Can't straighten arm front of shoulder pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Pain or tenderness in the front, side, or back of the shoulder occurring when you engage in throwing sports, raise your arm overhead, sleep on your side… or simply start a new day is relatively common. The most likely explanation is an injury to the muscles and tendons that make up the rotator cuff of the shoulder.

While other areas and conditions may lead to inability to straighten the arm, shoulder injuries will be discussed first.

Overuse injuries to the rotator cuff muscles surrounding the shoulder blade are common. They become more common with increasing age. These muscles are specifically involved in motions used in sports and also in helping to hold the upper arm bone in the shoulder socket. Rotator cuff injuries often involve muscle strength and flexibility imbalances.

This condition is often brought on by:

• Increasing the speed and force of throwing or hitting motions too quickly when starting a new sport season or doing the same type of thing over a long period of time.
• Tight pectoral (chest), posterior shoulder joint capsule, and rotator cuff and lat (mid back) muscles
• Weak rotator cuff muscles
• Faulty throwing, hitting and weightlifting technique


Unless your shoulder pain is severe or you're unable to raise your arm, you can try the following:

• Rest from all activities that cause pain.
• Ice 2-3x/day. Place crushed ice in a plastic bag over the shoulder for 15 minutes.
• Aspirin or Ibuprofen

Stretch - to reduce tension in the rotator cuff and tightness in the chest muscles.

• Technique: Warm up until you start to sweat, stretch to a gentle pull and hold without bouncing.

• Frequency: Do 4-8 repetitions per day, 5-7 days per week.

OVERHEAD (LAT) STRETCH

• Raise arms overhead until you feel a stretch in upper back and back of shoulders.
• Hold, without bouncing for 20 seconds.
• Stop doing this exercise if it makes shoulder pain worse.


CHEST (PEC) CORNER STRETCH

• Stand in corner with arms on walls and one foot in front of other.
• Slowly bend lead knee until you feel a gentle stretch in chest muscles.
• Hold, without bouncing for 20 seconds.
• Do not rest entire body weight on upper arms; this can stretch the stabilizing structures of the shoulder.


PRIMING THE PUMP STRETCH

• Lie on side with upper arm out 90Ί and elbow bent.
• Grab your forearm with the opposite hand.
• Slowly push the forearm down toward floor
until you feel a gentle shoulder stretch. • Hold 2-3 seconds then relax.


NECK STRETCH

• Sit tall and hold onto edge of chair with hand.
• Slowly pull head down to side until you feel a stretch on opposite side of your neck.
• Hold, without bouncing for 20 seconds.


PIT STRETCH

• Sit tall and hold onto edge of chair with hand.
• Slowly pull your head to the side and rotate down until you feel a stretch.
• Hold, without bouncing for 20 seconds.


STRENGTHEN - the rotator cuff and upper back muscles to prevent injury

• Frequency: Do three sets of ten repetitions, 3-4 days per week.

• Technique: Start with 1-2 pounds, when able to do 3 sets of 15 repetitions without fatigue, increase weight by 1 pound.

• Goal: 5 - 7 pounds

BACK HAND (rotator cuff)

1. Lie on side with your top elbow bent 90o and tucked into your side.
2. Hold 1-2 lbs. with forearm resting on stomach
3. Slowly raise forearm away from your body.
4. Keep elbow tight to side.
5. Hold 2 seconds, then slowly lower.


THROWING (rotator cuff)

1. Lie on your side with your lower elbow bent 90o
2. Rest the forearm on table or floor and hold 1-2 lbs.
3. Keeping your elbow tight to your side, slowly raise your forearm straight up to your stomach.
4. Hold 2 seconds, then slowly lower.


HITCHHIKER (upper back and rotator cuff)

1. With arm dangling down, bend forward at the waist with knees bent, or lie on stomach.
2. Straighten elbow and point thumb away from your body.
3. Slowly raise arm up to the side.
4. Hold 2 seconds, then slowly lower.


Shoulder Blade Squeeze

1. Lie on stomach with elbows bent down.
2. Squeeze shoulder blades together.
3. Raise lower arms to parallel to the floor and perpendicular to the elbows.
4. Hold 3 seconds.

CALL YOUR DOCTOR IF:

• Your shoulder pain continues after two weeks of self-care.
• You feel sharp, shooting pain even at rest (sitting or sleeping).
• You can't raise your arm above shoulder level.
• You see or feel a deformity in the collarbone, including the outer tip and where it attaches to the breastbone (indicates a possible fracture or separation).
• You feel unusual numbness or tingling in your arm, hands or fingers (indicates possible circulation or nerve problems).
• Your hand or fingers are blue and cold (indicates possible circulation problems).
• Your shoulder is red and hot and you have a fever (indicates possible infection).


Another reason of inability to straighten the arm with pain in the front of the shoulder is tendonitis involving the bicipital tendon. This tendon is intimately involved in movement of the arm and shoulder but is not a part of the rotator cuff. This problem usually occurs as a result of injury or repetitive motion that stresses the biceps such as hammering, using a screwdriver, or over vigorous weight-training.

The treatment involves physical therapy and occasionally steroid injection.

Inability to straighten the arm along with anterior shoulder pain can occasionally occur with elbow disorders such as tendonitis, inflammation of the elbow joint, or even a loose piece of cartilage in the elbow joint. When the elbow joint is involved along with the shoulder, an attempt should be made to examine the patient for a more generalized type of arthritis condition.

Visit our sister site to learn more about tendonitis... Tendonitis Treatment Tips

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