Seeing the Doctor

I just returned from seeing an orthopedic sports medicine doctor up at Dartmouth about my ailing shoulder. What she said has me feeling better about my pain/problem and gave some insights that might be useful.

After questions, pushing, pulling, and poking … she said it does NOT appear to be a torn rotator cuff (primarily because where the pain is located and because of the over head range of pain free motion I have). She said that it does appear to be the same bicep tendonitis that I had two years ago, which kept me out of Newk’s camp.

She believes it is in the long head of the bicep muscle, which, while functionary, is not critical to arm movements. In fact, the extreme “solution” to my problem is to have an operation to DETACH the tendon permanently from the shoulder!

Here are answers to some of my questions:

• If it were bicep (or any) tendonitis, wouldn’t it hurt all the time? She doesn’t know why; but surmises that it may take “a certain number of the wrong strokes” to inflame the area.

• What would be the downside of continuing to play tennis and taking meds? None. In fact, the “worst case” scenario is that I rupture the tendon and detach it from the bone, which would “solve my problem.”

• Which meds do you recommend and why? Between Ibuprofen and “Aleve,” she said it is usually a personal preference as to which a body tolerates better. But all other things equal, she would take the Aleve because it is longer lasting.

• What is the maximum dosage I can take? Two pills, three times a day, with each meal.

• What are the pros and cons of another “cortisone” shot? Cortisone is in quotes because they do not use that anymore; but that is what we the public call it. But she would be comfortable with my having a shot every year or two, if that gives me relief from the inflammation. But would not give anyone two or more within the same calendar year.

• What are the long term cures for this problem? Like any tendonitis… rest, ice, and anti-inflammatories.

My next steps?

• Take three doses of Aleve
• Play doubles tonight (!); but lighten up till it feels better
• Ice after each match
• If the pain gets to be too much, get a shot in early October.

8 thoughts on “Seeing the Doctor

  1. George; yes, Camp above everything! See you there. Kevin

    Kevin – during the exam, i made clear what my priorities were! see you there. geo

  2. George,
    So glad to hear you’re coming to camp — it just wouldn’t be the same without you.
    Interesting to hear that a detachment of the tendon would actually be a good thing.
    I’m guessing that she didn’t tell you to go out there and swing with abandon —
    but great to hear that you can keep playing!
    Looking forward to seeing you again at Newk’s in October!

    Jimmy – actually, she DID talk about that possibility! see you soon. geo

  3. Hey George,

    Good luck with the shoulder. As someone who has had a lot of shoulder issues over the last year or so, I just wanted to tell you that physical therapy, a lot of it on my own, eventually relieved my shoulder pain. It was a long process that required me to break through some pain thresholds along the way, but by challenging the muscle it did build up enough to finally (after 6 months) allow me to play pain free. Not sure if you went that route already, but I thought I’d toss it out there. Most don’t stick with the workouts long enough break through, but those who do may be able to eliminate the med cycle which can cause kidney and liver issues if too much is ingested over time.

    Paul – when you say “physical therapy,” what do you mean in actions? tks. geo

  4. That’s very encouraging I still think you should ice every night even on days you don’t play tennis. I biked 12 miles in 60 minutes today. Bill

    Bill – nice, warm day to bike 12 mikes! geo

  5. George- I asked Mike to read about your situation and he had a similar injury years ago and went the same route as Paul Rutherford. Mike also resolved his issue with stretching and weight training.

    Pam – well, i am doing both of those (plus icing and taking Aleve); so let’s hope it solves the problem! See you in just three weeks! geo

  6. If you have prescription drug insurance, or even if you don’t, you may want to ask for a prescription. Naprosyn 500mg, Mobic 15mg and Voltaren 75mg are selling at 4 dollars in our area. It might save you money compared to buying Aleve over the counter. Not that you need it – I’m sure you can afford it!

    Bill – Great advice! What is the over the counter dosage equilvalent to Naprosyn or the others? tks. geo

  7. My rehab was a combination of weights and stretching. Mostly weight work consistantly challenging the muscle groups that were most weakened by the injury. I found the backhand motion for me was the most difficult (low to high) with my latest injury. I started out with 2 lbs and couldn’t complete the swing without assist from my other arm. Now I am up to 25 lbs and pain free. I also did an array of other exercises to hit all the shoulder muscles. Even though I was frequently in pain (especially the next day or two) I could gage my improvement in that over time I was able to increase the range of motion and add more and more weight. Once I could complete the range without assistance from my other arm I added weight.

    The other component I failed to mention is deep tissue massage. Scar tissue forms in the area to stabilize it, but scar tissue doesn’t know how to form to maximize function, it just reacts to the injury. Deep tissue massage breaks down and softens this bulk tissue making it more plyable. Not a pleasant experience, but what is when you rehab. As you build more muscle and the muscle repairs it is important to stretch, massage and ice to insure maximum function while minimizing inflammation.

    Most Docs like drugs. It’s a quick fix and sometimes the inflammation is so severe that you need something to take you back to zero. It’s just that a long term regiment will yield some side issues.

  8. Equivalent dosages would be Naprosyn (naproxen) 500mg twice a day; Mobic (meloxicam) 15mg once a day; Voltaren (diclofenac) 75mg twice a day. Chemically, Naprosyn is most similar to Aleve. Mobic is popular because it’s only once a day.

    Bill – Once again, tks for your expertise. geo

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