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When shoulder pain is not shoulder pain

The shoulder joint is an extremely complex joint. It also happens to be one that a very large amount of people experience pain in. Lucky you there is a physical therapy clinic on every corner with 50 other shoulder pain patients going through the same rehab you are. Now you and the guy next to you get to have a competition to see who can progress to the red band first! Just like back in elementary school though you are a big puss and can’t seem to get past the pain of the exercises while your homie on the table next to you is rockin the gray band already. What do you do?

Go back to your doctor who now orders an MRI of your shoulder. Wouldn’t ya know it! Right there on that screen, clear as mud, there is a 50% tear in your rotator cup. All that pain and suffering for nothing! Off to the ortho surgeon you go. You sit down and tell him about how you painted your fence 10 years ago and had a sore shoulder after, must have happened then and you just pushed through the pain all those years. You tell him you have already tried PT and it made you worse so you get that steroid shot which helps for a day then wears off. Clearly, the only thing left to do is glue that broken cup back together right?!

Doc tells you about the rehab and that shoulder surgery is one of the more painful orthopedic surgeries you can have (or at least I hope they tell you). You agree and finally see the light at the end of the tunnel. The morning after surgery you wake up in just as much pain except now you also have a shoulder that has been cut open and fixed up. You go to rehab because, well it is supposed to hurt! 6 months in and the pain is still there and now you’re even losing grip strength. Yup… You done F*&^ed up.

What happened here? You fell victim to a healthcare industry that is based around an old thought process that imaging findings actually correlate to pain. You walked into a SHOULDER surgeon's office with a partial rotator CUFF tear that had likely been there for years and had absolutely nothing to do with your pain. BUT that imaging report gave the surgeon the ammo he needed to get those fat stacks from your insurance company so… Yeah, of course, he’s going to recommend surgery!

In case you haven’t noticed I’m kind of big on the spine so why am I talking about this? That is a good question… if you’re not in the medical field and/or don’t keep up with any relevant research. Otherwise, you know exactly what I am getting at. The pain in your shoulder had nothing to do with your shoulder outside of the fact that it was referred there by something else.

That something else happens to be… Your spine, specifically your cervical spine(less likely but possible is thoracic spine). Multiple cervical vertebral levels are associated with nerve roots that run out towards your shoulder. They form what is known as your brachial plexus which forms branches and runs straight through that painful shoulder of yours! Let’s say you have some nerve root irritation at your C5 nerve root from.. dun dun dun… a disc bulge(or any other issue you can think of). There are these great patterns called dermatomes that doctors rely on to determine if it is coming from your spine. These great patterns are a ridiculous thing to use to diagnose a patient. You cannot say that anything in the body is going to present the same in people across the board.

This has been something I have felt strongly about because anatomical variation is basically the norm. Expecting that every patient is going to present the same with the same issue is like saying we should all like the same foods because we all have tongues. I’m sure that insurance companies are a bigger driver for this false belief system because they have to see things in black and white in order to approve reimbursements. By relying on these patterns and other old-school ideas to determine when the spine is involved people are regularly misdiagnosed. Now in theory when you get a wrong diagnosis someone else involved in your care should catch this. Unfortunately, too many people rely on that initial diagnosis and don't do an appropriate exam due to time constraints or just lack of giving a s#!t.

What is simply mind-blowing about all of this is the fact that in most cases I can speak to someone on the phone and through a short series of questions determine the likelihood of the spine being involved. Our bodies are designed to move in specific ways, when you present with specific movement restrictions and symptomatic responses occur there is little guesswork left. The key to a successful differential diagnosis involving the spine and extremities is to ask the right questions and listen to the whole patient's history. Can you guess why they get it wrong so often? Well, it is kind of hard to listen to a patient’s whole history when you have 30 patients to see and no time to actually spend with any of them.

It is time to invest in your own health and wellbeing. Stop allowing your insurance company to dictate the quality of care you receive. Find a clinician who is ready and willing to listen to what you have to say. Demand better to feel better.

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