My shoulder hurts

[boomerang]

My right shoulder has been sore for about the last six months or so. The soreness emanates from the top of the shoulder itself. What's most difficult is washing my right armpit and reaching up into a cabinet. It's also difficult to find a comfortable sleeping position. Lately, it's having a big impact on my activities in the gym.

So, I go see the Doc. More than likely it's arthritis he says, but we'll get an x-ray and go from there. Results from the x-ray are essentially no problems found. Nothing amiss, no signs of an arthritic condition.

So, I ask what's next? Physical therapy he says. I say like moving the joint and doing mild exercise? Yes, is the answer. I'm already doing that and more several times a week at the gym, he knows this.

This is not a slight against my Doctor it's the absurdity of our system of medicine as a whole. Here's the path he laid out. This is the road map of the course of treatment that must be followed according to my insurance carrier. There will be no deviations.

X-ray
Physical therapy
MRI
More Physical therapy
Surgery

The diagnosis is either tendinitis or a partially torn rotator cuff but no way to know without an MRI. Evidently the best course of action is to spend more money on physical therapy than to get to the heart of the problem and correct it. I could understand the course of action with a sedentary person. This is evidently how our cookie-cutter medical system works.

Sigh...

 

[Monster_Munch]

Do you spend a lot of time using a mouse?

My Dad had the same problem from using a PC all day at work, I think he had to have an operation on his shoulder in the end.

 

[blackdogdeek]

i understand your frustration but in the end you are free to find a doctor you like. you are also free to question your doctor's prescribed treatment and suggest alternatives. if the medical care you receive is that important to you then you shouldn't settle for mediocrity.

 

[SociallyChallenged]

So wait, you're frustrated you're getting sent to physical therapy? I don't know if you understand what physical therapy is about then. Your light exercise is very different from directly endurance or strength exercises based on your personal profile. On top of that, they can manage postural changes, lengthen tissues that need to be lengthened, apply joint mobilizations to put your shoulder in the correct position, minimize your pain, etc. Physical therapists utilize tests that are more reliable than MRI when used in conjunction with each other (and a lot of the tests on their own are better for ruling in or out a condition). Tendonitis is very, very easy and reliably confirmed with a stretch test (typically PROM), static test (to test contractile ability), and direct palpation. That will give you better information about your function than an MRI. The same thing goes for torn rotator cuff.

Honestly, what you're describing doesn't sound like either of those. Shoulder pain through the top of the shoulder sounds most like AC joint pathology, shoulder impingement, or possibly labral tear. All of these are easily confirmed by physical therapy. I don't quite know why everyone thinks MRI is the gold standard - perhaps because it's the easiest and fanciest - but MRIs miss things all the time and actually don't give any detail on how it moves. That's like trying to get information about the heart through an x-ray. Sure, you can tell if it's enlarged or if there's calcification, etc... but no good cardiologist would pick x-ray over EKG or an echo.

Physical therapists go to school for 2-3 years after a bachelor's degree to learn what they do. They know more about musculoskeletal injuries than most MDs and I can guarantee they know more specific and better tailored interventions. Do the physical therapy, see if it helps. Physical therapy is much, much more than "just doing exercise." It's a complete evaluation of your biomechanics and structural positions, it's behavioral, postural, and neuromuscular re-training, it's strength testing, it's way, way more than you think or could do on your own. Honestly, I think if you go to PT and ask them to explain some of the things they're doing, you'll be pleasantly surprised.

 

[the DRIZZLE]

So wait, you're frustrated you're getting sent to physical therapy? I don't know if you understand what physical therapy is about then. Your light exercise is very different from directly endurance or strength exercises based on your personal profile. On top of that, they can manage postural changes, lengthen tissues that need to be lengthened, apply joint mobilizations to put your shoulder in the correct position, minimize your pain, etc. Physical therapists utilize tests that are more reliable than MRI when used in conjunction with each other (and a lot of the tests on their own are better for ruling in or out a condition). Tendonitis is very, very easy and reliably confirmed with a stretch test (typically PROM), static test (to test contractile ability), and direct palpation. That will give you better information about your function than an MRI. The same thing goes for torn rotator cuff.

Honestly, what you're describing doesn't sound like either of those. Shoulder pain through the top of the shoulder sounds most like AC joint pathology, shoulder impingement, or possibly labral tear. All of these are easily confirmed by physical therapy. I don't quite know why everyone thinks MRI is the gold standard - perhaps because it's the easiest and fanciest - but MRIs miss things all the time and actually don't give any detail on how it moves. That's like trying to get information about the heart through an x-ray. Sure, you can tell if it's enlarged or if there's calcification, etc... but no good cardiologist would pick x-ray over EKG or an echo.

Physical therapists go to school for 2-3 years after a bachelor's degree to learn what they do. They know more about musculoskeletal injuries than most MDs and I can guarantee they know more specific and better tailored interventions. Do the physical therapy, see if it helps. Physical therapy is much, much more than "just doing exercise." It's a complete evaluation of your biomechanics and structural positions, it's behavioral, postural, and neuromuscular re-training, it's strength testing, it's way, way more than you think or could do on your own. Honestly, I think if you go to PT and ask them to explain some of the things they're doing, you'll be pleasantly surprised.

IMO a good orthopedist will do the mechanical tests himself combined with an MRI to make a diagnosis. While PTs can certainly diagnose issues, when you go to an orthopedist you should leave with a diagnosis. If the doctor feel comfortable making a diagnosis without an MRI and prescribes PT as treatment, that's fine. But it makes no sense to send a person to PT as a substitute for a proper diagnosis. Its not like a few weeks of PT is any cheaper than an MRI anyway.

 

[boomerang]

So wait, you're frustrated you're getting sent to physical therapy? I don't know if you understand what physical therapy is about then. Your light exercise is very different from directly endurance or strength exercises based on your personal profile. On top of that, they can manage postural changes, lengthen tissues that need to be lengthened, apply joint mobilizations to put your shoulder in the correct position, minimize your pain, etc. Physical therapists utilize tests that are more reliable than MRI when used in conjunction with each other (and a lot of the tests on their own are better for ruling in or out a condition). Tendonitis is very, very easy and reliably confirmed with a stretch test (typically PROM), static test (to test contractile ability), and direct palpation. That will give you better information about your function than an MRI. The same thing goes for torn rotator cuff.

Honestly, what you're describing doesn't sound like either of those. Shoulder pain through the top of the shoulder sounds most like AC joint pathology, shoulder impingement, or possibly labral tear. All of these are easily confirmed by physical therapy. I don't quite know why everyone thinks MRI is the gold standard - perhaps because it's the easiest and fanciest - but MRIs miss things all the time and actually don't give any detail on how it moves. That's like trying to get information about the heart through an x-ray. Sure, you can tell if it's enlarged or if there's calcification, etc... but no good cardiologist would pick x-ray over EKG or an echo.

Physical therapists go to school for 2-3 years after a bachelor's degree to learn what they do. They know more about musculoskeletal injuries than most MDs and I can guarantee they know more specific and better tailored interventions. Do the physical therapy, see if it helps. Physical therapy is much, much more than "just doing exercise." It's a complete evaluation of your biomechanics and structural positions, it's behavioral, postural, and neuromuscular re-training, it's strength testing, it's way, way more than you think or could do on your own. Honestly, I think if you go to PT and ask them to explain some of the things they're doing, you'll be pleasantly surprised.

You know, after just talking with a friend of mine that went through a similar problem, I have to agree with you. Between the two of you, my eyes have been opened up. I mistakenly assumed that what I have is a 'mechanical' problem that can only be solved by mechanics - in this case surgery. My background is in mechanics and I guess that's the way I look at problems such as these.

Thanks for the reply. I'm going to call the Doc and get the physical therapy going.

 

[SociallyChallenged]

IMO a good orthopedist will do the mechanical tests himself combined with an MRI to make a diagnosis. While PTs can certainly diagnose issues, when you go to an orthopedist you should leave with a diagnosis. If the doctor feel comfortable making a diagnosis without an MRI and prescribes PT as treatment, that's fine. But it makes no sense to send a person to PT as a substitute for a proper diagnosis. Its not like a few weeks of PT is any cheaper than an MRI anyway.

Sometimes, it's difficult for an ortho to get a specific diagnosis as they aren't movement specialists. In a PT evaluation, the PT does a biomechanical analysis and can see problems. With that, the PT can test one or more structures, according to pain complaints. I agree that an ortho should give a diagnosis, but PT can just as well give you a functional and physiological diagnosis. And a few weeks of PT is way, way more effective than an MRI. The diagnosis should come in 1-2 PT sessions, and you should receive treatment for the rest of the time you're there. MRI just attempts to diagnose. PT is diagnosis and treatment.

 

[SociallyChallenged]

You know, after just talking with a friend of mine that went through a similar problem, I have to agree with you. Between the two of you, my eyes have been opened up. I mistakenly assumed that what I have is a 'mechanical' problem that can only be solved by mechanics - in this case surgery. My background is in mechanics and I guess that's the way I look at problems such as these.

Thanks for the reply. I'm going to call the Doc and get the physical therapy going.

I definitely understand what you mean. You think - it hurts, it must just be broken. Let's fix the broken thing. But if you don't think about what caused that thing to break, it never truly gets better. I hope you have a good experience with PT. Honestly, a good PT is more valuable to me than a lot of things in life. That's why I decided to go into the field myself.

 

[jman19]

I've had aching pain from my left shoulder blade to the top of my shoulder for years... but never did anything about it I had to stop lifting at the gym because of it...

 

[SociallyChallenged]

I've had aching pain from my left shoulder blade to the top of my shoulder for years... but never did anything about it I had to stop lifting at the gym because of it...

Honestly, that could be a pretty easy fix if you saw a PT about it. Does if feel like it's muscle?

 

[jman19]

Honestly, that could be a pretty easy fix if you saw a PT about it. Does if feel like it's muscle?

It's hard for me to say - not sure. Sometimes the pain radiates, occasionally it goes across my color bone. I guess I should just talk to a doc about it...

 

[SociallyChallenged]

It's hard for me to say - not sure. Sometimes the pain radiates, occasionally it goes across my color bone. I guess I should just talk to a doc about it...

The upper trapezius muscle pretty much goes where you're describing - from the scapula (shoulder blade) and clavicle (collar bone) up to the vertebrae in the neck.

 

[Edge1]

Hey bro I'll just throw my 2 cents in. Had similar issues with left shoulder a few years ago. Initially saw an orthopedic doc who ordered ibuprofen and a period of physical therapy. No real progress, went to see a shoulder specialist and he felt I may have "distal clavicular osteolysis". Occurs often in weightlifters and is a results of chronic "microtrauma" to shoulder region. I had been cross-training with boxing and the massive repetitions, along with over-the-head work really overtrained the shoulders. On top of that I work at a computer all day and you'd be surprised the effect of minor chronic movements or arm positions can have.

Basically the whole thing resolved with the doc giving me a steroid injection in the shoulder. Within about 3-5 days I was golden. Totally great since then, but I'm careful with my shoulders. If you think about it, the shoulders are probably engaged more than any other body part when it comes to all the different types of lifts or excercises we do.

 

[RedCOMET]

I've had aching pain from my left shoulder blade to the top of my shoulder for years... but never did anything about it I had to stop lifting at the gym because of it...

I play little to no tennis now becuase of shoulder pain.

Basically the whole thing resolved with the doc giving me a steroid injection in the shoulder. Within about 3-5 days I was golden. Totally great since then, but I'm careful with my shoulders. If you think about it, the shoulders are probably engaged more than any other body part when it comes to all the different types of lifts or excercises we do.

I use the computer all day for work, so this is good to know as a possible course of action.

I saw a chiropractor who specialized in sports injury and he worked on my shoulder for a bit and it was amazing. Out of the few chiropractors and doctors that I saw about my shoulder, this guy was the only one able to come to with a possible diagnosis and a course of action. Although now that i moved out of town, i wish i found another chiropractor ( or an MD for that matter) that could help me. Also to get me back on an excercise regimen.

 

[PowerYoga]

Wow, I'm surprised (maybe I shouldn't be?) that I found this thread with the same exact problem that I had for the past 4-5 years. I have the problem in my right shoulder but lately its spread (!!) to my left and I'm getting more concerned. I just got a new job (in chicago for a year now) so maybe its the new station I have that's causing it...?

I am on the computer all day for my job as well.

I've never really gotten it looked at closely before, what are the first steps you guys would recommend? Should I see my general practice doctor first or go straight to an orthopedist?

 

[Edge1]

Wow, I'm surprised (maybe I shouldn't be?) that I found this thread with the same exact problem that I had for the past 4-5 years. I have the problem in my right shoulder but lately its spread (!!) to my left and I'm getting more concerned. I just got a new job (in chicago for a year now) so maybe its the new station I have that's causing it...?

I am on the computer all day for my job as well.

I've never really gotten it looked at closely before, what are the first steps you guys would recommend? Should I see my general practice doctor first or go straight to an orthopedist?

Orthopedist, preferably a shoulder specialist. Forget the GP, they'll prescribe anti-inflammatories and possibly PT. Is your pain on top, like the OP's? That's what drew me to the thread as that is exactly where mine was. There are pretty much 3 options if its distal clavicular osteolysis:

1) rest (for a long, long time. I'm talking 6 months or more. Not feasible, I know.)
2) Corticosteroid injection (strong anti-inflammatory). Worked for me. Yes, its a painful shot but worth it.
3) minor surgery where they resect the tip of the distal clavicle. Never had to go there.

 

[SociallyChallenged]

Orthopedist, preferably a shoulder specialist. Forget the GP, they'll prescribe anti-inflammatories and possibly PT. Is your pain on top, like the OP's? That's what drew me to the thread as that is exactly where mine was. There are pretty much 3 options if its distal clavicular osteolysis:

1) rest (for a long, long time. I'm talking 6 months or more. Not feasible, I know.)
2) Corticosteroid injection (strong anti-inflammatory). Worked for me. Yes, its a painful shot but worth it.
3) minor surgery where they resect the tip of the distal clavicle. Never had to go there.

Distal clavicular osteolysis is pretty damn rare. I agree that people with serious shoulder issues should see an ortho (a specialist if possible), but I'd like for people not to get scared and think this is an everyday occurrence. Honestly, rotator cuff strains, capsular issues, weakness, AC pathology, and labral tears account for over 90% of shoulder injuries. Corticosteroids are crap for almost all of those. I just don't want everyone in this thread thinking they have osteolysis. That's likely not how it is for everyone else.