♪Bob and Brad, the two most famous ♪
♪ physical therapists on the internet ♪
- We're on! - [Man] Rolling.
- 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.
- All right, this is a remake,
or an updated version, of the video that we did in the past.
Is your shoulder pain from nerve, muscle, or joint?
And how to tell.
Now, this is difficult to do,
but we're gonna take a stab at it.
For the layperson, I should say.
- Right, because it's very common.
I would say very common, my opinion.
Shoulder pain often times can come from a nerve
or the neck. - The neck, right.
Refers down. - Right.
And the referral pain can really
this a little bit confusing, so we're
gonna show you some hints on what we do
to figure it out and see if, you know,
you could deal with it yourself a little bit at home.
- I'm getting my shoulder warmed up right here because,
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60 seconds of Bob and Brad a day.
That's about all some people can put up with,
including our spouses. - Right, exactly.
- All right. - And she lets me know it.
- Yeah. - Okay.
Just kidding, Julie.
Okay, here we go.
So, the first thing I do if someone comes in
with shoulder pain and I have any
suspicion at all, I wanna clear the neck first.
- Yeah, we wanna see if the neck is
causing any of this pain. - Right.
Because if it is, it really makes things a lot
simpler down the road. - Right.
- So this is what I'll do, I'll have-
- Do you want me to sit or do I?
- Sit.
Sit, Bob. - Okay, so, okay.
- I'll pretend.
Now, this is- - Sit, boo-boo.
- Yeah.
This first thing you really can't do to yourself.
You have to have someone help you
who you trust and is going to be
mature and serious about it.
Bob is gonna sit in a tall- - In good posture.
- Good, tall posture. - I don't wanna be like this.
- Right. - I sit as straight as I
possibly could sit. - Right.
So, he's got shoulder pain in his right shoulder.
And if I put gentle-
- Gentle!
- Gentle pressure down on his head.
If that changes anything with the shoulder pain,
makes it worse or better, that's telling me-
Well, let me put it this way.
You're gonna do that one.
If anything changes with it, we're gonna find out
by asking him, and then we're also gonna go
under the chin and behind the head
and gently pull up and put some distraction,
or traction, on the neck.
If either one of those changes the pain
in the shoulder, makes it better or worse,
that's a very strong indication there is neck involvement
or low neck involvement. - Right.
It's always possible, remember, that you could have neck
and shoulder involvement. - Exactly.
- That's why we're saying the neck may be involved
along with the shoulder or the neck alone.
- Right, right.
Now, if both of those are negative,
or they don't cause any problem at all,
I'm still not convinced.
I still need to screen the neck a little bit more,
so I'm gonna have Bob do some active range of motion.
In other words, I'm not gonna touch his head.
This one you can do to yourself.
And so, you wanna start- - I usually do forward.
- Protrusion? - Forward, yeah, head forward.
Or you just stick your neck out.
I do flexion. - Yeah.
- Flexion. - Up and down.
- I can do extension, it's for our back.
Again, we're looking for any movement causing pain
down the arm. - Right.
- Turning to the left, turning to the right.
You can even go side bend to the left,
side bend to the right. - Right.
- Now, even if you maybe don't have pain
down the arm but you have pretty severe pain
in the neck, it makes me think.
I wonder, I question whether or not
it is shoulder pain. - Right.
- Especially if it's on the right side.
- Right.
So, if the pain is here, and I've had people
with pain right here in the shoulder
do these exercises and all of the sudden they say,
"Oh, that hurts here" when I do this neck thing.
There's something wrong with the neck.
- Right. - It might not be the cause
of the shoulder pain, but it could be,
so we just wanna make sure we know what we have.
- What we're really looking for, you know,
for confirmation, is if it's connected.
- Yeah. - Like, you get pain going
all the way from the neck
to that shoulder. - Yeah.
- Then that's a pretty good sign that you're from the neck.
- And if it's from the neck,
it's almost certainly a nerve problem.
Not for sure, but it's leaning in that direction.
So that's what we do to find out if
it's from the nerve or the neck.
The next thing-
Yeah, we can get the chair out of here.
The next thing we're gonna do is look at
range of motion of your shoulders
and compare one to the other.
- Sure. - So if you have a mirror
at home, stand in front of the mirror
and both hands are gonna go up like this.
And if there's a problem, you might notice
this hand goes up to here and this one
only goes up to here.
And, you know, that's the sore side.
- Then we're starting to think there's some
shoulder involvement. - Right.
Possible it's a joint or a muscle.
- Right. - And the way you
do abduction, looking again.
Is it symmetrical, one side to the other?
- Thumbs up if, if you can. - Yep.
- Thumbs up and the shoulder
will go further. - There you go, yep.
And so pain on one side versus pain on the other.
Anything different from the good to the bad.
This one, this is a real common one
where there's often times a problem of
finding the joint is you go out like this,
keeping the elbows glued to the ribs.
Out like this and back, and see if there's a thing.
- External rotation. - Yep.
If you got a joint problem, a lot of times
this one's gonna hurt probably more
than the other ones or this one.
The next one is extensions, so you need
to be standing with this one.
It works best.
And you just go behind you like this.
And this one may- - And again, you can have
someone look at it for you. - Right.
- Because sometimes it's hard to tell.
- Yeah. - Whether or not one's going
higher than the other. - Exactly.
- And again, if you find one that's significantly,
especially like in most of the directions,
has lost motion- - Right.
- There's a sign there that there's your sign.
It might be a shoulder issue. - Yeah.
And it's probably in the joint.
It could be in a muscle, too, as well.
Then this is what I call functional range of motion.
With the good hand, let's say my right shoulder's
the sore one, my good hand I'm gonna reach
behind my neck and see if I can reach past-
This is pretty normal for someone my age,
and most people reach past their...
What do you call these? - Collar.
- Collar, yeah! (laughter)
- Sign of age! - I thought you (stutters)
like C7, this is T1. - No, I was gonna
keep it pretty layperson.
And if this one you can hardly get up to here or,
you know, only to there,
you know, that's an indication there's a problem and there's
usually pain associated with that.
And then, also, you wanna go-
I say, put your thumb right on your spine
and see how far you can go up to there.
- This is a great one to have someone with you
and put a piece of tape there. - Yep, and then
see if the other one- - Go within the line.
And look at that, there's a foot difference.
- Right. - And that's very common
to see stuff like that, especially on
painful shoulders. - Right, exactly.
And that's more indicative of shoulder
joint problem, typically.
So, then, also there's some tests.
- Sure. - Now, these are special tests
that therapists often do, or doctors.
The first one is called the Neer Test,
named after Doctor Neer.
It's a little bit harder to do yourself, but you can.
You're just gonna take your hand and flex it
straight up like this.
Use the other hand, if you want.
And put a little overpressure. - Overpressure.
- So, I always remember because we're going
near to the ear. - Yeah.
- Push that arm to the ear.
And up in here, if there's no pain and all of the sudden
you get up and hear, "Ow, it hurts,"
that's a positive sign. - Possible impingement.
- Possible impingement up in that shoulder joint.
These are all impingement.
- Yeah, the tendons getting pinched in there
basically, you can think of. - Right.
- And that will-
That's very common. - Yeah.
- And that can give you a lot of pain.
People are surprised how painful those can be.
- Right.
And then, also, do the other arm.
So the good arm should be negative as well, of course,
but it's nice to practice on that one.
I usually do one to the other on the patient.
The next one is crossover.
This one's easy to do yourself.
- Yes, it is. - You just simply grab
your elbow and go over.
And this shows some impingement when you get to
end-range over here and say, "Oh, it hurts!"
- This can also be the end of the collarbone.
- Sure. - Yeah, so it's not
necessarily impingement, but it's a shoulder issue
either way. - Right.
Now, this one I'm positive when I
have healthy shoulders, and I was like that
in PT school. - You can feel it.
- Yeah, not so much anymore.
In PT school, one side was always positive.
And it was like, "Oh, you want a positive sign?
Do it to Brad, you know." - Sure.
- So, all of these tests aren't definitive.
- Yeah. - That's why this is
more of a- - And I mean, to be honest,
sometimes we get done and we're not even
still certain. - Right.
- And sometimes we treat people for a while,
and then it becomes more evident.
- Right, right. - You know, we treat
one thing and like it doesn't get better,
so then we try another thing, so.
- So, and they're probably saying,
"Well, why are you showing us this video then?"
Well, because- - No, because sometimes
it does get fairly-
It's fairly easy to tell. - Yep.
It's particularly the first one
with the neck. - Yeah.
- And Hawkins-Kennedy.
Every therapist knows this one.
You bring your arm out like this,
keep the elbow still and rotate down.
And this will be painful as you do the rotation part.
- Yeah, and even bringing across sometimes, too.
- Yeah, and there is some variation
with therapists. - Yeah.
- Whether it's here or here- - Right, right.
- And you push down. - (mumbles)
- But that one would be painful as well.
So, that pretty much- - Well, we're gonna palpate
the muscle. - Oh, very good!
As far as- Is it a muscle? - Right.
- If, let's say, all of these are negative
and, you know, neck is clear and it's like,
"Oh, maybe I just pulled a muscle or a tendon."
You know, then get into the muscle.
And I'll do this, I'll just start.
I kinda have a system. - Poke-around.
- Yeah, poke-around.
You go into the muscle belly and push,
and see if you find a tender spot.
And here, a lot of times I'll find it up here.
But it could be a trigger point, so you can get
mixed up there. - Right.
- And the biceps.
If you tore your biceps a little bit, you can
usually find that spot just by squeezing
and working that bicep.
So work the muscle belly,
that's the squishy part. - Yeah.
I tore my tricep.
You know, micro tear,
one time. - Yeah.
- Yeah, I could find the spot right on.
- Right now I have a pectoralis
minor tear right in here. - Yeah.
- And I can clearly, when I get on it,
it's like, "Ohh, there it is."
- And what's shocking at our age is long it takes
for these things to heal. - Oh, why, Bob?
- I mean, it does! Doesn't it? - Why did you have to
bring it up?
I was feeling so good about life,
and now the slow healing.
But we're here to help you out, and we'll
get you going.
You finish, Bob.
I'm tongue-tied. - Okay.
Remember, we can fix just about anything.
- Except for! - A broken heart.
- There you go! - But we're working on it!
- That was a good finish. - There we go.