Fortunately, most musculoskeletal pain can be identified with a complete physical exam. The following is a short incomplete list of problems that might be discovered in the exam. Rotator cuff dysfunction including strain, tendonitis (inflammation), tendinosis (adhesions), impingement (pain when lifting arm away from or behind body), bursitis (inflamed bursa sacs that are irritated from friction), and adhesive capsulitis (frozen shoulder). Other musculoskeletal problems of the shoulder might require more advanced diagnostic testing such as x-rays, MRI’s and CT scans and may capture tears, arthritis (several kinds), avascular necrosis, fractures, infections, and tumors.
Fortunately, most shoulder problems are mechanical in nature and are the result of either muscle tightness, joint restrictions in the neck (cervical) and upper back (thoracic) region as well as myofascial trigger points (knots) and adhesions from repetitive stress. Repeated stress on the shoulder from poor posture and ergonomics will contribute to shoulder pain over time. This is why many patients will say that it just came on “out of nowhere” usually upon awakening from a night's sleep. It is not the fact that they “slept wrong” but rather the poor mechanics they use while they sit, stand, and sleep over a period of time. This will ultimately cause an imbalance in the shoulder region including the neck, upper back and shoulder. It is often accompanied by a shoulder impingement or subacromial impingement. SAI is a reduction in the gap between the ball and socket where one of the rotator cuff muscles slides through. The rotator cuff muscle becomes impinged when especially when raising the arm horizontally or attempting to put a coat sleeve on.
The treatment plan will be a relationship between the practitioner and the patient and will consist of therapies in office and exercise prescription at home. Progress is the key! Great results can be expected within 4-6 weeks. Usually, treatments are 1-2 times a week and home therapies prescribed daily.