Chronic Shoulder Pain

I’m an avid climber and have had chronic pain in both shoulders for six months. Since I don’t remember any injury event, the pain appears to be from repetitive abuse. Curiously, neither shoulder hurts when I climb except for the occasional jolt of pain when my arms are at the extreme limits of their range (up and back). Instead, they hurt late at night—often to such an extent that the pain wakes me. Holding my arm bent against my chest is the only thing that seems to lessen the pain. Once I’m up and around for the day, the pain goes away. The pain doesn’t seem to originate in the joint itself but instead seems centered in the muscle on the outside of the shoulder. It has been suggested that I have the classic symptoms of rotator-cuff tendonitis, but I have not been to a doctor for a proper diagnosis.

—Andy B, via rockandice.com

Stoic was what your granddaddy was because medicine was either overrated or unaffordable. The United States have somehow managed to make it still unaffordable,
which is impressive given the more socially progressive models on display in many Western countries. Nonetheless, go and get some!

Pain on the outside of your shoulder, in or around the deltoid muscle, tells you about as much as a foreign correspondent inside China—that there’s
a problem. The vast majority of shoulder injuries, from cartilage tearing to bursitis, refer pain to this area.

[Also Read Climbing Injury: Golfer’s Elbow]

To say that it is classic rotator-cuff tendonopathy is a bit like saying since the bed is wet you must have pissed it. Eighty percent of shoulder injuries
relate to rotator-cuff tendons.

Bilateral shoulder pain is concerning. One overloaded wing I can understand, two is a definitive step toward medical hellfire and has me considering autoimmune
arthritis. Blood tests. MRI.

On the good side, however, your pain pattern is fairly similar to tendonosis in that it warms up and goes away, returning after you cool down. You will
almost certainly have some internal joint issues such as synovitis given the nighttime pain and the protective position (which reduces pressure inside
the glenohumeral joint).

Solution: None. Get a diagnosis. This will dictate how you handle the problem. Tendonopathy can be corrected with manual therapy and an
eccentric exercise program. The other diagnostic options will be less fun.

This article appeared in Rock and Ice issue 199 (January 2012).