Charles V. Toman, MD - 4/17/2009

Question
i was in a mva on 3/3. injured my left shoulder.
negative xpray and negative mri.
my family doctor said it is inflammation. Prescribed PT.
received cortisone shot.
My pain is getting worse. I am continuing to do PT since the injection i can pin pint the painful area. PT said it is my rotator cuff.
I don't know what to do? Should I see an Orthopedic doctor or continue PT and follow up's with my family Doctor.
I am afraid that it is getting worse and I have had my limit with this disturbing my life.


Answer
Car,

Sorry that you are having to deal with this MVC and shoulder injury.  With a negative set of X-rays and a negative MRI, it is unlikely that you tore your rotator cuff.  It sounds like you family doctor is on the right track.  There is something called impingement syndrome and bursitis.  When people suffer from these conditions, the rotator cuff becomes irritated and painful with lifting to the front above the head and lifting straight out to the side.  The cuff itself can be inflamed, and more commonly the bursa sac that sits just above the cuff becomes irritated and fills with fluid.  When this occurs, there is significant discomfort with overhead activities, and this pain can actually make your arm weak.  Your muscles refuse to fire and pain sets in.

my questions for you are, did you get relief immediately after the injection?  ( I am assuming that the injection was a numbing medicine and cortisone) If you did, then you know that the medicine is in the right spot. believe it or not some family doctors just don't know where to put the shot.  With impingement or bursitis, the injection should have taken the pain away.  The cortisone is the actual treatment and it can take up to a week to set in.  

The cure to this problem is typically the physical therapy.  Remember use light light light weights and high repetitions with good form.  The rotator cuff muscles are tiny and need only very light weights, like about 1 pound.  Also you may want do some scapular stabilization exercises ask your doctor and therapist to see if this would be possible.

If you have any doubts go see an Orthopaedic Surgeon.  We see this on a daily basis.

Hopefully this has been helpful.  Good luck and feel free to contact me if you need any points clarified or elaborated upon.