Expert: Dr. J. Shawn Leatherman - 11/12/2006

Question
Seven days ago I felt a sudden, sharp pain in my tricep (closer to my shoulder than elbow) when I was reaching above my head to get a book from a shelf.  Once I stopped stretching the arm, the pain lingered for a minute and then subsided.  The next day I felt the same pain when I stretched the arm, so I tried icing the muscle and stretching it out in the shower.  However, that did not help at all and I am still experiencing very sharp pain whenever I stretch the arm.  What should I do to make this pain go away?

Answer
Dear Claudia,

Injuries such as this are very common, but are also many times left untreated.  This is because without an expensive test such as an MRI the diagnostic criteria is limited to your history of injury a few muscle tests, and a few orthopedic tests. Unless you have a severe full thickness tear of the muscle, which is easily visualized by a bulge under the skin, this should heal just fine.

The most likely cause of the pain is a muscle tear,and the possible involvement fo the fascial structures that cover the muscles.  "Sudden and sharp", imply a strain injury such as a tear.  Unfortunately the fix for these types of injuries is rest for the first couple of days, then a modest, slow and controlled return to activity with the muscle in question, (pain free range).  

This will need to heal with granulation tissue (scar), and will take a few weeks for improvement.  Muscles tend to heal in 6 to 8 weeks with active rehabilitation because they have great blood supply and are able to get the substrates needed for repair. Ligamnet injuries are notoriously harder to deal with, although, you must not over stress the tissue in this healing phase.  Continual increased demand on the muscle will further the injury.  Conversely, active range of motion is important for proper healing and muscle function.

Mild stretching with heat is okay, but always ice afterward, and never push through the pain after injury. you can take over the counter meds such as ibuprofen and acetomeophen, but do not utilize unless needed.  These medications have been shown in some clinical trials to actually impede the bodies healing response.  Make sure that you are getting good protien and plenty of fruits an vegetables over the next month for the muscle to utilize in tissue repair.  If you want to supplement some protein I would recomend whey protein isolate, not concentrate.  if it is microfiltered, even better.

I wouldn't get too worried about this Claudia. If you are not seeing improvement within the next two weeks, then you may want to get an examination, but many doctors will just give you some pain meds and tell you to rest it for a few more days...even a sports-med doctor.  

Respectfully,
Dr. J. Shawn Leatherman