shoulder pain

[Kateydid]

40 y/o female with left shoulder pain for one year.  Began after swimming for exercise.  Tried rest, ice, heat, PT (iontophoresis, massage, U/S, rom exercises) but no relief.  Tried several NSAIDS; only prescription strength Tylenol helped a bit but I had stomach pain so I had to stop.  1st steroid injection 6/07 thru side of my shoulder with no relief.  2nd steroid injection thru top of my shoulder in 9/07 with 85% improvement for one month but now hurting constantly again and waking me up at night.  Pain is on top, front, side, and back of left shoulder.  No loss of muscle strength, essentially full but painful range of motion.  Very tender to palpation.  MRI showed AC joint arthropathy with bone marrow edema and joint effusion, edema in the distal supraspinatous tendon consistent with either tendonitis or a large (16x16 mm) partial thickeness tear, and AC joint is compressing the rotator cuff at the musculotendinous junction.  My PT and ortho surgeon said to exercise my shoulder only to the extent that there is no pain, which means that I can only do ROM exercises.  If I try to lift even one or two pounds and do shoulder exercises, I get increased sharp pain in my shoulder.  Would it make sense for me to try to gradually increase weightlifting even though it is painful in hopes that my shoulder muscles will get strong enough to take care of my problem?  I have a friend who had impingement syndrome and underwent surgery, followed by PT, and she said her PT and surgeon told her to keep on working through the pain.  
Or is surgery my only real option?  Would oral prednisone help?  Some sort of muscle relaxant such as Skelaxin?  Some other sort of anti-inflammatory medicine?  I know there are only so many steroid injections I can get.  And even if I could do another one, I'm not sure it is worth it since I only got one month without pain (although that was a very nice albeit brief period!).  
Thanks!  Kate      

[Kevin Pho, MD]

There has clearly been a comprehensive evaluation, and I agree with each step.  

The MRI would be the most definitive diagnostic test, and normally conservative therapy like steroid injections and PT are normally tried.  

If the pain continues with limitations in ROM, then indeed surgery should be considered.

Before going through this option, another orthopedic opinion can be obtained.  

I would not recommend oral prednisone due to the systemic side effects.  

Another option would be to go to a physiatrist (rehabiliation MD) to further determine an appropriate rehabilitation regimen.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com