Q I am a 73-year-old man.
I have been having pain in my left shoulder and left upper arm for a few months, but have not sought medical consultation.
The pain, however, is not intense. It usually occurs at night when I am asleep in an air-conditioned room.
I used to play golf regularly until recently. I have now stopped doing so because I cannot turn my shoulders to the right and lift the golf club without feeling some pain.
Initially, I thought the pain was probably due to some muscle strain. As the pain has not gone away, I am more concerned about it now. Do you think my medical condition is serious enough to see a doctor?
A Your symptoms are extremely common.
The rotator cuff is a sleeve of tendons which attaches to the upper arm just beyond the shoulder joint. As a person becomes older, the rotator cuff is subject to degeneration, or "wear and tear". In some cases, the degeneration is severe enough to result in the development of a tear in one or more of the tendons that make up the rotator cuff.
Injuries in the neck skeleton (cervical vertebrae) or the shoulder joint itself can cause pain in the shoulder and upper arm.
Based on your description, the problem appears to be from your shoulder. The two most common shoulder conditions in patients your age are frozen shoulder and rotator cuff injury.
Frozen shoulders often develop the way you have described.
Patients may or may not recall any specific incident that brought on the pain. The pain develops insidiously and intensifies slowly over weeks or months.
Many patients describe pain which is worse at night, at times interfering with their sleep.
Stiffness in the shoulder develops over time, affecting the activities of daily living.
Women often find it hard to do up their undergarments, and men may encounter difficulty reaching parts of their back while carrying out movements such as putting their wallets in their back pockets.
A frozen shoulder, while painful and extremely inconvenient, usually resolves over time. Most patients will recover with a course of physiotherapy.
Rotator cuff problems are another group of common shoulder injury often seen in patients who are around your age.
The rotator cuff is a sleeve of tendons which attaches to the upper arm just beyond the shoulder joint. As a person becomes older, the rotator cuff is subject to degeneration, or "wear and tear".
In some cases, the degeneration is severe enough to result in the development of a tear in one or more of the tendons that make up the rotator cuff. I often use the analogy of a hole in a sock to help patients visualise what a tear of the rotator cuff might look like.
Despite the development of a tear in the tendons, many patients are still able to lift their arms, albeit with some pain and discomfort.
Some patients will do just fine with simple lifestyle modifications and physiotherapy, but some may require surgery. As you have been experiencing the symptoms for a few months, it is unlikely to be a simple "muscle strain".
I would advise you to seek medical advice from your family doctor, who will be able to assess you and refer you to an orthopaedic specialist if necessary.
DR BRYAN TAN
Consultant in the division of shoulder and elbow surgery at the National University Hospital
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