Last week, I woke up one day with severe R anterolateral shoulder pain and inability to raise my arm above shoulder height. In the days preceding, I had completed approximately 8 hours of painting and a heavy shoulder workout, all without pain. Initially, because of the severity of the pain and inability to raise my arm above my shoulder, I became extremely fearful of my inability to fully treat my patients, sleep, or do much of anything with my right arm.
Right Shoulder AROM: flexion 80 deg, abd 45 deg, ext 30 deg, IR 45 deg, ER 20 deg
R shoulder isometric strength: strong and painless in all directions at 0 deg abd
Cervical AROM: full and pain-free in all directions
(+) Obrien's Test
My shoulder was strong and essentially pain-free when at my side.
My primary treatment was to limit motion of my RUE to range with minimal discomfort, 5-directional resisted isometrics of the right shoulder at my side, and Quad Rock Back to perform CKC shoulder flexion AAROM. Additionally, I performed repeated shoulder extension with horiz. abduction in CKC between each patient treatment session. I took some anti-inflammatories each day to help encourage movement as well.
Over the span of the next few days, my shoulder gradually improved and I got back into some weight-lifting with my focus being legs, posterior shoulder/scapular and some running. Some of the initial testing was positive for labral tear. That plus my significant loss of ROM made my mind start running off into hypotheticals: will I need surgery, how long will I need off work, how can I support my family? As we are all aware from pain science research, these thoughts only serve to raise my pain-level. I had to continually remind myself not to jump to conclusions and to remember people have injuries like this all the time and recover. I'm not sure if the pain was due to RTC syndrome or labral tear or something else, but it shouldn't matter too much due to the lack of correlation between pain and imaging findings. While I am grateful to be nearly fully recovered, the experience was enlightening to me about how various factors can impact a patient's fear and pain experience. It reinforced the importance of addressing all concerns of the patient for an injury, especially the biopsychosocial factors.
-Dr. Chris Fox, DPT, OCS
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