Question
I'm a 63 year-old man in excellent health and am physically fit, and I work at taking care of myself.   I've got a problem, though, that doesn't seem to be getting better-- with time, with deep tissue massage, or with other things I've done to try to help.  

It's my left shoulder.  It feels as though there's something raw and rough around the soft tissue on the inside of the joint near the clavicle.  Certain kinds of motion (some kinds of reaching) bring on the pain;  it does NOT seem as though bringing on the pain makes the problem any worse.  I have not lost the ability to use the arm in pretty much all the usual ways, though I do think that if I were playing baseball, my comfort and control with my swing would be diminished.  

For financial reasons, I've not gone the diagnostic route, which I believe would entail an MRI. I'd like to see if between my description, and your expertise, I might learn something more about what the story is with my shoulder.

First, a question about the origin of the problem.  About a year ago I took a tumble coming down a mountain in Colorado.  The biggest immediate impact was that I landed in a way that gave me an uppercut to the chin.  There was no problem with my shoulder, but my left hand was a bit abraided in a way that showed I must have used my left hand to break my fall. After a few days, I noticed a bit of pain on my left arm along the outside halfway between the elbow and the shoulder.  That continued for some weeks, and then faded away.  It was only about two months after the fall that I began to have this shoulder pain.  

First question:  could whatever happened in the fall be the origin of the pain that eventually showed up in the shoulder? I'm not aware of having injured myself in any other way.

Second question has to do with diagnosis.  The fact that it's not getting better with time has made me think that it's not muscular --and it is not bone-- but some other kind of tissue.  The phrase "rotator cuff" has come to my mind, but I'm not really knowledgeable about what all that is.  On the basis of what I've been able to tell you, do you think that's what this is about?  

Finally, if I've told you enough for you to have an idea about what's going on, can you advise me as to whether there's something I can be doing --on my own, or at least that wouldn't cost me an arm and a leg-- that could get this injury moving toward recovery?  Thank you for your counsel.  

Answer
It is a little hard to diagnose without a hands on exam, but i would venture a guess that your tumble is what may have started this.  You may have a good sprain/strain to the shoulder, and even a bit of misalignment that is hindering the healing.  The Rotator cuff you always hear of is a group of 4 muscles that rotate the shoulder.  They are small muscles, which, when damaged, allow the larger muscles of the shoulder to perform their action.  An evaluation by a good chiropractor should be able to help you find an answer, as they would be best to treat and rehab the problem, as well as refer you to a specialist if need be.