Video and Transcript: Shoulder Pain and Surgery

Hi, everyone! Dr. Orit Hickman here from Pain Science Physical Therapy. 

So, I wanted to address a really quick question that we’ll get from patients which is, “If I have shoulder pain, do I need shoulder surgery?” And, the answer to that is it depends. Typically, if somebody’s had pain for a period of time and that pain came on without very clear reasons why… For example, you just started having pain one day, and you noticed your motion starts to get less and less, and your function starts to get less and less, that may not be an indicator for surgery. In fact, that could be a really great-that you might respond really wonderfully to physical therapy. Having a diagnosis of shoulder arthritis doesn’t immediately mean you need to go for a surgery. Having a rotator cuff tear definitely doesn’t mean you need to go for surgery. In fact, rotator cuff tears are incredibly common in the general population of patients and people in general who have no pain at all. So, if we image people, if we take MRIs of people on the street who have no shoulder pain, we will find rotator cuff tears as well as arthritis as well as labral tears. So, tissue injury is not always an immediate indicator for surgery. 

So, when does somebody need surgery? One of the most common is if you have a very, very acute or sudden injury. Let’s say you have something traumatic that happens to the shoulder, and you develop a significant loss of function associated with that. Sometimes, that will be a good indicator for physical therapy. So, it’s usually related to more of something related to trauma. 

But, if your shoulder starts hurting randomly, physical therapy does a great job. We’re going to do a couple of things when you come to PT. We’re going to look at your range of motion. We’re going to look at how well your shoulder moves through space. We’re going to look at how you’re doing with function. We’re going to look at your strength. We’re also going to talk to you a lot about your symptoms and want to know how do they behave. Are you able to sleep at night? Are you able to do things like reach up to grab things off of the shelf? You know? How does that shoulder actually behave? And, we’ll find that a lot of times physical therapy does wonders with that. 

And, in our clinic, what we’re going to do is we’re going to do a few different things. If you’ve had pain for a period of time, we’re of course going to evaluate it. We’re also going to see how well your sensory system functions and how well that’s-how much that’s impacting your motor system. So, a lot of times, when you’ve had pain for a period of time, your brain loses its clear sensory connection with that body part. 

So, for example, I’m going to show you my shoulders. Ok? I have no shoulder pain on the left. I have resolving shoulder pain on the right. Why do I say that it’s resolving? It’s been getting better and better and better. But, it has been about six months now. So, it’s been a long time that I’ve been having shoulder pain, So, when I go to lift up my left arm, that motion is very easy for me to do. I don’t even have to think about it. Before I go to lift up my right arm, I have… And, I don’t know if you can see this, but I cannot lift my right arm as far as I can lift my left arm. So, why is that happening? Well, that’s happening for a number of reasons. When I first started having shoulder pain, I had no problem lifting my arm up overhead, but my brain started protecting my arm. And, as it started protecting it, it started getting more and more difficult for me to engage the muscles around my shoulder normally. So, when I go to lift up my arm, before I-now I don’t have pain most of the time. Right? But, if I think about my shoulder, it will hurt me a little bit. And, before I go to lift up my arm, I’m afraid. I’m expecting it to hurt, so how I go to lift up my right arm is very different than how I lift up my left arm. Right? And, if you’re not sure and you can’t really see the difference… Right? That right arm is pretty far forward. So, what’s occurring now [is] I don’t have strength issues. I can lift weights on both sides pretty equally in terms of the amount of weight that I’m lifting. In fact, some weights are easier for me to lift on the right even though I’m left handed. But, what I find is that my brain treats my right arm differently. When I go to do things like take my shirt off or put a jacket on or go to reach for something, I do it differently on my right compared to my left. And, that is because I have had pain for the last six months. This is not going to change necessarily with strengthening exercises. This may improve with some manual therapy. So, if a clinician pushes my arm into end ranges, and I get comfortable with being in those end ranges again, [I will] probably feel a little bit better. I have had that happen, and it has felt better for periods of time, so then I feel more comfortable moving further. 

But, the big thing that’s worked for me has been graded exposure. So, what does that mean? Initially, when that shoulder was really, really painful, I stopped doing things with it, and I mean everything with it. I wasn’t doing my hair. I was making sure that I protect how I put my jacket on. I was very, very careful with the right shoulder. But, eventually, what I started doing is I started increasing the amount of activity that I do with the shoulder, and I’ve continued to do that slowly over time. And, the thing that’s really important is that when I first started doing this, my arm was even lower than it is today, but, slowly, it’s been increasing over time. 

So, I haven’t gotten an official diagnosis. I have a pretty good sense of what it is that’s happening. But, the reality is is that I’ve never had an image taken. I won’t have an image taken. My shoulder hasn’t stopped me from doing most of what I needed to do. But, I know that my brain treats this shoulder differently. 

So, when you go to physical therapy, it’s important to remember that there is a very complicated thing that’s occurring when you’ve had a pain in your shoulder for a period of time. And, your sensory system and your motor system are not communicating well together. So, when you go to do movement, you’re going to do it differently on the side that you expect will hurt. So, make sure that when you work with your clinician, whoever they are, that they’re aware of that and that they’re treating your sensory system just like they’re treating your motor system. 

Hope that was helpful. Again, you don’t need surgery for everything that happens in the shoulder, and if you have any questions, please feel free to pop them in the chat below. And, I hope you give me a thumbs-up, and subscribe to the YouTube channel, and you have a great day!