Tag Archive for: rotator cuff

Shoulder Impingement Syndrome

Shoulder Impingement Syndrome – Treat the cause not symptoms

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Have you ever had pain in your shoulders when you try to raise your arms overhead, pull off a sweatshirt, grab a gallon of milk from the fridge?  Or place grocery bags on the counter?  You were likely dealing with shoulder impingement syndrome – also known as rotator cuff impingement.

They call it impingement syndrome because your rotator cuff tendons literally get “impinged” between the round head of your shoulder joint and a hook-shaped bone in the front of your shoulder joint (called the acromion) that is part of your shoulder blade.

This can occur for a number of reasons…

You could have a deformity that causes this, an injury could lead to this, arthritis could contribute to this, or poor posture can cause it.

Any of these scenarios can cause crowding in the space where your rotator cuff tendon passes in front of your shoulder. If this happens often enough – it’s going to get irritated every time you raise your arm past 90 degrees.

When this first begins to happen, it will typically cause acute inflammation. You may be diagnosed with rotator cuff tendonitis. But eventually, the more constant pain and irritation of tendonitis subsides and you only feel pain when you go to raise your arm or reach in certain directions.

This is more commonly known as shoulder impingement.

With the exception of a deformity, almost all cases of shoulder impingement can (and should) be resolved naturally.

The tempting and easy fix is to get a cortisone shot to calm the inflammation.

But what you need to understand is that impingement syndrome – in most cases – is actually the symptom of a more overarching problem. And injecting the tendon with cortisone will often cause more harm than good.

The cortisone will temporarily mask your problem. It will eventually cause damage to your tendon if you keep getting injections. Remember, impingement is caused by crowding of the space where your tendon passes through. You can temporarily take the inflammation away and it will feel better. But, unless you address the reason for the crowded space, your problem will keep coming back.

So how do you naturally get rid of shoulder impingement for the long term?

First, you must address the reason for the crowded space in your shoulder joint where your tendon passes through. Most often – it’s due to poor postural habits and immobility around your shoulder joint – specifically your neck and upper back.

For example, if your upper back is stiff, curved, and lacks adequate mobility – it’s going to impact how your shoulder blades move and are positioned.

With a stiff and curved upper back, your shoulder blades will respond by moving out and up. This scenario makes that hook-like bone (the acromion) sit more forward and down than it should. When this happens, there isn’t enough room for your tendon when you lift your arm above shoulder height. The bony surfaces above and below your tendon create friction and this eventually turns into pain and inflammation. This can happen slowly over time. Or, more quickly if you’ve got something like arthritis where that space might have naturally already narrowed.

Another common scenario is after a shoulder injury. Your neck and upper back may have learned to compensate for a time while you were healing from your injury. The result is some unwanted postural deformities that can lead to impingement of your rotator cuff tendon.

When it comes to shoulder pain, always make sure to examine your neck and upper back FIRST.

If there are poor postural habits there, your shoulder will undoubtedly be impacted.

If you really want to get rid of your shoulder impingement – and back to lifting, reaching, and carrying things without any worry – it’s essential that you identify and address the root cause, not just the symptoms (inflammation of the tendon).

Next time you go to the doctor complaining of shoulder pain – and you hear the words “impingement syndrome” or “rotator cuff tendonitis” – don’t assume you need rest, ice, a cortisone shot, or surgery to resolve it.

None of these solutions will give you the long-term solution you’re looking for.

The very last thing you want to do is choose passive treatment interventions or procedures. These either mask the pain or prolong the problem because they only address symptoms.

You want to do everything possible to preserve the integrity of your tendon. The best way to do that is by optimizing the mobility and strength around your shoulder joint first. Do this before resorting to more aggressive measures like cortisone or surgery.

Are you currently suffering from shoulder pain (or anything else) that is keeping you from doing things you love?

Are you contemplating surgery or a cortisone shot because you have been told it’s your best and only option?

Let me know and let us help!

We’re happy to provide a second opinion for you.

We will examine your shoulder and see how it responds to certain movement tests. Then we’ll be able to tell you – and show you – if your problem can be resolved naturally with movement instead of a procedure like a cortisone shot or surgery.

Our patients find that if they end up needing a procedure (which is rare) – they do so with peace of mind. This is because they’ve exhausted a natural, movement-based solution with us FIRST.

If you want to talk to us and see if what we do is right for you – CLICK HERE to request a Discovery Call with my client success team.

They’ll let you know if we can help and get you on our schedule as quickly as possible!

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of one of her guide to neck and shoulder pain CLICK HERE or to get in touch, email her at [email protected].

pain

Shoulder Impingement Syndrome – Treating the cause over symptoms

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If you’ve ever had pain in your shoulders when you try to raise your arms overhead, pull off a sweatshirt, grab a gallon of milk from the fridge, or place grocery bags on the counter – you were likely dealing with shoulder impingement syndrome – also known as rotator cuff impingement.

They call it impingement syndrome because your rotator cuff tendons literally get “impinged” between the round head of your shoulder joint and a hook-shaped bone in the front of your shoulder joint (called the acromion) that is part of your shoulder blade. This can occur for a number of reasons… You could have a deformity that causes this, an injury could lead to this, arthritis could contribute to this, or poor posture can cause it.

Any of these scenarios can cause crowding in the space where your rotator cuff tendon passes in front of your shoulder – and if this happens often enough – it’s going to get irritated every time you raise your arm past 90 degrees.

When this first begins to happen, it will typically cause acute inflammation, and you may be diagnosed with rotator cuff tendonitis. But eventually, the more constant pain and irritation of tendonitis subsides and you only feel pain when you go to raise your arm or reach in certain directions. This is more commonly known as shoulder impingement.
With the exception of a deformity, almost all cases of shoulder impingement can (and should) be resolved naturally. The tempting and easy fix is to get a cortisone shot to calm the inflammation. But what you need to understand is that impingement syndrome – in most cases – is actually the symptom of a more overarching problem. And injecting the tendon with cortisone will often cause more harm than good. While the cortisone will temporarily mask your problem, it will eventually cause damage to your tendon if you keep getting injections.

Remember, impingement is caused by crowding of the space where your tendon passes through. You can temporarily take the inflammation away and it will feel better – but unless you address the reason for the crowded space – your problem will keep coming back.

So how do you naturally get rid of shoulder impingement for the long term?

First, you must address the reason for the crowded space in your shoulder joint where your tendon passes through. Most often – it’s due to poor postural habits and immobility around your shoulder joint – specifically your neck and upper back. For example, if your upper back is stiff, curved, and lacks adequate mobility – it’s going to impact how your shoulder blades move and are positioned. With a stiff and curved upper back, your shoulder blades will respond by moving out and up. This scenario makes that hook-like bone (the acromion) sit more forward and down than it should. When this happens, there isn’t enough room for your tendon when you lift your arm above shoulder height. The bony surfaces above and below your tendon create friction and this eventually turns into pain and inflammation. This can happen slowly over time – or more quickly if you’ve got something like arthritis where that space might have naturally already narrowed. Another common scenario is after a shoulder injury. Your neck and upper back may have learned to compensate for a time while you were healing from your injury – and the result is some unwanted postural deformities that can lead to impingement of your rotator cuff tendon.

When it comes to shoulder pain, always make sure to examine your neck and upper back first.

If there are poor postural habits there, your shoulder will undoubtedly be impacted. If you really want to get rid of your shoulder impingement – and back to lifting, reaching, and carrying things without any worry – it’s essential that you identify and address the root cause, not just the symptoms (inflammation of the tendon). Next time you go to the doctor complaining of shoulder pain – and you hear the words “impingement syndrome” or “rotator cuff tendonitis” – don’t assume you need rest, ice, a cortisone shot, or surgery to resolve it. None of these solutions will give you the long-term solution you’re looking for. The very last thing you want to do is choose passive treatment interventions that either mask the pain or prolong the problem because they only address symptoms. You want to do everything possible to preserve the integrity of your tendon – and the best way to do that is by optimizing the mobility and strength around your shoulder joint first – before resorting to more aggressive measures like cortisone or surgery.

Ready to get help with your pain or injury?

Request to speak to one of my specialists to see if we would be the right fit to help you get out of pain. CLICK HERE to request a Free Discovery with one of my specialists.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.  To get a free copy of her guide to taking care of shoulder pain – click here.

Will a Cortisone Shot Help Your Nagging Shoulder Pain?

Shoulder Injuries after Vaccination? What to look for

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Shoulder injuries related to vaccine administration (otherwise known as “SIRVA”) is a rare, but possible occurrence when you get any vaccine.

SIRVA happens when a vaccine is injected into the capsule of your shoulder joint instead of your deltoid muscle. It can also occur if the needle being used is not the correct length for you, or if it’s administered too high or too deeply into your muscle. SIRVA is essentially a shoulder injury that occurs due to an improperly administered vaccine – not from the vaccine itself.

Now, it should be noted that this condition is very rare. However, due to the sheer volume of vaccines being administered right now – we have seen a slight uptick in unresolved shoulder problems here in our office. Anywhere from weeks to months after vaccination. For most, the shoulder pain is very mild and it goes away on its own. But for a select few, their shoulder pain has persisted and manifested into a more severe problem. This could be a sign you have SIRVA.

Since the signs and symptoms don’t show up right away, I thought it would be helpful to go over with you what is considered “normal” versus not normal shoulder pain after you get a vaccine.

You’ve likely heard of the “Moderna arm” by now. This is a mild skin irritation specifically related to the Moderna vaccine for COVID-19 that typically involves a mild rash and skin sensitivity after your second shot. It usually lasts about 3-5 days and can be easily treated with topical anti-inflammatories. Moderna arm is not considered to be anything serious, and although it’s not normal to experience this after most traditional vaccines, it is considered a common reaction to the Moderna vaccine. If you’ve recently had your second Moderna shot and are experiencing what you think could be Moderna arm, speak with your doctor or dermatologist if symptoms continue to persist past 5 days, just to make sure there isn’t something else going on.

Localized shoulder pain at the site of your vaccine injection is also normal.

We see this with any type of injection or vaccine into your arm, not just with Covid vaccines. The pain you feel is from the mild trauma caused by the needle being inserted into the soft tissue (muscle) of your arm. It often feels like a bruise, and you may experience a little bit of swelling. It will typically go away after 2-3 days. Even though your arm can be quite sore, the important distinction here is that you’ll still have full, normal function of your arm. In other words, despite the soreness, you can still move your arm freely up and down if you had to without restriction. Your arm soreness will go away with time, but gently massaging the area of pain, and even some easy movement or exercise can help the soreness go away a little faster. 

The symptoms of SIRVA are different, and typically more severe than what I’ve just described above.

If not addressed, some of these symptoms could lead to long lasting shoulder problems. As I alluded to above, one of the main distinctions between “normal” shoulder pain after vaccination and SIRVA is how well your arm functions.

If the needle was accidentally inserted into your joint capsule, for example, you will notice limited mobility and possibly limited strength. When left unaddressed, symptoms like this can manifest into more serious shoulder problems down the line, such as adhesive capsulitis or frozen shoulder.

If the needle was inserted too high or too deeply, you can end up with shoulder bursitis, which means the needle was inserted beyond your muscular layer and directly into the bursa (a cushiony fluid-filled sack), causing it to become inflamed. Your mobility may or may not be impacted when this happens, but what you’ll notice is that your shoulder pain will take a lot longer than 2-3 days to subside. Bursitis is actually a really simple injury to treat, but where I see most things go wrong is that you can end up with compensatory problems in places like your neck, shoulder blade or elbow the longer it is allowed to persist.

The last thing you might see from an improperly injected needle is rotator cuff tendonitis. What you’ll notice with this is that you’ll likely have full mobility in your shoulder, but it will be very painful and weak to exert force in your arm.  Much like bursitis, this is not a complicated injury to rehabilitate, but if not rehabilitated properly, it leads to other problems that do become more difficult to treat down the line.

So to summarize, your shoulder WILL hurt after getting a vaccine.

And with the Moderna vaccine in particular, you may notice some skin sensitivity, mild swelling, and even a rash.

But these symptoms should go away after a few days.

If you have shoulder pain that persists, and especially if you’re noticing limited mobility, it’s something worth getting checked out.  The last thing you want is for these symptoms to go on longer than needed, or turn into compensatory, long lasting problems. The good news is that even with SIRVA, these problems and symptoms can be successfully treated naturally, and without medications or procedures. We’ve been successfully helping people right here in our office. If you’re worried about a potential shoulder problem after the vaccine and not sure where to turn – reach out. You can schedule a FREE Discovery Session with one of our specialists right here!

 

Is Shoulder Pain “Impinging” on Your Lifestyle?

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If you’ve ever had pain in your shoulders when you try to raise your arms overhead, pull off a sweatshirt, grab a gallon of milk from the fridge, or place grocery bags on the counter, you were likely dealing with shoulder “impingement syndrome…” otherwise known as “rotator cuff impingement” or “rotator cuff tendonitis.”

They call it “impingement” because your rotator cuff tendons get pinched between the round head of your shoulder bone and a hook-shaped bone in your shoulder blade called the acromion.

The pinching tends to happens every time you raise your arm above ninety degrees. After a while, the pinching eventually irritates your tendon, resulting in pain and inflammation. These symptoms are exacerbated and pronounced with any arm movements above shoulder height. Most of the time, the root cause of this problem has been there for a long time, but it’s only just now manifesting itself as pain — and this so-called “impingement syndrome.”

So what causes your rotator cuff tendon to get pinched or impinged in the first place?

Most of the time, the answer is POSTURE.

If your upper back is stiff, curved, and lacks adequate mobility, it’s going to impact how your shoulder blades move and position themselves. With a stiff and curved upper back, your shoulder blades will respond by moving out and up. This scenario makes that hook-like bone (the acromion) sit more forward and more down than it should. When this happens, there isn’t enough room for your tendon when you lift your arms above shoulder height. The bony surfaces above and below your tendon create friction, and this eventually turns into pain and inflammation.

The tempting and easy “fix” is to get a cortisone shot or attack the inflammation more conservatively with ice and topical anti-inflammatory agents.

But what you need to understand is that in most cases, “impingement syndrome” is actually the SYMPTOM. The root cause is usually coming from immobility and poor movement patterns in the upper back or neck. If you really want to get rid of your shoulder pain, get back to lifting and carrying things without any worry, and have full and free mobility of your arms, it’s essential that you identify and address the root cause and not just the symptoms. Since there is an 80% chance your shoulder pain is a mechanical or movement problem — the best people to examine and address this FIRST are movement experts like us.

So moral of the story… next time you go to the doctor complaining of shoulder pain and you hear the words “impingement syndrome” or “rotator cuff tendonitis” — don’t assume you need a cortisone shot or surgery to fix it.

Neither of these solutions will likely give you the long-term solution you’re looking for. The very last thing you want to do is get some kind of procedure or surgery that either masks the pain or corrects the wrong problem. You want to do everything possible to preserve the integrity of your tendon, and the best way to do that is by optimizing mobility and using natural movement and strength training prescribed by movement experts.

Interested in seeing if physical therapy could resolve your shoulder pain? Try a FREE Discovery Session on us. This is a chance for you to speak with one of our specialists, tell us everything that’s been going on with you, and determine for yourself if we’re the best people to help you. It’s a completely free, no-obligation appointment that will give you all the information you need to make the BEST decision for YOUR health – whether that’s working with us or not!

Carrie working on a client's shoulder

Shoulder Pain not Going Away? This could be why…

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Whether it’s shoulder pain, neck pain, back pain, or knee pain that you’re dealing with — if you have a nagging pain or injury that just won’t go away no matter what you try, it’s a clue that you’re missing something.

We see this ALL the time in our office with shoulders.

Folks just like you come to us wondering why their shoulder still hurts after trying ice, heat, rest, physical therapy, massage, and every possible shoulder exercise you could imagine.

The pain either goes away temporarily, or sometimes it gets WORSE!

When it comes to shoulder pain, it’s critical that you know for certain if the pain is actually coming from your shoulder, or somewhere else. If not, you risk trying to fix the wrong problem… and that explains EXACTLY why your shoulder pain isn’t going away.

So… if your shoulder pain isn’t caused by your shoulder — where is it coming from?

The most common culprit is actually your NECK. Below are a few key signs to help you figure out if that’s the case…

(PS – we’re doing an online workshop on this topic in just a few weeks.)

Where is your pain?

When your pain is coming from your shoulder, the pain will always be localized to your shoulder alone. True shoulder pain is felt directly in front of your shoulder, directly on top, or in a more involved shoulder problem (like a rotator cuff injury) you might feel some achiness down the side of your arm… but it will never go below your elbow.

If the pain goes past your elbow and into your forearm or hand, or radiates above your shoulder into your neck (the upper trap area), or if you feel it deep inside of your shoulder blade in your mid-back, odds are pretty good that you’re dealing with a neck problem and not just a shoulder problem. This could be the reason why your shoulder pain isn’t going away.

Do your symptoms involve numbness, tingling or burning?

These are signs of nerve compression or irritation. If that’s happening, it’s likely coming from your neck – and could be due to a bulging disc or a restricted/faulty movement pattern that is irritating nerve roots in your neck. An isolated shoulder problem typically does NOT involve nerve root compression or irritation. This is much more common in a problem related to your neck, and if that’s what’s happening, you will feel symptoms into your shoulder, shoulder blade, or even down into your arm. What’s particularly misleading is that it’s entirely possible to feel all these nerve symptoms and not actually feel anything localized to your neck. This is a big reason why shoulder pain caused by a neck issue gets missed by so many health practitioners.

Have you lost mobility or range of motion?

Lack of mobility and stiffness are common symptoms associated with a rotator cuff injury or the dreaded “frozen shoulder.” If your neck moves well and is pain free, but your shoulder is stiff and immobile, odds are good that the problem is actually in your shoulder and you just haven’t found the right treatment approach yet. BUT… if you have a stiff and painful neck, and you lack mobility in your shoulder, then it’s absolutely imperative that you investigate your neck. If your care provider only focuses on stretching and improving your shoulder mobility, and never bothers to look at your neck, it’s possible you could be missing a key component to full recovery… and that’s why your shoulder pain keeps coming back.

 

Questions About Your Shoulder Pain? Here are Some Real Answers.

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Often when clients come to us with shoulder pain, they’ve already tried several approaches without success. But the real issue is that everyone they’ve seen up to that point has failed to give them an accurate diagnosis.

Without an accurate diagnosis, treatment fails.

It’s not surprising. The true cause of shoulder pain is missed by many and can actually be difficult to diagnose. Sometimes it really is your shoulder, but in other cases the pain is actually caused by a problem in your neck. If there is irritation or inflammation in your neck, but someone is aggressively treating your shoulder, guess what? You aren’t going to see results and your pain may even worsen.

Here are a few questions to ask if you’re wondering if really have a shoulder problem… or if you should be getting help for your neck instead.

Where is your pain?

 When you have an actual shoulder problem, the pain is always going to be just in your shoulder. The most common areas to experience pain are directly in front of your shoulder, directly on top of your shoulder, or in a more involved shoulder problem – like a rotator cuff injury – you might feel achiness on the side of your shoulder and down into the side of your arm a little. If the pain goes past your elbow, is above your shoulder and into your neck (the upper trap area), deep inside of your shoulder, or in the back into the shoulder blade, it’s entirely possible (and maybe even likely) that your neck is involved or totally responsible for your “shoulder pain.”

Do you have numbness, tingling or burning?

These are signs of nerve compression or irritation. If that’s happening in your neck – say due to a bulging disc or restricted/faulty movement patterns that irritate your nerve roots – you can feel it into your shoulder, shoulder blade, or even down into your arm.

What’s particularly misleading is that all of this nerve difficulty in the neck will only be felt in your shoulder or arm.

When do you feel stiff?

Lack of mobility and stiffness are common symptoms associated with a rotator cuff injury or the dreaded “frozen shoulder.” If your neck moves well, is pain free, and your shoulder is stiff, odds are that the problem is in your shoulder. Now, let’s say you’ve got stiffness in your neck as well as your shoulder. It’s possible the neck stiffness is a result of your shoulder not moving properly. However, you’ll never know for sure without a proper assessment. If there is even a hint of a neck issue being fully or partially responsible for your shoulder problem, it must be addressed or you will never achieve full recovery.

I do everything I’m told, why won’t my shoulder get better?

This is probably the number one sign that your shoulder problem is not really a shoulder problem at all. If you’ve had pain for months, or if you fix your pain but it keeps coming back, then there is a very good chance someone has missed something. Quite possibly, it’s a hidden neck problem. I can’t tell you how many times I’ve seen this happen. I’ve seen people try three different therapists who’ve prescribed the best rotator cuff exercises on the planet. I’ve seen people get multiple cortisone injections in their shoulder. And worse, I’ve seen people get surgery – only for their shoulder to problem return months or years later. If this sounds like you, then someone has missed the boat and your shoulder problem may not be a shoulder problem at all. You need to find a physical therapist who is a specialist and can properly assess you. They’ll know the right questions to ask, take their time doing a thorough and proper assessment, and get you on the right track to getting better.