How To Find The Real Shoulder Issue > Even WITHOUT A Clear Diagnosis!
Posted By: Andy Barker
It’s the shoulder!
Unlike most therapists I actually like the shoulder and enjoy the challenge of identifying a patients diagnosis and rehabbing their injury.
You might think I’m mad, as shoulders are notoriously difficult to diagnose.
Maybe its all those years working in professional rugby!
But for many therapists shoulders are difficult to manage.
But why is it that shoulders are so difficult to treat and especially, tricky to diagnose?
There are several reasons for this…
And as challenging as the shoulder can be…
99% of New Grads (likely you too) are greatly overcomplicating the assessment.
This leads to overwhelm and uncertainty about the your diagnosis.
This leaves you feeling confused with your patient assessments, as your subjective and objective assessments don’t match up.
Even if you have a fair idea of what is going on…
Your treatments and rehab often only produce short term relief…
With your patients symptoms quickly returning, just about as soon as they leave your clinic room.
Frustrating isn’t it?
You may think that the shoulder is complicated and as a result you need some ‘magic’ assessment formula to find the right problem.
But you don’t!
It’s actually the opposite.
You don’t need a more elaborate assessment structure or to learn more shoulder tests.
You actually need to make it more simple.
A simpler shoulder assessment will make the management of the patients and athletes you see with shoulder pain much easier.
Not So ‘Special’ Tests
One of the big problems with the shoulder is that many of the special tests are not that ‘specific’ or ‘sensitive.’
As a result it is assumed more difficult to get an accurate diagnosis.
I’ll be honest…
This is true!
The special tests are NOT that great at the shoulder…
Even when combined together.
But you need to remember that special testing is just one small part of your patient assessment.
It is just one part of the your clinical jigsaw…
And just a small part of your objective assessment that you use to confirm your subjective suspicions.
If you are solely relying on special tests to diagnose a shoulder injury (or any other injury for that matter)…
Then you are greatly undervaluing the rest of your assessment.
The REAL Role Of The Initial Assessment
The initial assessment is NOT just about identifying a diagnosis.
There is much more to it than that and I’ll show you right now.
Your initial assessment should are aim to do these 3 things;
1) Find What Is Causing The Problem (The Diagnosis)
2) Find Out What Problems Have Resulted (e.g. Loss Of Range Of Movement (ROM) Or Reduced Strength) And…
3) Find Out What The End Goal Is (So You Know What Level Of Function The Patient Is Aiming To Return To)
That is it!
It’s not about treatment or rehab.
If you nail these 3 things and have time for treatment and rehab in the first session that’s great.
But you shouldn’t progress to hands-on treatment or rehab before you have nailed these 3 things.
Let’s look at how this might work in real life.
Lets say you have a tricky shoulder patient that you can’t seem to get your head around…
And you can’t identify a clear diagnosis.
Despite this, you should clearly be able to identify what problems have resulted (#2) and what your patients end goal is (#3).
You might identify your patient has reduced shoulder abduction or pain with shoulder flexion, or weakness with shoulder internal rotation (#2).
You ask the right questions and come the end of your assessment, you and your patient are clear what the end goal is (#3).
It might be a return to sport, like rugby, or the gym or being able to get back to work as a builder.
This is all in the first session…
And ALL without a diagnosis.
If you can nail a diagnosis that is great…
But if you can NOT, this should NEVER stop you identifying problems and knowing what the end goal of your treatment plan is.
And any how…
As a therapist you don’t treat a diagnosis…
…you treat the patients PROBLEMS.
You restore lost range of movement, improve muscle strength, or improve balance or proprioception or whatever other problems you have identified during your assessment.
STOP Assessment Overwhelm
If you take one thing away from reading this post I want you to understand that the shoulder, whilst a bit more complicated than some other joints…
Does NOT need to be complex.
If it does feel complex and you dread those patients that come and see you with shoulder pain…
Then I am almost certain you are overcomplicating the shoulder…
Probably relying too much on your special tests…
And getting your head in a spin if you get to the end of your assessment without a clear diagnosis.
This results in you feeling unsure where to start with your patients treatment and rehab.
Whilst it might be difficult to differentially diagnosis what is causing your patients pain…
It might not actually matter…
As the way you might treat a problem in the shoulder, regardless of what structure is causing that problem, will be very similar…
Maybe exactly the same.
Let’s say you see two shoulder patients in your next clinic.
One has a diagnosed sub-acromial bursa problem and the other, has a diagnosed suprapinatus rotator cuff injury.
On assessment they present quite similar (as most shoulder patients do).
They both have reduced shoulder flexion, a painful arc with shoulder abduction and a loss of shoulder external rotation strength.
With both these patients you might use the same treatments or rehab to restore their range of movement and strength.
It’s almost irrelevant that one patient has a problem with their bursa and one has a supraspinatus injury.
In short, the diagnosis is not that important.
What is more important is that you have identified what problems your patient has…
Then it is your job to fix these problems using your treatments and rehab.
But, Don’t Patients Want A Diagnosis?
In short no.
Despite what you may think, patients don’t often care that much about a diagnosis.
What they are more concerned with, is you being able to get them out of pain…
And help them back doing the activities, jobs or sports they enjoy.
That is the reason they came to see you in the first place.
I’m sure you have had patients describe previous injuries and say things like…
‘I once had a problem with the front of my knee, but I rested it a little and it has never bothered my since, not even when running.’
They had an injury…
They didn’t know what it was…
But it doe NOT concern them…
Because they got back to what they enjoy doing (running).
If you understand this concept then you already far ahead of 99% of other New Grad trying (usually unsuccessfully) to treat shoulder pain.
I’m not saying you shouldn’t aim to find a diagnosis (there is an easier way to do this too – see the bottom of the page).
But you can still help patients without a clear diagnosis.
Find the problems…
Establish your patients end goal…
Then get going with your patients treatment and rehab.
If you want to really improve your confidence treating shoulder injuries, even complex ones, then you need to check out this FREE resource…
In this special resource you will discover…
The #1 Reason Why New Grads Can’t Seem To Get The Right Diagnosis No Matter How Hard They Try!
Why You Should Never Trust People Who Tell You That The Shoulder Is ‘Complex’ And What You Should Do Instead
The Honest Truth About Getting Great Results With Shoulder Pain Patients And Why It Can Be So Much Easier Than You Ever Imagined!v
And Much, Much More!