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November 02, 2010

Why Are Anti-Inflammatories Sometimes Helpful ?

Rotator cuff tendonitis and its resultant shoulder pain are most typically a mechanical problem.  The rotator cuff muscles lose their tone, and this causes some upward migration of the arm bone.  This causes a pinching on the rotator cuff tendon, which is quite painful.  The important thing to understand is that not only is it painful, but it also causes tears, disease, and poor function in the shoulder.  When the body senses damage, it brings in inflammatory cells.  The inflammatory cells try to essentially repair the damage by laying down fibrinogen.  Fibrinogen is essentially scar tissue, and so the body is trying to lay down scar tissue in an effort to make something stronger.  This often worsens the shoulder pain and restricts the movement, and in fact at times this can lead to and contribute to frozen shoulder. 

Shoulder pain in the context of inflammation is what can at times be somewhat helped with anti-inflammatories.  Of course, anti-inflammatories are essentially a Band-Aid.  Nothing really helps until you alter the mechanical environment so that the shoulder is functioning better.  So, how do we alter the mechanical function?  I believe, as do many physical therapists and physiatrists, that the best way to do this is to restore balance to the shoulder.  I am also in favor of altering the sleep position, as I believe sleep position is a contributor to the impingement process, a fact that is proven with data we have presented to the American College of Sports Medicine. 

Shoulder pain, therefore, is first mechanical and then inflammatory. The anti-inflammatories help.  I recommend them to my patients not infrequently, and they typically help out a bit.  Band-Aids are what they are – they help out a little bit, and this gives us an opportunity to address the underlying cause of shoulder pain and get our patients better.  We do this with physical therapy as well as the RotatoReliever, now becoming an increasingly common approach to shoulder pain.  This is an interesting approach, one of the very few things in medicine where we see an actual guarantee along with research.   It seems at times the more something is guaranteed, the less research there is behind it.  This is a nice combination where they have good research and the product guarantee, representing, I think, very little risk for the patient. 

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