Why isn't my shoulder getting better?

I have had a number of patients come in this week with shoulder pain and presenting with a bunch of different diagnoses that they received from scans, other professionals or their doctors.  They were told that their condition was a tendinosis, a burisits, arthritis, impingement or maybe something more broad like a "rotator cuff problem".

All of these patients came in developing these problems gradually without any specific incident that set it off.  They were told that the causes stemmed from repetitive work,  bad posture, weak muscles or the classic "wear and tear".   As a result the treatments were the fairly standard.  Ultrasound and massage the painful area then do some theraband exercises.

We tackle these problems a little differently.  If there is no specific trauma or incident that indicates major structural damage and if our tests rule out some of the things that people require surgery for (like a significant labral injury) then we ask the question.  What can and cant you do?  Then we work to improve this.  We take this approach rather than trying to treat a "bursitis" or a "tendinosis".

There are certain things that a shoulder to be able to do and the shoulder should perform this in a certain way.

Two of the simple tests we use that bring on pain for many are the hand behind back and hand behind neck tests (or variations of the Apleys scratch test).  Most of us have likely tried this movement through our lives.  It's done by reaching one hand down back and behind the back and the opposite hand up and behind the neck.  Most of us have found that we can touch hands in one direction and not the other.

Although most of us arent as flexible in one direction compared to the opposite there are some signs that can tell us there may be an issue.

• A big difference between one side and the other.
• Reproduction of the pain that you came to the therapist to treat
• Difficulty getting to the scapula (shoulder blade) from either direction
• Abnormal movement of the scapula (shoulder blade) 
• Abnormal compensation with the neck or spine.

If it is an issue we treat it to regain the movement.  Typically you should improve it within one to three sessions.  Then move on to the next problematic movement or action.  Through this process you can regain pain free function.  Whether or not the ultrasound may have the word "bursitis" on it.