Shoulder pain: rotator cuff, relief and a video doctor visit

The most common cause is a rotator cuff problem. The rotator cuff is the group of muscles and tendons that holds the shoulder in place. Its tendons become inflamed (tendonitis) or worn, sometimes along with bursitis, inflammation of the fluid sac that protects them. It happens with overhead work or sports (painting, carpentry, swimming, baseball), poor posture and age.

Other causes include frozen shoulder (the shoulder becomes stiff and loses movement), arthritis, a rotator cuff tear after a fall, and pain coming from somewhere else, such as neck pain or the lungs. If the pain runs down the arm into the hand, it may come from a pinched nerve in the neck.

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A doctor visit costs US$79, the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the visit can’t take place. A doctor’s note is included. We do not bill insurance; the pharmacy, any imaging and any therapy charge separately. See all prices. The service is run by The Health Initiative, a nonprofit.

Depending on the cause, you may notice:

• Pain when raising your arm overhead or out to the side
• Pain in the front or side of the shoulder that stops above the elbow
• Pain at night, especially when lying on that shoulder
• Weakness or stiffness when lifting the arm or reaching behind your back
• Loss of shoulder movement (frozen shoulder)

Home care: MedlinePlus advises ice wrapped in a towel for 15 to 20 minutes several times a day; resting the shoulder and avoiding movements that make it worse; and returning to activity gradually. You can use acetaminophen, or ibuprofen or naproxen as the label directs (check first if you have high blood pressure, heart or kidney disease, or ulcers).

Exercise: stretching and strengthening, guided by a physical therapist, are a core part of treating rotator cuff pain and frozen shoulder. Improvement can take weeks or months.

Frozen shoulder: it is more common in people with diabetes or thyroid problems, during menopause and after an injury or surgery. With physical therapy and anti-inflammatories, full recovery can take 9 months to a year. In Puerto Rico, where 14.4% of adults had diagnosed diabetes in 2021 according to the CDC, it is worth checking your blood sugar: if needed, the doctor gives you a lab order for a lab near you. See type 2 diabetes.

Get seen if the pain lasts beyond 2 to 4 weeks of home care, or comes with fever, redness or warmth in the shoulder.

The doctor sees children and teens of all ages by video; patients under 21 need a parent or legal guardian on camera for the whole visit, with ID. In teens who pitch, swim or play tennis, pain often comes from overuse. For their safety: if the pain started with a fall and the arm looks deformed or the child cannot move it, go to the emergency room.

For your safety, call 911 or go to the emergency room if you have any of these signs:

• Sudden pain or pressure in the left shoulder or arm with chest pressure, shortness of breath, dizziness or sweating (possible heart attack)
• Pain that runs from the chest to the jaw, neck or arm
• A fall or blow with a deformed shoulder, or you cannot lift your arm
• A lot of swelling, bruising or bleeding after an injury
• A hot, red shoulder with a fever