Shoulder diagnosis and treatment

[Time2]

Last year my right shoulder gave me pain and limited mobility, I found I had a problem when I couldn't throw a ball with the kids. ( I had no idea, I was always a good ball thrower and handler)
Went to a surgeon, he took xrays, said I had a bone spur, not visible to me and he didn't explain. He have me a shot and my shoulder was worse for 8 days. Two weeks later I went back he said let's get an MRI, so would he know what to fix. I said, "can we try PT first", he said, "oh ya, you can try that if you want". So 6 weeks of PT and shoulder no longer aches and I have much better range of motion.
Shortly after that, my left should has a range of motion problem, different direction, and a different ache. I don't want to go to the same surgeon. I think I want an Orthopedist, but that seems to mean surgeon. Is there another type of doctor that would do xrays or an MRI, without immediately going to surgery? Maybe I should just sign up for PT, it worked before, but I want to know what is causing the pain and why! On Medicare.

 

[Bamaman]

Understand that what the first doctor was going through a standard plan of action they call "protocol." They essentially go through cortisone shots and PT for everybody.

Just be glad your actions worked--for now. That doctor did his job.

The bone spurs are results of a loss of cartilage in a joint, and the spur is to keep the bones apart. It's there because of arthritis in a joint.

And once arthritis starts up, you can expect it to crop up elsewhere. In your case, that may be the left shoulder.

Most people will go to orthopedic surgeons for treatment. Ortho groups also have sports medicine specialists and Physiatrists that may be M.D.'s but not surgeons. The Physiatrist specializes in sports medicine AND cortisone injections--and it's a new specialty.

I asked my physical therapist what his most dreaded condition was. He quickly said shoulder surgeries because they can take a full year to get over. And many people don't do their exercises as prescribed because the PT is often painful.

 

[DektolMan]

Talk to your PT and ask who is the best shoulder doctor in your area. They know them all and will recommend one for you. I had a frozen shoulder and then the next year after that healed I fell and broke the same shoulder. My doctor told me the last thing he wants to so is surgery and with PT and a lot of hard work I'm back 100%

 

[RunningBum]

Try a sports medicine doctor, or your family doc. I don't think a cortisone shot should be your first recourse. If you can go back to PT without a referral from a doc, just do that. If that fixes it, you don't need to know what it is. If it comes back, get the MRI and figure it out.

 

[RunningBum]

Talk to your PT and ask who is the best shoulder doctor in your area. They know them all and will recommend one for you.

Oh, that's a great suggestion! Yes, the PT should know who to recommend.

 

[Time2]

Understand that what the first doctor was going through a standard plan of action they call "protocol." They essentially go through cortisone shots and PT for everybody.

But that was not the impression I got, he took the xrays and diagnosed a bone spur. I was led to believe he then wanted an MRI, to guide him in surgery, I suggested the PT. I was not happy with him immediately turning to surgery.
Then there was another problem, I was talking with someone that has had back and shoulder surgery, his surgeon became ill so, he tried the doc I went to, he said he smelled alcohol on the doctor and he would not go back. I didn't notice that, but I can't forget it either.

Just be glad your actions worked--for now. That doctor did his job.

The bone spurs are results of a loss of cartilage in a joint, and the spur is to keep the bones apart. It's there because of arthritis in a joint.

And once arthritis starts up, you can expect it to crop up elsewhere. In your case, that may be the left shoulder.

Most people will go to orthopedic surgeons for treatment. Ortho groups also have sports medicine specialists and Physiatrists that may be M.D.'s but not surgeons. The Physiatrist specializes in sports medicine AND cortisone injections--and it's a new specialty.

I asked my physical therapist what his most dreaded condition was. He quickly said shoulder surgeries because they can take a full year to get over. And many people don't do their exercises as prescribed because the PT is often painful.

Maybe I should just try the PT route first.

 

[Montecfo]

My internist of many years strongly encouraged me to avoid shoulder surgery (rotator cuff) due to what he described as poor track record of success.

I have managed so far.

 

[SnowballCamper]

I third the ask the physical therapist who a good doc to see advice. Surgeons want to do surgery...

 

[harley]

I had a similar problem a number of years ago, but with both shoulders. My doctor told me I had frozen shoulder, and just to do PT and exercises. It got better, but very slowly. A couple of years later I noticed I could throw again and do movements that had caused pain before. I never really figured out what it was all about, but at least it got better. I'd have lived with the pain before I would get surgery, unless they could actually show me a physical problem that could be fixed.

 

[Bamaman]

Let me just say that surgeons don't necessarily do surgery first. Most of the big ortho groups have all the specialties in house--including physical therapists. They'll also have sports medicine doctors.

I'm getting ready to take my wife (today) to a huge practice, and they have health club and pharmacy in house.

Most often, diagnosis and treatment is first. Surgery is the last resort.

 

[Aerides]

I think I want an Orthopedist, but that seems to mean surgeon. Is there another type of doctor that would do xrays or an MRI, without immediately going to surgery?

You want an Orthopedist, who is also a surgeon, who also includes Sports Medicine in their skills. You just don't want this current guy, who seems like he has a hammer and thinks everything is a nail.

Most/many docs will go to surgery only after other less-invasive solutions didn't work enough for the patient. I mean a torn rotator cuff isn't going to fix itself, but for many people, PT alone can enable them to live with it.

Any doc that rushes to surgery would cause me to rush out of their office. Particularly the shoulder (rehab is a huge PITA and a long event). When it comes to my health I want to be comfortable with my doctor, period.

I'm currently looking at shoulder surgery in the near future, and I know to plan for being useless, in a sling for a month, and being unable to lift anything over 1lb for 2-3 months. Then the rehabbing starts. At 6 months I should feel back to 75%, but probably a year for 100%. But I'm going to go ahead before my latest cortizone shot wears off as we've exhausted other stuff over the past year.

ETA: Any doc that would even discuss treatment without an xray is a waste of time, and surgery without an MRI? Would insurance even approve that?

 

[Time2]

OP here.
I'm not sure if I didn't explain well, but the doc was ready to go to surgery, and I got in the middle between xray and MRI and said can we do PT first!
My family practice doc sent me to the orthopedic surgeon and said do not rush into surgery.
I called Boomer Benefits and they suggested if the PT said it was medically necessary than it would be covered by Medicare. I called the PT and they said get a referral (script as she said) from my family physician.
I need to get started, I hate this! It's a real pain in the
shoulder.

 

[Bamaman]

OP here.
I'm not sure if I didn't explain well, but the doc was ready to go to surgery, and I got in the middle between xray and MRI and said can we do PT first!
My family practice doc sent me to the orthopedic surgeon and said do not rush into surgery.
I called Boomer Benefits and they suggested if the PT said it was medically necessary than it would be covered by Medicare. I called the PT and they said get a referral (script as she said) from my family physician.
I need to get started, I hate this! It's a real pain in the
shoulder.

That's what they call a protocol. It's a step 1, step 2, step 3 and step 4 before the surgery. And look for cortisone shots and physical therapy to be part of those steps. It's all part of their plan of action to solve your problem.

I too had a nagging little shoulder injury. It'd sometimes keep me up at night. Fortunately I waited long enough and it healed.

My wife wasn't so fortunate as she ended up with a 6" rod inside the bone and the surgeon would have replaced her shoulder had he known how badly it was damaged. She still suffers with it 2 years after surgery. She originally was in PT, and the therapist insisted she life some free weights which finished her shoulder off.

 

[Aerides]

+100 on the cortizone shots. They don't work for everyone, and they don't work instantly, but when they do, it's wonderful. Basically a very local anti-inflammatory. Before my last one (I had let things go an extra couple of months to see if I could just grin and bear it), the pain was causing range-of-motion issues and was a real bear at night.

If your doc hasn't offered one, or some short term pain management, yet another vote for another doc.

 

[Time2]

OP here, last post. The doc didn't recommend PT, I did.

 

[daylatedollarshort]

I actually think your shoulder issues might be a normal bio-mechanical problem as I am going through the same thing right now. My right shoulder was pulled down and tight, my left shoulder was higher and and pulled forward. I had to raise my right shoulder with stretches and yoga to get it released, now my left shoulder is lower and needs to go back up a bit, get pulled back and get the tight muscles on the top massaged / stretched out.

The problem with PTs, in my experience at least, is many of the ones I have seen work on one part of your body when most issues really involve every part, from top to bottom and side to side. We're built more like a Jenga games than a car where you can change or remove one part and everything else stays fixed.

You might want to check the muscles at the top of your shoulders and see if one is tighter or higher than the other, and if so try to get them more even. Also there are books on posture where you can compare your posture / muscle alignment to perfect posture and see if uneven or forward shoulders might be part of your issues and what exercises or yoga poses might help for correction.

 

[Philliefan33]

Another vote that you are experiencing frozen shoulder. I’ve been through it (twice).

I tweaked my right shoulder lifting tree parts while cleaning up after superstorm Sandy. Within three months I had almost zero ability to raise my arm. Went to an ortho who gave me a cortisone shot and prescribed PT.

After six weeks of painful PT sessions with the therapist strapping me to the table and forcing my shoulder to move, I had gained some ROM. After a couple of more weeks continuing my home exercises I had about 80% ROM. It took a year to get back to normal, but even then my flexibility was not good.

Then year after the right shoulder issues my left shoulder froze for no good reason. This time I went to a different PT who preferred massages. That didn’t seem to work, but I noticed that my shoulder seemed looser after yoga (even though some of the poses were impossible with a frozen shoulder). I dropped the PT and just did my at home stretches and yoga. Paddling my kayak also seemed to help. It took a year for the left frozen shoulder to resolve.

My takeaway was that try what you like, frozen shoulder takes a year to resolve.

I used to have good shoulder flexibility but that has never recovered. Or at least not yet.

 

[eytonxav]

Some shoulder issues later in life are attributed to scar tissue from earlier injuries that can be broken up with some rolling, using a hard rubber ball. I actually use a baseball to roll my shoulder out periodically and it works wonders. Worth trying before PT, and other treatment options.

 

[Richard4444]

In 2000, I couldn't move my left shoulder. Internist referred me to shoulder orthopod who talked about rotator cuff surgery. I then googled 'rotator cuff' and for $19.95, I bought a set of elastic rubber bands and I obsessively used these (as per the instruction booklet) and a lot of ice. Took about 2 months and I have been asymptomatic since then.
Then I connected with a teenage neighbor who became an orthopod in Boston and now only does shoulders and he told me that everyone gets rotator cuff issues as they age, some require surgery and some don't.
Just sharing with the group that rubber bands and ice worked for me.

Rich

 

[scrabbler1]

Back in 2016 I had a frozen left shoulder (I am right-handed), with much of its movement limited and/or painful. I had been diagnosed with Type 2 Diabetes a year earlier and was told that people with Diabetes are more prone to this ailment. I went to an orthopedist and he gave me a cortisone shot which helped a lot, and very quickly (less than 24 hours). I went to PT for 6 weeks and took an anti-inflammatory for a few months. I had about 90% movement back by the time the PT ended, and the rest came back on its own a few months later. The PT was more boring than painful.

 

[Ian S]

I dealt with shoulder problems for a decade. First time (left shoulder), the orthopedic surgeon tried a cortisone shot followed by PT and that worked. Years later, the right shoulder acted up. Again, cortisone shot followed by PT which did NOT work. MRI showed torn rotator cuff and so surgery was performed followed by several months of PT. Just when I had recovered from that surgery, I tripped and fell in a parking lot and reinjured the left. Again, cortisone shot followed by PT didn't work and I had surgery which did.

I found the rotator cuff surgery fairly straight forward; it was the rehab that was a bear and lengthy. I wouldn't wish it on anyone. But the pain of the torn rotator cuff and the limitations on what I was able to do and the knowledge it would not get better on its own forced the decision to have surgery.

 

[daylatedollarshort]

In my experience with frozen and other shoulder issues for me and one of our kids, tight leg muscles are also usually a factor, especially on the sides of our thighs. I'm having that issue now. We were watching a movie the other night and while sitting there I just kept working on my leg and especially thigh trigger points, either with moist heat packs, trigger point tools or a roller, and since then my shoulders / neck pain issues have been noticeably better.

 

[tmm99]

In my experience with frozen and other shoulder issues for me and one of our kids, tight leg muscles are also usually a factor, especially on the sides of our thighs. I'm having that issue now. We were watching a movie the other night and while sitting there I just kept working on my leg and especially thigh trigger points, either with moist heat packs, trigger point tools or a roller, and since then my shoulders / neck pain issues have been noticeably better.

Thigh trigger points to relieve pain in your shoulders/neck? Interesting.

 

[daylatedollarshort]

Thigh trigger points to relieve pain in your shoulders/neck? Interesting.

If you have one low shoulder, then the other shoulder is usually high. Then the hips are usually out of alignment as well, and so on down your body. If tight muscles are the main problem, in my experience I can't fix one part without working on every part of the body. It is all connected by connective tissue.

You can do a search for upper crossed syndrome and lower crossed syndrome on Google. The resulting sites usually have diagrams of how muscles alternate between weak and strong when they are out alignment front to back and correlate with posture issues. There is no way if people look like any of the pictures simply exercising or stretching just one part of the body is going to result in a permanent fix. The whole dysfunction pattern has to be addressed.

Upper and lower crossed syndrome
https://healthjade.net/wp-content/uploads/2020/03/cross-syndrome.jpg

Side to side and all sorts of other variation issues can also occur but I am not away of any pattern names for those, but they are usually addressed in yoga therapy or posture books.

 

[tmm99]

If you have one low shoulder, then the other shoulder is usually high. Then the hips are usually out of alignment as well, and so on down your body. If tight muscles are the main problem, in my experience I can't fix one part without working on every part of the body. It is all connected by connective tissue.

You can do a search for upper crossed syndrome and lower crossed syndrome on Google. The resulting sites usually have diagrams of how muscles alternate between weak and strong when they are out alignment front to back and correlate with posture issues. There is no way if people look like any of the pictures simply exercising or stretching just one part of the body is going to result in a permanent fix. The whole dysfunction pattern has to be addressed.

Upper and lower crossed syndrome
https://healthjade.net/wp-content/uploads/2020/03/cross-syndrome.jpg

Side to side and all sorts of other variation issues can also occur but I am not away of any pattern names for those, but they are usually addressed in yoga therapy or posture books.

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?