“Can’t Shake it off”; Shoulder Differential Diagnosis
  1. There are many types of shoulder injuries. Some diagnoses are clear cut, while others may be the result of lifestyle choices, genetics or a complete medical mystery, with an unknown cause of origin altogether.

“How is she doing thaat?” If you have shoulder pain, dont try this @🏠

via GIPHY

via GIPHY

Neither of the above are suggested if you have shoulder issues. Better leave it to the birds.

 

Last week we talked about basic shoulder anatomy.

Fig.1

 Here are some of the most common shoulder diagnoses that send people to seek treatment rehabilitation and physical therapy.

 

Adhesive Capsulitis: There is no known cause. However, it is commonly associated with diabetes mellitus, hypo- or hyperthyroidism, and females more than males (age range 40-70).  It is usually clinically diagnosed by the recognition of Active and Passive Range of Motion Restrictions, with external rotation being restricted the most followed by shoulder abduction,  flexion and internal rotation. In addition to ROM restrictions, people may report radiating pain to elbow and night pain.

via GIPHY

We can agree that shoulder pain is NOT fun.

There are 3 stages of Adhesive Capsulitis :

Stage 1: Frozen 3-9 months. Progressive increase in pain.

Stage 2: Frozen 4-12 months. Decrease in pain; present with active and passive ROM.

Stage 3: Thawing 12-42 months. Pain present with stretching only.  Gradual return to function.

 

Rotator Cuff  Injuries: The Rotator Cuff consists of muscles: supraspinatus, infraspinatus, teres minor and subscapularis. RTC injuries may be classified as tears, tendinitis, tendinopathy or impingement syndrome.

 Tendinitis and Tears usually occur due to trauma and may be classified as partial or full thickness tears, while tendinopathy and impingements are usually chronic types of injuries. Some other contributing factors could be due to posture or capsular tightness. People may report catching at about 90 degrees of flexion, overall pain with movement and reaching out or rotating the shoulder, difficulty sleeping, deep ache in the shoulder. Weakness may be present with reaching out or rotation, weakness or pain with push/pull kind of activities.

Bicep Tendonitis: Local snapping sensation over the bicipital groove which is located in the front of the shoulder. Most common in females 45-65 years old after stress due to repetitive movements with poor biomechanics.  Pain present with shoulder abduction and external rotation. Pain with lifting and reaching overhead. Pain may radiate down the arm. May be associated with rotator cuff injuries.

 

Labral Tear: There are two types of labral tears, SLAP (Superior Labrum from Anterior to Posterior) Tears and Bankart Tears. They are most common in overhead sports’ athletes such as Volleyball or Baseball players, overtime wear and tear, strong bicep contraction or in cases where the person falls on their outstretched arm (FOOSH).

 

 SLAP Tears occur on top of the shoulder, which is also where the bicep tendon attaches.  Bankart Tears are most commonly associated with shoulder dislocations and may need to be surgically repaired. Labral Tears present with shoulder weakness into shoulder flexion and abduction and pain with reaching behind back and bringing the arm across the body, with the feeling of instability.

 

Thoracic Outlet Syndrome: Results from either vascular or neural compression in the upper chest and shoulder/lower neck area Due to Postural Compromise such as Forward Head and Shoulders.  People report numbness and tingling in the arm/hand; there’s poor localization of the pain. Thoracic Outlet Syndrome may be difficult to diagnose; however, it can be treated with physical therapy and postural correction. People may report pain carrying heavy objects.

 

Subacromial Bursitis: Inflammation of the bursa (fluid filled sac which lubricates the joints) that lies under the acromion. This injury occurs with trauma and poor biomechanics or repetitive or strenuous activities. It is common in athletes using repetitive overhead movements, factory workers, and manual laborers. It can also present in patients with inflammatory conditions such as rheumatoid arthritis. Severe and localized pain is present. People may report pain reaching out to the side.

Got Shoulder pain? BeneFIT PT wants to help. So if you feel like something is wrong or you are more sore than you should be just give us a call to get that free medical screening scheduled.  For Chester call : (908)-879-5700, Bridgewater: (908)-203-5200

 

References

Biel,Andrew. Trail Guide To The Body: How to Locate Muscles, Bones, And More. Fifth Edition. Boulder, CO: Books Of Discovery, 2014. Print.

https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-pain-and-common-shoulder-problems/