♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the Internet. ♪
- Howdy, folks.
I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- We are the most famous physical therapists
on the Internet.
- In our own opinion of course, Bob.
- How would you like it if I put my hand on your head?
- Well, I was tryin' to tighten the skull down, there.
- Today we're gonna talk about the top three signs
of a rotator cuff tear.
This an updated video, we had troubles with it
the first time when we did it, how many years ago?
- Yeah, it was about five years ago,
a little blurry, but this is, we got a new camera person,
new camera, and we're better lookin' now.
- That's right, better.
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All right Brad, go to work.
- Rotator cuff.
Now let's get the pronunciation,
- Right.
- We've had patients come in and say my rotator cup,
my cup, cup of coffee. - Yep, very is.
But, we shouldn't make fun,
because it is rotator cuff, C-U-F-F.
- Yeah, I've heard of cartridges too.
(laughing)
- Instead of cartilage, cartridges.
- So, it's one of those things, as therapists,
we get a little chuckle out of.
It's all in fun. - Yeah, we're amused.
- So anyways, the rotator cuff, let's talk about
we know it's in the shoulder.
- Right.
- But it's actually kinda involved,
but it's simplifies, to know what actually gets damaged.
- Yeah, let's show this,
are you gonna show this side first Brad?
Do you wanna show the capsule?
- Well, I'm gonna go here and just show the joint.
You got the ball, a real shallow socket.
It's actually composed of the socket and two other bones
from the acromion and the coracoid.
And it all fits in there,
but then we have a capsule, it's kinda like,
it's some tissue that encapsulates it.
- Helps hold it in place. - Yeah, hold it in place.
And then we have the four rotator cuff muscles.
- Right, let's flip all the way around here.
- Oh, yes.
- You got four muscles, you actually remember 'em,
you can call 'em the sits muscles.
- Sits.
- S-I-T-S.
So, supraspinatus.
These are it right here.
- Yep, this muscle right up by that spine bone,
infraspinatus, that's the I.
Teres minor, and then underneath, inside here,
Between the shoulder blade and the rib cage, actually.
- It actually is.
- Rib cage and subscapularis.
Now all these muscles, help turn the shoulder out,
turn the shoulder in, lift it up.
- Right.
- But, they also stabilize this bone, this bone,
right into the joint.
- Right.
- It helps hold it in place.
If you don't hold it in place like that,
it's gonna be sloppy and it's gonna 'cause impingement.
- Impingement, there you go.
- Which can cause,
- [Both] Rotator cuff tears.
- And impingement is just happens to be,
an estimated 70% of shoulder pain.
So that's why we're gonna focus in on that,
But my mic is fallin' off my ear, Bob.
I don't know what to do about it.
- Yeah, you're in trouble.
- Yeah, well anyways, let's get back.
Now, we do have the tendon of the supraspinatus,
which is that impinged tendon in pink.
Can you see that Mike?
Now that's where we're gonna find these tears.
Okay, or I shouldn't say tears, but the what I mean,
is there's three classifications of tears.
And what we have here, if you lift up the arm,
can you put your, point that out Bob,
right where that impingement is.
- Oh boy, you always like to do that--
- [Both] Ow, ooh.
- That hurt. - Yeah.
- Well, yeah that's what happens when the tendon
can get pinched and sometimes it's not a real bad pinch,
but over time it,
wears. - Wears out.
- Or you could fall
and have a real traumatic tear right away.
Oftentimes that's not the case, it happens over time
- It wears through.
And it can be a partial thickness tear,
which means it tore partly through
and in that case, very rarely, you would not have surgery.
- No, no, you do some therapy and allow it to heal
over time and things get back to normal.
- It could be a full thickness tear,
which means it goes all the way through the tendon,
but that's not always necessarily as bad as it sounds.
Because it could be a pinhole tear.
- Sure.
- I mean, it just, it goes all the way through,
but it's very small.
- Yeah, or it may be only 50% of it's tore,
- Right.
- but it's fully torn, so there's still some connection,
but it's not functional, it's painful.
There's issues.
- Yeah, they rate the tears by that way too,
by percentage of how much, you know,
it's full thickness tear, which is almost the entire tendon.
And then finally if it's fully, actually,
- [Both] detached.
- So it's actually detached from the bone.
Here's the supraspinatus, if that got actually,
yeah, it's no longer even attached to the bone.
That's a problem.
- Yeah.
- 'Cause then it starts to retract.
- Right, and I've seen 'em.
I had a patient was, fully detached.
She left it, he did not have surgery.
And the muscle here, you can see where it just concaved
the muscle, actually
atrophied. - Yeah, deteriorated.
It went away.
- Yeah, there was just really no muscle belly there.
- And he wasn't able to do much with his arm.
- Yeah, he was limited, but he was about 75 years old.
- He got by.
- He could function, okay.
Not as good as he'd like to.
- So what are the signs, Brad that you have, such a tear?
- Right, so we decided, there's a lotta different tests,
but we picked three of them,
that we thought you could do, at home.
We're gonna show you these.
If one of them is positive and two are negative,
that means you may, maybe not.
If all three of them are positive, that's a pretty good sign
you've got a rotator cuff tear.
- Right.
- But, remember you guys are not professionals, we are.
So, at least you have an understanding of the test.
And you may do quite well with it,
but you really should get it diagnosed
by a professional to finalize this.
- Right.
So what's the first one, Brad.
- Well let's get Sam outta the way.
Thank you Sam, you did a good job.
You didn't stutter or anything.
Okay, the first one is, the empty can test.
This one's been around forever in the therapy world,
and there's actually little controversy on how to do it.
But, we'll go through it for ya'.
If you look at this, straight out to your side,
we don't want it there.
You don't want it straight in front of you,
but you wanna lift your arm up at kind of a 45-degree angle.
And you can see, Bob has his thumb down,
and that's where it got the empty can name from,
it's like you have a can.
In Wisconsin, it would be a can of beer.
(snickers)
You tip it like this and it would empty out.
That's why it's called the empty can test.
But, now they say, you can do it with the thumb up.
So you can do it either way.
Bob, you wanna go halfway up.
Now, someone else pushes down on there,
and it very easily goes down, creates pain.
That's a positive sign.
- Yeah, that's a telltale sign of a tear.
- Yep.
That means, not 100% sure, but it's pretty likely.
- Sometimes, at least rotator cuff involvement
at any rate. - Right, there ya' go.
- Really fire it up.
- Now let's go to the second one.
This one, Bob, has got his arms out,
90-degree bend in the elbow.
Let's say this is the shoulder in question,
or let's have this one.
Now face me, Bob.
Now, this is the one that hurts.
So, I'm gonna go to the good one, face the camera now, Bob.
And I'm gonna push in this way and you hold strong.
Now he's real strong there.
Now, I'm gonna go to the other one.
I'm gonna do the same thing,
I'm gonna bring pressure this way.
- Ah, ooh, ow.
- And it usually falls right into it.
Little pain and it's very weak.
If it's very weak and there's painful, goes in,
that's a positive sign.
- Positive meaning that we think you might have a tear.
- Right, exactly.
Number three, this one you can do all by yourself.
It's called the lift arm test.
So you put your hand behind,
and do this with your good one first.
Palm is away, so it's touching like where your belt is.
And you're gonna lift away like this.
There you go, so.
- See, I'm lifting away from the body.
- Right.
Do it with your good arm first.
And then try it with the sore arm.
- And what you might find with the sore arm,
you might not even be able to get it up here.
- Right.
- You might only be able to go down here.
- Yep.
- And then try to go up.
- And that's leaning towards a positive sign.
- Right.
- So if you can get up there
and you can not lift it away from your body, it's positive.
Another indication you got a rotator cuff tear.
So, good luck with these, do all of 'em.
- We gotta tell what our give-away is.
- Oh, my goodness, yes.
- So this week, we're giving away, actually a device
that's gonna help you strengthen your rotator cuff.
- There you go.
- We're giving the wall anchors.
Can you come over here, Mike?
- Yeah, go over there Mike.
- There's four of them,
if you buy 'em from our website,
if you get 'em from Amazon, there's three.
We'll also try to get a discount goin' for ya',
because we love you.
Yeah, Brad, grab a band here.
What's nice about these, there's just a myriad of ways
to put these bands on here and attach 'em.
You can slide 'em through the middle like this,
and I got two sets of bands on this thing,
so it's a little heavy-duty.
- Now we use these anchors, with the bands
for rotator cuff strengthening all the time.
- Right.
- But, if you wanna show, one of the exercises.
- Well, I was just gonna show chest.
- Oh, okay, yeah because actually you got too much weight
for rotator cuff.
- Yeah, I got a lotta weight on there right now,
so you can actually get a decent workout with this.
I mean, Brad you use this
for all your strengthening, don't ya'?
- Exactly right, all of it.
I have a complete program, it takes me about 45 minutes
to get through.
This is what the anchor looks like,
there's long screws that must be secured into a wooden stud.
There's no options to that.
So that is one thing that you do need to know,
but we have one high, one medium, one low
for different exercises.
- What's nice is once you have it hooked up,
they don't slide.
- No, yeah.
- If you have 'em hooked up right.
- They're, the whole system is,
there's nothin' else like it,
- That's why we-- - We're real proud of it.
We are.
So yeah, again, you could get a set of,
- Four of 'em. - Four.
- As the give away - use the link below.
- Yeah, use the link for our website.
- Right.
So but, it's a give away too, right?
- Oh, it's a give away too, yeah.
You can sign up for the give away.
See if you won.
- Right.
- If you win, we'll still reimburse ya' too.
- You bet, absolutely.
- All right thanks for watching.
- That's just the way we are.
(laughing)
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