Posts Tagged ‘Conjunction’

Shoulder Pain – How Do I Tell What’S Wrong With Me?

Help for shoulder pain

Shoulder pain is a common problem that affects the majority of the population. Most people will experience some degree of pain in their shoulder at some point. The causes of the pain and the degree of the intensity of the symptoms will vary from person to person. The recovery and return to normal function will also vary from person to person for a variety of reasons. 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.

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?

Well, 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.

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. 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. If one of the manual muscle tests is painful the Physical Therapist can then perform 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. Adhesive capsulitis: this is also commonly known as frozen shoulder. To make a diagnosis of adhesive capsulitis the Physical Therapist must passively test the motions of the shoulder. Remember as I mentioned above that any one of the pathologies discussed here can present with a limited range of motion. 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. Some things that I may do for an adhesive capsulitis I might not do to treat a tendonitis and so forth. So a specific diagnosis can help guide the Physical Therapist toward a specific plan of treatment for the pathology in question. A well-rounded treatment plan will lead to positive results in improving your painful shoulder.

Use ice to decrease pain

Shoulder Pain – What’s Causing It?

Help for shoulder pain

Shoulder pain is a common problem that affects the majority of the population. Most people will experience some degree of pain in their shoulder at some point. The causes of the pain and the degree of the intensity of the symptoms will vary from person to person. The recovery and return to normal function will also vary from person to person for a variety of reasons. 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.

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?

Well, 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. Remember as I mentioned above that any one of the pathologies discussed here can present with a limited range of motion. 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. A well-rounded treatment plan will lead to positive results in improving your painful shoulder.

Use ice to decrease pain

Shoulder Pain Treatments: Steroid Injections

Help for shoulder pain

Steroid injection represents a useful tool in the management of chronic shoulder pain. Ideally, steroids should be thought of as providing temporary relief. When injections are used appropriately, and in conjunction with physical therapy, they can serve as a sort of Band-Aid for the shoulder pain. In this way, steroids will give people a temporary period of time in which physical therapy can really start working. This is because steroids act as an effective anti-inflammatory, which will relieve the pain that is caused by normal use of the joint.

If a doctor deems steroid injections to be of use to the patient, they will typically use a lateral approach to inject the subchromial space, particularly with rotator cuff problems. At different times, the doctor may use an anterior approach or a posterior approach to actually put steroid into the shoulder joint. To conduct these straight injections would be less common though.

Steroids have multiple actions. As an anti-inflammatory agent they frequently will reduce pain in an area affected with inflammation. Also, and essentially a side effect is that, they will cause destruction of protein.

This means that steroid injections do include a risk of complication, and it is possible to get too many steroid injections into a shoulder. Where previously it was unknown as to the exact number of injections which equated this “too many”, recently, there has been research to suggest that if someone were to get more than 3 steroid injections into the shoulder, it could make the subsequent rotator cuff repair surgery more difficult.

When it comes to making a decision with regards to the use of steroid injections, one should realize the possible benefit of the drug when it is used appropriately. When used in conjunction with physical therapy, they can be a very effective tool in alleviating shoulder pain. Further, the doctor will perform the steroid injection under sterile conditions as to not introduce germs into the joint space, which further decreases the chance that a problem will arise. One should also consider the fact that steroids are actually created naturally in the body before the simple fear of the injection causes them to discard the treatment.

The steroids injected into the joint are generally safe and do not have the systemic side affects normally associated with steroid pills. For those concerned, steroid injections typically will not increase blood sugar levels to a significant degree.

However, possible side affects/adverse affects of shoulder steroid injection would include bleeding into the joint if the needle goes through a significant blood vessel, an infection, and skin ulcerations if too much is injected closely underneath the skin. Another side affect could be a “dent” that is formed where the steroid was injected. Additionally, there can be tendon rupture and overall weakening of the structure receiving the steroid.

Use ice to decrease pain

Shoulder Pain – What’s Causing It?

Help for shoulder pain

Shoulder pain is a common problem that affects the majority of the population. Most people will experience some degree of pain in their shoulder at some point. The causes of the pain and the degree of the intensity of the symptoms will vary from person to person. The recovery and return to normal function will also vary from person to person for a variety of reasons. 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.

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?

Well, 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. Remember as I mentioned above that any one of the pathologies discussed here can present with a limited range of motion. 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. A well-rounded treatment plan will lead to positive results in improving your painful shoulder.

Use ice to decrease pain