Shoulder diagnosis and treatment

[tmm99]

OP,

Some of the posters have mentioned frozen shoulders. I had frozen shoulders (bi-lateral). I think mine was caused by doing too much shoulder press (or pulling too far out). The movement of my shoulder muscles caused excruciating pain. I'm not exaggerating. I see people getting handcuffed behind the back on TV. If someone did that to me when I had the frozen shoulders, I would have passed out from the pain! Even a small movement of my arms slightly toward the back was painful enough to cause me to shout. I couldn't wear anything that I had to pull my arms back to put on, like a coat, so I had to wear loose-fitting jackets/coats or sweaters that stretched. I could have been put under and gotten the muscle mass stretched (I don't remember what is called), or gotten some cortisone shots for the pain. I opted for a PT which hurt like hell and made the pain much worse, so I quit. Frozen shoulders are supposed to resolve in a year or so even if you do nothing about it, so I decided to do just that - nothing. My frozen shoulders lasted about 1.5 years. I didn't get an MRI or X-rays for the diagnosis.

 

[daylatedollarshort]

Frozen shoulders are supposed to resolve in a year or so even if you do nothing about it, so I decided to do just that - nothing. My frozen shoulders lasted about 1.5 years. I didn't get an MRI or X-rays for the diagnosis.

That is good to hear your issue resolved. My grandmother had a frozen shoulder most of her adult life, at least the whole time I knew her. I was glad I found a physical therapist and books to figure out how to fix them for me and our kids, but sad that in hindsight my grandmother lived her whole life with what in hindsight was an easily correctable problem. Mine came from too much computer work and my kid's from too much gaming, plus bum genes since these kind of issues run in the family.

 

[daylatedollarshort]

It sounds like you've studied this stuff! Yeah, I understand what you're saying about everything connected. My layman's idea is to massage the part that's tight, but I guess there are a whole lot more parts involved than just one area. What kind of roller do you use?

The roller I've been using the most is older and I don't know where I bought it, but if you look on Amazon and type in muscle roller there's a big assortment of similar items. Most are stick types but the one I've been using lately has a handle, but I also have the stick kind. They all seem to work well. I really like the little spiney massage balls, too. Diet changes and nutrition testing have helped, too. I have recent thread in on gut and nutrition testing in the Health section here.

 

[Time2]

That is good to hear your issue resolved. My grandmother had a frozen shoulder most of her adult life, at least the whole time I knew her. I was glad I found a physical therapist and books to figure out how to fix them for me and our kids, but sad that in hindsight my grandmother lived her whole life with what in hindsight was an easily correctable problem. Mine came from too much computer work and my kid's from too much gaming, plus bum genes since these kind of issues run in the family.

Hmm, I figured mine came from just not using them in full mobility. I'm hoping after I get mine working again, I can find a senior yoga class or some type of flexibility class.

 

[Bongleur]

I'd have gotten the MRI (at least if insurance covers the bulk of the cost) because the PT can use it to plan the therapy better than with an xray.

 

[pacergal]

Hmm, I figured mine came from just not using them in full mobility. I'm hoping after I get mine working again, I can find a senior yoga class or some type of flexibility class.

Be careful on that! I re-injured a healing shoulder durning a Sr Yoga class. Actually, the instructor did--she came over to "help" position my arms, not realizing I do not have full mobility (still working on PT--it's a lifetime commitment for me). She pushed my arm beyond its comfort place before I could say anything. Ouch.
You would think someone working with seniors would be aware of limited mobility and movement, thats why many take the yoga in the first place!

 

[Time2]

OP here, I went to my doc and got a prescription for PT. Because extended motion put me in such pain, I didn't want to start PT until I could do more movement without great pain. (didn't want someone pushing me) I'm amazed at the amount of movement I have regained in only two weeks, I went from not being able to put on a shirt or belt in a normal manor to now doing both. I'm also in much less pain when I try to sleep. I'm doing range of motion movements a little bit all day long. I have my elastic bands, weights and a rope on a pulley, so doing all the exercises I remember from PT on my other shoulder. Little by little.

 

[24601NoMore]

I'd have gotten the MRI (at least if insurance covers the bulk of the cost) because the PT can use it to plan the therapy better than with an xray.

I've also been dealing with shoulder (left) issues since getting the first COVID shot way back at the beginning of March.

Insurance company wouldn't let me get a MRI without first doing 6 weeks of "alternative therapy" which could have included PT. To me, that wasn't logical as the PT guy wouldn't know what it was he was trying to fix - or even if there was something TO fix. It would have also cost 5X+ what the MRI would cost..

So, I sucked it up and paid for the MRI out of pocket and can't even apply it to my deductible. Good thing I did, because it turns out I have a small (1 CM) tear in my supra... tendon/muscle in the rotator cuff. Doing "random" PT, cortisone injections or other random activities without knowing that could have EASILY made things worse!

I've read that PT can't "repair" a torn rotator cuff but as I'm not in nearly as much pain as some have described am going to give it a go for a couple of weeks at least. I have a really great PT guy and trust him completely..so will see if PT can improve my mobility and other muscles enough that the small tear won't be as much of an issue.

Does really stink, though, that I have a gazillion (OK, $7,000) dollar deductible on the "A"CA plan we have (literally the only choice in our area that will let us keep our existing doctors) so will have to pay everything out of pocket. Boy does ER insurance truly suck..

 

[daylatedollarshort]

Does really stink, though, that I have a gazillion (OK, $7,000) dollar deductible on the "A"CA plan we have (literally the only choice in our area that will let us keep our existing doctors) so will have to pay everything out of pocket. Boy does ER insurance truly suck..

It could be better but before the ACA it was hard for many of us seniors but not on Medicare yet to qualify for individual insurance at any price.

 

[audreyh1]

Be careful on that! I re-injured a healing shoulder durning a Sr Yoga class. Actually, the instructor did--she came over to "help" position my arms, not realizing I do not have full mobility (still working on PT--it's a lifetime commitment for me). She pushed my arm beyond its comfort place before I could say anything. Ouch.
You would think someone working with seniors would be aware of limited mobility and movement, thats why many take the yoga in the first place!

Oh no! Totally unacceptable for a yoga instructor to move your body for you.

Really unbelievable for a senior yoga class instructor as attendees are more prone to injury and take way longer to heal!

 

[Time2]

OP here, now been almost 6 weeks since I got the prescription for PT, that I didn't use, just worked it on my own for 2 weeks and got some decreased pain on movement. Then I started going to the bay and working my shoulder in the water for 45 minutes to an hour. I'm still getting better but very slowly. Sleeping on it is much better but still a little pain. I'll continue the water exercise, around all this rain we have been getting, I wouldn't want to get wet!

 

[ivinsfan]

I've also been dealing with shoulder (left) issues since getting the first COVID shot way back at the beginning of March.

Insurance company wouldn't let me get a MRI without first doing 6 weeks of "alternative therapy" which could have included PT. To me, that wasn't logical as the PT guy wouldn't know what it was he was trying to fix - or even if there was something TO fix. It would have also cost 5X+ what the MRI would cost..

So, I sucked it up and paid for the MRI out of pocket and can't even apply it to my deductible. Good thing I did, because it turns out I have a small (1 CM) tear in my supra... tendon/muscle in the rotator cuff. Doing "random" PT, cortisone injections or other random activities without knowing that could have EASILY made things worse!

I've read that PT can't "repair" a torn rotator cuff but as I'm not in nearly as much pain as some have described am going to give it a go for a couple of weeks at least. I have a really great PT guy and trust him completely..so will see if PT can improve my mobility and other muscles enough that the small tear won't be as much of an issue.

Does really stink, though, that I have a gazillion (OK, $7,000) dollar deductible on the "A"CA plan we have (literally the only choice in our area that will let us keep our existing doctors) so will have to pay everything out of pocket. Boy does ER insurance truly suck..

So the covid shot wasn't responsible for the tear in your rotator cuff?

 

[Aerides]

OP here, I went to my doc and got a prescription for PT. Because extended motion put me in such pain, I didn't want to start PT until I could do more movement without great pain. (didn't want someone pushing me) I'm amazed at the amount of movement I have regained in only two weeks, I went from not being able to put on a shirt or belt in a normal manor to now doing both. I'm also in much less pain when I try to sleep. I'm doing range of motion movements a little bit all day long. I have my elastic bands, weights and a rope on a pulley, so doing all the exercises I remember from PT on my other shoulder. Little by little.

While I'm glad you have a good outcome, I want to share a different PT story:

I went because I was facing reduced options with my shoulder (basically surgery for a calcification deposit left from an old tear, with increasing pain and starting to limit my movement). I can't find my MRI result paperwork, but my therapist listened to me, applied various massage and heat treatments, and prescribed a series of exercises to strengthen the lesser-used smaller muscles around my shoulder.

A couple of exercises didn't feel right, and I freely gave that feedback and the therapist always adjusted with me. No big deal. A good therapist is going to work around your pain and not make it worse.

It went great. Sure the first few sessions when some muscles were newly worked were a bit sore, but I never felt more pain in the injury. The first couple of weeks I was glad it was at least not getting worse as it had been progressing. Then a couple more weeks and it's definitely improved. I am weening myself off and have only two more sessions before I'll stop and see if I can maintain or continue improvement by keeping these new exercises in my routine. So, 10 paid sessions over 5 weeks and now I can sleep thru the night with a dramatic improvement in comfort, from a problem that's been getting worse over 2 years.

I have a HD plan so I'm paying a healthy price for each session, but I really don't care. That's what my HSA is for, and it will be far cheaper than surgery. And while, one day, I will gladly sign up for knee replacement, a shoulder is a totally different story, and the recovery was going to be miserable and long in comparison.

ETA: this is an ACA/HD plan, and I have access to a Sports Med PT facility linked to a local university, and my plan covers 35 visits a year.

 

[chassis]

@Twaddle a surgeon, a personal friend, told me, “ If you see a surgeon you’re going to get cut.” If I don’t want surgery, I don’t go to a surgeon.

I am about 90% recovered from a shoulder injury of my own diagnosis and treatment recommended by my wife, a 50+ state marathoner.

We are in a world of DIY health. The patient must collect his/her own information and make decisions. Similar in principle to DIY retirement savings compared with previously widespread defined benefit pensions.

Most sites that are .edu or .gov are mostly trustworthy.

Discussion boards like this one are good.

YouTube and Wikipedia are also good.

Suggestions from friends and family based on their experiences are good.

The poor U.S. health delivery system should be used a a last resort, after fully and completely exhausting the aforementioned resources.

 

[24601NoMore]

OP here, now been almost 6 weeks since I got the prescription for PT, that I didn't use, just worked it on my own for 2 weeks and got some decreased pain on movement. Then I started going to the bay and working my shoulder in the water for 45 minutes to an hour. I'm still getting better but very slowly. Sleeping on it is much better but still a little pain. I'll continue the water exercise, around all this rain we have been getting, I wouldn't want to get wet!

Glad to hear it's starting to get a little better even without PT.

I went the other route and DID start PT 2 weeks ago, and the one thing my PT guy told me is to absolutely under no circumstances sleep on the injured shoulder - because it would make it much worse and possibly cause a more permanent/larger tear.

Now, my injury might be totally different from yours, but something to be careful of for sure..

So the covid shot wasn't responsible for the tear in your rotator cuff?

Not sure one way or the other. PT guy says I have a "hook"-like knob in my AC joint area that is apparently rubbing on the supraspinatus tendon, and he seems pretty sure that caused some wear and tear over time. That said..the pain and reduced mobility started literally the day after the COVID shot. So, I suspect but can't be 100% sure that I "probably" had long term wear and tear of some level and the COVID shot - whether it was the administration of it that further knicked the tendon OR an inflammatory response from the vaccine itself (like I unfortunately had, big-time throughout my GI system) just pushed things over the edge.

Just started my second week of PT today. Things got a "little" better mid last week but I relapsed Sat/Sun and am feeling this AM's PT more than I usually do..I have a "partial" tear so PT guy is hopeful that it will heal without surgery..but some days I do get discouraged and it's hard to imagine it getting better without surgical repair..

We are in a world of DIY health. The patient must collect his/her own information and make decisions. Similar in principle to DIY retirement savings compared with previously widespread defined benefit pensions.

Very true. We as patients need to be more engaged than ever in doing our own research and really getting into the gory details of understanding what our various physicians believe to be going on - because in my experience, it's increasingly the case that they may or may not "really" be on the right path..and the more we actively engage, the better the outcome.

 

[big-papa]

@Twaddle a surgeon, a personal friend, told me, “ If you see a surgeon you’re going to get cut.” If I don’t want surgery, I don’t go to a surgeon.

I am about 90% recovered from a shoulder injury of my own diagnosis and treatment recommended by my wife, a 50+ state marathoner.

We are in a world of DIY health. The patient must collect his/her own information and make decisions. Similar in principle to DIY retirement savings compared with previously widespread defined benefit pensions.

Most sites that are .edu or .gov are mostly trustworthy.

Discussion boards like this one are good.

YouTube and Wikipedia are also good.

Suggestions from friends and family based on their experiences are good.

The poor U.S. health delivery system should be used a a last resort, after fully and completely exhausting the aforementioned resources.

Not my experience either when I went to an orthopedist for shoulder pain nor when I went to a Neurosurgeon for a lower back problem. In both cases, they started with a very conservative approach - quite a bit of PT work. When that was done, I had the world's strongest shoulder that still hurt and the strongest back that still hurt.

At some point, I could tell that each of the problems were mechanical. In both cases surgery, and the PT afterwards resulted in great outcomes.

Cheers.

 

[Time2]

While I'm glad you have a good outcome, I want to share a different PT story:

I went because I was facing reduced options with my shoulder (basically surgery for a calcification deposit left from an old tear, with increasing pain and starting to limit my movement). I can't find my MRI result paperwork, but my therapist listened to me, applied various massage and heat treatments, and prescribed a series of exercises to strengthen the lesser-used smaller muscles around my shoulder.

A couple of exercises didn't feel right, and I freely gave that feedback and the therapist always adjusted with me. No big deal. A good therapist is going to work around your pain and not make it worse.

It went great. Sure the first few sessions when some muscles were newly worked were a bit sore, but I never felt more pain in the injury. The first couple of weeks I was glad it was at least not getting worse as it had been progressing. Then a couple more weeks and it's definitely improved. I am weening myself off and have only two more sessions before I'll stop and see if I can maintain or continue improvement by keeping these new exercises in my routine. So, 10 paid sessions over 5 weeks and now I can sleep thru the night with a dramatic improvement in comfort, from a problem that's been getting worse over 2 years.

I have a HD plan so I'm paying a healthy price for each session, but I really don't care. That's what my HSA is for, and it will be far cheaper than surgery. And while, one day, I will gladly sign up for knee replacement, a shoulder is a totally different story, and the recovery was going to be miserable and long in comparison.

ETA: this is an ACA/HD plan, and I have access to a Sports Med PT facility linked to a local university, and my plan covers 35 visits a year.

You say, "my therapist" does that mean you are working one on one with someone? The two places I"m familiar with have 5 or 6 therapists and when you go in, you never know which one you will get.

 

[Time2]

Glad to hear it's starting to get a little better even without PT.

I went the other route and DID start PT 2 weeks ago, and the one thing my PT guy told me is to absolutely under no circumstances sleep on the injured shoulder - because it would make it much worse and possibly cause a more permanent/larger tear.

Now, my injury might be totally different from yours, but something to be careful of for sure..

I'll keep that in mind, since that is my first symptom, I'd be laying on my shoulder, nothing abnormal and then it would shift just a little and cause much pain, it didn't take to long and then I was in pain just to lay on it.

Not sure one way or the other. PT guy says I have a "hook"-like knob in my AC joint area that is apparently rubbing on the supraspinatus tendon, and he seems pretty sure that caused some wear and tear over time. That said..the pain and reduced mobility started literally the day after the COVID shot. So, I suspect but can't be 100% sure that I "probably" had long term wear and tear of some level and the COVID shot - whether it was the administration of it that further knicked the tendon OR an inflammatory response from the vaccine itself (like I unfortunately had, big-time throughout my GI system) just pushed things over the edge.

My problems started right around my covid shot also, and I have had thoughts about whether it was a cause or a coincidence.

Just started my second week of PT today. Things got a "little" better mid last week but I relapsed Sat/Sun and am feeling this AM's PT more than I usually do..I have a "partial" tear so PT guy is hopeful that it will heal without surgery..but some days I do get discouraged and it's hard to imagine it getting better without surgical repair..



Very true. We as patients need to be more engaged than ever in doing our own research and really getting into the gory details of understanding what our various physicians believe to be going on - because in my experience, it's increasingly the case that they may or may not "really" be on the right path..and the more we actively engage, the better the outcome.

 

[MissMolly]

Although this has nothing to do with shoulder problems I think my story is relevant:

I, too, have always been more of a DIY person when it comes to a lot of health issues. In late 2019 I started having pain in my thumb. I tried ice – made it hurt more. I tried heat – felt really good as long as my hand was wrapped in a heating pad, but as soon as I stopped the pain returned. I tried Voltaren gel – didn’t help. I tried CBD cream – didn’t help. I bought a brace and wore it every night for months – didn’t help. I researched PT for the problem and did thumb/finger wrist exercises – didn’t help.

The pain continued to get worse and worse. I was waking up several times a night from pain. My fingers began burning with pain – the kind of burning when you’ve been out in the snow for too long and when you come back in that horrible burning pain as your fingers warm up again. I had this pain 24/7. But now we were in the middle of a pandemic and all you heard was “don’t go to the doctor unless you are dying”. So I didn’t go to the doctor.

By late 2020 my fingers started to go numb. My arm would ache and burn sometimes up to my shoulder. I couldn’t grip things or twist things. I was in pain all the time. So I finally go to the doctor in Dec 2020. After x-rays, nerve test, MRI, CT/myelogram and steroid shots (which didn't help) it is finally determined I have severe arthritis of my thumb joint and a problem from a previous (9 years ago) carpal tunnel surgery. Scar tissue had grown in my wrist and hand from the previous surgery and exacerbated by the thumb arthritis had caused my nerve in my hand to become adhered to other tissue causing nerve damage.

In April I had carpal tunnel revision surgery to remove the scar tissue, free the nerve and wrap a thenar fat pad around the nerve to protect it from additional damage. Thumb surgery is still on the horizon later this year. The pain is gone, but the numbness in my hand and fingers remains.

It is a struggle to type. I can’t pick up small objects. I can’t push buttons. I can’t peel potatoes. I can’t button clothing. I cannot do all sorts of mundane, ordinary, daily activities because I can’t feel anything with my fingers. The doctor also explained the nerve that tells the brain where my fingers are in space is damaged. Since my brain does not know where my fingers are, it does not know how to tell them to move – thus the lack of fine motor control of my fingers. He said I waited too long trying to self-treat and it is highly likely the nerve damage is permanent. We still will not know for a few months as nerves grow at the rate of an inch a month, so it will take 6 months to know for sure.

Had I known a year ago that this would be the outcome, COVID or no COVID I would have gone to the doctor.

The lesson I learned is self-treatment is not always the best route to take. If you have pain. Go to the doctor or you may wind up like me. This is not fun.

 

[Aerides]

You say, "my therapist" does that mean you are working one on one with someone? The two places I"m familiar with have 5 or 6 therapists and when you go in, you never know which one you will get.

Yes, I have a scheduled appointments with a single PT Doctor who handles my overall case, who performs massage and laser therapies, and assesses me every visit, and then after about 30 mins hands me off to one of a half dozen or so therapists-in-training (mostly college interns it seems) who supervise thru a series of exercises that my PT doc has prescribed based on where things are overall with my progress.

My last couple of sessions I've asked to focus on things I can do at home, with equipment I have in my own gym.

 

[24601NoMore]

Yes, I have a scheduled appointments with a single PT Doctor who handles my overall case, who performs massage and laser therapies, and assesses me every visit, and then after about 30 mins hands me off to one of a half dozen or so therapists-in-training (mostly college interns it seems) who supervise thru a series of exercises that my PT doc has prescribed based on where things are overall with my progress.

My last couple of sessions I've asked to focus on things I can do at home, with equipment I have in my own gym.

My PT place is setup the same way. Dedicated Therapist who I see every time. A bunch of college age kids who are working their way through Health Science or PT degrees that walk you through your exercises.

I like having the same Therapist every time as he knows my issues, what my range of motion was last time vs last time (so he can gauge my progress, if any), etc. I'm fortunate to have the person who owns this particular location as my Therapist. Guy's been doing it 35+ years and seems to know more about the human body than anyone else I've ever met. Have gotten some really great explanations from him over the years on how things all connect to each other, why I'm likely having the issues I am, etc.

Lots of goodness to having the same Therapist every time, though the assistant (college age kids) do vary. That's not as big of a deal but I've found a pretty big difference in how well they explain things, how closely they watch you, etc so even requested that I get the same person every time, which PT owner guy was happy to do for me.

While I'm glad you have a good outcome, I want to share a different PT story:

I have a HD plan so I'm paying a healthy price for each session, but I really don't care. That's what my HSA is for, and it will be far cheaper than surgery. And while, one day, I will gladly sign up for knee replacement, a shoulder is a totally different story, and the recovery was going to be miserable and long in comparison.

Same here. Likely not going to ever hit my $7K per person deductible, so am paying the full cost of every PT session out of pocket. Was pretty worried about what it would cost and tried my darndest to figure that out ahead of time by working with the PT company's billing department AND my insurance company. Neither was really able to tell me, and I worried it was going to be a gazillion dollars as my average PT session consists of 15 minutes of heat, Therapist working with me (massage, range of motion stretches, etc) for a good 15-20 minutes, an hour or so of exercises with the assistants (college age kids), then 15 minutes of ice. I figured that was going to be hundreds of dollars a visit and was concerned until I FINALLY saw an EOB come through. PT company billed $75. My insurance "covered" $10, even though I haven't hit the deductible (??). So net cost was $65 per session. Fortunately, I only go twice a week and PT guy has me setup on home exercises I can do on the 'off' days. So, $130/week or $520/month. Financially a bit painful, but for what they do for me, pretty reasonable also. And as has been said earlier, a lot less expensive than surgery IF I can avoid it by doing the recommended PT..

 

[Aerides]

Same here. Likely not going to ever hit my $7K per person deductible, so am paying the full cost of every PT session out of pocket. Was pretty worried about what it would cost and tried my darndest to figure that out ahead of time by working with the PT company's billing department AND my insurance company. <snip> PT company billed $75. My insurance "covered" $10, even though I haven't hit the deductible (??). So net cost was $65 per session. Fortunately, I only go twice a week and PT guy has me setup on home exercises I can do on the 'off' days. So, $130/week or $520/month. Financially a bit painful, but for what they do for me, pretty reasonable also. And as has been said earlier, a lot less expensive than surgery IF I can avoid it by doing the recommended PT..

You are not paying the full cost, but the insurance-adjusted cost. Full would be over $200 according to the submissions from my PT to BCBS. I pay the adjusted rate of ~60 per session. I'm reimbursing myself with HSA funds.

I didn't have to do much homework for the price, nor did I try. I wanted the best place in town and googled to find it. there were other less attractive options which may have been cheaper but I wasn't interested. I simply showed up for my first appointment, and they were able to tell me the price per visit based on my insurance. When it comes to health, I will gladly BTD, I'm motivated by far more than cost to avoid shoulder surgery.

 

[24601NoMore]

You are not paying the full cost, but the insurance-adjusted cost. Full would be over $200 according to the submissions from my PT to BCBS. I pay the adjusted rate of ~60 per session. I'm reimbursing myself with HSA funds.

Right. That's what I meant to say - I'm paying the full CONTRACTED cost out of pocket.

I haven't seen what my provider bills yet, but I'm sure the "list" price is way more than $75 per session.

 

[drb391]

read only first page of posts. didn't see what my doc diagnosed - impingement syndrome. had it RT shoulder ~yr ago. got same protocol suggestions, PT, shots, surgery. dl'ed some PT exercises; most required rubber bands or small dumbbells. did couple of the others, occasionally. pain subsided, seemingly on its own; didn't do that much PT. now other shoulder is quite painful; hurts to put on sleeved garments. have appt to see ortho who replaced hip yr ago. will be asking for shots if he agrees