Exercise Your Shoulder Pain-free

Complete Shoulder and Hip Blueprint

Complete shoulder and hip blueprint come as a digital program package which helps to restore upper and lower body. The product has worked with athletes and other clients seeking to improve their body functions too. It is essential when it comes to adjusting body performance in terms of strength and resilience. Complete shoulder and Hip Blueprint is a creation of Tony Gentilcore and Dean Somerset- both respected coaches who have worked with many baseball players to correct shoulder dysfunction as well as injury-related problems for a long period of time. Shoulder and hip problems is a dominant condition that undermines people's daily activities. For that reason, this product was developed to eradicate such miseries by addressing them naturally rather than opting for medical treatment. It is important to give the product a little emphasis since it works on shoulder and hip regions, the parts credited to make human body gain additional strength, become resilient and endure pressures of heavy tasks. Complete Shoulder and Hip Blueprint is an amazing product. In the course of its existence, the product has received a lot of positive reviews from users. Give it a try and enjoy the benefits it guarantees. Read more here...

Complete Shoulder and Hip Blueprint Summary


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My Complete Shoulder and Hip Blueprint Review

Highly Recommended

The writer presents a well detailed summery of the major headings. As a professional in this field, I must say that the points shared in this manual are precise.

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Weakness Associated Shoulder Pain

Pain in the upper extremity often limits therapy and function and interferes with sleep, so it requires immediate attention. Indiscriminate traction on a paretic arm and shoulder during bed mobilization and transfers can start the pain. In the shoulder, some level of pain has been noted in up to 75 of patients by approximately 2 months after a hemispheric stroke. Subluxation of 1 or more cm, found in 50 -85 of hemiplegic patients, may contribute, though studies have not always shown this relationship. Glenohumeral subluxation is lessened by a variety of slings, but these do not necessarily prevent shoulder pain.121 Sources of pain include biceps tendonitis, capsulitis, rotator cuff impingement or tear, myofascial pain, brachial plexopathy, suprascapsular neuropathy, heterotopic osssification, osteoporosis and fractures, contractures, flaccidity or spasticity, overuse, degenerative joint disease, and RSD. Most patients have inflammation of the rotator cuff tendons and subacromial...

Introduction shoulder problems in sports

Shoulder problems are common in sports, and are the result of either relative overuse or trauma. The spectrum of problems is broad, because the shoulder more than any other joint is dependent on the soft tissues and a very precise neuromuscular coordination during movement. The risk of developing shoulder problems among athletes is closely connected to the sport, the activity level and the age of the athlete. Even though shoulder problems are common in overhead activities, they are rare in other sports, and the overall risk of shoulder problems in athletes is 3-8 1,2 . Up to 60 of athletes performing overhead throwing sports or swimming have experienced significant shoulder problems which have influenced their sporting activity 3 . Overhead activities are performed repetitively and with great force, mainly by younger athletes, and put enormous demands on shoulder stability and muscle coordination. These athletes are therefore at high risk of overusing tendons and muscles, of...

Shoulder pain

Predominantly symptoms are felt either around the AC or around the shoulder respectively (Gerber et al. 1998). Differential diagnosis is an important consideration when examining patients with symptoms in the shoulder area. The link between cervical and shoulder problems and the ability of cervical problems to mimic shoulder problems (van der Windt et al. 1996 Hargreaves et al. 1989 Wells 1982 Schneider 1989) means that when pain is present at the shoulder, the source of the symptoms must be considered carefully. Three scenarios might exist shoulder pain is entirely cervical referred pain and responds to neck management described elsewhere in the book shoulder pain is entirely local somatic pain and responds to shoulder management (McKenzie and May 2000) shoulder (and neck) pain is a combination of cervical and shoulder problems, both of which need addressing. There can be problems identifying the source of pain in the shoulder area. Often it is reasonably obvious from the history...

My son doesnt speak properly and has trouble communicating in general

Most children with ASDs do not use or understand gestures the same way as typically developing children. They may have difficulty using and understanding other nonverbal communication as well, such as facial expressions or body movements that may or may not accompany speech. They may not understand what it means when you shrug your shoulders to indicate that you don't know something or when you roll your eyes to indicate you are annoyed. They may not be able to use simple gestures themselves, such as waving good-bye when someone leaves or pointing with their index fingers when they want something. Jake used to shake his whole hand in the direction of a box of crackers or a toy that was out of reach, rather than use his index finger. Most typically developing children use gestures to indicate what they want even before their language emerges or while it's in the initial stages of development, such as tugging on a mother's hand and leading her into the kitchen to express hunger.

What is the treatment of whiplash injury

Whiplash injury is a term used to describe an acute cervical sprain or strain that results from acceleration and deceleration motion without direct application of force to the head or neck. Whiplash commonly affects the cervical facet joints and related musculature (trapezius, levator scapulae, scalene, sternocleidomastoid, and paraspinals). Although the symptoms of nonradicular neck and shoulder pain are often self-limiting (6-12 months), many people continue to experience more chronic symptoms. Treatment options include cervical traction, massage, heat, ice, ultrasound, isometric neck exercises, a soft cervical collar, and NSAIDs and or short-term analgesic use. Patients with persistent pain may have annular tears, coexisting degenerative joint and disc pathology, nerve root entrapment, spinal stenosis, or myelopathy. Neurologic symptoms or intractable pain symptoms that are not responsive to treatment indicate the need for further evaluation.

What injection techniques can help differentiate other pain generators that mimic cervical and lumbar pathology

Shoulder pain can frequently mimic cervical disorders. Careful examination of the shoulder joint should always be performed in a patient presenting with neck pain. Diagnostic injection into the subacromial space and the acromioclavicular joint can differentiate pain originating from the shoulder region from pain originating in the cervical spine.

Sumant G Krishnan John M Tokish and Richard J Hawkins

Ers had abnormalities of the glenoid labrum. Furthermore, partial-thickness rotator cuff tears, a diagnosis common to the throwing and overhead shoulder, may be missed by MRI as much as 44 of the time.3 Hence, even with the technologic advances available, we remain convinced that the diagnosis of a shoulder problem in the athlete is made by a proper history and physical examination and not in the scanner.

Somatic pain syndromes

Fig. 2-20 Shoulder pain referred from the midcervical spine. Fig. 2-20 Shoulder pain referred from the midcervical spine. Shoulder pain is often a radicular syndrome from the cervical spine with sharp, shooting pain. Paresthesia or numbness is often experienced in the involved dermatome sometimes muscles weaken and reflexes are affected.

Pain Secondary to Other Neurologic Conditions

This condition more commonly presents as weakness and atrophy in the supraspinatus, infraspinatus, or both and is therefore covered more extensively in the section on weakness. However, when an athlete presents with posterior shoulder pain, especially in the presence of weakness of the spinatii, consideration of compression of this nerve should be considered.29-31 There are no provocative maneuvers that exacerbate the specific pain associated with compression of the suprascapular nerve, but, with a high index of suspicion, an injection of lidocaine into the area of the suprascapular notch may alleviate shoulder pain and be diagnostic. There are two common sites of compression for this nerve. The proximal site, at the suprascapular notch, both the nerve to the supraspinatus and infraspinatus can be compressed, leading to pain and weakness of both muscles. More distal compression can occur at the spinoglenoid notch, most commonly from a spinoglenoid notch cyst (usually associated with a...

Pain in the Presence of Scapular Dyskinesia

Most overhead athletes with shoulder problems have some degree of scapular dysfunction. Given this, it is important to examine all athletes and any patient with shoulder pain for scapular winging. Although it is discussed more thoroughly in the section on weakness, winging can be either the cause or the effect of shoulder pain. Thus, it is incumbent on the examiner to determine whether scapular winging, when present, contributes to a patient's symptomatology. This is done by examining the patient from the back and asking the patient to elevate the arms at about half speed. Winging can be maximally demonstrated with resisted forward flexion at approximately 30 degrees of forward flexion (Fig. 16-20). It can also be observed with a push-up or wall push or when patients use their arms to rise from a seated position.

Tennis And Other Racket Sports

Racket sports, such as tennis, squash, racketball and badminton can sometimes be prescribed as alternative training for general fitness development and during convalescence for a number of injuries. Modifications may be required for example, a sore knee may allow baseline tennis play on grass but not allow sprints and turns on a hard court. A stiff shoulder may not allow overhead serves but be perfectly all right for baseline play. Elbow injuries, such as lateral epicondylitis, may require double backhands to avoid pain. Double or mixed games do not involve the same amount of running as singles. Squash is more demanding for the wrist and elbow than the shoulder badminton is very demanding for the Achilles tendon but may be played with a non-dominant shoulder injury. Thus, instead of resting completely, a keen player can maintain parts of their play until treatment and rehabilitation is completed. Meeting and playing with friends is also very important for encouraging the return to...

Upper Limb or Brachial Tension Test Elvey Fig 250

This test is important to determine if nerve tension is causing the cervical, shoulder, or upper limb symptoms. When the history indicates shoulder pain, it may be difficult to determine whether the origin of pain is from the cervical spine, shoulder joint, or myofascial trigger points. This test tells the therapist that it is from a neural origin (especially C5-C7 nerve roots).

Pediatric Overuse Injuries

There has been an increasing awareness of pediatric overuse injuries and their consequences in maturation over the past decade. This has led to increasing amounts of knowledge concerning the pathophysiology and predisposing factors to injury and pain in the adolescent athlete. Injuries sustained at the youth level may not be transient, but may affect the lifelong function of the athlete. Recent studies have postulated a relationship between humeral head remodeling in pitchers in response to lifelong throwing. A positive association has been found between risk of injury and increasing level of competition and age, possibly from the results of cumulative microtrauma. Several studies have shown a direct correlation between number and type of pitches thrown and risk of shoulder pain. These have led to recommendations limiting the number of pitches thrown per game and age recommendations for beginning certain high-risk pitches. Probably the best known overuse injury in children is Little...

Clinical Features And Evaluation

Internal impingement is a pathologic condition typically seen in overhead throwing athletes. Baseball pitchers are most commonly afflicted, although athletes participating in other sports requiring repetitive shoulder abduction and external rotation such as tennis, volleyball, javelin throwing, and swimming are at risk.1-6 Patients typically present with complaints of posterior shoulder pain when the arm is abducted and maximally externally rotated (late cocking and acceleration phases of throwing). Symptoms may be vague and reported by the athlete only as a gradual onset of loss of velocity or control during competition, often known as dead arm syndrome (Box 23-1). Other common complaints are feeling tight and uncomfortable while throwing, along with difficulty warming up.7 The majority of athletes do not recall a single acute event, but many report an acute exacerbation of previous lesser symptoms as the impetus for seeking medical attention. Concomitant labral injury is not...

Results And Outcomes

Shoulder pain in the throwing athlete was at one time attributed to subacromial impingement, even though we now know that this is a rare entity in the young population. Tibone et al35 were the first to report the lack of success treating throwers with chronic overuse disorders by acromioplasty. Only 43 of the patients (including just 4 of 14 pitchers) returned to their preoperative level of competition following surgery. Acromio-plasty alone was used with unflattering results by Kvitne et al.4 Andrews et al36 treated athletes with debridement of both rotator cuff and labral pathology, resulting in a 76 return to same level sport. Payne et al22 reported on debridement of

The subluxed shoulder

Post-stroke shoulder pain is reported to be very common, and in some cases the prevalence of shoulder pain has be reported to be up to 80 of stroke patients (Walsh, 2001) this however varies on how it has been measured. Shoulder pain can lead to difficulty with activity participation due to reduced range of movement, that is, washing under the arm. Shoulder pain additionally can lead to low mood, altered sleep patterns and therefore have an impact on the patient's quality of life. A number of situations can cause shoulder pain, including shoulder subluxation, scapular retraction, abnormal tone either hyper or hypotonicity, sensory changes and poor handling. Shoulder subluxation is caused by low tone around the shoulder, resulting in the glenohumeral joint being displaced as gravity causes the surrounding soft tissues to be pulled down and over-stretched. It is essential to try and determine the cause of shoulder pain to be able to plan the best intervention. Intervention is focused...

Cancer Treatmentrelated Pain

Before treating postmastectomy pain, the area of pain should be identified and therapy directed at the innervating nerve. For axillary and arm pain, a second intercostal or T2 nerve root block can be performed ( Figs. 28-13 A and B). For chest wall pain at the mastectomy site, multiple intercostal or thoracic paravertebral nerve blocks (T2-T6) may be helpful. For phantom nipple pain, a fourth intercostal nerve block can be performed (see Table 28-3 ). Tf a prolonged response from these blocks results, repeated blocks are indicated. Tn addition, this block can be done in conjunction with physical therapy for patients with shoulder pain and frozen shoulder. the mastectomy site (T2-T6). Fluoroscopic guidance is useful in guiding the catheter to the site of the pain. Although less widely used, intrapleural analgesia is conceivably appropriate for postmastectomy pain. This technique has been described for mammography with needle localization and breast biopsy. The catheter tip should be...

History and physical examination History

When a shoulder patient steps into the consulting room for the first time, it is always exciting to wonder whether this is going to be an easy case or one that will cause a headache. Shoulder problems can be just as difficult to diagnose as abdominal problems, and therefore a thorough patient history is mandatory and can save many speculations and investigations. As pain from the cervical spine can project to the shoulder girdle and arm, any history of trauma to the cervical spine and pain in the neck itself must be described. In that case the location of pain is often much more diffuse than pain from the shoulder, and in the case of cervical root compression, there will often be neurologic symptoms (numbness, paresthesia, etc.). If such symptoms are present, a detailed description of the nature of the symptoms, any variation and provocative factors, the precise location and information about fatigue of the arm are essential (see pp. 658-62, Chapter 6.5). Some patients with...

Multidirectional instability

In sports medicine the major problem is athletes with shoulder pain during and after activity. Some of these cases may be misinterpreted as having impingement syndrome. And indeed, some of them do have secondary impingement symptoms. As the head lacks stability, it will move superiorly in the joint during motion. This will excessively load the subacromial bursa leading to bursitis and impingement symptoms. Yet the basic problem is the instability and hyperlaxity Signs which are helpful in establishing the correct diagnosis are, apart from manual laxity testing, external rotation of 90 or more, bilateral symptoms or symptoms of instability from other joints (usually wrist, ankle, femoropatellar joint). Swimmers are a group of athletes well known to have problems with shoulder pain. Their problems are sometimes referred to as 'swimmer's shoulder'. It is shown that many of them suffer from MDI 4,113 . Among throwing athletes also, both pure MDI and secondary impingement are common...

Biceps tendon ruptures

Ment of the tendon to the superior glenoid. The most common complaint with rupture of the biceps tendon is anterior shoulder pain in the region of the biceps. Simple inspection of the involved extremity may demonstrate tears evidenced by migration of the muscle belly. Weakness during forearm flexion and supination is also a strong sign of this injury. In the latter two cases, a primary tenodesis has been recommended as giving the best chance of returning to activity and restoration of normal cosmesis. The technique for this procedure involves abrading the groove and tenodesing the tendon with a single staple. Treatment for rupture at the musculotendinous junction includes primary repair of the soft tissue and extended protection of the healing site. Most patients with either repair procedure are restricted from active elbow flexion for 4 weeks, after which rehabilitation may begin for 2 months. Combined biceps tendon and rotator cuff tears. Patients over the age of 50 and physically...

Yesr MomstoBe Can Lift Weights

Being pregnant doesn't necessarily mean passing up the weight room. In fact, some light weight training might cut back on some of the back and shoulder pain associated with enlarged breasts, extra weight, and a growing uterus. It might also reduce the leg cramps and neck strain that some women experience toward the last trimester. Personally, my favorite benefit from prenatal lifting is that your muscles will be primed for the baby aftermathThat is, you'll be ready to lug around your pocket-book, diaper bag, and stroller on one arm, while carrying your baby on the other. To this day, I still amaze my sister Debra with the amount of equipment I can juggle with just two arms

Other common problems

To traumatization of various structures and inferior subluxation can lead to injuries, including tendons, capsule or peripheral nerves and plexus. It is important to keep the shoulder correctly positioned to prevent subluxation by orthotic management. Hemi-plegic shoulder pain in stroke may be due to adhesive capsulitis (50 ), shoulder subluxation (44 ), rotator cuff tears (22 ), and shoulder-hand syndrome (16 ) 121 . The etiology of shoulder-hand syndrome with pain of the shoulder or arm and edema of the hand and arm is controversial many authors consider it a form of reflex sympathetic dystrophy complex regional pain syndrome, probably initiated by mechanisms mentioned above. Management includes positioning, orthotic management, physical therapy including steps for reduction of edema, and analgetics. In more severe cases intermediate dosage treatment with oral prednisone is effective 122 .

History of Present Illness and Injury

Once the circumstances surrounding the onset are established, the clinical course of the complaint is determined from its inception to the present. During this period, the effects and timing of various treatments are carefully considered. Any response to treatment, even if temporary, is important. For example, if a lidocaine and steroid injection was administered to the sub-acromial space for shoulder pain, it is important to note whether this was effective, even if only temporarily, as this will yield Although we should be confident with a solid differential diagnosis at this point, and although athletes are among the healthiest patients in our population, questions about medical history should not be neglected. These include questions about medications, allergies, and congenital or other medical problems. Finding out that a swimmer with shoulder pain has Ehlers-Danlos syndrome might not only point to multidirectional instability (MDI) as a diagnosis but might also influence the...

Leaning Forward Maneuver Pancreatic Pain

Pancreatitis And Shoulder Pain

The abdominal or chest wall, shoulder, jaw, or other areas supplied by the somatic nerves. Pain appears to originate in areas supplied by the somatic nerves entering the spinal cord at the same segment as the sensory nerves from the organ responsible for the pain. For example, right-shoulder pain may result from acute cholecystitis testicular pain may result from renal colic or from appendicitis. The common sites for referred pain are shown in Figure 17-3. The locations of pain in abdominal disease are summarized in Table 17-2.

Shoulder Arthroscopic Bankart Repair

Periosteal Sleeve Shoulder

Complications associated with either technique include inadequate tissue preparation leading to an inability to properly mobilize the capsulolabral complex. Inadequate tensioning of the capsulolabral complex can lead to suture breakage or recurrent laxity in the tissue. This may lead to an inadequate repair and surgery failure. Metallic anchors, if left protruding above the articular cartilage, can result in disastrous consequences for the humeral articular cartilage. Even slight prominence can result in a destruction of the humeral cartilage as the shoulder abrades on the metallic edge. Additionally, improperly placed metallic or bioabsorbable anchors can dislodge and become loose bodies that result in destruction of articular cartilage. Some bioab-sorbable fixation devices have been associated with a reactive synovitis as they are hydrolyzed. This may be manifested clinically as an increase in shoulder pain at 4 to 6 weeks postopera-tively and a loss of glenohumeral motion.

Techniques of laminoplasty and supplementary procedures

Double Door Laminoplasty

Postoperatively, patients with laminoplasty complain of various axial symptoms such as nuchal pain and stiffness of the neck and shoulder muscles. Neck stiffness usually appeared on the hinge side in our en-bloc lamino-plasty series. In our series, 59.7 of laminoplasty patients complained of some axial symptoms within 1 year after surgery, in contrast to 27.2 of laminectomy patients and 19.2 of subtotal corpectomy and fusion patients. After spinous process splitting laminoplasty, a few of the patients complained of neck and or shoulder pain. The symptoms were usually distributed on both sides. The causes of these symptoms are not clear. However, changes in and around the facet joints caused by surgical intervention may be the cause. The symptoms resolved by about 1 year after surgery in most patients. However, axial symptoms are the chief complaint in some patients, and their cause should also be clarified. Thermal therapy and active mobilization of the neck and shoulder is...

Ruptur Thympanic Membran Cruris

Vibratori Coppia Gif

Although shoulder pain may be related to a primary shoulder disorder, always consider the possibility that shoulder pain is referred from either the chest or the abdomen. Coronary artery disease, pulmonary tumors, and gallbladder disease are commonly associated with pain referred to the shoulder. The movements of the shoulder occur at the glenohumeral, thoracoscapular, acromioclavicular, and sternoclavicular joints. The glenohumeral joint is a ball-and-socket joint. In contrast to the hip joint, which is also a ball-and-socket joint, in the glenohumeral joint the humerus sits in the very shallow glenoid socket. Therefore, the function of the joint depends on the muscles surrounding the socket for stability. These muscles and their tendons form the rotator cuff of the shoulder. For this reason, many shoulder problems are muscular, not bone or joint related, in origin. Sudden onset of shoulder pain in the deltoid area 6 to 10 hours after trauma suggests a rotator cuff tear or rupture....

Hidden Home Exercises

Pijn Binnenkant Voet

Person to use 70 to 80 per cent of their maximal oxygen uptake, equivalent to running for 45 minutes at a good pace. Cleaning windows manually is excellent rotator cuff training after shoulder injuries vacuum cleaning requires core stability and posture washing dishes in warm water is excellent for a healed radius fracture. There are many, many other examples running up and down stairs, standing on one leg on a wobble board while brushing your teeth, stretching out in the shower, cutting the hedges, mowing the lawn, walking or jogging the dog, jumping off the bus one stop away from the office, using stairs instead of lifts. We neglect many of these things (if we can) during the week, then we spend money and energy on a one-hour run on a treadmill and gym training. Who needs a gym if there is a garden to attend to Who needs exercise if you are running after three small children all day or taking the dog out once a day

Inhibitory upper trapezius tape

Upper Trapezius Inhibition Taping

Another study using a different methodology examined the EMG activity of the scapular muscles during active shoulder flexion and abduction (Cools et al 2002) and failed to find any significant changes in EMG activity of the upper and lower trapezius or the serratus anterior with similar inhibitory tape applied. Only one study has examined the effects of the upper trapezius inhibitory tape in subjects with shoulder pain (Selkowitz et al 2007). The results from this study indicate that this taping technique can inhibit the upper trapezius with a resulting increase in activity in the lower trapezius muscle during shoulder elevation when compared to an untaped condition. The differences in methodology of these three studies make it difficult to draw conclusions about the absolute effects of inhibitory taping over the upper trapezius. Present evidence indicates that a single strip of rigid tape may decrease upper trapezius muscle activity and increase activity of the middle lower trapezius...

Shoulder Subluxation Dislocation

A posterior shoulder dislocation may result from direct posterior force to the humerus or a fall on an outstretched hand, a direct blow to the anterior shoulder, or an indirect force of flexion, adduction, and internal rotation. Other etiology may also cause posterior dislocation of the shoulder, such as a worker who sustains an electric shock to the shoulder region.47 Interestingly, an increment of posterior shoulder instability is sometimes desirable in swimming, volleyball, pitchers, and weightlifters. Symptoms include posterior shoulder pain with internal rotation, or flexing the arm to mimic strain or partial avulsion of the external rotator muscles.30 The patient is unable to fully supinate the forearm and hand with the arm in forward flexion.47 Treatment involves sling or splint immobilization with the arm adducted to the side and internally rotated, and the forearm positioned across the chest, providing this posture is not painful (Fig. 17-29). If internal rotation is painful,...

Degenerative Disc Disease

Compression of the C6 root typically causes numbness in the thumb and index finger, and compression of the C7 root typically involves the index and middle fingers. When compression is severe, myotomal weakness, reflex loss, and, with time, fasciculations and atrophy may ensue. With C6 compression, the biceps, brachioradialis, pronator teres, and radial wrist extensors may be weak, and the brachioradialis and biceps reflexes may be diminished or lost. With C7 weakness, the wrist and finger extensors and the triceps are typically weak. The triceps reflex may also be diminished or lost. With C8 compression, there is often interscapular pain and pain in the medial aspect of the arm and hand with weakness of the hand intrinsic muscles. The finger flexor reflex may be lost. Lesions above C6 are less common and are associated with correspondingly more proximal sensory symptoms and weakness. Lesions of the C5 root may cause shoulder pain and pain and numbness...


The humeral head may be slightly inferior from the normal resting position, with inferior glenohumeral instability. The humeral head may also sit superiorly if there are capsular restrictions secondary to adhesive capuslitis. Many shoulder problems cause deltoid atrophy, so this should be looked for.

Example of clinical reasoning process

By arm movements - she felt she had developed a shoulder problem as well. She admitted at this point being 'thoroughly fed up with it all'. She was taking NSAIDs and analgesics, neither of which seemed to do much except provide temporary lessening of symptoms. She felt the job was making her worse and asked for a sick note off work and a referral to a 'specialist'. The doctor signed her off work, but instead referred her for physiotherapy Although initially being off work seemed to be easier, overall in the last few weeks she feels her symptoms are unchanging. It is obviously necessary to take baseline measurements of range of shoulder and neck movements however, at this point no direct intervention will be aimed at the shoulder Very often in such instances, where the initial and primary problems are cervical, when this is addressed the apparent 'shoulder' problem goes away. However, this is not always the case, and sometimes it becomes clear that a secondary and genuine shoulder...

Treatment Options

Nonoperative treatment of disorders of the long head of the biceps is usually directed by the treatment for concomitant rotator cuff disease. Initially ice, rest, and anti-inflammatory medications in conjunction with a well-supervised physical therapy program should be prescribed. Athletic activity that incites shoulder pain should be temporarily curtailed. Patients who fail a trial of rest and physical therapy may require a sub-acromial steroid injection to help control the inflammation. Injections can also be given in the glenohumeral joint or directly into the tendon sheath. During the acute phase of inflammation, physical therapy begins with range-of-motion exercises of the shoulder before moving on to strengthening of periscapular musculature. The serratus anterior and trapezius muscles help create a stable platform for the scapula. Strengthening exercises can The treatment algorithm of the biceps is not always straightforward. The majority of biceps tendon ruptures are...

Neurologic Sources of Weakness

It is uncommon that a radiculopathy will result in weakness without pain, and the examiner is referred to the cervical spine sources for shoulder pain in the previous section. Any findings of weakness should be cross-checked for pain with the various cervical spine provocative tests to strengthen or discredit the suspicion of a cervical source for the shoulder symptoms.

Table 283 Causes Of Postmastectomy Patn And Symptoms

Shoulder pain Many patients develop pain after radical neck dissection. The pain is described as a sensation of tightness, burning, and dysesthesia in the shoulder, neck, and jaw. Lancinating-type pains are occasionally reported.1 The cause of the pain is likely secondary to damage to the cervical nerves and cervical plexus during surgery. Shoulder pain can result from loss of normal support to the shoulder secondary to loss of the neck musculature, leading to musculoskeletal pain. 2 Tt has been suggested that the cervical plexus provides some innervation to the trapezius. Tf the cervical plexus is damaged, chronic shoulder and arm pain may result.1 Tn addition, damage to the spinal accessory nerve has been shown to increase the risk of chronic shoulder pain. This can result in loss of innervation to the trapezius muscle and musculoskeletal pain in the shoulder girdle.1 Damage to the auriculotemporal nerve after cancer surgery has been reported to lead to gustatory sweating,...

Shoulder Dislocation Clinical Summary

Anterior shoulder dislocations are the most common dislocations seen in the emergency department. They are most frequently caused by falling with the arm externally rotated and abducted. Acutely, patients present with the affected extremity held in adduction and internal rotation. Often, the patient complains of shoulder pain, refuses to move the affected arm, and may support the dislocated shoulder with the other arm. The acromion becomes prominent and there is a loss of the rounded contour of the deltoid. A neurovascular examination of the upper extremity should be performed to rule out associated injury, most commonly of the axillary nerve (sensation over the deltoid), and of the musculocutaneous nerve (sensation on the anterolateral forearm). Standard radiographic examination to evaluate for associated fracture should include anteroposterior (AP) and either axillary lateral or scapular Y views.

What is a sports injury

For younger athletes trying to establish themselves in their sport, an injury can result in major family-related conflicts. Over-ambitious or over-protective parents and pressure from coaches and team-mates can put stresses on to a young athlete not able to participate in their sport. For recreational athletes, injuries may mean loss of regular physical and social activities and problems with general health, such as blood pressure, insulin control or secondary problems to the lower back from limping. A shoulder injury from squash may cause difficulties for a builder or plumber with their own business or raise concerns about the safety of a police officer or firefighter. Completely irrational charity bets - 'I must Most sports injuries are specific to the sport and the level of participation for example, 70 per cent of keen runners will be affected by a lower limb injury during their career, usually through over-use soccer players have a high risk of traumatic ankle or knee injuries...

Pain Secondary to Cervical Spine Pathology

Spurling Test

One potentially confusing cause of pain in the shoulder is that which is referred from the cervical spine. Herniated disks can cause pressure on the C5-T1 nerve roots, which can cause vague symptoms in the anterior and posterior shoulder girdle. Patients may interpret this as shoulder pain, and thus it is incumbent on the examiner to determine exactly where the pain comes from. In such cases, the patient will not often localize the pain. The various tests that are good indicators of cervical pathology are described.

Pain of Uncertain Origin

Rotation signals a positive internal rotation resisted strength test, and intra-articular pathology is then suspected. This test has been reported to be 88 sensitive, 96 specific, and 94.5 accurate in differentiating between intra-articular and subacro-mial sources for shoulder pain.32 We occasionally use this test in the presence of a difficult examination, often to help direct which injection to begin with, although we rely more heavily on the subsequent injection test to delineate the source of pain.

Pain at the Coracoid Subcoracoid Impingement

Although a rare cause of pathology, subcoracoid impingement has been recognized as a source of anterior shoulder pain.25 One test for this is the coracoid impingement sign, which is performed with the patient standing with the shoulder abducted 90 degrees with horizontal adduction in the coronal plane and maximally internally rotated (tennis follow-through position, similar to the Hawkins sign with less horizontal adduction). A positive test is marked by pain around the coracoid process.

Chief Complaint Loss Of Control Andor Velocity

Compensations, they have been noted by pitching coaches for years and lead to increasing strains in the shoulder should the athlete continue to pitch. This may lead to new shoulder problems that will be difficult to completely eliminate until the more proximal elements of the chain are evaluated and rehabilitated.

Suprascapular nerve entrapment

Suprascapular nerve entrapment is an often overlooked cause of shoulder pain. Proximal entrapment of the suprascapular nerve in the suprascapular notch beneath the transverse scapular ligament results in both supraspinatus and infraspinatus muscle weakness, whereas a more distal entrapment at the spinoglenoid notch involves only the infraspinatus muscle. The most frequent site of injury occurs at the point where the suprascapular nerve crosses the suprascapular notch near the transverse scapular ligament (Fig. 6.6.20).

Quadrilateral space syndrome

The quadrilateral space lies laterally to the inferior border of the teres minor muscle. The posterior humeral circumflex artery and the axillary nerve travel within this space. The quadrilateral space syndrome was initially described in 1983 178 and usually compromises axillary nerve function by fibrous bands in the quadrilateral space. In most cases function is limited when the arm is positioned in abduction and external rotation or the cocking phase of throwing. Patients can complain of posterior shoulder pain in the area of the teres minor muscle that is heightened by abduction and external rotation of the arm as well as direct tenderness. Diagnoses are most often confirmed with an arteriogram of the subclavian and axillary arteries. Initially the shoulder is placed in the neutral position and the posterior humeral circumflex artery is visualized. After repeated injections with the arm in abduction and external rotation the artery becomes no longer patent.

Sequelae and Rehabilitation

Gold Eyelid Weights And Mri

When the spinal accessory nerve is injured and the sternomastoid and trapezius muscles subsequently paralyzed, shoulder pain and restricted range of motion may occur. In these situations, aggressive postoperative physical therapy can prevent the development of adhesive capsulitis and scapular winging, although normal shoulder range of motion and strength are not possible.54 Isolated glossopharyngeal or hypoglossal nerve paralysis is not usually associated with significant morbidity, although speech and swallowing therapy may assist with any resultant dysphagia or articulatory difficulties. However, combinations of nerve paralyses such as a simultaneous

Rationale For The Differentialdirected Approach

The initial pathologic differential in the athlete's shoulder is formed from two important pieces of information (1) the athlete's age and (2) the athlete's chief complaint. One simple example of this is the 60-year-old male tennis player with shoulder pain. Certainly the diagnosis is not guaranteed with such limited information, but the astute clinician has a working differential from the very start. Throughout the examination, the clinician has certain findings that he or she is expecting may be positive. In this example, impingement signs with associated weakness with supraspinatus testing would strongly suggest a rotator cuff tear. At the same time, features of the examination that focus on subtle glenohumeral instability might be less emphasized. This format emphasizes attention to a set of expected findings and makes the diagnosis that much more specific.

Monoamine Reuptake Inhibitors

Duloxetine has been shown to be effective in reducing physical symptoms (back pain, shoulder pain, headache) in depressed patients as well as the core depressive symptoms (Detke et al., 2002), possibly due to its dual action on 5-HT and NE systems (Stahl, 2002). These findings have stimulated a renewed interest in reevaluating the diagnostic criteria for major depression given the relative underrepresentation of physical symptoms in the DSM-IV criteria (Fava, 1996).


The technique of swimming is very demanding and often hampers its aerobic and anaerobic effects and thus the time spent in the water. To swim for 30 minutes requires a well-developed technique. Even though there is no direct impact, swimming may cause problems if the training is not precisely defined it is important to recommend or restrict different techniques of swimming for different injuries. For example, swimming the breaststroke can exacerbate knee injuries such as medial meniscus tears, osteoarthritis, anterior knee pain and most shoulder injuries. Most swimming techniques will provoke sub-acromial impingement and patients with multidirectional instability in the shoulder should not be prescribed swimming. Low back pain and neck pain may well be aggravated if the athlete does not lower the head down into the water in the swimming stride but looks up, protecting the face or eyes from the chlorine but hyper-extending the cervical and lumbar spine. Such simple mistakes often mean...


Perhaps the classic sports model for overuse is baseball pitching. During recent years, new understanding of the biomechanics and pathoanatomy of throwing injury have given us insight into the causes of shoulder pain in the athlete. A thorough understanding of these advances is essential to the successful approach to treating overuse injury in the baseball pitcher. Throwing sports continue to contribute significantly to the overall incidence of shoulder injury. In particular, the past 30 years has seen a significant growth in organized baseball. Children as young as 5 years old are involved and soon after may participate in multiple leagues. This is in contrast to 30 years ago when organized baseball was not available until the athletes reached the age of 9 (Table 21-3). In general, young athletes today tend to focus on single-sport specialization rather than the free-play concept of multisport involvement. Those athletes involved in free play tend to play multiple sports in a...

Clinical Evaluation

With disorders specific to the biceps tendon, pain often radiates down to the muscle belly. Patients can also give a long history of anterior shoulder pain and popping that spontaneously resolved after a specific incident requiring elbow flexion. This is a classic story of a patient with chronic biceps tendonitis who ruptured his or her biceps tendon. Instability of the biceps tendon can sometimes be difficult to assess clinically. Often the patient will describe a history of painful snapping when moving from an abducted externally rotated position to internal rotation, a motion that is replicated frequently in overhead athletes. Due to the difficulty in isolating biceps tendonopathy, diagnostic tests designed specific to the biceps tendon have been described to help localize shoulder pain. The clinical effective Patients with biceps instability will usually present with a history of shoulder pain associated with popping and catching. One method for testing...

Thoracic Spine

Any decrease in range or signs of pain or clicking during the opening or closing of the mouth can demonstrate temporomandibular pathologic conditions. Any lateral deviation of the mandible during opening indicates temporomandibular joint dysfunction or muscle imbalance. If TMJ dysfunction exists, the resulting forward head posture and myofascial syndromes can cause adaptive shoulder problems.


Several muscle trigger points from shoulder problems and cervical lesions are located around the scapula 0anet Travell's work) (see Fig. 3-60). It is important to be familiar with the trigger points for the levator scapulae, trapezius, supraspinatus, infraspinatus, rhomboids, teres minor, and latissimus dorsi muscles because they refer pain around the scapula. The suprascapular notch is also an acupuncture point or trigger point for shoulder pain and any damage to the suprascapular nerve can elicit pain here.


A confounding problem arises in distinguishing depression from the neurobehavioral sequelae of stroke, TBI, and MS. With a right cerebral lesion, some patients minimize impairments and distress and appear indifferent. This affect can mask depression. Minor and major depression take some leg work to detect in patients with anosognosia.250 Aprosodia and nonverbal vegetative behavior can be mistaken for depressive signs in patients who are not depressed. Many of the somatic and cognitive complaints that suggest depression can reflect treatable problems particularly during inpatient hospitalization. For example, a noisy neighbor or shoulder pain may lead to sleep deprivation, fatigue, and poor concentration. Adverse reactions to any centrally acting medication may produce loss of energy, poor appetite, and systemic somatic complaints. Somatic complaints after stroke or any serious illness are common. In isolation, they do not imply a mood disorder.

Assistive Trainers

Erally produce negative results.241 Functional electrical stimulation (FES) devices for hand grasp and opening (see Chapter 4) could also augment retraining, or simply allow greater functional use of a profoundly weakened hand.285 Five weeks of FES may also reduce shoulder pain related to subluxation arising from paresis. The FES may improve shoulder function,286 perhaps by allowing pain-free practice. Virtual reality systems that augment feedback about the position of the hand in space offer a potentially powerful form of practice for hemiparetic subjects. This computerized approach can be programmed to provide feedback information regarding knowledge of performance and knowledge of results using parameters such as velocity, trajectory, and accuracy of the reaching movement.

Neck pain

Neck pain may be classified according to etiology, pathophysiology and biomechanics, or symptom localization. Commonly neck pain radiating to the arm (cervicobrachialgia) is discriminated from neck pain (cervicalgia). The pain may radiate in a nerve root pattern (cervical radiculopathy), or may be aggravated on elevation of the arm and palpation of the brachial plexus (thoracic outlet syndrome) or result from entrapment by peripheral nerves. A common clinical challenge is to discriminate primary neck pain radiating to the shoulder and arm from primary shoulder pain associated with secondary cervical myalgia. Neck pain may also result from collar tumors or infections. In the elderly population, a vertebral artery stenosis may result in dizziness and neck pain.

Longterm Care

One-fourth of patients who had sustained their injuries 20-40 years ago evolved a greater need for physical assistance over the years, especially for help with transfers.218 Patients reported shoulder pain, fatigue, weakness, weight gain, and a decline in the quality of life more often than patients who did not require more assistance.

What to Do

Let the warmth move through your head. Relax all the muscles in your head and face. Allow the warm feeling of relaxation move through your neck and shoulders. Relax your shoulders. Allow the warm feelings of relaxation to move throughout your back muscles. Let the warm feelings of relaxation move down your spine. Let the warm relaxing feeling fill your legs and move into your feet. Imagine that the tension is just gradually draining away. Let the tension disappear gradually as you relax. Breathe slowly and deeply. Allow yourself to be calm and peaceful, warm and relaxed. Let all your muscles become heavy and loose. Enjoy the calm gentle feelings of relaxation. Tense your shoulders by thrusting them forward. Hold the shoulders in this position for five seconds and notice the muscles in your back and shoulders stretching and tensing. Release and relax. Loosen your muscles and allow your shoulders to drop. Allow the tension to leave your shoulders and allow the warm pleasant feeling to...

Pain following TBI

Various forms of pain can arise in the context of the recovery following TBI contingent upon the nature of the initial injury and the subsequent development of the condition over the ensuing period. The most commonly encountered forms of pain syndromes following TBI include dysautonomia, neuropathic pain, spasticity, headache, heterotopic ossification (a nonmalignant overgrowth of bone often occurring after a fracture) (Harris, Nagy, & Vardaxis, 2006), deep vein thrombosis, genitourinary and gastrointestinal pain, and the pain associated with orthopaedic trauma including shoulder pain (see Ivanhoe & Hartman, 2004 for a recent review). Fractures and dislocations are observed in 71-80 of TBI patients (Bontke, Lehmkuhl, Englander et al., 1993), and 20 of patients complain of limb pain six months or more following the injury (Gellman et al., 1996) Shoulder pain resulting

Shoulder Instability

Shoulder Maneuver Family Medicine

The conservative treatment of shoulder instability is targeted at balancing the flexibility, optimizing the motor strength, and optimizing the function of the kinetic chain. The core component is rotator cuff-strengthening exercises as well as scapular stabilizer exercises. Controversy surrounds the ideal treatment for a first-time shoulder anterior dislocation. In young athletes or military populations, the risk of recurrence and future shoulder problems approaches 90 . Surgical treatment with repair of labral detachments has led to a high rate of return to play and return to performance, with a low risk (40) with first-time dislocation have a reduced risk of recurrent instability (


Back pain is one of the most frequently reported health problems. It ranks second only to the common cold as a reason for doctor's office visits in the U.S. Low back pain is the most common problem brought to chiropractors, although headache, shoulder pain, neck pain, sports and workplace injuries, tension, and carpal tunnel syndrome (pain, weakness, numbness, or tingling in the arm or hand) also are frequently treated by chiropractors.

Thoracic pain

As mentioned above, there is ample room for confusion between symptoms that emanate from the thoracic and cervical spines. Several studies have indicated that pain around the scapular and shoulder region commonly arise from cervical discogenic or zygapophyseal joint disorders (Cloward 1959 Smith 1959 Whitecloud and Seago 1987 Grubb and Kelly 2000 Dwyer et al. 1990 Aprill et a .1990). However, stimulation of thoracic structures has also caused pain in the chest and scapular region (Bogduk 2002c). Any combination of neck and scapular or shoulder pain is probably referred pain from cervical structures.

Disabled Athletes

Athletes with spinal cord injuries have their own set of medical concerns. For example, shoulder injuries and carpal tunnel syndrome are very common among the wheelchair-dependent population. Exercises that strengthen the rotator cuff and scapular stabilizers should be initiated early. Also, paralyzed athletes can accumulate fluid in the immobilized extremities during physical activity, which diminishes cardiac return and cardiac output. These individuals should be advised to use compressive garments during exercise. Paraplegic athletes with high thoracic injuries (above the T6 neurological level) have problems regulating body temperature and should be advised to avoid exposure to severe environments. There are also skin issues of potential concern, such as pressure sores, and persistent fungal infections which must be identified and addressed.

Suggested Readings

Abrams J Special shoulder problems in the throwing athlete Pathology, diagnosis, and nonoperative management. Clin Sports Med 1991 10 839-861. Lyman S, Fleisig GS, Andrews JR, et al Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med 2002 30 463-468.

Clinical Features

Shoulder pain secondary to biceps tendon pathology can be quite severe, causing significant disability. Often the exact etiology of the pain is not clear, as the pathogenesis of biceps ten-donopathy is intimately related to existence of other shoulder disorders. Yamaguchi and Bendra10 classified three major groups of pathologic processes in order to help describe and manage biceps disorders inflammatory, instability, and traumatic. This classification system was designed to characterize the pathologic process present in the biceps tendon, taking into account that overlapping conditions may exist.


In a study on soft tissue injuries to USA para-lympians at the 1996 Summer Games there was found a decreased incidence of shoulder injury among wheelchair athletes suggesting that the injury prevention advice provided by previous studies is being implemented among athletes at this competitive level

Local Pain

Horrific Tmj Pain

Shoulder pain may occasionally be present due to nerve compression or entrapment from muscle spasm. This is usually caused by muscle spasms of the scalenes, causing entrapment of the long thoracic nerve, or trapezius spasm, affecting the suprascapular nerve. The mandible is attached to both the cranium and the shoulder girdle and any positional change of either can be manifested in positional changes of the mandible (Rocabado M). Positional changes of the mandible can lead to TMJ dysfunction and pain. 5. Shoulder pain Shoulder pain Shoulder pain

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