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. 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.
3. 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.
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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!
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