Jim didn't see the large mogul ahead of him. He was watching his three friends dash down the mountain and suddenly found himself face first in the powdery three inches of the morning snowfall. He struggled to roll over and then managed to get on his knees. Leisurely dusting himself off, he looked up and realized it was snowing. In a matter of a few minutes, he could barely see three feet in front of him. He wished now he had stayed on the trail instead of following his friends. After slowly skiing down the mountain, Jim realized he wasn't sure which way to go. After about twenty minutes, he knew he was lost. Lost in a blinding snow storm, cold and scared.
I know of very few feelings worse than the feeling of being lost. Students I work with spend a large amount of mental energy and time fighting the feeling of being lost. When they exit the initial interview, they aren't sure what the problem is and consequently spend too much time during subsequent visits searching for an answer. Each day is another journey into the blizzard looking for something recognizable. I know. I've been there too.
Shoulder pain is one of the most common musculoskeletal complaints encountered in an outpatient healthcare setting. With over 23 physical examination tests for the shoulder alone, there is plenty of information available. The question is what information is the most helpful?
Whether shoulder pain is related to a gall bladder problem, heart, tendinosis or a rotator cuff tear, wouldn't it be nice to know? The good news is that when it comes to rotator cuff tears, you only need three physical examination tests to help you predict if a person actually has a tear (there's that number three again!).
A positive impingement sign, weakness in external rotation and supraspinatus weakness when found together in a person with shoulder pain create a high degree of suspicion of a rotator cuff tear. When you add the age of the individual along with pain at night, the suspicion goes up even more. The older the person the more likely the presence of a cuff tear. (Murrell G, Wlaton J (2001): Diagnosis of Rotator Cuff Tears. Lancet 357: 769-770) .
Although the blizzard has cleared, the path down the mountain is still not well defined. We still don't know the degree or magnitude of the tear. Large or complete tears of the rotator cuff do not respond as well to rehab as do smaller and less complete tears. In order to position yourself for maximal success, consider a referral to the appropriate source to help you further define the tear. Once you know, you can make a better decision and get on the right path.
Make Today Count.
Doug Kelsey
Author. Teacher. Therapist.
