Please Stay Home … and do this for your shoulder instead of seeing me in the office

As we brace ourselves for the inevitable surge of coronavirus cases, we all must do our part to minimize any unnecessary contact, so that we can make our best possible effort at flattening the curve so that our health care system has the capacity to keep up with the number of people that need to be treated. To that end, I am transitioning as many of my office visits as possible to virtual visits, and cancelling all of my patients who I think in good conscience can have surgery at a later date and still have the same outcome.

This crisis will leave us with a gap in care not just for the people whom we have seen and identified have a need for treatment that must wait, but also for people that will go on suffering with problems for which they would otherwise have sought out treatment. I have considered writing this article before with the intent of reaching people who have resigned themselves to potentially treatable shoulder pain, but today I woke up at 5am and could not fall back asleep because of the sense of urgency to let people know that they should not be seeing the doctor this week for the shoulder pain they have had for years, and to give them something that would be a reasonable place to start while we are getting better prepared to see people virtually.

• If you have had a shoulder injury and you are not able to raise your arm above your head, you should get checked out soon. There are many reasons why someone would not be able to move their arm (dislocation, fracture, rotator cuff tear, etc.) and this is not meant to be a comprehensive guide on how to diagnose yourself … so if you hurt yourself and can’t move your arm at all, you at least need a virtual visit as soon as possible.
• If you have not had an injury, you have pain in the upper arm (not up near your neck, and not pain that radiates down to your fingers) I want you to examine yourself to see if you are able to move your arm in all directions (Reach straight up in the air with both arms — are they the same height? With your elbows at your side, how far apart can you get your hands — are they the same distance from your belly button? Reach up behind your back — do both your hands go the same distance up your back?). If you can do all of this, even with some pain, then this puts you in a category of patients that likely has some inflammation in the shoulder that is potentially treatable with a short course of a long acting NSAID* (e.g Naproxen 220mg that you can get over the counter and take 2 tablets twice a day with food for 2 to 3 weeks — do not take this if you have kidney problems, stomach problems, if you’re on a blood thinner, or you have any other reason that your doctors have told you that you can’t take Ibuprofen or other NSAIDs). If the pain gets better after a few weeks of the long acting NSAID then doing a strengthening program (see below) as you wean off the NSAID may mean that your shoulder pain will go away permanently and never come back.
• If you have not had an injury, you have pain in the upper arm (not up near your neck, and not pain that radiates down to your fingers), and you are not able to raise your arm above your head even with help from the other hand, it is possible you have to be seen sooner rather than later for an xray and a physical exam. If the pain and loss of range of motion is not related to an injury and has been going on for less than a month, it would be reasonable to try the long acting NSAID (see above) to see if your symptoms improve. If your shoulder is not getting better on the NSAID, has been affecting your sleep at night, and you have not been able to reach up above your head for more than a month then it would be very reasonable to be seen virtually to see if it is worth coming in for an xray and a possible cortisone injection.
• If you have not had an injury, and your pain is in the area at the base of your neck, or the pain radiates down the arm in to your fingers, then it is very possible that the pain is actually coming from your neck, and it would be outside of my area of expertise.

I hope you find this helpful. I hope you take this for what it is worth as an attempt to care for people with shoulder problems in a time where social distancing and minimizing the spread of the coronavirus is more important than shoulder pain … yes, I am finally realizing that shoulder pain is not the center of the health care universe. As always, any medical advice in the public domain must be very limited and impersonal, so I invite you to feel free to reach out to me if you need any guidance or clarification on anything you see here. If you do not have any shoulder pain and are wondering how to avoid having a future shoulder problem (prevention is the best treatment), I would recommend doing the following four shoulder exercises:

1. Rowing exercise for the shoulder blade muscles — you can do these with a rubber band at home if you have one, or use a cable machine at the gym with light resistance setting.
2. Internal rotation and external rotation exercises for the rotator cuff muscles— same as the rows, these can be done with therabands or light cables, and just make sure to do these slowly, particularly when you are coming back in the direction of the resistance.
3. Elevation exercise in the scapular plane for the supraspinatus and deltoid muscles — you can do these with either light weights or a water bottle/jug that you fill up with just the right amount of water that you can do the exercise slowly and carefully while keeping your shoulder blade back and not moving up and down with your arm. If it is too hard to do this exercise without moving your shoulder blade, either avoid it completely, or you can do it by simply lifting up the weight and holding it out in front of you with your shoulder blades back.

Those are the four exercises I think everyone should be doing for their shoulders. Exercises that should be avoided are ones where your hands leave the “strike zone,” the cube of air space immediately in front of you between shoulder height and waist level. Examples are the military/overhead press and the hyperabduction exercise that makes me cringe when I see people doing it at the gym. Are there some people that do just fine with these exercises? Yes. Are they advisable for people with shoulder problems? In my opinion, no. The take home message is that I think shoulder exercises are very important for the overall health of your shoulder, and it is critical that you do the right exercises and do them the right way. Ideally, this is done under the guidance of a therapist, but until the coronavirus situation settles down, this is a good place to start to see if you get better with as little public exposure as possible.

*I have written another article in response to feedback that NSAIDs have been discouraged out of fear that they make COVID-19 symptoms worse.