How to Diagnose Shoulder Injury?

The shoulder joint is made up of many different structures. This includes bones, muscles, and tendons that attach to them as well as ligaments that hold everything in place securely so you can move around with ease. However, these structures are prone to injury due to being used often and because of the shoulders’ location.

What injuries cause shoulder pain?

• Instability– a condition when either of the capsule, ligaments, or labrum stretches. An unavoidable tear can cause the socket to open completely or partly. In the end, it results in dislocation. An instability problem can cause pain when raising an arm.
• Impingement – is a condition that results when the rotator cuff rubs against its edges. Rubbing leads to pain and irritation, often caused by repeated motion at work. It can also be from aging muscles losing flexibility in this area.
• Fractures – are devastating injuries that can impair your ability to move. The condition occurs as a result of trauma or injury. Examples are falls, sports injuries, and car accidents, among others.
• Tears – are an injury to the soft tissue that helps your shoulder move. A tear can happen in the tendons, muscles, or in labrum. It can be a small tear, or it can cut through the whole thing.
• Frozen Shoulder – is a painful condition that occurs when the shoulder becomes inflamed. It usually takes place in the capsule, a tissue surrounding your shoulder joint. 

In what ways are shoulder injuries diagnosed?

1. X-rays. X-rays are a crucial part of determining the cause and severity of the symptoms. It can show whether there is any problem with the bones in the body, such as spurs or fractures. It can also help doctors see if there is any arthritis in the shoulder.
2. MRI scan. Magnetic resonance imaging (MRI) uses magnetic fields, radio waves, and a computer. It can look inside shoulder joints. The test results will help assess injuries. 
3. CT scan. CT scans are a type of advanced x-ray device. Doctors use it for diagnosing internal organ injuries. Using cross-sectional images, it is able to see the bones and soft tissues in the shoulder. It detects abnormalities and may also help identify tumors and blood clots.
4. Electromyography (EMG). Electromyography records the muscle’s response to when a nerve stimulates the muscle. It is a way to measure how muscles are working. The test helps doctors to detect any neuromuscular abnormalities in the body.
5. Arthroscopy. Arthroscopy is a procedure for diagnosing and treating joint problems. A surgeon inserts a narrow tube attached to a fiber-optic video camera. It passes through a small incision — about the size of a buttonhole. A high-definition video scanner transmits the view inside a joint.

Common Diagnostic Tests for Shoulder Injuries

Neer’s Test

It can help determine if your shoulder pain could be due to impingement. It assesses the range of motion in your shoulder. Using a bend-and-press technique, it simulates rotator cuff impingement symptoms. A practitioner will stand back with their hand on the top of the affected shoulder. It begins with the arms by the sides. A rotation of the arm follows. The thumb should face backward/down and then raise its arm straight up.

Speed’s Test

It can help identify tendonitis in the bicep. Overuse of activities like golf, tennis, and weight-lifting can cause tendonitis. Two tendons attach the bicep muscle to the shoulder bones and one to the radius bone in the forearm. These tendons can get torn, and that causes tendonitis. During Speed’s Test, the patient’s elbow is straight, with the arm lifted. Then, the examiner applies manual resistance to the forearm in a downward direction.

Apprehension and Relocation Test

When a physician suspects shoulder instability, they might perform an apprehension test. This test assesses the diminution of pain and apprehension. During the test, the patient lies on an exam table facing up. A healthcare provider extends their arms straight out. They then bend their elbows 90 degrees while the healthcare provider stabilizes the shoulder with one hand. The forearm is then pulled toward the floor. Shoulder external rotation is the term used for this process. This test is positive if the shoulder feels like it is about to pop out of the joint or if it pops out of the joint. The name of the test comes from the fact that this position may cause apprehension. Afterward, a relocation test will follow. It checks for possible glenohumeral instability, dislocation, and subluxation. A healthcare provider must place one hand on top of the shoulder. If it reduces the patient’s apprehension or pain, the relocation test is positive.

Sulcus Test

In this test, the practitioner will grasp the wrist or elbow, pulling down the arm while the arm hangs down on the side. A small divot or sulcus at the top of the shoulder indicates shoulder instability. The shoulder may pull away from the socket as a result.

Hawkins-Kennedy Test

An alternative test for shoulder impingement is the Hawkins-Kennedy test. A practitioner lifts the arm with the elbow bent about 90 degrees before taking the arm in front of the body. The patient will then raise the elbow while lowering the forearm. Pain in the shoulder is a sign of pinched structures.

Drop Arm Test

When suspecting rotator cuff tears, a drop arm test is another option. A practitioner lifts the arm out to the side of the body while keeping the arm straight, then drops it. When the arm falls to the side and can’t hold it up, then there is a positive test result for rotator cuff tear.

Crank’s Test

Another test for identifying labral tears is the Crank’s Test. Labral tears are common in athletes who perform repetitive movements. The examiner holds the arm and bends the elbow 90 degrees. The examiner will grab the patient’s elbow with one hand and rotate it back and forth. If the arm feels painful or the shoulder makes strange noises, the test result is positive.

Teres Minor Test

This test determines the strength of the teres minor. The teres minor tendon is one of the major shoulder tendons. A healthcare provider asks to place the hands by the sides. Then, the patient should lift the hand so that the elbows bend at a 90-degree angle (like doing a bicep curl). As the practitioner pushes for resistance, the patient should move the hand backward. At the same time, the elbows must continue bending. Pain or weakness is a sign of a minor injury.

A Friendly Reminder

A medical professional can diagnose you and help with the treatment. Diagnosing shoulder injuries is very important. It helps come up with the right treatment and speed up healing. But, sometimes, it could get worse. Misdiagnosis can also occur and may complicate things. Because causes aren’t addressed, some things like inflammation may worsen in some cases.

If you need help with your shoulder condition, book an appointment with us at N8 Family Chiropractic.

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Resources: 

https://www.webmd.com/pain-management/why-does-my-shoulder-hurt

https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions

https://www.radiologyinfo.org/en/info/shouldermr