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Shoulder, Elbow, Wrist Pain

Cracking, popping, grinding, snapping and crunching.  We’ve heard all the descriptors of shoulder pain.  If you’re one of the many people to have felt or heard one of these as you move your arm around, you’re going to want to read on.  First thing we need to figure out is why, and that is one of our jobs as physical therapists. 

Shoulder pain is usually induced by movement.  The sharp pain that nearly brings us to our knees as opposed to the dull aches of life.  People will often say to us, “it’s only when I reach over my head” or “when I reach behind my back”.  This is a mechanical problem.  What does that mean?  The shoulder is a unique part of our body in that it relies on so much help from its neighbors for assistance.  The neck, the shoulder blade, the ribcage and the thoracic spine.  If something isn’t working right, other structures make up for the slack and contribute.  This turns into overuse which then leads to inflammation or tears and ultimately pain.  This all plays out in a matter or weeks, months or even years.  We’ve heard it a thousand times, “no I never hurt it but it’s just gradually been bothering me more and more the last 6 months”.  

So what do you do about it?  Well deep down in all of us we like to solve problems.  We ask a friend, a co-worker, turn to youtube or online resources.  Except not a single one of them knows your exact problem.  What works well for one person may not help for another.  That’s because even though you have shoulder pain on the front of your shoulder like your aforementioned friend, you have them for entirely different reasons.  That is where we come in and it’s something you’re not going to find a solution to having an x-ray or MRI.  Imaging may tell you if there’s a problem, not why!  Having a physical therapist break down your mobility, range of motion, and strength evaluating you specifically during your movement pattern will tell us, and you, where the problem is.   

The next step is what do you do about it?  Fortunately we’re here to help.  It’s important to realize that no matter how long you think the problem has been going on there is something you can do about it.  An evaluation with us will look at all the moving pieces of your shoulder and come up with the reason and solution for your particular pain.  There’s lots of good information out there for people to selfdiagnose but it may not fully help your particular need.  So if you’re ready to get back control of your shoulder, give us a call and we’ll get you started in the right direction.  

Common Shoulder Problems 

  • Tendonitis, tendonosis, tendonopathy: In most cases, the best term is the latter because inflammation is not present in most cases – the term tendonitis is overused and misunderstood. Tendonopathy just means painful tendon so can be used for a full spectrum of shoulder tendon issues. Rotator cuff tendon injuries are the most common – also frequently called shoulder impingement. The rotator cuff tendons that can be injured include – supraspinatus, subscapularis, infraspinatus, and teres minor. The bicep tendon can also be a frequent offender, also called bicipital tendonopathyAll of these tissues can heal with time and physical therapy, but the underlying problem must be addressed to solve the problem for the long haul. The key indicator of shoulder impingement or tendonopathy is pain with behind the back or overhead movement or activities. Pain can be sharp and leave you with a constant dull ache as it progresses. It can be painful to lay on that side and click when moving it around.  
  • Bursitis: This is swelling or changes to the fat pad/cushion that protects the tendon from friction while moving across the bone. It can go along with tendonopathy and is treated the same way. 
  • Rotator cuff tear: Over time, the wear and tear on a tendon can cause it to tear or rupture. This can occur over time or with trauma. The symptoms are similar to rotator cuff tendonpathy but strength is greatly reduced, in fact you may have trouble lifting your arm overhead. Smaller tears can be addressed with physical therapy and typically PT is the first course of action prior to surgical consideration. Rotator cuff repair rehab can be grueling so it’s best to see if a course of PT can help before considering surgery. 
  • Shoulder subluxation or dislocation: You pretty much know if you have dislocated your shoulder because you have to go to the ER to have it put back into place. If your shoulder pops out and then spontaneously goes back into place, this is called a subluxation. The course of treatment is very different depending on your age. Evidence suggests if you are under 20, the likelihood that you will dislocate/sublux again is ~ 95%. Surgery is typically advised. After age 40, you surgery is not typically recommended unless you have a significant history.   
  • Labral tear: The labrum is the fibrocartilage attached to the rim of the shoulder socket. It can be disrupted by a dislocation/subluxation or just wear down over time. The bicep tendon attaches to the labrum so this can also contribute to overuse injuries. Labral problems can cause pain with overhead or throwing activities and there can be grinding, popping, sticking of the shoulder. There is usually pain at night and you may experience loss of shoulder motion or strength. Teasing out a labral problem vs. tendopathy can be tricky but that’s wear a BIA physical therapist can help. Evidence suggests, in many cases these problems can resolve with a good course of PT vs. surgery. 
  • Arthritis: Osteoarthritis (OA) can occur in the shoulder and the AC joint. Hallmark signs of OA are stiffness in the morning that improves with movement then pain can occur later in the day or with increased activity. There can be popping, clicking, grinding sounds in the joint. While we cannot make OA go away, we can improve the mobility, strength, and control to help mitigate the symptoms of OA allowing for better quality of life and avoidance of surgery.  

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