My Shoulder Hurts. Now What?

By Andy Parsons, PT, DPT - Board-Certified Orthopedic Specialist

Shoulder pain is a common problem affecting many people across the lifespan.  Lifetime prevalence of shoulder pain is as high as 66% in the general population.  Pain in the shoulder can come from many different sources including arthritis, rotator cuff problems like tears and strains, or issues deep in the joint with the labrum. These are just a few of the potential sources of pain at the shoulder. 

When managing shoulder pain, you have many choices including the wait and see approach, anti-inflammatory medications, steroids, injections, physical therapy, and even surgery.  You can initiate care through your primary care physician, your physical therapist, or your orthopedic surgeon in most cases. Some avenues will require prescriptions and some specialists may require referral.  Treatment should ultimately be chosen based on the diagnosis. Rotator cuff tendinopathy and tears are among the most common problems at the shoulder. In many cases, it makes sense to manage shoulder pain conservatively with a physical therapist prescribing stretching and progressive strengthening/loading strategies.  X-rays and MRI tests are generally not indicated as a first line of assessment unless there was a specific traumatic injury. These tests can lead to false positive results if performed too frequently or too early in care. A good orthopedic exam from your physical therapist or orthopedic surgeon can give you much information and options for management. Working your way from most conservative treatment up to the most invasive is appropriate with most musculoskeletal problems.

In people aged 60-80 years old, 20-30% have rotator cuff tears at any given time. Typically, one third of the tears are symptomatic and two thirds are asymptomatic.  About half of the asymptomatic tears may become painful over time. Recent quality studies show that people with rotator cuff tears that do not undergo surgery get similar results to those that opt for surgery.  This outcome may depend if the tear was traumatic or more chronic in nature. Arthritis in the shoulder generally responds to stretching, hands on manual therapy, and NSAID drugs. Total shoulder replacements are a more invasive option if more conservative measures have failed.  Multiple factors determine what care path you choose including your preferences, diagnosis, and what treatment you have tried in the past. Either way, you have options to improve your condition.

Andy Parsons is a physical therapist at ProMedica Defiance Total Rehab at ProMedica Defiance Regional Hospital. You can call 419-783-6943 for more information.

Images source: CDC [Public domain], via Wikimedia Commons

**  This information is not intended to replace the advice of a physician/ physical therapist.

Dizzy? Physical Therapy can help with Dizziness and Unsteadiness!

By Andy Parsons, PT, DPT, Board-Certified Orthopedic Specialist, Vestibular Rehab Certified

When you look up into the cupboard, wash your hair, roll over in bed, or bend to look into a low cupboard does your world spin around you?   Do you feel more unsteady with walking, or do you feel like you're being pushed over? Is it difficult for you to walk down the aisle of the supermarket? Do you feel like you're intoxicated even though you haven't had any alcohol?   If you had any or some of these experiences, then you might be suffering from an inner ear problem. Dizziness often comes from a portion of the inner ear called the vestibular system. Issues in this area of the ear can cause the above symptoms or many other problems.

In fact, 35% of people forty and older have experienced a vestibular problem at some point in their lives.  Luckily, there are good treatment options for folks that are having inner ear dysfunction. The most common type of inner ear dizziness called benign paroxysmal positional vertigo (BPPV) creates a sensation of spinning when moving from sitting to lying, rolling over, or looking up for example. Some people complain of unsteadiness with this condition as well. One out of ten people 75 years and older have this problem. The gold standard treatment for this condition is a series of specific physical positions that reposition loose calcium particles in the inner ear.  Studies report success rates between 75-90% for this type of treatment. Medication is not generally helpful for this condition. This treatment is supported by the American Neurotology Association, the American Academy of Family Physicians, and the American Physical Therapy Association among others. Physical therapists with additional training often perform these positioning treatments for people with dizziness. This is generally accomplished in between 2-4 sessions.

Alternatively, the inner ear system can lose function from a variety of issues like infections, viruses, or diseases specific to the inner ear. People with these class of conditions may complain of increased unsteadiness, bouncing vision, falls, and slower walking. Vestibular rehabilitation can be very effective for these people to increase balance and stability with walking by training the brain to compensate for the inner ear problem. Guidelines recommend around 6-8 weeks of treatment for this type of vestibular problem.

Dizziness is a complex subject. Not all dizziness comes from the inner ear.  Lightheadedness is the most common issue that is generally not responsive to physical therapy.  Talk to your doctor or physical therapist about whether or not this type of treatment would be appropriate for you.

Andy Parsons is a physical therapist at ProMedica Defiance Total Rehab at ProMedica Defiance Regional Hospital. He is certified in Vestibular Rehabilitation and has nearly 9 years of experience working with “dizzy” patients. You can call 419-783-6943 for more information.

References:

1. BPPV: Experts Update Best Practices for Diagnosis and Treatment. Am. Academy of Otolaryngolgy- Head and Neck Surgery. https://www.entnet.org/content/bppv-experts-update-best-practices-diagnosis-and-treatment

2. Vestibular.org

3. Image source: Pixabay via Kalhh. https://pixabay.com/photos/trees-away-nature-eddy-turn-dizzy-358418/