I Believe I Have Rotator Cuff Tendonitis but mostly referred pain in the arm. Where do I put the ice?

by Marianne Martin
(Northampton, UK)


I believe that I have rotator cuff tendonitis.

Most of the pain I feel is in the arm, in various places but mainly near the bottom of the bicep.


I am assuming inflamation of one or more rotator cuff tendons is impinging on a nerve so I feel it in the arm.

I have started to use ice this week, just frozen peas (not having any problems with smell). A friend recommended heat as well and Googling ice and hot I found your excellent site today, which has put more detail on how often to use the ice etc plus given me some tips for my partner who has trigger finger.


Where should I massage the ice if I feel no pain in the shoulder? You mention its hard to get at.

I have a steroid jab tomorrow. Could this actually delay my recovery or will it not do any harm.

I had a feeling it would not really help healing in the long run, but hoped if it would bring the inflamation down which would help the referred pain.

Is there somewhere I can read up about the biochemistry of how the ice works?

I am a yoga teacher and feel that this injury is teaching me a great deal that I can pass onto my students.

Thanks again for your site. I will pass on your web link.

Kind regards
marianne



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Joshua Answers:

Hi Marianne.

As you commented, pain is a GREAT teacher. Or at least, if one is willing to look, pain can teach a lot.

I have learned a lot from each and every injury I have had. There's a whole world of inquiry and insight around pain and injury....

Anyway, back to you.

1. Why do you think you have Shoulder Tendonitis as opposed to Biceps Tendonitis?

2. Please describe symptoms and locations in greater detail, as well as what hurts with what activities (or lack of activities).

3. How'd the Corticosteroid Injection go? Where exactly did the doctor inject you? And what were his/her reasons for that location?

4. When you poke around in your shoulder, can you find a painful or tender spot? You mentioned there was no pain when you were trying to ice. Again I wonder if you have biceps tendonitis instead of a shoulder issue.

5. Do you have a history of pain and/or injury?

6. Are you a hypermobile person? (can you touch your thumb to your forarm, when you straighten your arm, does the elbow bend past straight?)

7. How long have you been having this pain?

8. Vegetarian?



Thanks for passing my site on. I appreciate that.

Answer the above questions, and let's figure out what's up and how best to deal with it.





Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
www.TendonitisExpert.com
















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Comments for I Believe I Have Rotator Cuff Tendonitis but mostly referred pain in the arm. Where do I put the ice?

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Nov 29, 2009
PART 2 - answers to questions - I Believe I Have Rotator Cuff Tendonitis but mostly referred pain in the arm. Where do I put the ice?
by: Marianne

Only a slight tenderness on the front of the shoulder I think on the collar bone

My bicep is tender towards the bottom of the muscle about 2 inches from the inside of the elbow

The GP diagnosed rotator cuff injury from the range of arm movement I have:

Cannot raise the straight arm to the side higher than about 45 degrees without pain in bicep

Cannot raise the arm forward and up higher than about 120 degrees without pain in bicep

Cannot take my arm behind the back more than a few inches without pain in the bicep.

Not too much history of pain. None in arm, some history of tension and related soreness in shoulder. One bout of serious lower back pain.

I'm not hypermobile

I eat very little meat but not 100% vegetarian. Do take milk and cheese and occasionally fish.

I have had the pain and lack of arm mobility for about 2 months now.


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Joshua Comments:

Hmmm.

And, was there an incident or injury that set this off?

It's a safe bet that the bicep is involved here...:)

I wouldn't expect pain down low from the limitation you describe, but every body does what it does.

1. What happens if you hold your elbow against your side, with your elbow at 90 degrees, like you're holding a drink in your hand, and you rotate your arm by taking your hand out towards your right (or left, if it's the other arm, I can't see the original post right this instant).

Directions make sense? Basically, I want to see what happens if you rotate your upper arm out.

It could be referred pain. I wish I could poke around on your shoulder for a minute and take a look at all the shoulder cuff tendons.

2. Gone on any trips lately where you carried luggage with that arm?










Nov 30, 2009
PART 2 - Answers to Joshuas questions - I Believe I Have Rotator Cuff Tendonitis but mostly referred pain in the arm. Where do I put the ice?
by: Marianne

Its my left arm.

I think I did the injury while decorating an old ceiling. I'm right handed and I was using my left arm more than usually, more vigorously, repeatedly and in awkward directions. I was not concious of a precise moment of injury.

I'm a fit 58 year old women.

Bending the arm at the elbow and trying to take the hand from the body out to the left I can only get to about 45 degrees. I feel the resistance in the bicep.

Forgot to tell you about the injection.

It was in my shoulder from the back just above the top of the shoulder blade and below the collar bone. The needle went in about 50mm.
For the first 3 days the condition seemed worse, there was some trauma created in the shoulder I feel. But after three days there did seem some improvement in the condition. But from what I have read the injection will not help on its own.

While I still assumed there was tendonitis in the shoulder causing refered pain. I had a go at putting an ice pack on the shoulder and then taking the arm as far as it would go.

Is there any work on the use of exercise at the same time as ice? Seems logical to me.

But maybe I should be putting the ice on the point of pain at the bicep.


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Joshua Comments:

Icing is all about shocking the system to create ciruclation. Old stuff (including pain enhancing chemical) out and new blood and nutrition in.

I bet your subscapularis muscle is stuck in spasm. The lower biceps isn't the usual spot of referred pain, but hey, every body is different.
Infraspinatus muscle spasm fits that a -bit- more.

In a perfect world you would get skilled massage therapy on your subscap and infraspinatus to kick out the spasm. And everything else connected.

1. Start EASY stretching of that motion I had you test for. Constantly throughout the day. Don't push it, just go for easy lengthening.

2. Drink lots of extra water, and make sure to get some extra Magnesium in you.

3. In general, start eating more protein than you are used to. This is a good thing over the course of the rest of your life.


I doubt that you are 'injured' per se. I'll put my money on that you irritated the muscle(s) and it is now stuck in spasm.

Can't hurt to ice there at the lower bicep too. Does it hurt if you poke it/massage it, there on the tendon/muscle? That could be the culprit too, of course.



Dec 01, 2009
PART 3 - thanks for advice and help - I Believe I Have Rotator Cuff Tendonitis but mostly referred pain in the arm. Where do I put the ice?
by: Marianne

Many thanks your thoughts everything makes a lot of sense and it felt amazing that someone across the world can help me out.

Still can't get used to, or take for granted the wonders of modern technology.

Thanks again. I'll let you know how I get on.


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Joshua Comments:

Ahh, the miracles of modern science. If only our wisdom matched our intellect....


Definitely do update us!



Dec 07, 2009
PART 4 - progress report - I Believe I Have Rotator Cuff Tendonitis but mostly referred pain in the arm. Where do I put the ice?
by: Marianne

Have had a good poke around on the shoulder and sure enough have found a muscle in spasm and some tender areas. Thanks for the advice that lead me to look!

I've been using hot and cold treatment on the shoulder always finishing with cold. During the treatment I take the arm as far as I can in the direction of the pain, seeing if I can release the contraction. Also using massage with both hot and cold. It feels like the hot may help me to release the contraction and stretch the muscle, while the cold will keep the inflamation down.

I have already got a lot more mobility during the rest of the day.

Touch wood I hav'nt had any moments of excruciating pain for 2-3 weeks. I think I know not to make sudden movements now and it seems to me that the inflamation is much improved.

Feel confident now that if I keep up the daily treatment the problem will be sorted some time in the next few months.

Many thanks again for your help and advice. You were spot on even without the obvious help of being able to feel around my shoulder yourself!


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Joshua Comments:

Great!

I'm glad you've been doing the work. That's the only way to get results.

Now with the poking around and icing, start looking for HOT spots, specific spots on or around tendons. -If- you have a specific hot spot that is/can be a specific site of wear and tear damage/scar tissue.

Ice massage that spot, dig into it (gently at first, then add pressure as you can, avoid 'bad' pain)

And as far as calling it without seeing it first hand, I gotta say, when one works with enough of this kind of problem, one starts to see how similar all the Tendonitis problems are.

Keep at it, and update me again.




Dec 16, 2009
PART 5 - progress report - I Believe I Have Rotator Cuff Tendonitis but mostly referred pain in the arm. Where do I put the ice?
by: Marianne

Just wanted to say recovery is progressing really quite qucikly.

I have enough free movement now to do all everyday tasks without any problem.

Still icing at least once a day and working into the difficulty not quite as free as the 'good' arm yet but not far off.

I just hope that when I report back to my GP (general practitioner/doctor) in the new year that he believes it's the daily icing that has done the trick rather than the one injection he gave me! I have my doubts on that score.

There's no big pharmaceutical company trying to sell him the remedy. Perhaps we should get the frozen corn/pea companies behind the treatment!
Have an excellent holiday period and thanks again for your help.


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Joshua Comments:


Thanks for the update Marianne!

I'm glad things are progressing. I'm glad you're doing the work.

I'm curious what your doctor says:)

And I got a good laugh out of your idea of getting the frozen corn makers into the health care market. It's not a bad idea, actually....





Dec 21, 2009
Happy New Year
by: Marianne

Look forward to hearing about your research funding from the corn growers!

Let you know what the doctor says in the New Year. Signing off for the holiday - enjoy yours!

Jan 28, 2010
PART 7 - Good news - I Believe I Have Rotator Cuff Tendonitis but mostly referred pain in the arm. Where do I put the ice?
by: Marianne

Gradually have had more movement each day since I mailed in December. Now able to fully stretch the arm up with just a tinge of discomfort - would not even call it pain now. This is really stretching up my arm, so I rarley notice it now doing daily tasks.

I went to see the doctor as he'd asked me to do that even if I was well. I guess this is a benefit of our health system in the UK.

I intimated that I did not feel the improvement was anything to do with the cortisone injection. He agreed that it only gave a window of less pain and inflamation in which you could bring more movement to the joint. He agreed it was not a cure and recommended I carried on with the stretching and exercise.

He got me to see how I was with my arm behind my back. This was useful as it helped me realise that this movement was still not back to my old flexible self. I used to be able to easily touch my fingers putting one arm behind my head and the other up from the small of the back.

I have to confess with the arm movement so improved I have not been icing as often more like once a week than 2 or 3 times a day.

The doctor's input will get me icing again until I have full mobility as before.

I've also become aware of long term tension in my neck some areas of muscle in spasm. I going to see if I can ease this. These habits often take ages to release but once I target an area I usually find a way in the end.

Thanks again for your input. I'm learning lots from the blog and hearing about other peoples experience.

Regards Marianne


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Joshua Comments:


Sounds like a big one for you is shortness in the armpit/muscles/structures area.

Hmm, actually, which arm is most restricted, the one reaching up over your back, or the one reaching around on the low side?

Yep, at a certain level, one just has to keep at it until one gets the wanted results. Ideally one can fine tune this for faster results, but I consider any speed of recovery to be good.

And sounds like you're on your way:)




Feb 02, 2010
PART 8 - residual pain - I Believe I Have Rotator Cuff Tendonitis but mostly referred pain in the arm. Where do I put the ice?
by: Marianne

Hi,
It's painful when I put my left arm down and the hand behind the back, then bring the hand up the back bringing the elbow towards the centre of the back.

Would there be a specific place to ice in this case?

Other than that I'm really fine.


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Joshua Comments:


As a general rule, ice wherever it hurts.

When you put your arm down and back like that, does it hurt in the front of the shoulder, top of the shoulder, back of the shoulder?




Feb 09, 2010
Residual pain
by: Marianne

Just put my arm at the back as discribed previously and the pain is in the biceps. Perhaps I have strange nerve path ways! I think I was feeling it in the front of the shoulder before as well but no pain in the shoulder at all today. I'm very happy with the everyday usage. managed to help a friend with her home in boxes over the weekend, could not have done that before Christmas.


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Joshua Comments:


Hurts in the bicep? Hmmm.

Where/how exactly?




Oct 27, 2012
SAME ISSUE
by: debbie

I have the same issue was told by my gp that I have shoulder tendonties and got a jab 3 weeks ago but mine was on the top side of my arm. I have not gotta and pt and just started the same exercise she did. thanks for this site.






Oct 27, 2012
Same Issue
by: DEBBIE

I have the same issue as this poster .I HAD IT FOR ABOUT 9 WEEKS .I got a shot about 3 weeks ago a little better but not much at this time I had no pt and am going to ask for it .I did start doing the exercise you took the lady to do and it been two day's I do feel a little better today .

The worse part for me is waking up at night I am so over that I can't get things done that need to be done I am also 61 yr old and I fell on my shoulder front part into a trash can .

Thank for the site and help .

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