Miscellaneous Causes of Upper Extremity Pain

Rotator cuff tendonitis

The rotator cuff is a set of four muscles (Supraspinatus, Infraspinatus, Subscapularis, and Teres Minor) that lie over the humeral head in the shoulder that help provide shoulder stability. These muscles can become inflamed and produce shoulder pain. The pain tends to be:

• Generally worse at night or after activity
• Shoulder motion causes pain and is limited
• More common in athletes who do a lot of throwing
• More common in older individuals (over 50)

If the pain is severe, it can be difficult to distinguish between rotator cuff tendonitis and a cervical radiculopathy. In such cases, an injection of a numbing agent (such as Lidocaine) into the shoulder area can help. If the pain is completely relieved, then the cuff is probably the pain generator (not the nerve).

Tendonitis may be associated with a rotator cuff tear, which can be diagnosed with either an MRI scan or an arthrogram of the shoulder.

NSAID's medications and exercise

Treatment includes NSAID’s and physical therapy exercises to strengthen the rotator cuff. For more severe cases, a steroid injection into the shoulder can help decrease the inflammation. If a tear is present, surgery may be necessary to repair the torn muscle/tendon.

• Article written By:
• Peter F. Ullrich, Jr., MD

November 2, 2006

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