Right Shoulder Pain: Cortisone Shot?

[justin2001]

Dear Doctor,

I am a 21 year old male who has been experiencing right shoulder pain for 20 months now.  The pain first developed at a very mild level during weight lifting exercises.  Then, shortly there after I had an acute injury in the same shoulder while performing a dip exercise incorrectly.

As an active person I "played" thru the pain which subsided to a tolerable level after a few weeks.  The pain was/is mostly on the top and front of my shoulder and most noticeable when say doing a bench press like activity.  I then tried to return to weight lifting but the pain was still there.  I then took a break to try and let it heal completely on its own for 6 months.

After 6 months of rest and only slight improvement I went to a sports medicine doctor who told me to rest it for 3 more months.  I cannot exactly remember what he diagnosed but it was something to do with the distal clavicle and we would give it some time and if necessary I could get a cortisone shot to help.  3 months from then my shoulder seemed to be getting better and I did not even return to the doctor. However, despite a number of attempts to get back into full activity I keep finding myself back in the same spot with shoulder pain that is tolerable during most activites, but painful during others.  I'll rest if for a while and then slow back into activites and it'll be the same result time and time again.

Now 20 months from the start of the pain I have a few questions to ask before I go back to my doctor once again.  

1) Should I shy away from cortisone shots if possible?  Some information details that the only downside to these shots is that it can weaken tendons and should only be done 3 times at max.  I am only 21 and don't want to do damage to my tendons so young.

2) Are the cortisone shots effective in treating cases such as mine?  That is, is there a return of pain after the shot wears off? or does the shot attempt to "heal" the problem?

3) Any other suggestions/thoughts?

[Michael L Gross, MD]

Usually, I don't advise patients to "play through the pain."  If you can eliminate the inclines and still train effectively, without pain, then you are probably not doing more damage.
One note, if you do have an arthritic AC joint, there is no need for treatment unless the pain is a problem.  If surgery is ultimately the solution, the operation and recovery are the same no matter how bad the arthritis.

[justin2001]

Thank you very much for your response.  If possible, I would like to ask one more simple question which is;

If I am able to manage the pain, which I am right now as it not that severe, am I doing more harmful damage to my shoulder by continuing on through the pain or as long as I do things in moderation my condition will remain about the same?  I have no problem moderating this problem, and it seems the psychological aspect of my problem is worse the the physical because when I experience the pain I feel like I am damaging my shoulder even more and won't be able to lift weights or exercise when I am older.  So essentially my question is am I doing further non-reversible damage to my shoulder by ligting weights? (without the exercises that cause pain; ex incline bench press)

Thank you very much, this is a great service and I am extremely appreciative of your help!

[Michael L Gross, MD]

I'm sure your doctor was describing AC joint arthritis, or osteolysis of the distal clavicle.  This is very common in weight lifters, and your classic.  The weight training maneuver that aggravates this most is incline bench presses.  Often, my patients get relief by simply taking this excercise out of their routines.  Sometimes, an over the counter NSAID befor exercise is helpful.  
Finally I dont think that a cortisone shot here will be harmful, in fact, I frequentl give them for this problem.  However, you must know that if it works, the effect will probably only be temporary.  
The definitive treatment, if all else fails and yu cant live with it, will be arthroscopic surger and resection of the AC joint, and approximately 1.5 cm of the distal clavice