How To Diagnose Shoulder Pain With 3 Simple Tests

Are you suffering with shoulder pain, and you’re wondering what the heck is going on in there? In today’s video, I’ll be covering three simple tests that you can do to diagnose fairly accurately what’s going on inside your shoulder and find the root problem of your shoulder pain so that you can figure out what type of exercise what type of treatment you best need right now, because some treatments might hurt certain types of shoulder problems, while others of course will help.

Finding the root problem is very important in properly treating your shoulder issue. Real quick, my name is Dr. David Middaugh, and I’ve been helping out people with shoulder problems for years here in the clinic. In El Paso, I have a clinic here called El Paso Manual Physical Therapy. And then we’ve also been helping out people online for years through our YouTube channel.

Over the years, we determine the three most common types of shoulder problems that we see are one tendon related problems, like your rotator cuff tendinitis, rotator cuff tears, there’s also the biceps tendon is a it’s a common tendon that can be affected in shoulder pain, to joint problems, the ball and socket joint itself can be an issue, there’s cartilage there, there’s other tissues involved, that can cause problems in the shoulder, it can be the source of a shoulder problem.

Then the third one is nerves, there are tons of nerves surrounding the shoulder itself. And those feed into muscles and the joint itself. So finding out if your problem is more nerve driven, is a big deal so that you can do the right treatment for nerves. Because you don’t want to do a joint treatment for a nerve problem, or a nerve prop, no nerve treatment for a tendon problem, you got to make sure you find the right one.

Now, oftentimes, when people come into the clinic to see us here, for their shoulder problems, they’ve had an X ray or an MRI, and they’re looking at the certain tissues, specifically arthritis to try and see they got arthritis in the ball and socket joint, or some sort of tear, especially in the rotator cuff muscles. There’s for rotator cuff muscles as supraspinatus, subscapularis, terry’s minor, and the infraspinatus. And their four muscles that hold the ball up against the socket, and the tendons of those muscles sometimes can get injured or even torn.

There are different types of tears. And that depending on what you’ve got going on, it’s probably very likely that you can get better despite even having a tear. We’ve seen this in research and of course, here in the clinic, and I’m sure other clinics around the world that have been treating people for shoulder problems have seen that even if there’s a tear in your rotator cuff tendons, it is possible to improve.

Another common tenant that can get involved is the biceps tendon, your biceps muscle is right here. And it’s got two tendons that come up into the shoulder. One of them the longer one goes right over all those rotator cuff tendons and the muscle and attaches to the top of the joint in the ball and socket joint. And if you’ve got problems in your shoulder, you often will find that that biceps tendon gets irritated that could be one of the sources of pain as well.

I just want you to note, it is possible to have two or even three of these things happening all at the same time. So it’s and that’s more common. It’s rare that it’s just one thing. It’s just a tendinitis or a tendon tear, or just an arthritis, or just a nerve problem, it’s very often that you have overlapping conditions. So as I go into the test that I’m going to show you here next, just keep in mind that it is possible to have multiple things happening. And that might mean that you need to treat multiple things at the same time, in order for your shoulder problem to get better. And this information is critical.

Because if you’ve had a shoulder problem for a while, and you’ve been trying out different types of shoulder exercises, or shoulder treatments, like you’ve got to go see some specialists, maybe a doctor or a physical therapist, or some other shoulder treatment that you’ve done, maybe at home, you’ve done some videos or stretches and exercises, a common one is a rubber band exercises return in and out.

If they have not worked for you, chances are there’s multiple things going on. And it just you need a combination of treatments to make sure that you effectively treat this shoulder problem so that it is cured because there’s a good chance that you don’t need surgery. And that you can resolve the shoulder problem without having to rely on medications or having to get injections frequently.

Now let me go into the tests here next, so you can try them out at home right now. They’ll take just a few minutes to do and then I’m going to talk to talk about them a bit afterwards. So that if you want to hear the breakdown about why doing these tests and what they mean, you can listen for that and make sure you have a better understanding of what’s going on in your in your shoulder so that you can know how to proceed and treatments.

Number one loss of motion or painful motion. So all you need to do is with that shoulder that bothers you reach all the way up. As long as it doesn’t hurt. You know if it starts to hurt, it becomes too Hear and it starts to bother you, or you just can’t you come up to here and you’re like, Ah, it’s kind of hurting too much to even go. Those are loss of motion and painful motions. In other motion, it’s important to do is reaching behind your back like you’re reaching up towards a bra strap or to put on your belt, like the back belt loops behind you.

If going in that direction is beginning to hurt up here in the shoulder area. That’s also what we call a positive sign, or it means that it’s a sign that is a ding towards your shoulder problem. That test specifically tells us that there’s probably a tendon problem, or a joint problem one of the two, if you have a loss of motion, like you can’t even get back there, you can even come up, then you probably have a joint problem.

I’ll explain more about what the reasons for that is that if you just have painful motion, maybe you can actually move pretty good in every direction. And you can try reaching forward, you can go in any direction, you’re not really limited. in a specific direction of movement, what you’re looking for is does your shoulder hurts whenever you move it in the extreme ranges of motion, or are you limited compared to your other side, whenever you move in all these ranges of motion, if you have pain at without any of the motions, and this would be a positive test. And if you can’t reach the same way in one side versus the other side, especially if it’s the painful side. That’s also a positive test. So loss of motion, and or painful motion is your first test.

Now the second test is tenderness into specific places. If you feel the bones in your shoulder up here, and right on the corner of your shoulder where you feel the bony part, and then it kind of there’s an edge right there. And then you fall off right off the edge. If you poke and rub it right there. That’s one of your rotator cuff tendons.

A lot of people think they’re way down here, they’re actually up here, you can look it up in the anatomy books, or Google the images, rotator cuff tendons are way up here. Now, in that spot, there’s a specific tendon called the supraspinatus. And then right in front of is a subscapularis a little bit behind it would be the, the infraspinatus muscle, it’s a little harder to get to the Terry’s made terry’s minor muscle, I’m sorry, you have teres major, that’s not a rotator cuff muscle though.

If you poke around in that area, just past the corner of the shoulder where the bone ends, and you find a tender spot, there’s a good chance you’ve got a rotator cuff injury, it’s hard to say if you have a tear, you have to go get an MRI and get it diagnosed. But if you have a tear, then you’re probably going to have a loss of motion or painful motion. In addition to this test, this one’s just specific for the rotator cuff tendons.

And there’s another tendon that I mentioned the biceps tendon, and the way that you find is you come to the front of your shoulder kind of the most forward part of your shoulder right here. And you have to kind of dig in there and rub and you’ll find a ropey structure a ropey tissue under there, and that’s your biceps tendon, it’s tender to touch or if you can kind of shift it and strum it back and forth, like it’s a string, a guitar string. And it’s painful.

When you do that, then you probably have involvement of that biceps tendon as well. Some people do get biceps tendon tears, which messes up shoulders, of course, but they’ll see an actual balls of the muscle all the way down here into their elbow, the biceps will kind of sink down. It can be painful, and some people it’s actually not painful, it just looks weird and Goofy, in that usually is surgically repaired, they can bring the tendon back up. But I would look for what’s the root cause of this problem, because there’s tendons don’t just tear out of nowhere, there’s usually some repetitive trauma, some motion that’s happening.

That isn’t correct. There’s some muscle imbalance, usually some way that you’re training, possibly when you exercise or the way that you do things at home, that’s fed into this problem. And it’s usually years in the making, it’s not something that just happens all of a sudden, that’s pretty rare. So just to recap that that’s the second test is tenderness. And these spots just past the corner of the shoulder, the bone of the shoulder out of here, and then on the front of the shoulder, if you rub in there, if it’s tender, that would be another sign that you’ve got a tendon problem.

And the third sign that you’re looking for is nerve related. So what you’re looking for are feelings or sensations that you get specifically pain. If you’ve got pain besides hearing your shoulder like it kind of comes down and especially in this area right here. Or even further down. If you have pain that goes down into the elbow, forearm or even into the hand, or maybe it’s not pain, but it’s like a numbness, adult ache, a tingling sensation of pins and needles sensation.

Maybe it comes on with certain activities, or when you lie when you go to sleep in any lie down especially if you lie down on that side. Even if you lie down the other side and it starts to hurt or ache or become numb or tingly. Oftentimes people’s hands can get numb or tingling, especially if you’re using a phone quite a bit. And then at the end of the day, what tends to happen more thing of the day, that’s another common sign of a nerve problem. numbness, tingling, pain, pins, and needles.

A deep ache is another common one. All of those are signs of nerve problems that could be feeding into that shoulder pain. Now, if you find that those nerve sensations that I just described, kind of come and go, but you have more of a constant ache in your shoulder, that isn’t really affected by movement. So if you have this pain that I’m talking about, but the first test that you did, you’re reaching around, and you’re poking around, and it didn’t really bother you, then likely you’ve got nerve pain driven shoulder pain. So your shoulder problem is rooted in nerve problems.

We’ve actually got to look further up into the neck because all those nerves that end up in the shoulder start up in the neck and the bunch together and go under your collarbone, and end up going in different directions around your shoulder, those the problem may be rooted up in your neck there, you might have neck stiffness, you might have trouble turning from one direction to the other, it could be limited on the side that you have shoulder pain, you may not it’s it takes some investigation to figure this out.

You might also have knots in the neck and shoulder area like in this zone appear, if you find that you have some lumps or some hard spots that are even kind of sore and tender, especially when you poke them. And if you rub them and they it kind of sets off symptoms further down, it’s very likely that you have a couple of ribs that are shifted up. In fact, I’ve got a video covering the top two exercises that you can do at home to relieve knots in the neck and shoulder area.

The link for that video is in the description below. If you just look down there, you’ll get to the exercises the top two exercises that you can do to relieve those knots in the neck and shoulder area and hopefully relieve a nerve driven shoulder problem up here.

Now let me just talk to you a little bit about why these tests are important and how we use them here in the clinic. Now here in the clinic, we have other tests that we specifically do as a specialist as physical therapists. We’re looking at a certain muscle, certain joints, certain tissues like cartilage versus ligaments, and all that you need to know all that all I want you to know is on that first test that I described the range of motion tests you’re reaching around to see if you’re limited.

Or if it’s painful whenever you go and reach out in certain directions. on that test, it’s moving your joint, so it’s testing the joints, it’s also causing to use your muscles. So that means that it’s straining a little bit on the tendons which tendons connect muscles to bones. And the muscles themselves haven’t even mentioned muscle spasms, muscle spasms tend to be pretty painful just for a moment. And then they kind of like go after a while if you take medication or rest.

But if you’ve got a shoulder problem that’s been going on for weeks or months, it’s less likely that you’ve got just a muscle spasm and there’s probably some sort of tendon involvement or joint involvement. Now, when I’m talking about joint problems, specifically, you might be saying, well, what’s the diagnosis? What’s the doctor going to tell me when I go and see them, or maybe you went to the doctor already. And they’ve given you a couple of diagnosis. Here is what you’ll find, though, you might have signs of arthritis, you might have some changes on the bone surfaces within the joint, that would be arthritis.

Another one is cartilage loss like bone-on-bone type of situation developing in the shoulder joint, if you’ve got a loss of cartilage and arthritis both can happen simultaneously, then you’re typically going to have a loss of motion like you can’t get up past a certain amount, you might be able to go all the way up on this arm. But this arm is just kind of stuck and doesn’t want to go up even further. It might even be painful to push through it and you can’t even get through it.

Another sensation people will get as a kind of clumps and pops repetitively, every single time you move, there’s a repeatable clunk or pop in the joint, that’s a sign that there’s some cartilage or joint problem. Now if you’re younger, if you’re say 40s and under, and you’re you have this issue going on, you may not have full blown arthritis, or you may just have beginnings of arthritis. But the joint might actually get stuck like an older person, you know somebody in their 70s or 80s or beyond. And that could be what we call an acute joint restriction acute meaning it just happened.

It’s sudden, joint restriction the ball and socket joint can shift it has quite a bit of flexibility. And it can shift in a certain direction where the joint just kind of get stuck. It needs to be wiggle back in place that can be done on your own using certain exercises. Or if you go see a specialist like us here, we’re a manual therapy clinic for physical therapists. We can by hand move that joint back into place and oftentimes restore the motion back to normal which is miraculous for the person.

They usually like oh my gosh, what kind of booted did you do? And they’re back to normal with their with all their emotions in the shoulder. There’s some exercises to do afterwards, but it’s typically quite curable real quick Let’s talk a little bit about that second test where you’re poking in the finding the exact location can be a bit challenging for some people.

So remember, just go off the corner of your shoulder and fall right off the edge, you can still like right now I’m on it, and I can still feel the edge of the bone with the pad of my finger and the tip of my finger. So here’s the pad, here’s the tip. So pad of my fingers still on the bone, the tip of my fingers digging in on the tendons right there, those tendons will get irritated. And just think of this, if you were to rub your skin real hard, you could take that for a little while.

But after a minute or so maybe a few minutes, your skin will become irritated, right, you’ll get red, you will like it, you want somebody to stop doing that, whoever’s rubbing you like that. And if you rub long enough, you probably rub the skin raw and maybe even cause it to bleed inside the shoulder. Because the shoulder joint is so flexible, you’re, you’re it’s possible for you to rub those tendons a little too much just like you’re rubbing your skin and irritate them. And that’s what sets up a tear.

If you do this long enough, some people don’t have much pain leading up to the tear. There are several reasons for it. There are genetic reasons. So people have the inside of their shoulder joint is just shaped in such a way that they’re more predisposed to get tears. The chromium is something you hear about the chromium shape, there’s different types, type one, type two, type three, and so forth.

So your doctor might have mentioned this to you, if you had an X ray or MRI, they might have wrote that on the report for the X ray to the MRI. So if you’ve got one of those types in, you’re predisposed, but that doesn’t mean that you’re going to need surgery or have to have the joint cleaned out like they do. In some cases, you still have an excellent shot of rehabilitating a fixing this shoulder problem without surgery.

Even though you’ve got you know, a frayed rotator cuff tendons or a funny shaped acromion the bones inside the shoulder where they’re poking the tendons, what you’ve got to do is make sure that you find a specialist physical therapist that can help this issue or go to some of our exercises on our channel, you can go look for neck and shoulder exercises.

If you go to our homepage, and there’s tons of exercises there to begin to help us to begin to help out a rotator cuff tear. We’ve also we’re planning on making some more videos. So if you want to catch those videos, please subscribe to our channel so that you don’t miss any new videos that we put out for shoulder issues as well as other body parts.

Now the last one that I want to talk to you about just explain and break down because we get a lot of questions on this one especially is the nerve problems. So I mentioned how you can get numbness and tingling achyness happens right here is a really common spot because that’s one of the biggest one of the biggest nerves that passes down from the shoulder into the arm.

It’s called a radial nerve, it goes right through here. And oftentimes, even healthcare providers will mistake this for a rotator cuff, they’ll think that they’re causing rotator cuff pain, because whenever they lift their arm up, or if they dig in their heart enough, they’ll feel increased pain right in this area. And they think the rotator cuff muscle is hurting them down here.

Now the one that they’ll mistake you for is the deltoid muscle, the deltoid muscles the covering the outside right here, but it’s pretty rare to get true deltoid pain. And if you’ve traced the nerve, if you look up the nerve on Google or, or you pull out an anatomy book, you can see the pathway, the nerve, and if you follow that same area, you can find that your radial nerve is just upset, it’s just irritated.

If that’s the case, looking up into the neck looking up into the shoulder, the shoulder blade itself, the collarbone those ribs up here, your first ribs here and your second rib is right here, you need to treat those ribs and the collarbone the neck in order to calm down the nerve down here. We’ve seen it so many times here in the clinic where we’ve had patients come in that are scheduled for rotator cuff repair surgery, we look at their MRI, and yeah, they have a small tear, it doesn’t seem like anything super big, something that it seems like they can get it better.

When we test out their symptoms, we find that the primary reason for their pain is the nerves. And so we have to ask the question, if you go get that surgery for your rotator cuff repair, given that today your symptoms are primarily nerve driven, is you really going to fix the shoulder problem. We’ve seen it time and time again. And so we’ll tell people, why don’t you hold off on the surgery, the tears not going anywhere. And let’s treat the nerve problem.

We go to the nerve problem. And we do all the treatment associated with it, which was usually neck and shoulder blade related. And they actually get better. And if they can get better and learn better mechanics and actually have a great shot at repairing that tendon naturally. it’ll heal if you do the right things and calming down the nerves so that you can get back to doing everything.

We’ve had tons of clients go through this we’ve had people that lift weights cross fitters people that are very active with their upper body get cured and they’re shorter problems because we treat the right root of the problem and like in In this case, as I’m describing, it’s the nerves if we can treat those nerves, those rotator cuff issues will begin to diminish and completely go away.

I hope this video was helpful for you today. If you’re considering getting our help in person to help you out or virtually, we could do we have that option as well. All you need to do is scroll down to the bottom of this page and find the button that says request a free discovery visit.

What that is a discovery visit. It’s a 20-minute visit with a specialist physical therapist, we can take a look at your shoulder problem in person or virtually through video software. And we can see how you’re moving if you’re in person will feel your shoulder and will talk to you and ask all the questions that we need to to properly diagnose your shoulder problem. And this is free.

We’re going to do this for free for you. We’ll give you some time as well to ask questions about what treatment would look like for your shoulder problem. We’ll look at the anatomy book and the skeleton. You can ask questions off of those pages as well anatomy book pages in the skeleton. And our goal for you in leaving this appointment is to have an excellent understanding of why your shoulder is bothering you what the root causes and what needs to be done next. Whether it involves us or not, is up to you.

If you choose to hire us to help you with your shoulder problem, then we’ll ask you to become a patient at that time we will develop a plan to treat your shoulder issues so that we can get you back to being healthy, active and mobile again, while avoiding unnecessary surgery or injections or having to take pain medications to treat the shoulder problem.

Oftentimes people are having trouble sleeping at night or having trouble Stephen holding a cup of coffee or a glass of water picking up heavy pans’ pots for cooking or even just putting on their bra or reaching behind themselves for their belts. And in this problem can be cured oftentimes without surgery, medications or injections. I hope that we can be a part of your success story real soon. Have a wonderful day.