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"Head of my humerus is pushed up and causing pain. Can physical therapy cure this?"

ZocdocAnswersHead of my humerus is pushed up and causing pain. Can physical therapy cure this?


My doctor said that the head of my humerus is pushed up, which is what is causing pain in my left shoulder (rotator cuff tendons getting irritated and inflamed) I also have type 2 acromion. He said 6 months of rigorous and diligent physical therapy should cure me. Is this true or will I eventually need surgery? I hurt my left shoulder almost a year ago and 1 month of physical therapy and a cortisone injection were not helping (MRI was clean). He said I have rotator cuff tendonitis. I sought out a second opinion from a fabulous doctor, who said my MRI showed that the head of my humerus is pushing up, thus causing this pain.


I'm sorry to hear about your shoulder pain. I recommend that you speak with your orthopaedic surgeon. We'll start off by discussing some of the terms and phrases that have been used to describe what's going on with your left shoulder. This will provide a basis for our discussion. Firstly, your "shoulder" refers generally to the construct formed by your shoulder girdle bones (of which your acromion is one), the head (or ball) of your humerus, and the glenoid (or golf tee) with which your humeral head articulates. Your rotator cuff muscles surround the articulation between your glenoid and humeral head, serving two purposes: 1) stabilize the head on the golf tee; and 2) facilitate movement between those two bones. The acromion is a bone that is part of your shoulder girdle, and overhangs your rotator cuff muscles and hence your humeral head. What you are describing is essentially subacromial impingement and rotator cuff tendinopathy. If you imagine that each time you raise your arm (humerus), your humerus could in theory bump up against the overhanging ledge that is your acromion. Since your rotator cuff muscles surround your humeral head and glenoid, they can get pinched between your acromion and your humeral head; this is subacromial impingement. Over time, enough impingement can cause enough fraying and wear and tear of your rotator cuff muscles that they degenerate and tear, no longer stabilizing the humeral head on the glenoid golf tee, and hence allowing the humeral head to "push up". Your type 2 acromion refers to the abnormal shape of your acromion, particularly the fact that it is curved, and hence causes more impingement. Physical therapy is designed to strengthen, condition and stretch your muscles, but it can't cure your anatomy. While physical therapy and cortisone injections can help calm down your symptoms, it will never cure your mechanics of what's causing your symptoms. That said, for some people, this alleviating of symptoms can last for quite some time, allowing them to bypass surgery altogether. For others, unfortunately, their anatomy and the symptoms can be bad enough that therapy has little to no effect. As always, your best source of advice is your orthopaedic surgeon, so please let them know if your symptoms should worsen or change.

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