visiting a doctor, it is advisable to abandon painkillers in order to accurately determine the cause of the pain. You can not do any massage or exercise on the shoulder joints until a specialist examination.

How to sleep better

Pain in the shoulder region can reach its peak at night, it is completely undesirable for the patient to acquire insomnia and sleep problems in addition to shoulder problems.Following these simple guidelines will help reduce shoulder pain at night:

  • Try not to sleep on your stomach. Often, patients specifically sleep on their stomachs, because this way they feel less pain in the shoulder region. However, the opposite is true. The prone position pushes the shoulders forward, which puts additional stress on the shoulders during sleep. It is much wiser to sleep on your back – in this position, the shoulders are in a relaxed and stable position.
  • If you cannot sleep on your back, then sleep on your healthy side.
  • Discard tall and hard pillows. Great if you have an orthopedic pillow or can afford to buy one. Or a towel roll will come to the rescue, which must be placed under the neck.
  • Use a full body pillow. You can buy them in maternity stores or in the orthopedic department. Alternatively, place a few pillows over your body. This will help you to maintain a comfortable position and not toss and turn during sleep, which brings additional pain.


In order not to face such an unpleasant problem as pain in the shoulder, it is necessary to carry out prevention. Here are some tips to keep you safe from shoulder pain:

  • Take care of your posture. Do not sit hunched over at the computer, keep your posture straight when walking. Correct posture is the key to the health of your shoulder, neck and back joints.
  • Avoid carrying heavy bags and backpacks. Avoid the habit of carrying the bag on only one shoulder, distribute the load evenly between the two shoulders.
  • Go in for sports. This will help keep your muscles and joints toned and keep you from sprains and joint problems. A regular morning exercise may be enough to keep your body fit.
  • If you are already in sports, always warm up your muscles before exercising and stretch after. Don’t overload your body with too much activity. Protect your body from injury.
  • Monitor the weather and temperature in your home. Avoid hypothermia, dress for the weather.
  • Sleep in a comfortable position, preferably on an orthopedic mattress and with an orthopedic pillow. Avoid unnatural positioning of your neck and shoulders while sleeping.

By following these simple rules, you will save yourself from shoulder pain and a long treatment period. If trouble has already happened to you, do not delay the visit to the doctor – early treatment is much easier and faster than in advanced cases.

90,000 Pain in the neck and shoulder joint in the practice of a rheumatologist Text of a scientific article in the specialty “Clinical Medicine”


strangeness and severity of Ps.So, the onset of arthritis in old age is usually a favorable prognostic sign, the disease does not lead to severe destructive changes and impairment of the functional ability of the musculoskeletal system. And if the disease first occurred in a young man, then it is often accompanied by a severe course of arthritis, widespread Ps and its atypical forms, as well as numerous systemic manifestations. PsA is not inferior to RA and ankylosing spondylitis in terms of the degree of impairment of the quality of life, persistent disability, severity of the course and outcomes of PsA [13].Erosion of the articular surfaces is detected in 47% of patients with PsA already in the first 2 years of the development of the disease. Mortality


in PsA is higher than in the population (in men – by 59% and in women – by 65%), and the causes of death are cardiovascular diseases, concomitant PsA, nephropathy, metabolic disorders, treatment complications, and malignant neoplasms.

So, PsA is of great medical and social importance, as it leads to early disability of patients and requires significant costs for treatment.Progress in the study of the pathogenesis of PsA and the development of new drugs may change the strategy of its therapy. The goal of PsA treatment is to achieve remission, and if remission is not achieved, then one should strive at least to reduce the activity of the disease.


1. Molochkov V.A., Badokin V.V., Albanova V.I. et al. Psoriasis and psoriatic arthritis. Moscow: KMK Scientific Publishing Association; Author’s Academy,

2007; 33-9.

2. Badokin V.V. Rheumatology. Clinical lectures. Ed. Prof. V.V. Bado-kina. M .: Litterra, 2012; 151-82.

3. Alenius G.M., Berglin E., Rantapa a Dahlqvist S. Antibodies against cyclic citrullinated peptide (CCP) in psoriatic patients with or without joint inflammation. Ann Rheum Dis 2006; 65: 398-440.

4. Badokin V.V., Troshkina I.A., Alexandrova E.N. Rheumatoid factor and antibodies to cyclic citrullinated peptide in patients with psoriatic arthritis. Scientific-practical rheumatol 2011; 5: 32-8.

5. Eder L., Chandran V., Pellet F. et al. Human leucocyte antigen risk alleles for psoriatic arthritis among patients with psoriasis. Ann Rheum Dis 2012; 71: 50-5.

6. Clegg D.O., Reda D.J., Mejias E.et al. Comparison of sulfasalazine and placebo in the treatment of psoriatic arthritis: a Department Veterans Affairs Cooperative Study. Arthr Rheum 1996; 39: 2013-20.

7. Mumtaz A., Gallagher P., Kirby B. et al. Development of a preliminary composite disease activity index in psoriatic arthritis. Ann Rheum Dis 2011; 70: 272-7.

8. Helliwell P., FitzGerald O., Pedersen R.

et al.Comparison of composite disease activity scores in psoriatic arthritis. 3th World Psoriasis & Psoriatic Arthritis Conference 2012 “Psoriasis – a global health challenge” June 27-July 1, 2012 in Stockholm, Sweden. Abstr. P: 4-5, P009.

9. Ash Z., Gaujoux-Viala C., Gossec L. et al. A Systematic Literature Review of Drug Therapies for the Treatment of Psoriatic Arthritis. Current Evidence and Meta-analysis Informing the EULAR Recommendations for the Management of Psoriatic Arthritis.Ann Rheum Dis 2012; 71 (3): 319-26.

10. Mease PJ., Ganguly R, Wanke L et al. How much improvement in functional status is considered important by patients with active psoriatic arthritis: applying the outcome measures in rheumatoid arthritis clinical trials (OMERACT) group guidelines. Abstract presented at EULAR 2004. Ann Rheum Dis 2004; 63 (Suppl. 1): 391-2.

11. Ash Z. A systematic literature review of conventional and biologic therapies for the treatment of psoriatic arthritis: current evidence informing the EULAR recommendations for the management of Psoriatic Arthritis.Ann Rheum Dis 2012; 71 (3): 319-26.

12. Rahman P., Inman R.D.,

Maksymowych W.P. et al. Association of interleukin 23 receptor variants with psoriatic arthritis. J Rheum 2009; 36 (1): 137-40.

13. Ali Y., Tom B.D., Schentag C.T. et al. Improved survival in psoriatic arthritis with calendar time. Arthr Rheum 2007; 56 (8): 2708-14.

Pain in the neck and shoulder joint in the practice of a rheumatologist

Yu.A. Olyunin


Diseases accompanied by pain in the neck and shoulder joint are quite numerous, often lead to the development of persistent functional impairment and occur in a significant proportion of patients seen by rheumatologists, neurologists, orthopedists and therapists.The incidence of such disorders can vary from 7 to 47%, depending on the characteristics of the studied population and the definition used. The list of nosological forms that should be excluded when conducting differential diagnosis contains diseases caused by damage to the cervical spine, muscles, ligaments and tendons located in this area, neurological changes, systemic inflammatory diseases, myofascial pain syndrome, as well as diseases that can cause reflected pain in the neck and shoulder joint (pneumonia, coronary heart disease, gastric ulcer and duodenal ulcer).In the treatment of diseases of the soft tissues of the shoulder joint, compliance with a sparing regimen plays an important role. An important component of therapy is the use of analgesics, primarily non-steroidal anti-inflammatory drugs (NSAIDs), in particular nimesulide (Nise). The drug is successfully used for back pain, osteoarthritis and extra-articular soft tissue diseases. If reducing the load on the affected area and the use of NSAIDs do not give the desired effect, the issue of local administration of glucocorticoids should be considered.

Keywords: pain in the neck and shoulder joint, non-steroidal anti-inflammatory drugs.

Contacts: Yuri Aleksandrovich Olyunin [email protected]


Pain in the neck and shoulder joint in a rheumatologist’s practice Yu.A. Olyunin

Institute of Rheumatology, Russian Academy of Medical Sciences, Moscow

Diseases accompanied by pain in the neck and shoulder joint are rather numerous, frequently result in permanent functional failure, and are encountered in a considerable number of patients followed up by rheumatologists, neurologists, orthopedics, and therapists.The frequency of these impairments may vary from 7 to 47% according to the characteristics of the study population and used definition. The list of nosological entities to be excluded in the differential diagnosis includes diseases caused by lesions in the cervical spinal area, its muscles, ligaments, and tendons, neurological changes, systemic inflammatory diseases, myofascial pain syndrome, as well as diseases that can induce referred pain in the neck and shoulder joint (pneumonia, coronary heart disease, gastroduodenal ulcer disease).To follow a sparing regimen plays a large role in the treatment of soft tissue diseases in the shoulder joint. The use of analgesics, primarily nonsteroidal anti-inflammatory drugs (NSAIDs), such as nimesulide (nayz), is an important component of therapy. The drug has been successfully used for back pain, osteoarthrosis, and extraarticular soft tissue diseases. The local administration of glucocorticoids is worth consideration if a reduced load on the affected area and the use of NSAIDs produce no desirable effect.

Key words: pain in the neck and shoulder joint, nonsteroidal anti-inflammatory drugs.

Contact: Yuri Aleksandrovich Olyunin [email protected]

Diseases accompanied by pain in the neck and shoulder joint are quite numerous, often lead to the development of persistent functional impairment and occur in a significant proportion of patients seen by rheumatologists, neurologists, orthopedists and therapists.The frequency of such disorders can vary from 7 to 47%, depending on the characteristics of the studied population and the definition used [1, 2]. The list of nosological forms that should be excluded when conducting differential diagnosis includes diseases caused by damage to the cervical spine, muscles, ligaments and tendons located in this area, neurological changes, systemic inflammatory diseases, myofascial pain syndrome, as well as diseases that can cause reflected pain in the neck and shoulder joint, such as pneumonia, coronary heart disease, gastric ulcer and duodenal ulcer.

When examining a patient, first of all, it is necessary to determine the leading symptom of the disease (pain, weakness or functional impairment), as well as clarify the presence or absence of provoking factors (injury, sports or occupational stress). For example, persistent pain can be caused by even minor damage to the neck resulting from a traffic accident, and pain in the shoulder joint is often caused by changes in soft tissues resulting from sports training or professional activity.At the same time, it is sometimes difficult to distinguish pain associated with damage to tissues located in the neck and shoulder joint, since the clinical manifestations of such disorders can be similar.

The peculiarities of the existing disorders largely determine the localization and nature of pain. Pathology of the cervical spine and soft tissues in the neck without involvement of nerve structures is accompanied by pain in the cervical spine, which spreads to the upper trapezius muscles and has no dermatomal distribution [3].With the defeat of the facet joints, pain usually radiates to the occiput, scapula, shoulder and upper forearm [4].

A patient with a shoulder joint lesion in the acute period may find it difficult to determine the localization of pain, in contrast to

from a chronic pathological process, usually with a clearer clinical picture. Patients with arthritis or ruptured lip of the shoulder joint initially complain of diffuse pain localized deep in the shoulder joint [5].At the same time, changes in the rotator cuff are often accompanied by pain along the anterolateral surface of the shoulder, which can radiate along the deltoid muscle down to the upper part of the forearm [6]. Changes in the acromioclavicular joint are characterized by pain in the affected area [7].

Peripheral neurological disorders usually, although not always, have a well-defined type of pain [8]. During the first few days or weeks, radicular syndrome associated with changes in the cervical spine is manifested by pain along the medial edge of the scapula or in the shoulder joint.This symptomatology can be mistakenly regarded as a disease of this joint or a pathology of periarticular tissues [6]. Over time, these disorders can progress and the spread of pain is limited to the area of ​​innervation of the affected root. When the Oy-y segments are involved, the pain can be localized only in the area of ​​the shoulder joint, which significantly complicates the diagnosis. Patients with acute brachial nerve neuritis (traumatic or atraumatic) may complain of pain in the shoulder joint before distal neurological symptoms appear.Pain in the medial scapula may be associated with superior thoracic outlet syndrome, neuropathy of the thoracic long nerve or suprascapular nerve [9].

In the presence of diffuse widespread pain and no recent history of trauma, systemic connective tissue disease should be ruled out. The presence of aching pain and morning stiffness in the neck, shoulder joints and pelvic girdle in people over 50 is a characteristic sign of polymyalgia rheumatica [10].The disease usually begins acutely and is accompanied by functional impairment. Patients with polymyalgia rheumatica may initially only complain of pain in the shoulder joints, but with more detailed questioning, they may indicate pain in the neck and in the muscles of the pelvic girdle. It may be difficult for the patient to get out of the chair and get dressed –


Xia. Myalgia is often combined with general manifestations such as low-grade fever, fatigue, and weight loss.On examination, there is a limitation in the mobility of the neck, shoulder and hip joints associated with pain. Often, patients complain of muscle weakness, although muscle strength is usually preserved. There is an increase in ESR, CRP levels, anemia. If polymyalgia rheumatica is not combined with giant cell arteritis, a good effect can be obtained with the appointment of prednisone 15 mg / day.

Significant help in the differential diagnosis can be provided by identifying movements and postures that increase or decrease pain.Thus, an increase in the intensity of pain during neck extension is characteristic of the defeat of the facet joints, while a decrease in pain in the supine position with an unbent neck suggests the discogenic nature of the disease [11]. Discomfort caused by damage to the rotator cuff or the acromioclavicular joint prevents the patient from falling asleep while lying on his side [7]. In patients with cervical radiculopathy, the pain may be exacerbated by neck extension, tilting the head, or turning the head to the affected side [8].Radicular pain may be relieved by abducting the shoulder or placing an arm behind the head. Sensory impairment, paresthesias and weakness in pain in the neck and shoulder joint indicate damage to nerve structures and can be caused by radiculopathy, especially if the symptoms are localized in the nerve root zone.

Sensory disturbances are not always associated with root pathology. They also occur in patients with superior thoracic outlet syndrome, which may be accompanied by numbness or paresthesia in the shoulder girdle.Cervical myelopathy can cause sensory disturbances in the upper or lower extremities. Cervical myofascial pain can also be associated with sensory disturbances in the hands. Muscle weakness associated with neck and shoulder pain is proximal or distal. Painless proximal muscle weakness may be a sign of mononeuropathy of the suprascapular, long thoracic or accessory nerve [11]. The defeat of the suprascapular nerve can lead to impaired abduction and external rotation of the shoulder.With the involvement of the long thoracic nerve, it is difficult for the patient to raise his arm above his head, and in the case of an accessory nerve pathology, it is difficult for the patient to shrug and move the shoulder.

The onset of non-trauma-related shoulder pain followed by progressive muscle weakness suggests brachial neuritis. The weakness caused by it usually appears in the first 2 weeks after the onset of pain. Various muscles can be affected, most notably those innervated by the upper brachial plexus.The most commonly involved are the supraspinatus, infraspinatus, serratus anterior and deltoid, but various muscle combinations have been described, including a purely distal shape [12]. Proximal muscle weakness with or without myalgia may be the first manifestation of dermatomyositis (DM) or polymyositis (PM) [13]. These diseases are accompanied by a wide range of clinical manifestations. Muscle weakness is the most common of these. The disease usually develops gradually, with a gradual increase –

symptoms melted over several months.In this case, the muscles of the pharynx and neck are often involved, as a result of which swallowing is impaired, and it becomes difficult for the patient to hold his head. Selective lesions of the muscles of the neck and paravertebral muscles have been described, but usually the proximal muscles of the limbs and muscles of the trunk are usually affected. It is difficult for the patient to climb stairs, get up from a chair, brush your hair. In a significant proportion of cases, myalgia and tenderness to palpation of the affected muscles are also noted. Unlike PM, in DM, muscle pathology is combined with skin changes.A characteristic sign of the disease is an increase in the activity of enzymes (creatine phosphokinase, lactate dehydrogenase, aldolase, transaminases). Electromyography and muscle biopsy may also be needed to confirm the diagnosis. The presence of PM or DM is an indication for the appointment of glucocorticoids (GC). This treatment is usually combined with the use of immunosuppressants and, in some cases, with the use of genetically engineered biological drugs (rituximab or tumor necrosis factor inhibitors).

Distal muscle weakness in combination with pain in the neck and shoulder joint is often associated with cervical radiculopathy. It also occurs in cervical myelopathy, Pencost’s cancer, and superior thoracic outlet syndrome [14].

Crunching, clicking and wedging during movement in the shoulder joint are characteristic of the violation of its stability. In such patients, damage to the glenoid lip is often detected, including its separation from the edge of the glenoid cavity of the scapula (Bankart injury) [15].

Pathological changes localized in the neck area can induce the appearance of symptoms that have no spatial connection with the lesion. One of the characteristic signs is headache, which can be caused by various disorders, in particular, the defeat of the facet joints and muscle-tonic syndrome. Visual impairment, numbness, dizziness, nausea and vomiting are signs of vertebrobasilar insufficiency due to atlantoaxial instability, for example, in rheumatoid arthritis (RA) [16].

If this complication is not recognized in a timely manner, it can be fatal. Subluxation of the cervical vertebrae in patients with RA can be caused by insufficiency of the ligamentous apparatus or destructive changes in bone structures. Atlantoaxial subluxation is more common, subaxial subluxation is less common. The clinical picture is determined, first of all, by the degree of displacement of the vertebra. Minor subluxations are usually asymptomatic. As the displacement increases, pain appears, which can radiate to the back of the head, temple, retroorbital, and in some cases is accompanied by muscle spasm.There are also phenomena of myelopathy with sensory and motor deficits. C1 subluxation can induce the symptoms of medulla oblongata lesion. The development of vertebrobasilar insufficiency is accompanied by dizziness, imbalance.

On examination, you can see the smoothness of the cervical lordosis and the limitation of neck mobility. If subluxation of the cervical vertebra is suspected, patients with RA are shown a lateral X-ray of the cervical spine from


maximum flexion and extension of the neck, as well as in frontal projection with an open mouth.The distance between the odontoid process Cp and the anterior arch of the atlas> 3 mm is a sign of impaired stability. An increase in this index> 9 mm is associated with an increased risk of spinal cord compression. It is believed that early aggressive treatment of RA can effectively inhibit the development of structural disorders, including changes in the spine. In the presence of subluxation of the cervical vertebra, accompanied by pain without neurological deficit, the patient may be advised to use the Shants collar.When signs of spinal cord compression appear, surgical treatment is performed. It can also be indicated in the presence of persistent neck pain, resistant to conservative therapy, and an increase in the distance between the odontoid process Cp and the arch of the atlas> 14 mm.

When examining a patient with complaints of pain in the neck and shoulder joint, it is necessary to take into account the presence of a forced position. Thus, patients with cervical radiculopathy usually tilt their head to the side opposite to the affected area, which makes it possible to somewhat reduce pain [8].Forward tilt of the head with this pathology can increase the tension of the cervical muscles, which in turn limits the mobility of the neck. At the same time, patients with a lesion of the facet joints tilt their head forward, unloading these structures. An anterior tilt of the head in such cases is usually combined with a rounding of the area of ​​the shoulder joints due to internal rotation of the shoulder and anterior displacement of the scapula. This posture can lead to a narrowing of the subacromial space, thereby contributing to compression of the rotator cuff and impeachment.It also contributes to the formation of the upper thoracic outlet syndrome [17].

The area of ​​the shoulder girdle, neck and scapula is best viewed from behind, comparing opposite sides. Diffuse atrophy of the muscles of the shoulder girdle can be a consequence of neuritis of the brachial nerve, while selective atrophy of individual muscles of this zone occurs with ruptures of the corresponding tendons of the rotator cuff, as well as with the involvement of the subscapularis and accessory nerves [12].Systematic palpation of the affected area in some cases allows you to obtain diagnostically significant information. Thus, local pain on palpation of individual muscles (trapezius, rhomboid, supraspinatus, infraspinatus) is often a sign of myofascial pain syndrome [18]. At the same time, diffuse pain on palpation of the neck is nonspecific and occurs in various diseases. A protrusion, palpable in the clavicle, may be due to a fracture. Tenderness to palpation of the acromioclavicular joint indicates a lesion.

Local soreness in the subacromial zone or in the area of ​​tuberosity of the humerus suggests the presence of shoulder impeachment syndrome or tendon rupture. The area of ​​the shoulder joint is one of the most frequent localizations of pain syndrome associated with damage to the periarticular soft tissues. The anatomical features of the shoulder joint and the large volume of movements performed in it determine the increased vulnerability of the periarticular structures.In clinical practice, it is customary to distinguish several basic variants of patho-

logical changes in soft tissues in the shoulder joint. These include rotator cuff tendonitis (compression syndrome of the rotator of the shoulder), biceps tendinitis, calcific shoulder tendonitis, adhesive shoulder capsulitis, and impeachment shoulder syndrome. The impeachment syndrome of the shoulder is understood as a complex of changes resulting from compression of the soft tissues located in the subacromial region between the head of the humerus and the rigid structures lying above it (acromial process of the scapula, clavicular-acromial joint, coracoacromial ligament).

This mechanism leads to the development of changes in the supraspinatus tendon, the long head of the biceps, and the subacromial bursa. In the medical literature, the term “impeachment shoulder syndrome” is widely interpreted. Within the framework of this syndrome, three main nosological forms are often combined – rotator cuff tendonitis, tendonitis of the long head of the biceps and subacromial bursitis. In patients with rotator cuff abnormalities, active and passive movement in the shoulder joint is usually limited.Soreness can limit passive internal rotation of the shoulder and active abduction, as these movements compress the rotator cuff tendons between the humerus and the rigid structures above it. At the same time, a decrease in the mobility of the shoulder joint can partly be compensated for by the movements of the scapula [19]. In contrast to the pathology of the rotator cuff, damage to the shoulder joint itself can cause limitation of movement in all directions. If passive external rotation of the shoulder is more limited than internal rotation, the presence of adhesive capsulitis can be suspected.

In the treatment of diseases of the soft tissues of the shoulder joint, compliance with a sparing regimen plays an important role. The patient should limit the load on the affected area, avoid movements that cause pain, and not make movements with a large amplitude. Limiting the load creates favorable conditions for the development of reparative processes and the reduction of inflammatory changes. An important component of treatment is the use of analgesics, primarily non-steroidal anti-inflammatory drugs (NSAIDs).They effectively suppress inflammatory changes caused by damage to the periarticular tissues, and in a significant part of patients provide a pronounced clinical improvement already in the early stages of treatment. The basis of their therapeutic action is the suppression of the activity of the enzyme cyclooxygenase (COX). This effect provides a decrease in the synthesis of products that mediate the development of inflammation, but is associated with a significant risk of adverse events, primarily from the gastrointestinal tract.This risk is significantly reduced when using drugs that have a predominant effect on one of the isoforms of COX – COX 2. One of these drugs is nimesulide (nise). The drug is very rapidly absorbed from the gastrointestinal tract, its maximum concentration (from 2.86 to 6.50 mg / l) is observed in the period from 1.22 to 2.75 hours after oral administration [20]. Food intake does not decrease absorption. After absorption, the drug actively binds –


is taken with albumin and is rapidly distributed in tissues.Nimesuide is metabolized to form compounds that are excreted from the body through the kidneys and intestines. These metabolites also have anti-inflammatory properties. The drug is successfully used for back pain, osteoarthritis, and extra-articular soft tissue diseases [21-23]. Among other NSAIDs, nimesulide stands out for its speed of action. Good absorption allows for a clear clinical improvement in a very short time [24]. If a decrease in the load on the affected area and the use of NSAIDs do not give the desired effect, the issue of local administration of HA should be considered [25].Prep-

rats of this group can quickly and effectively suppress pain syndrome when accurately introduced into the inflamed synovial structures (tendon sheath or synovial bursa). It is necessary to avoid injecting HA directly into the affected tendon, as this can lead to an increase in degenerative changes. It should be remembered that the use of anti-inflammatory drugs does not eliminate the underlying tendon degeneration of the disease.Therefore, when pain decreases, the patient should not immediately increase the load. He must follow a gentle regimen for at least a few weeks.


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