♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi, folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- We are the most famous physical therapists
on the internet.
- In our opinion of course, Bob!
- Today, the name of this video is,
what is causing your shoulder pain?
Tendonitis, bursitis, how to know.
- Sure.
- We got a whole series
of videos that we're kinda talking about
what is your shoulder pain.
- Sure.
- Now with tendonitis and bursitis,
they often present very similar.
- Mm-hmm (affirmative).
- Similar pain, similar actions, similar movements.
So it's often the result of impingement.
We already did a video on impingement,
but we'll kinda repeat a little bit what's going on here.
- Sure!
- So first, let's talk about the tendon, Brad.
This right here, we got tape over the superspidotis tendon.
(Brad laughing)
That came out a little bit rough.
And it actually can get pinched or impinged
right below your chromium there.
- Right where my finger is!
My finger's being pinched, same thing with that tendon.
- It can also get pinched under this ligament here.
- Sure.
- After time, it can get irritated.
It can get wore down and it can become tendonitis.
Also in this area is the bursa.
The bursa is a fluid filled sac that helps slide
the bones on each other, basically.
- Well, yeah, it actually helps prevent
the tendon from wearing out on one side.
It acts as a lubricant layer.
So they all work together and they're literally
right on top of each other.
- So you can understand if the tendon's getting pinched,
the bursa could get getting pinched.
So quite often, you may have both.
It really doesn't matter which one you have,
we're gonna do a similar treatments
as you'll see in the future.
- Exactly.
- But some of the common, I guess
I'm holding this one here, Brad.
- (laughs) What ya got there, Bob?
- Well, I was gonna show that here's a muscle
and it becomes a tendon,
and the tendon attaches to the bone.
I just wanted to show that.
- Right, so he's holding the scapula which is right here.
- The shoulder blade.
- But the muslces are on this model which they are not here.
- Right.
- And they show the rotator cuff specifically.
- Yeah, and this is a really wide tendon.
I don't know if it's really that wide.
- Yeah, that's of the infra supra-
- Infrasprinatus and teris minor.
- Yeah, well, the suprasprinatus is up here.
- Right here, yeah.
This is the infrasprinatus.
- Teris minor and teris major.
- Right.
- Yeah.
- But the teres minor's part of the rotator cuff.
- Right, yeah.
- Were having discussions
- Yeah, well you know, you always got to clarify.
- So what are the symptoms, you're going to
possible have pain and swelling on the front side
or the side of your shoulder. You're going to have
pain and weakness. A lot of times with these actions
like lifting forward
- Right.
- Which is flexion.
- Usually when you get right around in here.
- Yep. You'll get that pinching.
It could again be the bursa or the tendon.
It may hurt going out to the side.
And also behind your back like this.
- Yep.
- Any one of those could be a problem area.
You might hear a clicking sound
and I think there's a roughness on the tendon.
- Yeah.
- And, that's, that could cause that clicking sound
- There could be some arthritic problems
in there depend on your history or your age.
- Yep.
- There can be a lot
of things going on in your shoulder simultaneously.
- Exactly.
- Difficult to lift objects, obviously
because that muscle again is narrows
up to a tendon and tend is effective.
So it's gonna hurt when you lift objects.
Sleeping on the shoulder makes it worse
which almost every problem makes a, a shoulder problem
worse if you sleep on it.
So we're gonna show you three self tests.
We did these already for impingement
but these are very similar, right?
So the first one you're gonna take your hand.
Let's say this is my painful shoulder.
I'm gonna take the hand of that and put it
on my opposite shoulder and just lift the elbow like this.
If that hurts, that could be
in impingement or it could be tendonitis bursitis.
- You can add a little over pressure on the elbow.
- Yep. I'm gonna grab a chair, Brad.
- Okay.
- Because we're gonna talk about
if you want to do one where you actually stabilize.
- Oh sure.
- I did this before.
- Before we go into further
make sure you do these tests
on the uninvolved or the pain free shoulder.
- Absolutely.
- See how that responds
and then compare that to the sore shoulder.
- Good point, Brad. I forgot to mention that.
So you're gonna put, I'm putting my shoulder blade.
You wanna show the shoulder blade again.
So we're looking at right here.
That's leaning up
against the chair that kind of stabilizes it right here.
Yep. And then I'm gonna lift the arm up like this again
this is the painful arm I'm gonna lift the arm.
It just really jams the shoulder and it
it impinges even more.
So if this hurts again, a sign of impingement
a sign of bursitis, a sign of tendonitis.
- Yeah. And if you look here, you can see what's going
on. It, it just takes
and kind of squish, not technically speaking
but it impinges and causes that problem become magnified.
And it's a, if it's positive, meaning painful
there's a good chance you have that.
- Yep. The last one is, this is again
one I mentioned on another video.
I haven't really used this one before
but it makes sense to me.
So you put your thumb, your, your arm out painful arm out
turn the thumb down Palm facing away
grab the wrist and just pull it down to the opposite hip.
- So are you resisting with this hand?
- No. No, just bring it down.
- Just bring it down.
- Okay. So again, that's kind of jamming it here
jamming it up here at the shoulder here.
Right? So there is, you can also check for tenderness.
I definitely do this.
When, when I'm working with somebody
what I do is I know right where to go
but you can follow along the collarbone here with your hand
- Do you want me to show?
- That's probably the easiest one to find.
- You can start right where that bump is there.
Right? Where the sternal notch is a very good
the stern notch right there.
Yep. Follow that across that bone will lead you right
- To the end of the shoulder.
Yeah. And then kind of go under the bone a little bit
and just start rubbing right there.
- Yeah. Right there.
- And if that's sore, that's
you know where it's gonna be sore
with bursitis and tendonitis might bring the arm
back a little bit while you're doing this.
Cause that exposes it a little bit more now.
So you bring it back.
- You may have problems finding this.
I remember in PT school, my PE patient skills were poor
and now it's like very easy, but
- Now you go right to it.
- Right. So, you know, if you feel
like you don't know what you're doing, that's okay.
Just do, we're gonna mention painful arc syndrome.
- You can do painful arc and you
can also even a little bit of resistance.
Like let's say you take the arm
out like this and you give a little resistance.
Right. It might give way
because the tendon is again is sore
- Irritated.
- But yeah. Talk about painful arc.
- Painful arc, very common.
Particularly with impingement tendonitis, tendonitis.
Yes. So it's simply that when you go up, it hurts.
But if you work through it, then you get up
but to here becomes pain free again.
Then when you drop it, it's painful here.
And then down here is better painful arc syndrome.
Good. Positive sign
that you do have that impingement tendonitis, impingement.
Impingement. Yeah.
I'm not sure what birth side is.
It seems like birth side kind of hurts all the way up.
Doesn't it?
Wouldn't you think?
- Yeah. You know, I don't get too hung on my, yeah.
- I don't because the exercises
and the treatment are so similar.
I just remember a doctor I worked with years ago
he was a physiatrist is basically a physical therapy doctor.
Right. He just, he, he told me this when I was a new grad
he said, most often you're gonna find both.
- Right.
- It's probably tendonitis bursitis.
We don't really know.
And, and you can just assume it's both.
- Yeah. There's symptoms that are so consistent.
They're literally stacked on top of each other.
- Yeah.
- They're gonna get better if you treat 'em right.
- Treat 'em right.
So thanks for watching.