RecoverRx Performance and Recovery Blog
This blog is dedicated to all things from recovery to performance. Our industry expert Physical Therapists provide evidence based information and opinions educating our readers on how to optimize their health in order to be able to overcome injuries and live the life they were meant to live!
In order to effectively treat so many people with shoulder pain, we need to be able to diagnose the problem, create a clear path for treatment, and establish steps for the resolution of pain. We do this on a daily basis without the use of X-rays or MRIs. Although we don't utilize medical imaging in creating our clinical diagnosis, I will explain to you why 2 other aspects of the evaluation are more important than an expensive image. Those 2 aspects are the subjective history and physical examination.
When a patient presents to the clinic, the first thing we do is listen and let the patient explain their story- we are looking for key features which help to explain common causes of pain. Subjective history includes:
Physical examination includes:
The information gathered from the subjective history and physical examination will create a clear picture if an MRI is warranted or if treatment can begin in the clinic.
Let's break down 2 patient examples of how a physical therapist would use their skills to determine if an MRI would be necessary.
Patient 2: Shoulder pain began 3 months ago without a known cause, but started to hurt when bench pressing and military press. He denies any history of trauma. Pain is not present at rest but only hurts during reaching in the backseat of his car or at the gym. His pain is the same but not constant. If he avoids bench press and military press his shoulder does not bother him in the gym. Physically he has limited active motion overhead and in rotational motions. His strength is appropriate in all motions but has pain and a little weakness when resisting motion with arm away from body. His joint mobility is limited in rotation in 1 direction and has tenderness along his rotator cuff muscle. He occasionally has numbness in the outside of his arm after sleeping on his side.
Hopefully reading through the subjective history and physical examination of 2 different patients, you can see that these patients' recommendations may be a little different.
I would recommend an MRI for patient 1, but I would not recommend an MRI for patient 2.
For patient 1- his injury was traumatic- there is a known cause for a potential significant tissue injury due to the force from a fall. His functioning is very poor with inability to lift arm, his strength indicates a potential significant injury to his muscle system, and his pain is not improving whatsoever even after 7 days.
For patient 2- there was no injury that caused the pain so the likelihood of significant tissue injury is very low, his biggest limitation is weakness caused by pain which is typically related to mechanical issues versus structural issues. His functioning is appropriate, his pain is not constant, and it does not limit him outside of the gym.
As you can see, there is a lot of information needed to determine if an MRI is appropriate and warranted for each individual case. Seeing a skilled physical therapist for your shoulder pain is the Best First Step to set you on a path to recovery. We will use your subjective reports and physical exam to create a clear diagnosis for you, as well as a treatment plan to resolve the pain and get back to the things that matter most.
Learn more about our unique approach to resolving shoulder pain: https://www.recoverrxpt.com/shoulder-pain.html
For more on this topic, check out our YouTube Curiosity Corner. Or give us a call to set up a visit: 331-253-2426
Dr. Luke Greenwell, Dr. David Bokermann, Dr. Sarah Greenwell, & Dr. Ariel Sernek are Performance Based Physical Therapists with extensive backgrounds in treating the injured athlete. At RecoverRx, they are passionate about returning people to the sports & activities they love. Check out more about them by visiting our About Us page.