Shoulder Pain?

Kellie, I am having the exact same problem, only on opposites sides from you.  I just sat in the recliner a little while ago with a heating pad on my shoulder.  My husband thinks it's because I overdue it with my right because I had a SNB and 2 lumpectomy's in the past 2 weeks.  It feels like it could be arthritis, and I sometimes get this feeling in my knees....a really bad burning kind of feeling.  Hope it goes away for you soon! 

I read that one of the SE's of AIs is a tendency to problems in the rotator cuff. I have been on Femara for nearly a year now and have been having rotator cuff problems. After the first 2 months I tried to be very careful with that shoulder (non-cancer side)- not to carry my purse on that side, not to pull a suitcase or lift things on that side, etc. The pain went away after about a month of being careful. It has now come back again but I'm not worrying this time about it being mets. Could it be the SE's of AIs for you, too?

From the New York Times Personal Health Column:

February 28, 2011

For Tendon Pain, Think Beyond the Needle

By JANE E. BRODY

Two time-honored remedies for injured tendons seem to be falling on their faces in well-designed clinical trials.       

The first, corticosteroid injections into the injured tendon, has been shown to provide only short-term relief, sometimes with poorer long-term results than doing nothing at all.       

The second, resting the injured joint, is supposed to prevent matters from getting worse. But it may also fail to make them any better.       

Rather, working the joint in a way that doesn't aggravate the injury but strengthens supporting tissues and stimulates blood flow to the painful area may promote healing faster than "a tincture of time."       

And researchers (supported by my own experience with an injured tendon, as well as that of a friend) suggest that some counterintuitive remedies may work just as well or better.       

A review of 41 "high-quality" studies involving 2,672 patients, published in November in The Lancet, revealed only short-lived benefit from corticosteroid injections. For the very common problem of tennis elbow, injections of platelet-rich plasma derived from patients' own blood had better long-term results.       

Still, the authors, from the University of Queensland and Griffith University in Australia, emphasized the need for more and better clinical research to determine which among the many suggested remedies works best for treating different tendons.       

My own problem was precipitated one autumn by eight days of pulling a heavy suitcase through six airports. My shoulder hurt nearly all the time (not a happy circumstance for a daily swimmer), and trying to retrieve something even slightly behind me produced a stabbing pain. Diagnosis: tendinitis and arthritis. Treatment: rest and physical therapy.       

Two months of physical therapy did help somewhat, as did avoiding motions that caused acute pain. The therapist had some useful tips on adjusting my swimming stroke to minimize stress on the tendon while the injury gradually began to heal.       

The following spring, although I still had some pain and feared a relapse, I attacked my garden with a vengeance. Much to my surprise, I was able to do heavy-duty digging and lugging without shoulder pain.       

Could the intense workout and perhaps the increased blood flow to my shoulder have enhanced my recovery? A friend, Richard Erde, had an instructive experience.       

An avid tennis player at 70, he began having twinges in his right shoulder while playing. Soon, simple motions like slipping out of a shirt sleeve caused serious pain. The diagnosis, based on a physical exam, was injury of the tendon that attaches the biceps muscle of his upper arm to the bones of the shoulder's rotator cuff.       

He was advised to see a rheumatologist, who declined to do a corticosteroid injection and instead recommended physical therapy and rest.       

"I stopped playing tennis for a month, and it didn't help at all," Mr. Erde told me. "The physical therapist found I had very poor range of motion and had me do a variety of exercises, which improved my flexibility and reduced the pain somewhat." After two months, he stopped the therapy.       

Then several weeks ago, after watching the Australian Open, he thought he should do more to strengthen his arm and shoulder muscles and decided to try playing tennis more vigorously. "The pain started to drop off dramatically," he said, "and in just 10 days the pain had eased more than 90 percent."       

A Frustrating Injury

Tendinopathies, as these injuries are called, are particularly vexing orthopedic problems that remain poorly understood despite their frequency. "Tendinitis" is a misnomer: rarely are there signs of inflammation, which no doubt accounts for the lack of lasting improvement with steroid shots and anti-inflammatory drugs. They may relieve pain temporarily, but don't cure the problem.       

The underlying pathology of tendinopathies is still a mystery. Even when patients recover, their tendons may continue to look awful, say therapists who do imaging studies. Without a better understanding of the actual causes of tendon pain, it's hard to develop rational treatments, and even the best specialists may be reduced to trial and error. What works best for one tendon - or one patient - may do little or nothing for another.       

Most tendinopathies are precipitated by overuse and commonly afflict overzealous athletes, amateur and professional alike. With or without treatment, they usually take a long time to heal - many months, even a year or more. They can be frustrating and often costly, especially for professional athletes and physically active people like me and Mr. Erde.       

In a commentary accompanying the Lancet report, Alexander Scott and Karim M. Khan of the University of British Columbia noted that although "corticosteroid injection does not impair recovery of shoulder tendinopathy, patients should be advised that evidence for even short-term benefits at the shoulder is limited." Like the Australian reviewers, the commentators concluded that "specific exercise therapy might produce more cures at 6 and 12 months than one or more corticosteroid injections."       

Treatments to Try

Now the question is: What kind of physical therapy gives the best results? Most therapists prescribe eccentric exercises, which involve muscle contractions as the muscle fibers lengthen (for example, when a hand-held weight is lowered from the waist to the thigh). Eccentric exercises must be performed in a controlled manner; uncontrolled eccentric contractions are a common cause of injuries like groin pulls or hamstring strains.       

Marilyn Moffat, professor of physical therapy at New York University and president of the World Confederation for Physical Therapy, prefers "very protective" isometric exercises, at least at the outset of treatment until the tendon injury begins to heal. These exercises involve no movement at all, allowing muscles to contract without producing pain. For example, in treating shoulder tendinopathy, she said in an interview, the patient would push the fists against a wall with upper arms against the body and elbows bent at 90 degrees.       

In another exercise, the patient sits holding one end of a dense elastic Thera-Band in each hand and, with thumbs up, upper arms at the sides and elbows bent at 90 degrees, tries to pull the hands apart.       

"The stronger the shoulder muscles are when the tendinopathy calms down, the better shape the shoulder is in to take over movement without further injury," Dr. Moffat said. "You don't want the muscles to weaken, which is what happens when you rest and do nothing. That leaves you vulnerable to further injury."       

made a Dr. appt about my shoulder...he is sending me for an x-ray in an hour, thinks it's my rotator cuff...we'll see.  Always something!

x-ray's are meaningless.  You need an MRI to find a rotator cuff tear or tendonosis.

This is from wikipedia:

 Common medical studies used in diagnosing a rotator cuff tear include X-ray, MRI, double-contrast arthrography, and ultrasound techniques. A normal rotator cuff tear usually goes undetected with an X-ray, although bone spurs, which can pinch the rotator cuff tendons and result in a tear, can be captured.^[10] Moreover, if bone spurs are present, it suggests chronic severe rotator cuff disease. Double-contrast arthrography involves injecting contrast dye into the shoulder joint to detect leakage out of the injured rotator cuff.^[11] Arthrography and ultrasound are used, but depend heavily on the experience of a radiologist. The most effective and common diagnosis tool is magnetic resonance imaging (MRI), which can sometimes tell how large the tear is, as well as its location within the tendon. Furthermore, MRI enables the detection or exclusion of complete rotator cuff tears with a reasonable accuracy and is also suitable to diagnose further pathologies of the shoulder joint.^[12]

x-ray came back fine...Rx: vicodin, heat, and rest

thegood5...that's good news about the x-ray results...hope the Rx resolves your shoulder pain...

tifj...good luck on your CT scan..

If the shoulder pain is with your computer mouse arm, try lowering your mouse and mouse pad below the keyboard level (give it one week). Perhaps use it on a lower table below your computer desk. I had this agonizing problem, and my ortho doc said he had the same problem. He lowered the mouse pad...it worked for him and me.

voraciousreader - Ergonomics...That's PRECISELY the word I couldn't think of when I keyed my post. My chemo brain is STILL sad.  It's amazing how a few simple adjustments, CAN make a difference. Thanks for sharing. Here's one place that sells supplies:

http://www.ergostoreonline.com/

Best wishes with your surgery...hopefully this will be the last one?

I am having the exact same problem - massive pain in my right shoulder three weeks after a unilateral mastectomy and lymph node dissection on the left. It is excruciating, and hurs so bad it has even tempted me to take some of the leftover Vicodin from my surgery. (Fortunately, I have only succumbed to taking Tylenon and Advil). The pain spreads from my spine up through the muscles of my upper back, along my shoulder, up my neck, and even up into my head/scalp.

In the past two weeks I have tried an osteopath, a chiropractor, a physical therapist, and a massage therapist, but none has really helped. I've found that rubbing it myself and using a vibrating massager helps just as much, if only temporarily.

Given the number of posts here, this seems to be a common issue!

windlass...I say take the vicodin!  that's what my Dr. told me to do to help my shoulder!

For those of you with shoulder pain after a masectomy, you may want to read this from another bc poster.  It's one of those things that isn't mentioned by the surgeon, but is more common than you  may realize.

 http://butdoctorihatepink.blogspot.com/2011/03/post-mastectomy-problems.html

Just returned from orthopedist. I threw in the towel and agreed to surgery. I asked if we could at least do another MRI to see if my tear is improving. He said that there are at least six things that can be causing the shoulder pain and the MRI can only show a few of those things. Also, when I had my last shoulder surgery on my other arm, the MRI missed many of the bone spurs that were causing my pain.



I am going on six months of sleepless, painful nights. This wimp is ready for relief and will do whatever it takes to feel better.