– THOMAS E,SPORTS MEDICINE
Rotator Cuff and Tendons
The muscles that insert into the capsule of the glenohumeral joint combine in a sheet of tendon known as the rotator cuff. It reinforces the joint as well as enabling the muscles to act as stabilisers and movers. The rotator cuff is relatively easily injured by such actions as throwing or overhead racquet shots from an unusual arm or body position. An acute rotator cuff tear produces severe pain, weakness, bruising and can lead to swelling, limited mobility, pain and weakness.
The pain experienced is sometimes tearing, sore, neuralgic, or as if sprained or aching. Any movement of the arm or shoulder may be painful. Abduction, adduction, raising the arm and rotating the shoulder may be painful. There may be swelling, stiffness, weakness and perhaps a feeling of paralysis. Rest, relief of pain and restoration of a complete range of pain-free movements comprise the normal management of the injury. Choose a homoeopathic remedy that is appropriate to the symptoms, but begin with Arnica.
Arnica
A tear to part of the rotator cuff inevitably produces bleeding and its consequences. Arnica taken soon after the injury will help to reduce the pain, shock, bleeding, immobilisation and consequent recovery time.
Dosage: One Arnica 30c hourly for two days, reducing in frequency as symptoms improve. Repeat one dose if the pain returns.
Bryonia
The main symptom for Bryonia is that any movement is painful, and the person avoids it. The arm and shoulder feel too weak to move. Raising the arm is very painful and makes him feel bad. The joint feels swollen and hot. The pain is burning and tearing, and the shoulder feels pulled out of place. Pressure relieves the pain, so that he is most comfortable when lying on the injured shoulder. The pain is better from heat applied locally to the shoulder, but the patient feels worse from heat in general. The person feels discouraged, and averse to conversation.
Dosage: One Bryonia 30c.
Chelidonium
Painful right shoulder. Unable to use the arm. The least touch is exceedingly painful. Abduction is exceptionally painful. There is tearing, neuralgic and rheumatic pain. The arm feels heavy, stiff and flabby and there may be trembling. The pain may extend from the shoulder to under the scapula, and there may be a stiff neck. Although touch makes it worse, pressure may relieve the pain. Worse from any change of weather, from warmth, at 4 a.m. Restless, depressed and anxious, as if he had done something wrong. Chelidonium is similar to Bryonia in that movement is painful, but Chelidonium’s stiffness is more rigid, and the muscles are more in spasm. Bryonia is afraid to move; Chelidonium cannot move.
Dosage: If Bryonia does not work on an injured right shoulder, try one Chelidonium 30c.
Ferrum Metallicum
Ferrum also affects the right shoulder, but when this remedy is indicated the person insists on trying to lift his arm even though it is extremely painful to do so. Moving the arm is intensely painful. You will notice this patient because he keeps trying to lift his arm gingerly to relieve the pain. There may be cracking or crepitus in the joint, and the pain may be tearing and stinging, and is worse at night. The person may be excitable, nervous and sensitive to the least noise. Feels much better when working or doing something.
Dosage: One Ferrum 30c if the symptoms fit.
Rhus Toxicodendron
This remedy may be useful at any time during recovery, especially if first movement is painful and continued movement relieves the pain. See Chapter 10 for details.
Dosage: One Rhus Tox. 30c daily for not more than two weeks.
Ruta Graveolens
Because of the damage to tendons, Ruta should be given regularly during recovery. The pains are sore, bruised, and aching and the arms are restless. See Chapter 10 for details.
Dosage: One Ruta 30c, daily for not more than two weeks.
Sanguinaria Canadensis
Cutting or stabbing pain felt in the right deltoid, worse on raising the arm. A feeling of rheumatism in the right shoulder. The shoulder pain is much worse at night, and seems to be in the bones, especially the acromion and the greater tuberosity. Neuralgic pain which is relieved by touching the part. The pain may also be relieved by swinging the arm back and fore. The shoulder feels burning hot. He feels better from a good sleep, but may be morose and he grumbles about things.
Dosage: One Sanguinaria 30c.
CASE 24
While on a cross-country run, Robert vaulted over a gate. He described what happened next.
‘I put my right hand on the gate and swung up. My right arm seemed to be supporting me, but suddenly it gave way. I fell from the top of my vault with a great heavy fall on my side. I was terribly shaken from the fall, but, worse of all, my right arm did not want to work any more. I could not lift it any way without a great deal of pain. I walked home slowly, and in pain.’
I saw him the next day. He was still in pain, feeling bruised all over, had not slept well, and wondered whether he should go to casualty. Strangely, though, as he walked in I asked him how he was and he said, ‘Oh! I’m fine thanks.’ I also noticed that he was very careful that no-one came anywhere near his arm and shoulder. One Arnica 30c three times a day for two days helped with the pain and discomfort. He was immediately less shocked, and agreed to see a physiotherapist colleague who diagnosed a partial tear in the rotator cuff.
Two days later Robert called me to say that his shoulder was very painful, and could I help? He had woken at 4 a.m. with intense pain and stiffness in his shoulder and neck. Any movement of his arm hurt badly. I gave him one Bryonia 30c. He called again later that evening to say he was still in pain. His neck was worse, the pain was spreading around his back and the only relief seemed to be a hot bath. He wondered if he had something more serious like a dislocation. His arm felt like a heavy dead weight. Abduction was the most painful movement. I gave him Chelidonium 30c to take whenever he had the pain.
Two weeks later he came to the clinic for physiotherapy and was feeling much better. He was still quite depressed and blaming himself for his injury. I gave him one Ruta 30c to take three times daily for a week to help his tendons recover.
Six weeks later he called again. He had played a hard game of squash, the first since his injury, and after one backhand shot felt a nasty twinge in his shoulder. This was a symptom caused by overexertion, and typical of Ruta. He took Ruta 200c, one tablet on waking, for two days.