Friday, January 19, 2018


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Lumbar Pain: Signs and Symptoms

Are you suffering from back pain? Why live with it?..... Instead lets try and find out the ways and means of relieving the discomfort associated with back pain

However, the thing that you need to know is to learn more about the main causes. Any problem that you may have in moving your back has a specific cause behind it. While your back pain can develop slowly over days, you may often experience an intense shooting pain, tingling, and even numbness in your low back or down either lower extremity when you try to move, walk or sit.  The reasons behind each kind of pain may differ as well.

 The Lumbar spine is comprised of five bones (vertebrae) in the lumbar spine, although it is not unusual to have six. Each vertebra is stacked on top of the other and between each vertebra is a gel-like cushion called an intervertebral disc. This disc functions to help absorb pressure, distribute stress, and help the vertebrae from rubbing /grinding against each other. The vertebrae and disc are held together by groups of ligaments. Ligaments connect bone to bone, whereas tendons connect muscle to bone. In the spine, tendons connect muscles to the vertebrae. The ligaments and tendons help to stabilize the spine and guard against excessive movement in any one direction.

The spine it very similar to all our joints in our body as the knee, shoulder, and other joints. The spinal joints are called (facet joints). The facet joints link the vertebrae together. They are located at the posterior area of the spinal column (on the back side of the vertebrae). The facet joints functions to make the spine more flexible and enable you to bend forward, backwards as well as side to side.

In the center of the spinal column is a vertical hole called the spinal canal. This canal contains the spinal cord. The bones of the vertebrae serve as armor to help protect the spinal cord from injury.

The spinal cord descends from the brain, through the cervical, thoracic and lumbar vertebrae in the spinal canal. It ends, usually in between the first and second lumbar vertebrae. Below this level a group of nerves called the (cauda equine) which translates to (the horse’s tail) travels through the rest of the spinal canal and branches off to various parts in the lower half of your body.

The spinal cord and the nerves are part of the central nervous system that includes the brain. The nerves are the body’s message board (system). Without this we would not be able to move, feel and experience sensations such as temperature.

Let us now take a look at some of the most common causes of Low back (lumbar spinal) pain:

Lumbago or Low back pain: This is the most common disorder involving the muscles and bones of the back. Lumbago affects approximately 80% of people at some point in their lives. In the United States low back pain is the most common cause of job related disability and a leading contributor to missed work. Low back pain which could be classified as one of the below classifications Sprain or Strain. Can also be classified by duration as Acute pain: (pain lasting less than 6 weeks), Sub-chronic pain: (pain lasting between 6 weeks to 12 weeks) or Chronic pain: (pain lasting more than 12 weeks). Low back pain can be further classified by the underlying cause as either Mechanical, Non-mechanical, or Referred pain.

Mechanical low back: is the general term that refers to any type of back pain caused by improper movement, activities as lifting a heavy object, bending forward, or static loading of the spine via prolonged sitting or prolonged standing activities. Examples:

  • Sprain / Strain
  • Degenerative Disc
  • Degenerative Facet
  • Disc Herniation
  • Spinal Stenosis
  • Compression Fracture
  • Spondylolisthesis
  • Spondylolysis
  • Bulging Disc

If your low back pain is diagnosed to be mechanical in nature then Physical Therapy is a great treatment option for you. This is because in Physical Therapy we are treating the cause of your symptoms and not masking them with Medications or injections. However, there are times when pain medications and or injections are needed for treatment of mechanical symptoms. Sometimes taking medications or injections for low back symptoms will mask or cover up symptoms and patient will return to mechanical cause as poor posture, poor lifting technique, or poor body mechanics with work duties and make injury / symptoms worse.

Non- Mechanical low back: is the general term that refers to any type of back pain caused by inactive life styles. Meaning not caused by activity, movements, posture related stresses to the spine. Example:

  • Neoplasia
  • Infection
  • Inflammatory arthritis
  • Ankylosing spondylitis
  • Psoriatic spondylitis
  • Reiter
  • Paget
  • Scheuermann disease

Referred Low Back Pain: Referred pain is pain that is perceived at a location other than the site of the painful stimulus. Referred pain from the back for example would be. If someone had symptoms as pain, tingling and numbness or any combination of these in one or both lower extremities, however, painful stimulus is from lumbar disc or discs. Example:

  • Bulging Disc
  • Herniated Disc
  • Slipped Disc

Back Strain: Strain is an injury to the area that attaches the muscle to a bone. Now a strain of the low back can be caused by over stretching or over working the muscles by either a physical activity or poor imbalanced posture. Strains will result in pain and or stiffness within the muscles that are being worked/stressed in the low back.Contracting the affected muscle can aggravate the involved tendon that is strained.

Signs and Symptoms:

  • Pain
  •  Swelling
  • Bruising
  • weakness and stiffness
  • popping sensation
  • Immobility of area of strained muscle

Back Sprain: Sprain is an injury to the ligament that attaches a bone to a bone. Now a sprain of the low back can also be caused by over stretching or over working the ligament or ligaments by either a physical activity or poor imbalance posture. We must realize a sprain is a non- contracting injury because a ligament does not contract it is mainly a supporting structure between bones. Therefore sprains will result in pain and or stiffness within the ligaments that are stressed in the low back. Stress on the supporting low back ligaments can result in stretching, tearing or completely tearing the ligament between bone attachments causing lack of stability at that bone to bone attachment.

Signs and Symptoms:

  • Pain
  • Swelling
  • Bruising
  • Stiffness
  • Instability at joint

Degenerative Disc Disease:  Degenerative disc disease is really not a disease at all, but rather a set of circumstances that leads to the breaking down of the vertebral disc or loss of fluid in the disc. This reduces the ability of the disc to act as shock absorbers and make them less flexible. Degenerative disc disease usually starts to show itself as we age and the stresses we put on our low back over the years start to break down the structures of the disc and its surrounding structures.

Signs and Symptoms:

  • Low back Pain “Worse” with sitting
  • Increased Low Back pain with bending, lifting and twisting activities
  • Better with changing positions frequently as in walking and even running
  • Best with lying down

Degenerative Facet: The Facet joints are the joints structures that connect the vertebrae to one another. The facet is like any other joint in the body. They have cartilage that line the joint allowing the bone to glide smoothly over one another. The function of the facet is to provide support, stability and mobility to the vertebrae spine. A degenerative facet mostly occurs when the thin layer of cartilage covering the joints break down, causing inflammation and pain, which maybe slight, moderate to severe.

Signs and Symptoms:

  • Stiffness low back after standing in one place too long
  • Difficulty with twisting and stretching low back
  • Dull pain moving into thigh and buttocks
  • Tenderness around the inflamed joints
  • More discomfort when leaning backwards the forward

Herniated Disc: Is when the disc has weakness in the outer wall in the spine. This allows the soft tissue that makes up the inside of the disk called nucleus propulsus to push against the weakened wall. This results in a bulge forming in the side of the disc wall. This bulge becomes under more stress, during activities as twisting, lifting, bending forward of the spine. When this bulging disc becomes too stressed it can herniate. Herniation is when the disc fluid call nucleus propulsus comes through the disc wall and places pressure on the nerves in the spinal canal. A true herniated disc is when you have symptoms of pain, tingling, or numbness or any combination of these in the associated disc distribution area that does not stop, change no matter what you do with body positions.

Signs and Symptoms: vary greatly depending on the position of the herniated disc and the size of the herniation.

Not pressing on the nerve:

  •  Ache in the low back or no symptoms at all

Pressing on the nerve:

  • Pain, tingling, numbness, or weakness in the area of the body to which that nerve being compress travels.
  • These symptoms will not lessen once they start no matter what body positions you change to.
  • Gets more intense with sneezing, coughing, or straining to pass stools.
  • More intense symptoms with sitting, prolonged standing, and bending or twisting movements of the lumbar spine.
  • Weakness in both legs and or loss of bowel or bladder control are specific symptoms of nerve root compression called “Cauda Equina Syndome”. If you have any of these symptoms you should go to emergency room emediately.
  • When sciatica nerve is pinched or compressed you will get “Sciatica”.

Sciatica is pain that travels down lower back through buttocks and down usually one leg to the ankle. However, sciatica can be present in both legs.

Spinal Stenosis: Is the narrowing of space in the spine which causes pressure on the spinal cord or nerves exiting the spinal cord. Most commonly a result of wear and tear changes related to aging process of the disc, ligaments, bones and facet in the spinal canal.

Signs and Symptoms:

  • Pain in legs, feet, buttocks.
  • Weakness in legs, feet, buttocks.
  • Numbness in legs, feet, buttocks.
  • Cramping in the legs, feet, buttocks.
  • Stiffness in Legs, feet, buttocks.
  • All above symptoms are when Standing or walking for long periods of time.
  • Above symptoms worsen with stretching or extending your low back.
  • Above symptoms worsens with Walking (especially downhill)
  • Above symptoms worsen with standing straight or leaning backwards
  • Symptom Relief with bending forward low back, or sitting down.
  • Symptoms Relief with leaning over grocery cart.
  • Symptom relief with walking Up-hill.
  • Worse cases – loss of bladder and bowel control

Compression Fracture: Is when the normal vertebral body of the spine is squished, or compressed, to a smaller height. This is usually seen in two groups of people. First group are people that were involved in traumatic accidents. What happens in a traumatic accident is a load is placed on the vertebrae that exceeds its ability to maintain stability and the vertebrae collapses causing a compression fracture. Most commonly seen after a fall. The second group are people with Osteoporosis. Osteoporosis is a condition that causes a thinning of the bones or what is called brittle bones. In this condition the bones thin out and are less able to support a load. These people may develop compression fractures without severe injuries as in their daily activities.

Signs and Symptoms:

  • Back Pain that comes on sudden.
  • Back Pain that is severe and comes on gradually and worsens over time.
  • Worsening of pain with Standing or Walking.
  • Pain relief with Lying down
  • Difficulty with bending or twisting activities.
  • Pain with bending or twisting activities.
  • Loss of Height
  • Deformity of the spine (Kyphosis)
  • Constipation
  • Loss of appetite
  • Weight loss
  • Hip pain
  • Breathing difficulties

Spondylolisthesis: Is the displacement of a vertebrae or the vertebral column in relation to vertebrae below. The term “spondylolisthesis” was coined in 1854, from Greek “spondylo” for vertebrae and “olisthesis” for slip. These “slips” occur most commonly in the lumbar spine L5 on S1.

Signs and Symptoms:

  • General stiffening of the low back musculature.
  • Tightening of Hamstring musculature.
  • Changes in Posture (leaning forward slightly when standing).
  • Changes in Gait more of a “waddle” then a walk appearance due to decreased mobility of hamstrings.
  • Atrophy of Gluteal musculature.
  • Generalized Pain in lower back L5-S1.
  • Intermittent shocks of shooting pain beginning in buttocks traveling downwards into back of thigh and lower leg.
  • Sciatica extending below knee into feet
  • Sometimes including tingling and numbness.
  • Sitting and trying to stand up may be very painful and difficult.
  • Complaints of “slipping sensation” when moving into upright position.

Spondylolysis: Is a defect of a vertebra. More specifically it is defined as a defect in the “pars interarticularis of the vertebral arch”. Mostly seen in the lower lumbar spine (L5) vertebrae but can occur in any lumbar or thoracic vertebrae though less common.

Signs and Symptoms:

  • Pain in Low back: leads to reduced mobility and inactivity.
  • Weight Gain
  • Loss of Bone Density
  • Loss of Muscle Strength (core, hips, quadriceps, Hamstrings)
  • Loss of Flexibility of (trunk, hips, quadriceps, hamstrings)
  • Can Progress until one vertebrae slips out of place leading to “spondylolisthesis”

Bulging Disc: A disc bulge (commonly referred to as slipped disc) can potentially press against or irritate the nerve where it exits from the spine. This occurs when the ligament surrounding the disc is injuried to such an extent that the disc loses its ability to absorb and its outer wall called “annulus” becomes weakened. This allows the soft inside of the disc called “Nucleus Propulsis” to bulge outwards and compresses on the nerve root. Depending on how much bulging occurs will result in pain or other symptoms as numbness, sensations of pins and needles, weakness in the area or areas associated with that nerve level. Thus, some of the symptoms may be felt far away from the source of the trouble, for example in the lower leg or foot. Remember that in a bulging disc the Nucleus propulsis stays inside the annulus at all times, unlike in a herniated disc where the Nuleus propulsis breaks through the annulus wall.

Signs and Symptoms:

  • Pain, spasm, cramping, numbness, pins and needles, and or a combination of any of the above.
  • Location depends on at what level the compression, pinching or irritation occurs from L1 to L5.
  • Severity of the above symptoms or combination of symptoms depends on how much the disc (nucleus propulsis) pushes out and puts press on the nerve or nerve root.

Knee Pain: Signs and Symptoms

Are you suffering from knee pain? Why live with it? Instead let's try and find out the ways and means of relieving the discomfort associated with knee pain

However, the thing that you need to know is to learn more about the main causes. Any problem that you may have in moving your knee has a specific cause behind it. While your knee pain can develop slowly over days, you may often experience an intense shooting pain in your knee when you try to move it or walk on it.

The reasons behind each kind of pain may differ as well. The knee is a joint that is compromised of cartilage, bone, muscle, ligaments and tendons all working together. The knee joint has three parts. The thigh (the femur) meets the large shinbone (tibia) to form the main knee joint. The joint has an inner (medial) and an outer(lateral) compartment. The knee(the patella) joins the femur to form a third joint, called the patellofemoral joint.

Let's now take a look at some of the most common causes of knee pain:

Patellafemoral Pain Syndrome (PFPS): this term usually refers to pain around and under the knee cap. It is often called "Runner's Knee". The pain of PFPS may occur in one or both knees, and tends to worsen with activity, while descending stairs and after long periods of inactivity. It is believed that the cause could be the way the patella tracks along the groove of the femur and lead to irritation of the cartilage on the underside of the patella.

Signs and symptoms

  • Knee pain
  • Pain when the van
  • Pain when squatting
  • Pain when jumping
  • Pain when going downstairs
  • Knee buckling suddenly
  • Knee unexpectedly gives away
  • A catching, popping or grinding sensation when walking

Knee Tendonitis: tendonitis is a condition that occurs when one of the tendons that attaches your muscles to the bones become inflamed. In tendonitis of the knee the superior patellar tendon sometimes referred as "quad tendon", or inferior patella tendon becomes inflamed and irritated.

Signs and symptoms

  • Knee tenderness at superior patellar tendon (SPT) or inferior patella tendon (IPT)
  • Knee pain when running
  • Knee pain or hurried walking
  • Knee pain with jumping activities
  • Knee pain with extending the knee joint
  • Difficulty with lifting leg, straight leg raise

Knee sprain: a sprain is a tear of the knee ligaments, the tough bands of fibrous tissue that can expose the bones. In the knee you have a medial collateral ligament (MCL), a lateral collateral ligament (LCL), anterior cruciate ligament (ACL), and posterior cruciate ligament (PCL). These injuries are very common in sports that require stopping or quickly changing directions. These extreme forces on the knee can result in a torn ligament.

Signs and symptoms

  • Knee pain, knee buckle sideways toward side of sprain
  • Knee pain on palpation MCL or LCL
  • Knee pain with special test for ACL
  • Knee stiffness
  • Knee pain with bearing weights
  • Knee pain on standing up
  • Knee pain with cutting activities
  • Unstable knee with stopping or cutting activities

Meniscus injuries: The meniscuses are two pieces of cartilage that act as a cushion in the knee joint. The Cartilage sits between the tight bone (femur) and the shinbone (tibia). These meniscus are named as to where they sit on the tibia condyle, the one on the outside (lateral meniscus) and the one on the inside aspect of the knee (medial meniscus). A meniscus tear occurs when one of these pieces of cartilage tear in her injured it usually during movement that forcibly rotates the knee while bearing weight. This is usually seen in athletic playing sports in which therefore is firmly planted in cutting is involved.

Signs and symptoms

  • Audible click or popping during injury
  • Knee may become locked
  • Knee will become weak and swell up
  • Tenderness on the side of meniscus injury
  • Pain with any weight bearing on the joint

ACL and PCL injuries: these ligaments were mentioned above in the knee sprain section but are much more common than the MCL or LCL to injury.  The ACL (anterior cruciate ligament) and the PCL (posterior cruciate ligament) are two major ligaments in the knee joint that work together to provide the main stability of this joint.  They cross each other and form and X which allows the need to flex and extend without side to side movement.  The ACL injuries are most common during sports that require a sudden change in direction, sudden or abrupt stops and starts and jumping activities.

The ACL is often stretched, or torn by sudden twisting motion while the bullet remains planted in one direction and the knee is turned in the opposite direction.  This can also happen when landing from a jump.  The PCL injuries are likely with impact to the front of the knee, or from hyper extending the knee.  The PCL can also be injured by a direct impact from the outside of the knee joint, such as those that occurred during soccer or football.

Signs and symptoms

  • Excruciating knee pain at time of injury
  • initially a sharp pain on outside and back at knee
  • throbbing aching pain deep in the knee
  • bending or straightening the knee will increased pain
  • pop sound when injury occurs, audible "pop"
  • swelling immediately
  • loss of stability in knee joint
  • loss of strength
  • feeling of unstable or knee giving out
  • limitation with movement 

Plica Syndrome: Plica syndrome occurs when bands of branded synovial tissues are irritated by overuse or injury.  Synovial plicas are remnants of tissue pouches found in early fetal development.  These pouches normally combined to form one large synovial cavity, but if the process is incomplete, plicae remain as for folds or bands of synovial tissue within the knee.  Injury, chronic overuse, or inflammatory conditions are associated with development of this syndrome.  Usually play has syndrome is characterized by pain near the anteriomedial (in front and toward the midline) cited the patella (kneecap).

Usually the pain is associated with bending of the knee and is irritated after and during exercise.  Usually, no other symptoms other than the pain are present, but it can occasionally be accompanied by swelling of the knee after prolonged physical activity.

Signs and symptoms:

  • Knee pain
  • knee swelling
  • knee clicking
  • knee locking
  • knee weakness

Chondromalacia: Chondromalacia patellar is the most common calls of chronic knee pain.  This condition occurs due to softening of the Cartilage beneath the knee cap.  Chondromalacia patellar results from the generation of Cartilage due to poor alignment of the patella (kneecap) as it slides over the lower end of the thighbone (femur).  This is sometimes referred to as patellofemoral syndrome.

Signs and symptoms:

  • Lateral tracking of the patella
  • rapid growth causing uneven pressures of knee Cartilage
  • discomfort of inner front of knee
  • aggravated by activities, running, jumping, climbing or descending stairs
  • prolonged sitting makes it worse
  • quadriceps weakness
  • mild swelling at the knee joint

Total knee replacements: the severe pain in knee joints can be due to arthritis, injury or other infections which can cause deterioration of the Cartilage in the knee.  The knee is made up of three boats: the end of the femur (thigh bone), the top of the tibia (shin bone), and the patella (kneecap), which are all held together by tendons and ligaments and cushioned by cartilage.  When the musculature of the knee joint declines, then the bones of the knee joint mentioned above begin to grind against each other, wearing away causing moderate to severe pain.  Totally replacements involve removing that portion of the bone which is damaged and resurfacing the knee with metal and plastic implants.

Knee replacements have come a long way over the past 10 years.  Latest being gender specific artificial knee replacements developed especially for women.  This was developed because women skeletal features are different from that of men.  The design of the gender knee is based on computer imaging of a woman, it is more narrow, enter and track set a different angle to better match a woman's knee shape and size.

Its biggest advantage is that it allows for better knee bending "flexion" and there is no kneecap discomfort.

What to consider or discuss with your doctor before getting a total knee replacement, always remember the 4R's:

  1. Remove: this type of procedure is the leastUsing a small camera, the orthopedic surgeon will evaluate the cause of her causes of the patient's knee pain and remove any damaged tissue.  This procedure helps patients with knee pain related to or torn meniscus or cartilage injury may greatly benefit from the removal technique.  Total recovery with physical therapy ranges from 2 to 6 weeks after surgery procedure.
  2. Realign: this type of procedure is for patients experiencing knee pain because their joint is not properlyIn proper alignment may contribute to poor joint function and pain.  To restore proper alignment, a surgeon may manipulate the bone, or may release or tighten soft tissues.  This surgical option may require longer recovery time because it takes time for tissue to heal and physical therapy after this procedure is typically required.  However the benefits may be best of all.  Re-alignment of the knee can decrease pain and prevent further damage to the joint.  Physical therapy will balance soft tissue and musculature to better regain range of motion and stabilize the joint for long-term functional outcome.
  3. Repair: some patients with knee pain may benefit from repair of diseased or damagedCartilage transplant can improve and/or restore normal joint function.  With this procedure, cartilage defects are repaired using tissue borrowed from other areas of the patient's own me or from a donor knee.  This repair procedure may be the best option for younger patients who are not ready for knee replacement.  Once again physical therapy would be very helpful in the recovery of this patient, the recovery time will vary based on what area of the knee and how much the knee has been repaired.
  4. Resurface: the resurface option refers to partial knee replacementThe femur, tibia and the patellar and a total knee replacement are all replaced and knee ligaments are removed.  With a partial knee replacement, only one or two of the parts are resurfaced or replaced and the ligaments are not removed.

When considering any knee surgery it is very important to remember your age, overall health, activity level and the gender into consideration for options.

Therefore some knee considerations may benefit from one, two or even three of the 4R's.  For this reason, it is most important that you pick an orthopedic surgeon wisely, we had many excellent orthopedic surgeons in this world but you need to pick one that will best evaluate and diagnose your knee or knees, but most importantly understand your lifestyle and expectations before determining what option is best for you.  I always recommend you get more than one opinion before making any decisions on surgery.

As the owner of Cross Keys physical therapy I have been trained in the Graston technique.  I personally will do a full evaluation and treatment and one of our locations.  The Graston technique is an innovative, patented form of instrument assisted soft tissue mobilization that enables clinicians to effectively breakdown scar tissue and fascial restrictions.  The technique utilizes specially designed stainless steel instruments to specifically detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation.


Shoulder Pain: Signs and Symptoms

Are you suffering from shoulder pain?  Why live with it?

Instead let's try and find out the ways and means of relieving the discomfort associated with silt shoulder pain. 

However, the thing that you need to know is to learn more about the main causes. any problem that you may have in moving your shoulder has a specific cause behind it.  While your shoulder pain can develop slowly over days, you may often experience an intense shooting pain in your shoulder when you try to move it.  The reasons behind each kind of pain may differ as well.  The shoulder is the most-free moving joint in the body.   No other joint in the body has the degrees of motion that the shoulder joint does.  It is composed of four bones:

  • the humorous (upper bones)
  • the scapula (shoulder blade)
  • the sternum ( chest bone)
  • the clavicle ( collarbone)

The humorous and scapula form a ball and socket joint, but the socket is very shallow in the shoulder.    The head of the humorous or upper arm bone is much larger than the socket, like a golf ball sitting on a tree. This bony anatomy allows free motion but does not give the shoulder inherent stability or support.

Let us now take a look at some of the most common causes of shoulder pain

Shoulder Bursitis

Inflammation to the bursa due to trauma, excessive pressure or infection in the fluid filled sac of your shoulder joint.

Signs and symptoms:

  • Discomfort to touch over the shoulder
  • Pain in the upper arm, in particular over the the outside of the shoulder
  • Pain while asleep at night
  • Having difficulty and pain sleeping on the affected shoulder
  • Having pain while lifting the arm, in particular lifting it above the head, as well as other overhead actions or activi

Shoulder Tendinitis

Tendinitis is a condition that occurs when one of the tendons that attach your muscles to the bones become inflamed.  In tendinitis of the shoulder at the tendons of the rotator cuff or tendons of the biceps become inflamed and irritated.

Signs and symptoms

  • Restrictive movement in the shoulder joint secondary to pain
  • pain in the joint with or without stiffness or swelling
  • Pain that is worse at night and early morning
  • pain when shoulder is actively moved
  • pain after activity that has use the shoulder

Shoulder sprain

A sprain is a pair of the shoulder ligaments, the tough bands of fibrous tissues that connects bones to bones.

Signs and symptoms

Most common shoulder sprain is a Grade 1, Acromioclavicular joint (AC) joint sprain.

  • Slight tenderness at the outside tip of your collarbone
  • Mild pain when you move arm or shrug shoulder joint

More severe AC joint sprain signs and symptoms:

  • Swelling at AC joint will distort the normal contour of this joint
  • AC joint will be very tender to touch
  • Significant pain to move arm or shrug shoulder joint

Shoulder impingement

Impingement refers to mechanical compression and where of the rotator cuff tendons.  This condition has many names as swimmers arc, throwing shoulder, and painful arc.  It can cause significant pain, especially if a person places his or her hand behind her back to try to move it or elevate it.  Shoulder impingement symptoms show up when there is some injury to the rotator cuff muscles.  When the injured rotator cuff muscles swell up, it causes an increase pressure inside the muscles.  As a result, the normal blood flow of the surrounding blood vessels gets badly infected.  Due to the decrease in blood flow, the muscles lose the strength and become weak.  It can also occur along with other problems of the shoulder, like bursitis and tendinitis as described above.

Signs and symptoms

  • Constant shoulder pain
  • Pain with rest as well as movement
  • Initial stage of pain is at top of edge of front part of shoulder
  • Later stage of pain moves to the lateral part of shoulder
  • Pain increases with movements of the hand
  • Pain increases when lifting arm above head or reaching up (sharp pain) will occur
  • Quick movements of the shoulder increases pain
  • Muscle weakness
  • Shoulder joint stiffness
  • Cracking or popping sensation at involved shoulder
  • Can lead to rotator cuff tear or damage to bicep muscle
  • Can lead to frozen shoulder

Labral tear

A labral tear is an injury to the cartilage of the shoulder.  The labrum is a ring of fibrous cartilage that surrounds the socket of the shoulder.  It is sometimes called Glenoid labrum.  The labrum helps to deepen the socket and provide stability to the shoulder joint.  It is also where the shoulder capsule attaches.  The labrum helps to provide shock absorption to the shoulder and cushion the joint. 

Labrum tears are usually caused from one of the following:

  • Direct contact blow to the shoulder
  • A sudden jerk or pull of the arm
  • Shoulder dislocation
  • Falling on an outstretched arm
  • Lifting a heavy object with poor technique

Signs and symptoms

  • Pain, especially with overhead arm motions
  • Catching our grinding in the shoulder
  • Sense of shoulder instability
  • Decreased range of motion
  • Loss of strength

Subacromial bursitis

This is an inflammation or irritation of the bursa, which is a small sac located between a bone and muscle, skin or tendon.  The bursa allow smooth gliding between the structures.  The subacromial bursa helps the motion of the rotator cuff and activities such as overhead work.  This movement is most often seen while playing sports as it controls the ability to throw objects or swing objects.  Bursitis is often developed secondary to injury, impingement, overuse of the muscle, or calcium deposits.

Signs and symptoms

  • Pain or motion and at rest, referred to the insertion of the deltoid muscle, about 4 to 5 inches down the outer arm
  • Occasional regional loss of active movements
  • Local tenderness, typically located in the front anterior and superior aspects of the shoulder, or the upper third of the arm
  • Acute burning pain in the shoulder
  • Pain may be described as severe pain which may interrupt sleep and prevent active movement
  • Passive arm movement is often restricted in a production (bringing arm outward) only

Adhesive Capsulitis/Frozen Shoulder

Frozen shoulder, medically referred to as adhesive capsulitis, is a disorder in which the shoulder capsule, the connective tissue surrounding the shoulder joint, becomes inflamed and stiff, greatly restricting motion and causing chronic pain.

Signs and symptoms

  • There is a strong component of night pain
  • There is a marked increase in pain with rapid or unguarded movements
  • It is uncomfortable to lie on the affected shoulder
  • Pain is easily aggravated by movement
  • The onset is generally in people greater than 35 years old
  • Global loss of active and passive range of motion
  • pain at the end of motion five
  • Loss of passive glenohumeral joint movement