♪ 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.
- Trying to do that 100 miles an hour
and sometimes (indistinct)
- (indistinct)
- Yep. All right, today Brad, we're going to talk
about whether or not your shoulder pain
is a rotator cuff tear
and we're going to show you how to tell.
- Sure.
- We're giving you some tests to work on.
- Right.
- A lot of times people get pain and you know,
they hear about this, some people call it rotary cup or
- Rotator cup.
My rotator cup is all messed up because I get, yeah
and oftentimes it can be something else.
So this will give me some indication.
- Right. Rotator cuff, it's four muscles,
superspinatus,infraspinatus,teres minor, and subscapularis.
- Very nice.
- Four muscles that come together.
And usually a cuff tear is not in the muscle itself,
it's in the tendon.
The muscle narrows up becomes a tendon,
- Right.
- Attaches to the bone. And that's how it can tear off.
- Later on, we're gonna show you a nice model.
- Yeah, we got a nice model with that.
We can show you on here too.
- Yeah, so hold on and watch cause some of the people are,
ooh, we just lost the humorous,
are new to this channel and haven't watched it before.
- Yeah. If you're new to our channel
please take a second to subscribe to us.
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- There you go.
- All right. So the four muscles,
we're going to test them.
Let's start off with some of these now.
- Okay.
- Okay. The first one is the empty can.
So, if I stand
and I'm gonna bring my hand
like I'm emptying a can.
- Right. So you go down, you can do it in that direction.
Or you can do it this direction.
- So, I'm bringing it like 30 degrees out right here.
And then I'm going to have you push down on it, Brad.
- Okay.
- And if it just gives way
or it hurts and you know, there's a sign
that you might have a little bit of impingement.
- Right.
_ Or that you actually tore the muscle.
- Right. You know, and at home
if you want to do it with the other hand,
the good side, so you have a feeling what,
what the good one feels like.
- Yeah. You could push down on your own.
- Right.
- You can certainly do it on your own
and is push down like that.
- Yeah.
- All right. Next test. The drop arm.
In this one, you're going to go ahead
and bring your arm all the way up like this.
- Yep.
- Lift it up.
A little bit out to the side, Brad.
- Sure.
- And then slowly just try to lower it down slowly.
And if it just gives away, that means there's probably
a tear and that you've had a little bit of
- Yeah. Because chances are,
you're not going to be able to get it up here by yourself.
That's why you're going to help it out.
And if it hurts too much to get up there
you may want to go to the next test.
Depends on how severe your shoulder is.
- Next one, Brad, yeah, is external rotation
where you're going to put your hands like this.
This is where you do kind of
need someone to help you out.
So if you do that.
- And this one, I always have problems in the clinic
with people getting their position right.
So, 90 degree bend the in the elbow
and not back here or not like this,
but it's right there.
So you are kind of in position like that.
- Yeah. And you're gonna push
on both of them at the same time.
- Right.
- And if that one gives way.
- Almost always, it doesn't take much.
And that, you know, if there's a rotator cuff problem,
that side will go in with very little pressure.
- Kind of like the rock 'em sock 'em robots.
It's been a long time.
- Yeah. I got one of those when I was six years old.
- All right. Next one Brad,
is you actually just take your hand
and you're going to put it flat on your back like this
and you're going to try to lift it away
from your back like this.
- Sure. Can we do a profile on that?
Then we can see that, that gap right in here.
And you're gonna have difficulty doing that.
- Right. So those are the four tests.
And if you find out like all three
you can't do all three.
- Right.
- You're starting to lean towards
the possibility that you might have a tear.
- Right. And don't get too excited about this
because you haven't done this before.
You know, if you've got a skilled therapist
it's much easier for us to tell.
So just go on and just think, well,
you know, the possibilities are there.
- So let's talk about a little bit
what you're going to do if you find out
you do have a tear, Brad, and what
what has happened, why this tear happened.
- Sure.
- And even how to prevent tears, I'd say is a good way.
- I do want to say one thing, if you go like this,
if you're trying to do this
and you've got this kind of stuff going on
- Swinging.
- That's a really good indication that it's a tear
or it's something else serious in your shoulder.
- Right. You can get pretty bad tendonitis even
that can, you know, rotator cuff tendonitis
and it can be so fired up that.
So, let's talk about why you get a tear.
So this, this red band here in this case,
we're actually going to use it
to represent the superspinatus muscle.
That's the muscle that most commonly is tore.
- Right.
- The tendon.
- Yeah. Should we show them on this?
If we were to pull that off of there.
- Brad, you want to just take it up there and show them.
- Sure. Lonnie, you got that?
So here's your shoulder blade and
there's that boney part of your shoulder blade.
Everyone can feel that.
- So, it's like this.
- Yeah. Right, right like that.
And there's that boney part right there.
Just above that, that soft spot
is the muscle here, superspinatas
by far the most commonly injured muscle
I would have to say with the rotator cuff injury
but it comes up underneath your chromium.
That's another bone here and it's right there.
And it connects to the humorous where the ball is.
It connects over the ball and it plays a great role
with mechanics of doing this or this.
- And it's the tendon there is what tears.
- Oh, sure.
- Do you want to show that Brad?
- Yep.
- He's going to grab a pen. So here's the muscle.
It narrows up and becomes a white tendon here
and it gets we're going to show you in a second
why that there's some rubbing that happens on here.
If you get impingement and
eventually it can fray and tear.
- Right. Just right from the bone.
And if you've got a complete rupture like that
oftentimes you'll do surgery. Don't have to.
- Yeah, there's three grades basically.
There's a partial thickness tear
where you might just even have a little pinhole
that's a little frayed or looks like a kind of frayed rope.
- [Brad] Right. Exactly.
- Or you can have a full thickness tear
which still doesn't mean that it can't heal.
I mean, it can go all the way through the tendon.
The one that's bad is when you get the full thickness tear
and it retracts, it actually pulls away from the bone.
- [Brad] Right. So you got a big gap
and then it's hard to get them.
- Yeah. It doesn't want to come back together again.
- [Brad] Right.
- But the thing about that Brad is
I've had people who have had that
and they still didn't have surgery and they did fine
because some of the other muscles helped take over.
- [Brad] Sure. The body is amazing and what it can do.
- Yeah. The body can heal itself.
So, this all starts from, Brad,
which you're well aware of is what we call impingement.
So this bone here, there's not that much space here
and the bone can go up in here, it can pinch.
Again we can look, if that red thing is the muscle
and the tendon, it can get pinched right there.
- Can you see that Lonnie?
- [Lonnie] Do it again.
- Do it again? Okay. Let's bring it like that.
So right in there, when you get that,
you can see the two bones right here
pinching into that tendon.
And it is just like taking a pair of pliers
and pinching it. Or if it doesn't pinch real hard
but you do it 30, 40, 50 times all in,
you know, one time working on the ceiling
or painting the ceiling, whatever.
And you end up with a real sore shoulder
that very likely could be the mechanism.
- Yeah. If you have poor posture
and you're going like this,
I'm pinching my shoulder right now.
- Yep.
- You sleep with your arms overhead at night.
- Yep.
- All night long you could be putting a little pressure
on that tendon and the blood's not flowing as well.
These are things you want to avoid, you know
so that you don't end up with a rotator cuff injury.
So the goal with treatment Brad, by the way,
often is trying to open that space up again.
- Sure. Yep.
- And so one of the first things we always want
to have people do is really get really good posture.
- Sure.
- And so we do shoulder squeezes.
- Right. Go ahead. You can do it from there.
Go ahead.
- This way?
- Yep. So he's gonna squeeze those shoulder blades together
from the profile it looks like this.
I tell people, I want you to have your head up
with a good posture.
Chest goes out, shoulders, go back.
- And you can do these every hour throughout the day.
- Yep.
- You can do these preventatively
or let's say you have a rotator cuff tear.
You should, you can start doing these immediately.
We'll discuss what you can do the first four weeks.
- Right. This is one of the exercises
for one of those people that are really painful.
Say, let's start this as long as it doesn't hurt
or create sharp pain.
But it does usually say, oh
they feel a stretch in this area.
And that's what we're looking for.
Open that up. And that's the first step.
- Right. Good posture too, like always.
We want to make sure.
- Sure.
- So let's say you find again, you have a tear.
We're talking about what you're going to do
the first four weeks.
You're going to first start off with the shoulder squeezes.
- Yep.
- You can use ice.
- Sure.
- You can use an anti-inflammatory like the NSAIDs
and you can even use a sling for comfort if it
- Absolutely.
- If you, you need to.
- I'll have someone, you know, put the, you know
they'll say by halfway through the workday
I can hardly hold my shoulder but this feels really good.
And I said, well, get a sling on it.
Not only that, it lets other people know
you've got a shoulder problem so they don't come up and say,
how you doing?
- You want to give me a pillow too, Brad?
- It's funny now. But you know.
- I know it's not funny when it happens to you.
Exactly. Like that's saying a big thing
on there is like, do not kick me.
- Right. Exactly.
- The other thing is even when you're sitting in a chair
I'd like to see you have it supported.
- Sure.
- So if you don't have the sling on
at night you're going to want to support it.
- Yeah.
- When you lay on your side or whatever.
We're going to do a whole video
on how to properly position your shoulder.
- Sure. You bet.
- So you're going to look for that.
That's coming up in the next couple days
is a video on how to position your arm for shoulder pain.
- Sure.
- And then once you got to get through the positioning thing
you're also going to want to start doing pendulum exercises.
- Oh yeah.
- So, so if I'm using this one here
it's just a gentle, relaxed, starting to get some movement
and keeping it stretched out while it's healing.
- Right.
- And you can do circles.
You can go clockwise, you can go counterclockwise.
- And there is some controversy.
If there's some therapist watching and they might say,
oh you're not supposed to, you're supposed to
get the arm moving from the body motion.
And it's completely relaxed. But I think there's a little.
- It depends on what are you, you know, as far as pain wise.
- Yeah.
- I've heard some people not even say
you can do pendulum exercises.
- Yeah. I only do them if people say,
usually they say it feels really good, relaxing.
So then I'll say, let's do them.
- The last thing you're gonna try is you can
start doing some capsule stretches.
The shoulder is surrounded by a capsule,
a tough fibrous material.
- Right.
- So you can start doing a little bit of stretches
because we want to make sure again, that opens up.
We got a lot of room for the tendon to go through.
- Right.
- So, one is you're going to stretch the posterior capsule.
So you're going to go across, now again,
if these hurt I don't want you doing them.
- Yeah. These, some of these probably will.
- Are gonna probably hurt.
- So then you just back off and go to the next one.
- So gentle stretch this way.
You can stretch the inferior capsule
by stretching it this way.
Again could be a tough one to do.
- Yeah. This is maybe, or may not be uncomfortable.
- And you can also go in a doorway
and put your arm on the end and stretch this way.
- Sure.
- And stretching the anterior capsule.
So that'll get you through the first four weeks.
And then after that, you know,
you can start some isometric strengthening.
- We've got a number of rotator cuff
and shoulder strengthening exercises.
We'll put more up too, in the future.
- Yeah. Sounds good.
- All right.
- Thanks for watching.