How To Diagnose Shoulder Pain With 3 Simple Tests

hey are you suffering with shoulder pain and you're wondering what the heck is going on in there in today's video i'll be covering three simple tests that you can do to diagnose fairly accurately what's going on inside your shoulder and find the root problem of your shoulder pain so that you can figure out what type of exercise what type of treatment you best need right now because some treatments might hurt certain types of shoulder problems while others of course will help so finding the root problem is very important in properly treating your shoulder issue real quick my name is dr david middoff and i've been helping out people with shoulder problems for years here in the clinic in el paso i have a clinic here called el paso manual physical therapy and then we've also been helping out people online for years through our youtube channel over the years we determined the three most common types of shoulder problems that we see are one tendon related problems like your rotator cuff tendinitis rotator cuff tears there's also the biceps tendon is it's a common tendon that can be affected in shoulder pain two joint problems the ball and socket joint itself can be an issue there's cartilage there there's other tissues involved that can cause problems in the shoulder it can be the source of a shoulder problem and then the third one is nerves there's tons of nerves surrounding the shoulder itself and those feed into muscles and the joint itself so finding it out if your problem is more nerve driven is a big deal so that you can do the right treatment for nerves because you don't want to do a joint treatment for a nerve problem or a nerve pro a nerve treatment for a tendon problem you got to make sure you find the right one now often times when people come into the clinic to see us here for their shoulder problems they've had an x-ray or an mri and they're they're looking at the certain tissues specifically arthritis they're trying to see they got arthritis in the ball and socket joint or some sort of tear especially in the rotator cuff muscles there's four rotator cuff muscles a supraspinatus a subscapularis teres minor and the infraspinatus and there are four muscles that hold the ball up against the socket and the tendons of those muscles sometimes can get injured or even torn there's different types of tears and that depending on what you've got going on it's probably very likely that you can get better despite even having a tear we've seen this in research and of course here in the clinic and i'm sure other clinics around the the world that have been treating people for shoulder problems are seen that even if there's a tear in your rotator cuff tendons it is possible to improve another common tendon that can get involved is the biceps tendon your biceps muscle is right here and it's got two tendons that come up into the shoulder one of them the longer one goes right over all those rotator cuff tendons and the muscle and attaches to the top of the joint in the ball and socket joint and if you've got problems in your shoulder you often will find that that biceps tendon gets irritated that could be one of the sources of pain as well i just want you to know it is possible to have two or even three of these things happening all at the same time so it's and that's more common it's rare that it's just one thing it's just a tendonitis or a tendon tear or just an arthritis or just a nerve problem it's very often that you have overlapping conditions so as i go into the test that i'm going to show you here next just keep in mind that it is possible to have multiple things happening and that might mean that you need to treat multiple things at the same time in order for your shoulder problem to get better and this information is critical because if you've had a shoulder problem for a while and you've been trying out different types of shoulder exercises or shoulder treatments like you've gone to go see some specialists maybe a doctor or a physical therapist or some other shoulder treatment that you've done maybe at home you've done some videos or stretches and exercises a common one is the rubber band exercises where you turn in and out if they have not worked for you chances are there's multiple things going on and it just you need a combination of treatments to make sure that you effectively treat this shoulder problem so that it is cured because there's a good chance that you don't need surgery and that you can resolve the shoulder problem without having to rely on medications or having to get injections frequently now let me go into the tests here next so you can try them out at home right now they'll take just a few minutes to do and then i'm going to talk to talk about them a bit afterwards so that if you want to hear the breakdown about why doing each test and what they mean you can listen for that and and make sure you have a better understanding of what's going on in your in your shoulder so that you can know how to proceed in treatment number one loss of motion or painful motion so all you need to do is with that shoulder that bothers you reach all the way up as long as it doesn't hurt you know if it starts to hurt if you come up to here and it starts to bother you or you just can't you come up to here and you're like oh it's kind of hurting too much to even go those are losses of motion and painful motions another motion that's important to do is reaching behind your back like you're reaching up towards a bra strap or to put on your belt like the back belt loops behind you if going in that direction is beginning to hurt up here in the shoulder area that's also what we call a positive sign or it means that it's it's a sign that is a ding towards your shoulder problem that test specifically tells us that there's probably a tendon problem or a joint problem one of the two if you have a loss of motion like you can't even get back there you can even come up then you probably have a joint problem i'll explain more about what the the reasons for that is now if you just have painful motion maybe you can actually move pretty good in every direction and you can try reaching forward you can go in any direction you're not really limited in a specific direction of movement what you're looking for is does your shoulder hurt whenever you move it in the extreme ranges of motion or are you limited compared to your other side whenever you move in all these ranges of motion if you have pain at throughout any of the motions then this would be a positive test and if you can't reach the same way in one side versus the other side especially if it's the painful side and that's also a positive test so loss of motion and or painful motion is your first test now the second test is tenderness in two specific places if you feel the bones in your shoulder up here and right on the corner of your shoulder where where you feel the bony part and then it kind of there's an edge right there and then you fall off right off the edge if you poke and rub it right there that's one of your rotator cuff tendons a lot of people think they're way down here they're actually up here you can look it up in anatomy books or google the images rotator cuff tendons are way up here now in that spot there's there's a specific tendon called the supraspinatus and then right in front of it is a subscapularis a little bit behind it would be the the infraspinatus muscle it's a little harder to get to the teres mage the teres minor muscle i'm sorry you have a teres major that's not a rotator cuff muscle though if you poke around in that area just past the corner of the shoulder where the bone ends and you find a tender spot there's a good chance you've got a rotator cuff injury it's hard to say if you have a tear you have to go get an mri and get diagnosed but if you have a tear then you're probably gonna have a loss of motion or painful motion in addition to this test this one's just specific for the rotator cuff tendons now there's another tendon that i mentioned the biceps tendon and the way that you find is you come to the front of your shoulder kind of the the most forward part of your shoulder right here and you have to kind of dig in there and rub and you'll find a ropey structure a ropey tissue under there and that's your biceps tendon if it's tender to touch or if you can kind of shift it and strum it back and forth like it's a string a guitar string and it's painful when you do that then you probably have involvement of that biceps tendon as well now some people do get biceps tendon tears which messes up shoulders of course but they'll see an actual bulge of the muscle all the way down here into their elbow the biceps will kind of sink down it can be painful and some people it's actually not painful it just looks weird and goofy and that usually is surgically repaired they can bring the tendon back up but i would look for what's the root cause of this problem because there's tendons don't just tear out of nowhere there's usually some repetitive trauma some motion that's happening that isn't correct uh there's there's some muscle imbalance usually some some way that you're training possibly when you exercise or the way that you do things at home that's fed into this problem and it's usually years in the making it's not something that just happens all of a sudden that's pretty rare so just to recap that that's the the second test is tenderness and these spots just past the corner of the shoulder the bone of the shoulder out here and then on the front of the shoulder if you rub in there if it's tender that would be another sign that you've got a tendon problem now the third sign that you're looking for is nerve related so what you're looking for are feelings or sensations that you get specifically pain if you've got pain besides hearing your shoulder like it kind of comes down especially in this area right here or even further down if you've got pain that goes down into the elbow forearm or even into the hand or maybe it's not pain but it's like a numbness a dull ache a tingling sensation a pins and needle sensation maybe it comes on with certain activities or when you lie when you go to sleep at night you lie down especially if you lie down on that side even if you lie down on the other side and it starts to hurt or ache or become numb or tingly often times people's hands can get number tingly especially if they're using a phone quite a bit and then at the end of the day if it tends to happen more at the end of the day that's another common sign of a nerve problem numbness tingling pain pins and needles um a deep ache is another common one all of those are signs of nerve problems that could be feeding into that shoulder pain now if you find that those nerve sensations that i just described kind of come and go but you have more of a constant ache in your shoulder that isn't really affected by movement so if you have this pain i'm talking about but the first test that you did you're reaching around and you're poking around and it didn't really bother you then likely you've got nerve pain driven shoulder pain so your shoulder problem is rooted in nerve problems and we've actually got to look further up into the neck because all those nerves that end up in the shoulders start up in the neck and they bunch together and go under your collarbone and end up going in different directions around your shoulder those the the problem may be rooted up in your neck there you might have neck stiffness you might have trouble turning from one direction to the other it could be limited on the side that you have shoulder pain it may not it's it takes some investigation to figure this out you might also have knots in the neck and shoulder area like in this zone up here if you find that you have some lumps and some hard spots that are even kind of sore and tender especially when you poke them and if you rub them it kind of sets off symptoms further down it's very likely that you have a couple of ribs that are shifted up in fact i've got a video covering the top two exercises that you can do at home to relieve knots in the neck and shoulder area the link for that video is in the description below if you just look down there you'll get to the exercises the top two exercises that you can do to relieve those knots in the neck and shoulder area and hopefully relieve a nerve driven shoulder problem up here now let me just talk to you a little bit about why these tests are important and and how we use them here in the clinic now here in the clinic we have other tests that we specifically do as a specialist as a physical therapist um we're looking at a certain muscles certain joints certain tissues like cartilage versus ligaments and all that you need to know all that all i want you to know is on that first test that i described though the range of motion test you're reaching around to see if you're limited or if it's painful whenever you go and reach out in certain directions on that test it's moving your joint so it's testing the joint it's also causing you to use your muscles so that means that it's straining a little bit on the the tendons which tendons connect muscles to bones and the muscles themselves i haven't even mentioned muscle spasms muscle spasms tend to be pretty painful just for a moment and then they kind of let go after a while if you take medication or rest um but if you've got a shoulder problem that's been going on for weeks or months it's less likely that you've got just a muscle spasm and there's probably some sort of tendon involvement or joint involvement now when i'm talking about joint problems specifically you might be saying well what's the diagnosis what's the doctor going to tell me when i go and see them or maybe you went to the doctor already and they've given you a couple of diagnoses here's what you'll find though you might have signs of arthritis you might have some changes on the bone surfaces within the joint that would be arthritis another one is cartilage loss like bone on bone type of a situation developing in the shoulder joint now if you've got a loss of cartilage and arthritis both can happen simultaneously then you're typically going to have a loss of motion like you can't get up past a certain amount you might be able to go all the way up on this arm but this arm is just kind of stuck and doesn't want to go up even further it might even be painful to push through it and you can't even get through it another sensation people will get is it kind of clunks and pops repetitively every single time you move there's a repeatable clunk or pop in the joint that's a sign that there's some cartilage or joint problem now if you're younger if you're say 40s and under and you're you have this issue going on you may not have full blown arthritis or you may just have beginnings of arthritis but the joint might actually get stuck like an older person you know somebody in their 70s or 80s or beyond and that could be what we call an acute joint restriction acute meaning it just happened it's sudden joint restriction the ball and socket joint can shift it has quite a bit of flexibility and it can shift in a certain direction where the joint just kind of gets stuck it needs to be wiggled back in place that can be done on your own using certain exercises or if you go see a specialist like like us we're a manual therapy clinic for a physical therapist we can by hand move that joint back into place and oftentimes restore the motion back to normal which is miraculous for the person they're usually like oh my gosh what kind of buddha did you do and they're back to normal with their with all their motions and their shoulder there's some exercises to do afterwards but it's typically quite curable real quick now let's talk a little bit about that second test where you're poking in the finding the exact location can be a bit challenging for some people so remember just go off the corner of your shoulder and fall right off the edge you can still like right now i'm on it and i can still feel the edge of the bone with the pad of my finger and the tip of my finger so here's the pad here's the tip so pad of my fingers still on the bone the tip of my fingers digging in on the tendons right there those tendons will get irritated and just think of this if you were to rub your skin real hard you could take that for a little while but after a minute or so maybe a few minutes your skin will become irritated right it'll get red you won't like it you want somebody to stop doing that whoever's rubbing you like that and if you rub long enough you probably rub the skin raw and maybe even cause it to bleed inside the shoulder because the shoulder joint is so flexible you're you're it's possible for you to rub those tendons a little too much just like you're rubbing your skin and irritate them and that's what sets up a tear if you do this long enough some people don't have much pain leading up to the tear there's several reasons for it there's genetic reasons some people have um the inside of their shoulder joint is just shaped in such a way that they're more predisposed to get tears um the acromion is something you hear about the acromion shape there's different types type 1 type 2 type 3 and so forth so your doctor might have mentioned this to you if you had an x-ray mri they might have wrote that on the report for the x-ray or the mri so if you've got one of those types and you're predisposed but that doesn't mean that you're going to need surgery or have to have the joint cleaned out like they do in some cases you still have an excellent shot of rehabilitating of fixing this shoulder problem without surgery even though you've got you know a frayed rotator cuff tendons or a funny shaped acromia in the the bones inside the shoulder where they're poking the tendons what you've got to do is make sure that you find a specialist physical therapist that can help this issue or go to some of our exercises on our channel you can go look for neck and shoulder exercises if you go to our homepage and there's tons of exercises there to begin to help to begin to help out a rotator cuff tear we've also we're planning on making some more videos so if you want to catch those videos please subscribe to our channel so that you don't miss any new videos that we put out for shoulder issues as well as other body parts now the last one that i want to talk to you about just to explain and break down because you get a lot of questions on this one especially is the nerve problem so i mentioned how you can get numbness and tingling achiness it happens right here is a really common spot because that's one of the biggest one of the biggest nerves that passes down from the shoulder into the arm it's called a radial nerve it goes right through here and often times even healthcare providers will mistake this for a rotator cuff they'll think that they're causing rotator cuff pain because whenever they lift their arm up or if they dig in there hard enough they'll feel increased pain right in this area and they think the rotator cuff muscle is hurting them down here another one that they'll mistake it for is the deltoid muscle the deltoid muscles the covering the outside right here but it's pretty rare to get true deltoid pain and if you trace the nerve if you look up the nerve on on google or or you pull out an anatomy book you can see the pathway of the nerve and if you follow that same area you can find that your radial nerve is just upset it's just irritated if that's the case looking up into the neck looking up into the shoulder the the shoulder blade itself the collar bone those ribs up here your first ribs here your second rib is right here you need to treat those ribs and the collarbone in the neck in order to calm down the nerve down here we've we've seen it so many times here in the clinic or we've had patients come in that are scheduled for a rotator cuff repair surgery we look at their mri and yeah they have a small tear it doesn't seem like anything super big something that it seems like they can get it better we when we test out their symptoms we find that the primary reason for their pain is the nerves and so we have to ask the question if you go get that surgery for your rotator cuff repair given that today your symptoms are primarily nerve driven is it really going to fix the shoulder problem we've seen it time and time again and so we'll tell people once you hold off on the surgery the tears not going anywhere and let's treat the nerve problem we we go through the nerve problem and we we do all the treatment associated with it which was usually neck and shoulder blade related and they actually get better and if they can get better and learn better mechanics and they actually have a great shot at repairing that tendon naturally it'll heal if you do the right things and calming down the nerves so that you can get back to doing everything we've had tons of clients go through this we've had people that lift weights crossfitters people that are very active with their upper body get cured in their shoulder problems because we treated the right root of the problem and like in this case as i'm describing it's the nerves if we can treat those nerves those rotator cuff issues will begin to diminish and completely go away so guys i hope this video was helpful for you if it was please give us a like right here and hit the subscribe button over there so that you can get notified whenever we release new videos and i've got a question for you did you try these tests if not rewind and go find those tests again and do them again it's the the motion test you know are you are you having pain with any motions is it limited in any motions did you try to poke those tendons in the area the biceps tendon in the front and the the rotator cuff tendons right up here and do you have any nerve symptoms the numbness tingling aching the pins and needle sensation pain of course and not just up in the shoulder but down in the arm or possibly in this area up here to the neck if you've got any of those positive tests please drop us a comment right here let us know if you have one or two or all three positive and then go check out our channel to find some exercises to start doing to fix this problem go find the playlist that says neck and shoulder videos there's some exercises in there that you can try out today i wish you the best of luck in fixing your shoulder problem we'll talk soon bye

Channel: El Paso Manual Physical Therapy

Views: 29,436

Keywords: physical therapy, el paso tx, physical therapist, physical therapist el paso tx, Physical Therapy Videos, Physiotherapy, Physiotherapy Videos, exercises, stretches, shoulder pain, rotator cuff, rotator cuff tear, shoulder diagnosis, cause of shoulder pain, causes of shoulder pain, physical therapists, signs of shoulder pain, tests for shoulder pain, bicep tendonitis

Id: 3_hKnrnr-90

Length: 21min 13sec (1273 seconds)

Published: Tue Jan 26 2021