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What is the treatment for painful arc syndrome?

Q: I am 63 years old, a patient of gout. I have been taking Zyloric tablets regularly from the past one year. Since then there have been no apparent gout attacks. The uric acid levels are under control and are less than 5.6 mg/100 ml. From the last five months I have started getting pain in my left shoulder, which extends up to the elbow joint. The pain is severe when particular movements of the arm are performed. It is more prominent during night. I consulted an orthopaedic surgeon who after taking a shoulder x-ray stated that there are no signs of any arthritis in the joints. However, he stated that I might be suffering from 'mid arch syndrome' for which he prescribed some pain killers and advised arm exercises. But, there is no relief. What is mid arch syndrome? How can I overcome this? I don't want to continue taking pain killers as I get side affects like constipation. What is the relation between gout and mid arch syndrome?

A:When you find that raising your shoulder sideways from 145 degrees to 160 degrees is painful, you are suffering from painful arc syndrome. Raising it up to 45 degrees and beyond 160 degrees to full elevation will be painless. Physiotherapy will help you. I suggest you go to a nearby physiotherapy clinic for the following treatment: 1. Short Wave Diathermy. 2. Relaxed passive movements of the shoulder for full abduction of shoulder. 3. Gravity eliminated assisted abduction. 4. Strong isometrics to abduction with self generated internal tension 5. Gradual progression to active and then resisted shoulder abduction exercises. Since it is a 4-5 month old case, your muscles of the shoulder could be weak to give a smooth recovery. In that case, your physiotherapist will decide if you need any other modality to strengthen your muscles. There are various causes of painful arc syndrome like,

  • Minor tear of the supraspinatus tendon.
  • Calcified deposits in the supraspinatus tendon.
  • Subacromial bursitis.
  • Supraspinatus tendinitis.
  • Crack fracture of greater tuberosity of humerus.
Gout can have an overall effect on your health. This is not the reason for your present problem.

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