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3 months of physical therapy - shoulder pain

Alidecker

I went to the orthopedic for shoulder pain in October, he did an x-ray (which really won't tell much), he gave me a cortisone shot and sent me to physical therapy. The cortisone shot made it able to actually lift my arm up. I don't have constant pain anymore, it doesn't keep me up at night, but I still can't do a lot of things and randomly will have horrible pain if my shoulder gets in the wrong position. Last night I picked up an armload of laundry off the floor and it was horrible. I iced it, seems mostly better.

So the question is, would you continue with PT or go back to the doctor and have him do more?

Replies

mom23mangos

I've been fighting shoulder impingement, but am hesitant about going to PT because I know they are just going to give me exercises to do at home and I'm already doing them. And it seems that Dr's don't really do anything unless bone is involved. So I'm not really sure which would be best for you.

I will tell you a great trick to help with the immediate pain if you have the same thing. Sit in a chair and grab hold of the bottom. Then lean to the side and really pull that arm for 30 seconds or so. Whammo, no pain. Not a long term solution however.

spiriteagle99

I injured my shoulder a year ago. The doctor said either bursitis or torn rotator cuff. We tried shots, but they did little to help, so I went to PT. I was able to gain a lot more range of motion, but then improvement seemed to stop. I quit going to PT but continued to do my exercises, though not as frequently as before. The pain is gone for my every day activities, but I still feel it occasionally when I reach in the wrong direction or lie directly on the sore area. It's not bad enough for me to want to do surgery, especially since that requires another year of PT afterward. I just decided to live with the pain and continue to try to regain strength and mobility on my own. Torn rotators take a very long time to heal.

rsergeant79

Hi! I feel your pain! I had a shoulder issue and scans came up clear and I was sent to PT - after a year of this and cortisone shots I was referred for surgery - I would press for further intervention

Alidecker

I am trying to stay away from surgery, but I also hate not doing my full workout. I am thinking of going and having the doctor dig a little further than an x-ray, so at least I know the problem. @spiriteagle99 I am the same way, my range of motion got better quickly with PT, but now I feel like I have stalled.

me0231

You should get an MRI to look at the ligaments. I've dealt with impingement/bursitis and later managed to tear the long head of the biceps. Shoulders are tough joints to heal because of the range of motion. I'd want to make sure nothing is torn before doing a ton of PT and potentially more steroid shots.

RAinWA

What does your physical therapist suggest you do? We initially thought I just had inflammation in my shoulder after a car accident but after a couple of weeks of PT she wanted me to go back to the doctor for more evaluation (i.e. MRI). Turned out I tore my rotator cuff.

Your PT should be able to tell you if you are progressing as expected and if they are concerned you aren't they should refer you back to the doctor.

Alidecker

RAinWA wrote: »

What does your physical therapist suggest you do? We initially thought I just had inflammation in my shoulder after a car accident but after a couple of weeks of PT she wanted me to go back to the doctor for more evaluation (i.e. MRI). Turned out I tore my rotator cuff.

Your PT should be able to tell you if you are progressing as expected and if they are concerned you aren't they should refer you back to the doctor.

Due to the range of motion getting so much better and the fact that I am not in constant pain and it doesn't keep me from sleeping, she think I am doing good. She is against surgery unless it is a last resort.

brznhabits

I second consulting with your PT. Ask them if you are progressing as expected and also tell them it isn't meeting your expectations. Then consider going back to your Dr. I also recommend exploring alternative healers, chiropractor, sports massage therapists and/or acupuncture.

Maxxitt

I went through impingement on one shoulder which led to "frozen shoulder." I figured out that it was an over-use injury as I had started swimming regularly and I learned I needed to adjust my crawl stroke. I suffered with it for months before seeing my dr who eventually gave me a referral to a PT. It was about 3 months of PT before I was pain free. The second time I had severe shoulder pain (other side this time) I went directly to a sports med dr who noted that I was pretty loosely strung and and been having partial shoulder dislocations (horrid pain). Another few months of PT and some instruction about how to handle physical activity moving forward. Long story short, the only treatment that worked for me was PT. I would stick with it.

Alidecker

Maxxitt wrote: »

I went through impingement on one shoulder which led to "frozen shoulder." I figured out that it was an over-use injury as I had started swimming regularly and I learned I needed to adjust my crawl stroke. I suffered with it for months before seeing my dr who eventually gave me a referral to a PT. It was about 3 months of PT before I was pain free. The second time I had severe shoulder pain (other side this time) I went directly to a sports med dr who noted that I was pretty loosely strung and and been having partial shoulder dislocations (horrid pain). Another few months of PT and some instruction about how to handle physical activity moving forward. Long story short, the only treatment that worked for me was PT. I would stick with it.

You sound a lot like me. I grew up swimming on swim team and added it to my fitness routine, but only once a week or so. This summer I trained for a 1.2 mile open water swim, so I went from once a week to twice a week and more distance each time. I also do some boxing, so I don't think swimming in the morning and boxing in the evenings was a good idea since I was adding in distance too. I also dislocated my shoulder years ago, it was not pleasant.

EHollander89

My boyfriend whose main form of exercise is boxing has had surgery on both of his shoulders in the past few years. I have learned so much about the shoulder, and how complex it is, just be being there with him throughout the process. He went through a series of resting, physical therapy, cortisone shots, PRP injections, MRI, etc. His surgeon wanted to try everything before doing surgery. He ended up having a biceps tenodesis on both shoulders. He carefully followed his PT exercises and is back to 100%.

I would ask about other options. It seems like you aren't satisfied with your current treatment plan progress.

Alidecker

EHollander89 wrote: »

My boyfriend whose main form of exercise is boxing has had surgery on both of his shoulders in the past few years. I have learned so much about the shoulder, and how complex it is, just be being there with him throughout the process. He went through a series of resting, physical therapy, cortisone shots, PRP injections, MRI, etc. His surgeon wanted to try everything before doing surgery. He ended up having a biceps tenodesis on both shoulders. He carefully followed his PT exercises and is back to 100%.

I would ask about other options. It seems like you aren't satisfied with your current treatment plan progress.

I'm impatient and I know that, but at the same time if I am not progressing how I should, I need to do more. I like my PT, just itching to get back to working out how I used to. I miss it and getting bored.

lorrpb

Cortisone shots do not last forever, so if you had it in Oct, it might be time for another. Sometimes they give a couple shots close together and then they last longer. Do you think the PT helps at all? What instructions did your doctor give you regarding follow up and future options? What does your PT say?

You say you can't exercise because of your shoulder. We tend to focus on what we "can't" do at the moment. There are still a lot of exercises you could do besides ones that aggravate that shoulder. Maybe you could research that angle. Ask PT to show you modifications to your usual routine that accommodate your shoulder.

eptanubrata

If you find you've hit a plateau, it may be worth it to consult a different PT. If your current one has not changed their treatment program and keeps repeating the same things over and over, you won't see new results. Not all PTs are equal.

Packerjohn

Alidecker wrote: »

I am trying to stay away from surgery, but I also hate not doing my full workout. I am thinking of going and having the doctor dig a little further than an x-ray, so at least I know the problem. @spiriteagle99 I am the same way, my range of motion got better quickly with PT, but now I feel like I have stalled.

If you want to stay away from surgery, what do you want the doctor to do? What did the doctor say was the problem?

I've had 6 shoulder operations. In the US the protocol for many insurance companies is PT/cortisone for x amount of time before they will pay for extensive scans and or surgery.

If you want to get educated on the shoulder, read some stuff from Eric Cressey. My orthopedic surgeon and several therapists I have worked with follow him

https://ericcressey.com/

Also, talk to the PT. Can he/she be more aggressive with treatment in the office and what they send home with you (obviously without going to Stupidville)?

Fflpnari

I am in PT currently for my shoulder. I would talk to your PT, and your doc. I personally would want to avoid surgery if I could

sgt1372

You should definitely ask for an MRI.

mitch16

Did you doctor actually give you a diagnosis, or was it more like, "I don't know what's wrong, but try some PT..."? Did he (or your PT) give you a reasonable expectation of what your healing process would look like, and what the PT would actually accomplish? If not, then I would consider either going back and getting that information, or getting a second opinion.

RAinWA

Alidecker wrote: »

RAinWA wrote: »

What does your physical therapist suggest you do? We initially thought I just had inflammation in my shoulder after a car accident but after a couple of weeks of PT she wanted me to go back to the doctor for more evaluation (i.e. MRI). Turned out I tore my rotator cuff.

Your PT should be able to tell you if you are progressing as expected and if they are concerned you aren't they should refer you back to the doctor.

Due to the range of motion getting so much better and the fact that I am not in constant pain and it doesn't keep me from sleeping, she think I am doing good. She is against surgery unless it is a last resort.

Shoulders can seriously take months to heal after an injury according to my surgeon, even without surgery. He said the biggest problem is that people get impatient and want to rush things leading to more problems.

If you are concerned you aren't healing up like you should, certainly see your doctor for further evaluation. There could be something more wrong than originally thought or you could just be impatient. I totally get being exasperated with how long it takes to heal and get back to doing everything - patience is NOT one of my many virtues.

Azdak

The problem with going to an internist or GP is that they know pretty much doodley about this type of injury. Going to an orthopedist can be tricky because many of them want to cut first and ask questions later.

Usually, PT is a better option, but that also depends on the therapy practice. If you have surgery, full recovery can take a year, so it's usually worth spending some time in therapy.

If you can, I would look for a sports medicine ortho who is associated with a university or teaching hospital, and who specializes in shoulders. Usually they are less quick to cut and may also have some indepedendent research information

stanmann571

Maxxitt wrote: »

I went through impingement on one shoulder which led to "frozen shoulder." I figured out that it was an over-use injury as I had started swimming regularly and I learned I needed to adjust my crawl stroke. I suffered with it for months before seeing my dr who eventually gave me a referral to a PT. It was about 3 months of PT before I was pain free. The second time I had severe shoulder pain (other side this time) I went directly to a sports med dr who noted that I was pretty loosely strung and and been having partial shoulder dislocations (horrid pain). Another few months of PT and some instruction about how to handle physical activity moving forward. Long story short, the only treatment that worked for me was PT. I would stick with it.

Also, make sure that you're happy with your PT. If the goals of your PT aren't aligning with your goals, communicate that clearly, and then switch PTs if possible. If the PTs office is filled with young athletes, you're likely to have a different experience than if their primary customer base is older/overweight patients.

Another test is how they answer questions about returning to specific "normal" activity, like weight training, or running, or bodyweight strength exercises.

Good answers are "timeline", "about as many as you used to be able to do", "you'll need to go slow and we'll see as you recover"

Bad answers sound like "why would you want to do that"

Alidecker

Thanks for all the input, especially the personal experience with shoulder pain.

lorrpb wrote: »

You say you can't exercise because of your shoulder. We tend to focus on what we "can't" do at the moment. There are still a lot of exercises you could do besides ones that aggravate that shoulder. Maybe you could research that angle. Ask PT to show you modifications to your usual routine that accommodate your shoulder.

I do still exercise, I just can't exercise the way I had been prior to the shoulder pain started.

I am impatient, I have PT again on Thursday I will talk to her a little more. I am happy with her, she understands that I want to get back to my workouts and she gives me exercise that help replicate the motions and what imitates what I would be doing. The orthopedic looked at an x-ray and said I think it's tendonitis, go to physical therapy. I don't want to have surgery, but if it is necessary I would. I don't want to waste 6 months in physical therapy if it isn't going to fix the problem enough to go back to the workouts I enjoy. I am all for modifying. even long term, but within reason.

Jthanmyfitnesspal

Over the years, I have had problems in my neck, back, shoulders, hands, hips, knees, ankles, and toes. But only those!

I have tried to develop a consistent approach to pain: I start with ice/heat/advil/rest for a week or two. It it doesn't get better, I report it to my doctor. They decide whether to refer, sometimes to an orthopedist nurse-practitioner that has been very helpful. If directed, I go for imaging. Then we all talk some more. I have been shot up with cortisone a few times, but I have learned that there are risks associated with it, so I wait until there is really no choice. I am happy to visit the PT, where I look for exercises that I can do at home by myself (saves time and money). Finally, I submit to "intervention" (e.g., surgery) when nothing else works.

My main message here is to stay engaged with the medical community, if you can. I am acutely aware that many people may not have access to healthcare, or can't afford all of the associated cost and or time. I'm advising that it can be worth it, if you keep at it.

I decided to have a bone spur removed from a big toe, and that worked out well, for example.

Best of luck!

lorrpb

Alidecker wrote: »

Thanks for all the input, especially the personal experience with shoulder pain.

lorrpb wrote: »

You say you can't exercise because of your shoulder. We tend to focus on what we "can't" do at the moment. There are still a lot of exercises you could do besides ones that aggravate that shoulder. Maybe you could research that angle. Ask PT to show you modifications to your usual routine that accommodate your shoulder.

I do still exercise, I just can't exercise the way I had been prior to the shoulder pain started.

I am impatient, I have PT again on Thursday I will talk to her a little more. I am happy with her, she understands that I want to get back to my workouts and she gives me exercise that help replicate the motions and what imitates what I would be doing. The orthopedic looked at an x-ray and said I think it's tendonitis, go to physical therapy. I don't want to have surgery, but if it is necessary I would. I don't want to waste 6 months in physical therapy if it isn't going to fix the problem enough to go back to the workouts I enjoy. I am all for modifying. even long term, but within reason.

You are not alone in your impatience. Most of us are impatient about healing/recovery, especially when other goals are at stake. Patience can be hard to learn and accept, but working on this outlook helps reduce the frustration. There are no guarantees about what PT, surgery, or most other medical treatments will or won't fix or to what degree the outcome will meet our expectations of "workouts you enjoy". I don't want to discourage you or sound negative--certainly we all need to push for what we want--just trying to temper the outlook if needed, speaking from my experience and that of others.

Just a note to clarify that it is highly unlikely that an x-ray "shows" tendonitis. Probably what the doc really means is that there is no identifiable injury to the structures that can be visualized on an x-ray (which does NOT include tendonitis) so defaults to tendonitis as a catch-all dx. Tendonitis is inflammation and can be from mild to severe, and depending on exactly which tendons involved can affect a person in vastly different ways. Good luck with your treatments, I hope they help.

Alidecker

Well, went to two doctors since one didn't explain anything to me or really do anything. The second one did another x-ray and ultra sound in the office. It is arthritis, small tear in the rotator cuff, bone spurs and some other things he described as odd when looking at the ultra sound. Now trying to figure out how to fix it or if to fix it are the issues. The second doctor said most doctors wouldn't suggest surgery at this point because it is messed up enough that it would most likely need shoulder replacement. Of his options for treatment, he suggested stem cell therapy, which is a big decision since insurance doesn't cover it. I can say I am happy to know, but not happy about the outcome and the activities he said he would suggest I give up...

mitch16

Well, at least that's a starting point... did the second doctor suggest any other options--is there more/different PT that you could do? Is shoulder replacement surgery an option for you? Is it something you would consider?

9 years ago I injured my knee (turned out to be a meniscal tear) and the orthopedist I saw said that "even if it was your ACL, we wouldn't repair it because you're old"... I did PT and returned to all of my activities, and even took up running (half marathons!) after that. 2 years ago I injured my knee again (although I was skiing for both injuries, they are not related and the first injury really had no bearing on the second). This time is was the ACL, and my new orthopedist (whom I adore) felt that the surgery would be better for my lifestyle, but did also inform me that there are plenty of people out there who tear their ACLs and go on to live perfectly normal, athletic lifestyles, but the choice was up to me. Obviously the path would have been slightly different with respect to timelines and physical therapy and such, but they were both options that I was offered.

stanmann571

mitch16 wrote: »

Well, at least that's a starting point... did the second doctor suggest any other options--is there more/different PT that you could do? Is shoulder replacement surgery an option for you? Is it something you would consider?

9 years ago I injured my knee (turned out to be a meniscal tear) and the orthopedist I saw said that "even if it was your ACL, we wouldn't repair it because you're old"... I did PT and returned to all of my activities, and even took up running (half marathons!) after that. 2 years ago I injured my knee again (although I was skiing for both injuries, they are not related and the first injury really had no bearing on the second). This time is was the ACL, and my new orthopedist (whom I adore) felt that the surgery would be better for my lifestyle, but did also inform me that there are plenty of people out there who tear their ACLs and go on to live perfectly normal, athletic lifestyles, but the choice was up to me. Obviously the path would have been slightly different with respect to timelines and physical therapy and such, but they were both options that I was offered.

A lot of this is on Insurance companies.

But just as much can be placed on the Orthos in the US. Some Orthos deal largely with young active healthy patients and are relatively prompt to recommend/perform surgery if PT doesn't do the job. Others deal primarily with older sedentary ill patients and are reticent to recommend surgery or even refer to effective PT.

But the root of the problem in the second group is the patients who don't/won't participate in PT.

Alidecker

mitch16 wrote: »

Well, at least that's a starting point... did the second doctor suggest any other options--is there more/different PT that you could do? Is shoulder replacement surgery an option for you? Is it something you would consider?

9 years ago I injured my knee (turned out to be a meniscal tear) and the orthopedist I saw said that "even if it was your ACL, we wouldn't repair it because you're old"... I did PT and returned to all of my activities, and even took up running (half marathons!) after that. 2 years ago I injured my knee again (although I was skiing for both injuries, they are not related and the first injury really had no bearing on the second). This time is was the ACL, and my new orthopedist (whom I adore) felt that the surgery would be better for my lifestyle, but did also inform me that there are plenty of people out there who tear their ACLs and go on to live perfectly normal, athletic lifestyles, but the choice was up to me. Obviously the path would have been slightly different with respect to timelines and physical therapy and such, but they were both options that I was offered.

Shoulder replacement could be a possibility, but not recommended at this point. Kind of in the bad, but not that bad category and I am younger than they like to do it on. Orthoscopic surgery is in the we could do it, but you aren't a great candidate for it and the results would be less that optimal. I am not ready to go through the shoulder replacement surgery yet.

I can still lift weights, which is the good news, in fact he encouraged it and said the more strength in the shoulder the better. He did say to try and keep the push lifts to a lower weight. This doctor was more optimistic about these things. The other doctor makes me feel like I should just go for a walk and call it a day, I used to be that girl, but 9 years ago I decided to lose weight and get fit and it no longer fits the lifestyle that I enjoy. Of course the two forms of cardio I have been doing in the last few years are swimming and boxing/kickboxing - neither of those are great for a bad shoulder.