The Ultimate Strong And Healthy Shoulder Program

What Structures Cause Pain In The Shoulder? – by Pete Harris

But how do you tell what is causing your shoulder pain? This article addresses some common ways that the various pain generators of the shoulder are diagnosed from the perspective of an experienced Physical Therapist.

There are several structures in the shoulder that can cause pain if they are injured. It is common to think that shoulder pain is always from a rotator cuff injury. This is not the case and determining what structure is the primary source of your pain is important to know how to treat the problem effectively. This article addresses some common ways that the various pain generators fo the shoulder are diagnosed from the perspective of an experienced Physical Therapist.

Three common pain generators of the shoulder are the rotator cuff muscles
and tendons, the bursa and the shoulder capsule. The purpose of the rotator cuff muscles and tendons is to move our shoulder in a rotating fashion (hence their name) and to help up elevate our arms over our head. The purpose of the bursa or bursal sac is to protect the muscle from scraping on the edge of the bone. So the bursa sits between the muscle and the bone and acts like a cushion. Without it the rotator cuff muscles would repeatedly scrape on the edge of the bone and become easily irritated. The shoulder capsule offers added stability to the shoulder joint. Any one of these structures can become a pain generator if they are inflamed or injured. Often times they will be inflamed in conjunction with each other.

It can sometimes be tricky to diagnose the exact pain generator because the symptoms that are experienced by people with these pathologies are typically very similar to each other. More often than not these pathologies will cause symptoms of pain, weakness, and loss of motion. The pain is typically felt in the shoulder region and is often felt in the upper arm above the elbow. People with shoulder pain will commonly feel an increase in pain when they are trying to raise their arm overhead or out to the side. So if these pathologies are so similar in nature how can we tell them apart?

WellFree Web Content, in physical therapy there are some simple tests that can be performed that will help distinguish between the different pathologies described above. I will describe them here briefly.

1. Rotator cuff tendonitis: if one or more of the rotator cuff muscles is inflamed this is termed tendonitis. This is diagnosed by simple manual muscle testing where the physical therapist will resist specific motions of the shoulder that the rotator cuff is responsible for. If the patient experiences pain during a manual muscle test this is indicative of a tendonitis.

2. Bursitis: this can pose a challenge for the therapist to diagnose but if they are well trained they can more easily identify this as a problem. The tests start with manual muscle testing as described above. A painful manual muscle test should be followed by a Pull Test. This is a specific test that is specific to the bursa. If it is positive then it is likely that the person has a bursitis of the shoulder.

3. Adhesive capsulitis: this is also commonly known as frozen shoulder. The diagnosis of adhesive capsulitis is made with specific testing called passive motions. Limited range of motion of the shoulder is a common finding in any of the pathologies discussed in this article. Adhesive capsulitis presents with a very specific limitation in motion that will likely differ from the limited motion seen in tendonitis and bursitis.

If the symptoms of these pathologies can be so similar then why do we need to be so specific in the diagnosis? The reason is that although symptoms are similar the treatments for these conditions can vary slightly from each other. Treatment that I apply for a shoulder bursitis I may not apply for a shoulder tendonitis or adhesive capsulitis. When a specific diagnosis is made the Physical Therapist can design a specific treatment plan that will help alleviate shoulder pain. The more thorough the treatment plan the more likely the outcomes will be positive.

Peter Harris is a licensed Physical Therapist with 17 years experience in the profession treating patients with shoulder pathology. Learn how I have helped hundreds of patients with shoulder problems overcome their pain and get their life back! http://www.squidoo.com/shoulderpain

The fear of the ever-dreaded rotator cuff tear is enough to send one into complete denial. I know this because I’ve had patients who’ve had shoulder pain for years and did nothing about it just because they were “afraid of the rehab”. They’ve heard the typical horror stories about their Uncle Larry’s “rotary cup” surgery taking a year to heal, all the while having to endure months of grueling torture by Stan the “physical terrorist”.

Afraid of the rehab??? Most of the time what was a mild shoulder injury to begin with has now turned into a problem that WILL take surgery and months of therapy to correct. While it is out of the scope of my practice act to diagnose a specific injury, I still attempt to answer a patient’s questions about what a rotator cuff tear feels and acts like, if nothing more than to give them some direction or peace of mind about their shoulder pain.

Rotator cuff tears are usually preceded by some traumatic event, whether it is a lifting action, throwing motion, or some type of event that involves a twist of the shoulder. However there are incidents where a simple “reaching out” can cause a tear. This usually is because the person had a “type III” or “hooked” acromium (sharp point at the end of the clavicle bone) which caused gradual wearing away of the cuff tendon. In either case the person typically describes a sudden sharp pain in the shoulder followed by a burning sensation. The days ahead are followed by extreme shoulder pain and weakness when attempting to lift the arm above shoulder height or possibly just reaching out for an object.

A simple test for a more severe tear is called the “drop arm test”.  The examiner lifts both of the patient’s arms out to their side and instructs them to keep them from dropping. A positive test is when patient is unable to keep the involved arm from dropping down and is typically accompanied by shrugging the same shoulder toward the ear in attempts to keep it by their side.

Smaller tears are more difficult to assess, but can be picked up by a trained examiner. The clinician decides there might be a tear through a combination of the mechanism of injury (was there an event likely to cause a tear), and assessing the strength of the cuff muscle in isolation through specific tests. If there are positive signs then the patient is sent for further tests which may involve a diagnostic injection, or possibly injecting a radiographic dye into the rotator cuff and then examining it under flouroscopy to see if any of the injected medium leaks out.

If a tear is discovered it is crucial to get treatment as soon as possible to avoid further complications and a stiff and painful shoulder requiring frozen shoulder treatment. Very small tears may be treated with cortisone followed by a course of rotator cuff physical therapy. Larger tears will likely need surgical repair.

"Is This You?"

It’s time to get some answers…

I’m a registered physical therapist with a specialization in hand and upper extremity therapy. Being a former shoulder patient myself, I can tell you firsthand of the wrenching pain this one appendage can cause. All of my patients are special to me, but I have a certain special connection with my patients who have shoulder problems.

You see, the shoulder is a person’s connection with the world. An injury or disability to the shoulder suddenly breaks that connection. The patient’s focus is now on finding relief or getting back function so the connection to the world is once again re-established. This is often where the difficulty lies… There are so many reasons for shoulder pain and even more “remedies” that a person can become overwhelmed. Even worse, a wrong self-diagnosis can lead to ineffective treatment or even damaging treatment.

This site attempts to answer some common questions about shoulder pain, it’s origin or cause, and current available treatments for any given diagnosis.

What This Blog Is NOT Meant For:

This blog is meant for informational purposes only and not meant to replace the advice or treatment of a physician or qualified specialist.

What This Blog IS Meant For:

People with shoulder pain want pain relief, bottom line. They need a resoursce with easy-to-find answers to their most common questions. While education about their particular condition is a very important part of treatment, I believe it is not necessary to give overly detailed anatomy lessons, or spill out a lot of medical jargon in order to educate the patient. In fact, sometimes using an analogy that relates to the person’s hobbies or interest is the best education of all. They begin to understand their condition on their terms which translates to more emotional meaning for the patient and therefore  more compliance with treatment.