Rotator Cuff Tear VS Shoulder Impingement VS Shoulder Tendonitis

Summary

Dr. David Middoff, a specialist physical therapist, educates viewers on common shoulder issues: rotator cuff tears, shoulder impingement, and tendinitis. He outlines the differences, symptoms, and progression from impingement to severe rotator cuff tears. Emphasizing the importance of early intervention, he offers insights on natural healing and provides resources for home treatment and exercises to prevent surgery.

Takeaways

• 👨‍⚕️ Dr. David Middoff, a specialist physical therapist, discusses common shoulder problems and aims to help viewers avoid unnecessary surgeries and medications.
• 🤕 Shoulder pain can be caused by various issues including rotator cuff tears, shoulder impingement, or tendinitis, which can lead to difficulty in daily activities.
• 💤 Pain at night, especially when lying on the affected shoulder, is a common symptom for severe shoulder problems.
• 📉 Rotator cuff tears often present with a loss of motion and can be painful even at rest, distinguishing them from less severe issues like impingement and tendinitis.
• 🔍 The upper trapezius muscle can become tight or painful due to shoulder problems, indicating a need for proper treatment to prevent further complications.
• 🔴 Tendinitis is characterized by a specific, localized pain point in the shoulder, unlike rotator cuff tears and impingement which can have more diffuse pain.
• 🔄 The progression from shoulder impingement to tendinitis and finally to a rotator cuff tear represents a spectrum of increasing severity in shoulder pain.
• 🛑 Dr. Middoff emphasizes the importance of early intervention to prevent the progression from impingement to more severe conditions like a rotator cuff tear.
• 🏋️‍♂️ Conservative care, such as physical therapy, is often effective for rotator cuff tears, with research showing similar outcomes to surgery in many cases.
• 🔗 The video provides resources for home exercises to treat a rotator cuff tear and a playlist for shoulder and neck exercises and stretches.

Q & A

What are the three common shoulder problems discussed in the script?

The three common shoulder problems discussed are rotator cuff tear, shoulder impingement, and shoulder tendinitis.

What is the primary symptom that indicates a shoulder problem according to the script?

The primary symptom indicating a shoulder problem is pain, especially with reaching up, behind the back, and out with the arm extended, especially while holding something heavy.

How does pain at night relate to shoulder problems as described in the script?

Pain at night, particularly when lying on the affected shoulder, can be a sign of shoulder problems like rotator cuff tears, impingement, or tendinitis.

What is the difference between pain at rest and pain with movement in the context of shoulder problems?

More severe shoulder problems like rotator cuff tears can cause pain at rest, while less severe issues like impingement and tendinitis tend to be more painful with movement or activity.

What is the role of the upper trapezius muscle in relation to shoulder problems?

The upper trapezius muscle can become tight or painful when there's a shoulder problem, and it's important for the stability of the shoulder joint.

How does the script describe the progression from shoulder impingement to a rotator cuff tear?

The script describes a spectrum where shoulder impingement can lead to tendinitis, and if left untreated, can progress to a rotator cuff tear.

What is the significance of a focal point of pain in shoulder tendinitis according to the script?

In shoulder tendinitis, there is typically a specific focal point of pain in the shoulder that is consistent and not diffused, unlike the more widespread pain in rotator cuff tears and impingement.

Why does the script suggest that surgery may not be necessary for a rotator cuff tear?

The script suggests that research shows people who undergo conservative care, such as physical therapy, often have similar outcomes to those who have surgery, in terms of pain reduction and motion recovery.

What advice does the script give for treating a rotator cuff tear at home?

The script recommends checking the description for a link to a video on how to treat a rotator cuff tear at home, suggesting that natural healing is possible.

How does the script connect neck issues to shoulder problems?

The script explains that neck issues and upper trap problems can contribute to shoulder problems, emphasizing the importance of addressing neck and upper trapezius issues to prevent progression to a rotator cuff tear.

Outlines

00:00

🤕 Understanding Shoulder Pain: Causes and Differences

Dr. David Middoff, a specialist physical therapist, introduces common shoulder problems such as rotator cuff tears, shoulder impingement, and tendinitis. He explains the symptoms associated with each, including pain with certain movements and at rest. Dr. Middoff emphasizes the importance of understanding the differences to take appropriate action. He outlines the common symptoms like pain with reaching, sleeping discomfort, and pain at rest for severe issues. He also discusses how these conditions can lead to neck and upper trapezius muscle issues, which are often associated with shoulder problems.

05:01

📝 The Spectrum of Shoulder Issues: From Impingement to Tendonitis

Dr. Middoff uses a whiteboard to visually differentiate between shoulder impingement, tendinitis, and rotator cuff tears. He describes impingement as the initial stage where the shoulder's ball and socket space is reduced, leading to irritation and potential tendonitis. Tendonitis is characterized by a specific tender spot in the shoulder, which, if left untreated, can progress to a rotator cuff tear. The video explains how these conditions are interconnected and can escalate in severity, with the rotator cuff tear representing the most severe stage, often accompanied by a loss of motion.

10:04

🏋️‍♂️ Natural Healing and Treatment for Rotator Cuff Tears

The video concludes with a positive message about the potential for natural healing of rotator cuff tears without surgery. Dr. Middoff cites research indicating similar outcomes for those who undergo surgery and those who opt for conservative care like physical therapy. He provides resources for exercises and further information on treating shoulder and neck issues, emphasizing the importance of addressing neck problems to prevent the escalation to a rotator cuff tear. The video encourages viewers to engage with the content by asking questions and subscribing for more health and wellness tips.

Keywords

💡Rotator Cuff Tear

A rotator cuff tear refers to an injury to the group of muscles and tendons that surround the shoulder joint, providing stability and allowing for a wide range of motion. In the video, Dr. David Middoff explains that a rotator cuff tear is typically more severe than impingement or tendinitis, often involving a loss of motion and being painful even at rest. The script mentions that severe shoulder problems like rotator cuff tears can be painful at rest, indicating a more serious condition requiring attention.

💡Shoulder Impingement

Shoulder impingement is a condition where the space between the shoulder blade and the upper arm bone narrows, causing the tendons to get pinched or compressed. The video script describes impingement as a precursor to tendinitis and rotator cuff tears, often causing pain with certain movements like reaching up or behind the back. Dr. Middoff uses the term to illustrate the early stages of shoulder problems on the spectrum of shoulder pain.

💡Tendinitis

Tendinitis is the inflammation or irritation of a tendon, which can occur from overuse or injury. In the context of the video, shoulder tendinitis is described as having a focal point of pain, often with a tender spot that is consistent and not as diffuse as the pain from a rotator cuff tear or impingement. The script mentions that with tendinitis, there's typically a specific area of the shoulder that hurts, indicating localized irritation.

💡Pain with Movement

Pain with movement is a common symptom of shoulder problems, as highlighted in the video. It refers to the discomfort or pain experienced when performing certain physical activities that involve the shoulder. The script specifically mentions pain with reaching up, behind the back, or out with the arm extended, especially while holding something heavy, as indicative of shoulder issues like impingement, tendinitis, or a rotator cuff tear.

💡Upper Trap Muscle

The upper trapezius muscle, often abbreviated as 'UT' in the script, is a large muscle that extends from the neck to the shoulder. It plays a crucial role in shoulder stability and movement. The video explains that issues with the upper trap muscle, such as tightness or knots, can be associated with shoulder problems, as these muscles need to be strong and stable for proper shoulder function.

💡Spectrum of Shoulder Pain

The term 'spectrum of shoulder pain' is used in the video to describe the range of severity and types of shoulder issues, from less severe conditions like impingement and tendinitis to more severe ones like rotator cuff tears. Dr. Middoff uses a visual aid, a whiteboard, to illustrate how these conditions are related and can progress from one to another, emphasizing the importance of early intervention to prevent worsening of the condition.

💡Conservative Care

Conservative care in the context of the video refers to non-surgical treatments for shoulder problems, such as physical therapy. The script mentions that many people with shoulder issues, even rotator cuff tears, can heal through conservative care, which typically involves exercises and stretches aimed at strengthening and stabilizing the shoulder without the need for surgery.

💡Physical Therapy

Physical therapy is a form of conservative care that involves exercises and treatments to help restore function and reduce pain in injured areas, such as the shoulder. In the video, Dr. Middoff, a specialist physical therapist, discusses the importance of physical therapy in managing and treating shoulder problems, suggesting that it can be an effective alternative to surgery for many individuals.

💡Loss of Motion

Loss of motion refers to the reduced ability to move a joint through its normal range of motion due to injury or pain. The video script uses this term to describe a serious symptom of a rotator cuff tear, where the individual may struggle to perform simple movements like reaching up or behind the back. This loss of motion is indicative of a more severe shoulder issue that may require more aggressive treatment.

💡Natural Healing

Natural healing in the video refers to the body's ability to recover from injuries without surgical intervention. Dr. Middoff discusses how many shoulder problems, including rotator cuff tears, can heal naturally through conservative care and physical therapy. The script emphasizes the potential for significant recovery without surgery, which can be reassuring for viewers concerned about the necessity of invasive treatments.

Highlights

Dr. David Middoff explains the differences between rotator cuff tear, shoulder impingement, and shoulder tendinitis.

Pain with reaching up, behind the back, and out with the arm extended is common in shoulder problems.

Shoulder pain at night, especially when lying on the affected shoulder, is indicative of shoulder issues.

Rotator cuff tears can be painful at rest, unlike less severe problems like impingement and tendonitis.

Loss of motion is typical with rotator cuff tears, making certain movements difficult or impossible.

Impingement and tendonitis often result in neck problems and upper trap muscle tightness.

Shoulder tendinitis is characterized by a focal point of pain in the shoulder.

Rotator cuff tears and impingement can cause more diffuse pain that moves around the shoulder.

The conditions exist on a spectrum, with impingement being the least severe and a rotator cuff tear the most.

Impingement occurs when the space for the ball and socket joint decreases, leading to irritation.

Tendinitis is an inflammation of the tendon, often caused by overuse or compression.

A rotator cuff tear signifies a serious condition with a loss of motion and potential need for intervention.

Conservative care, such as physical therapy, is often effective for rotator cuff tears without surgery.

Exercises and stretches for shoulder and neck can help prevent progression to a rotator cuff tear.

Addressing neck issues and upper trap problems is crucial in managing shoulder conditions.

Dr. Middoff provides resources for home treatment of rotator cuff tears and other shoulder issues.

Transcripts

hey are you dealing with shoulder pain

right now and are you wondering

what the heck is going on in there is it

a rotator cuff tear could it be shoulder

impingement

or do i just have shoulder tendinitis

i'll be telling you the difference

between these three common shoulder

problems

so that you can have a good

understanding for what they are and what

to do next about it

my name is dr david middoff and i'm a

specialist physical therapist at el paso

manual physical therapy

this channel is dedicated to helping

people stay healthy

active and mobile while avoiding

unnecessary surgeries

injections and medications be sure to

subscribe

and turn on your notifications for this

channel so you don't miss any of the

helpful videos that we put out

every week i'm going to use this

whiteboard in a second to draw you the

differences and

how to understand and and get your head

around these different shoulder problems

but real quick let me just tell you some

of the common things that you'll find

with shoulder problems like rotator cuff

tears impingement and tendonitis

number one thing obviously is going to

be pain but specifically

pain with reaching up pain with reaching

behind your back

and pain with reaching out with your arm

extended especially while you're holding

something heavy

another time to get pain is when

sleeping at night

if you lie on that shoulder and compress

the shoulder joint sometimes

that can be very painful for these type

of shoulder problems

and the more severe shoulder problems

like rotator cuff tears

will even be painful at rest when you're

just doing nothing you could just be

sitting around

having a meal watching tv and it hurts

but the less severe shoulder problems

like impingement and

tendonitis tend to not be as painful

at rest they tend to be more painful

with movement or with activity

let me tell you about how they're

different with the rotator cuff tear

there's typically

some loss of motion it could be that

it's just painful

to get into certain motions like

reaching up or behind the back

it could also be that you need help like

if you assist your arm up with the other

arm

it will go up it just can't get there on

its own

with both impingement and tendonitis

it's common to get

neck problems and pain in this area or

knots in this area of the body this is

called the upper trap

muscle and that muscle can get quite

tight or naughty

whenever there's a shoulder problem

going on with shoulder tendinitis

there's typically a focal point in the

shoulder like

right here it hurts or right here it

hurts and it's not as diffuse meaning

it's not spread around or it doesn't

change too much it's pretty consistently

at one spot whereas rotator cuff tears

and impingement can be more diffused it

can move around

from the front to the back to the side

can run down the arm a little bit or it

can be a combination of all those

depending on how you feel and depending

on the severity severity of it that day

what i want to make sure you understand

today i'm going to use a white board for

all three of these problems a rotator

cuff tear

shoulder impingement and shoulder

tendinitis are on a spectrum

of shoulder pain and the reason why

they're on a spectrum is because they're

all related

one leads into the next one is a more

severe version of the one before

so on the left side of the spectrum here

what i'm going to put down for you here

is shoulder impingement

so just for short i'm going to

abbreviate it

shoulder impingement

in the middle of the spectrum you've got

tendinitis

[Music]

tendinitis then on the far end you've

got a rotator cuff tear i'm just going

to write rtc

there you go so on

shoulder impingement what's usually

happening

is the space where the ball and socket

live let me use my skeleton here for you

and take them off so you can see right

there

you this is the space where the ball and

socket is right under

this overhanging bone it's called the

acromion that's

the the area that commonly gets impinged

or pinched is another way to look at it

but that space somehow gets decreased or

pinched

and that's what sets up the tendonitis

in the area and eventually

a tear but what leads up to that some of

the symptoms that you'll see

is neck problems and

upper trap which is going to write up ut

tightness

just right tight and pain

and that will carry on all the way to

rotator cuff tear if you end up going

that far

now if this lasts for a while what

the symptoms that you'll see is it just

kind of aches and hurts certain

movements will hurt like if you're

turning

a doorknob or turning a key it won't

hurt all the time

a common experience that people have had

is they'll go reach for like a heavy

coat

and when they go pick it up it bites

them in that moment but picking up

something light you know like a pen or a

marker or something is no big deal

or also picking up something and turning

it or maneuvering it

away from their body that can be pretty

painful

and what you can gather from that is

that

this motion out here where you're

reaching out and picking up something

heavier turning

is just a lot of stress on the shoulder

and it's becoming irritated in there

it's usually the rotator cuff muscles

and tendons that become irritated

and that is what we would label an

impingement situation

the reason why people get pain into the

neck and shoulder in this upper trap

area

is because these muscles need to be

strong and stable in order for the ball

and

socket out here to work properly so

oftentimes these get achy because

they're

being overused or they're just not being

used appropriately

you can also have pinched nerves in the

neck that

set up weaknesses in these muscles and

the rotator cuff muscles that eventually

start to create an impingement situation

in the shoulder

joint and if that impingement lasts long

enough

it becomes severe enough then we

progress into

tendonitis so in tendonitis

i'll use pink here this is where you've

got a tender spot

tender

spot on the shoulder

it begins to form where usually you can

poke in there and find a

spot that just gets you if you and you

might even want to rub it out to get

some relief

and this will keep going of course into

rotator cuff tear

but that tendinitis what's happening is

at

the ball and socket joint where the

where the muscles

meet the tendons and then the tendons

meet the bones muscles connect to

tendons tendons connect to bones

that tendon gets overused or over

compressed or irritated

and it's just like if you rub your skin

really hard you know your skin's fine

normally

but if you rub it for a while you can

take it for maybe a few seconds maybe a

minute or two

but after a while it starts to get

irritated and red

it may not break you may not bleed but

it gets irritated and if you were to do

that for

an hour or if you were to do it several

times a day for you know a few minutes

at a time

you bet your skin will be irritated and

it would probably take a little while

for it to recover

maybe a day maybe even a few minutes

depending on how hard you do it

what you need to understand is with the

tendon it doesn't recover as fast as

your skin does

your skin recovers really really fast if

it gets irritated

as long as it's in a good healing

environment it should be minutes hours

at most a couple of days

tendons is more on the time frame of

weeks

to get over an irritation so that's why

tendonitis can last a while

and if you don't identify if you don't

figure out

what the aggravating motion is or what

the aggravating

thing is the thing that sets you up to

get it and remove it from your situation

it's gonna stay

irritated it's gonna stay tendinitis

tendonitis just means inflammation of

the tendon that's why

it gets irritated like i was saying and

if that persists if weeks go by months

go by like that

then eventually that tendon becomes so

irritated as if you were to be doing

this that it will break

it will break open just like your skin

will break open eventually if you were

to do this

you know i might get a blister at first

but eventually that blister will pop

open

and there could be blood under there

same thing with a tendon you don't get

an

actual blister on your tendon it just

starts to break down

and tear and that's what sets you up for

a rotator cuff

tear so when you have a rotator cuff

tear

typically let's use green here

you have a loss

of motion

and that's when it's serious because now

you know usually leading up to this with

shoulder impingement and tendonitis

people can still do stuff they can still

function they can get through their day

they can

clean the house they can typically work

just fine it might be concerning to them

that they have pain but they might even

be able to take a

pain medication you know a tylenol

motrin ibuprofen something like that

and deal with it but if you lose motion

if you just

can't reach back there anymore if you

can't reach up if there's things that

you just can't do

some people can't even wash their hair

or you know fix their hair

or cook a meal because of their shoulder

pain that's when it's serious and

ideally you don't want to get to this

point where you've got a loss of motion

you want to start treating the problem

when you've got just a tendonitis or an

impingement issue

but if you're at this point where you're

having difficulty moving your arm

it's pretty bad you make sure you do

something about it so i hope this makes

sense to you i hope you better

understand

what a rotator cuff tendon tear is

what an impingement is and what a

tendonitis is here

and how they're on a spectrum and as you

move along from left to right here

it gets more painful more limiting and

more serious

now the good news you need to take away

from this is that even if you've got

a rotator cuff tear and you're you know

concerned you're losing motion

you still have an excellent chance at

healing it

naturally without surgery the current

research shows this that people that get

surgery versus people that don't get

surgery and go through conservative care

which means physical therapy usually

they end up about the same six months

later and even 12 months later

they both get more motion back and get a

reduction in pain

and they're pretty good so why even do

the surgery now there are cases where

it's pretty severe and

there's it's been going on for a while

maybe it's not the first rotator cuff

tear where

you go get the surgery right away but in

most cases

you can get away with not having surgery

and healing this rotator cuff problem

naturally if you've got a rotator cuff

tear and you're looking for exercises to

do

i've got a video for you called how to

treat a rotator cuff tear

at home it's in the description below

you can find the link in there

and if you've got more of a tendonitis

or a

shoulder impingement problem there's

another link for our playlist covering a

bunch of shoulder

and neck exercises and stretches and

tips and advice as well

and the reason why there's neck stuff in

there is because as i said in this video

you can get neck issues

and upper trap problems that feed into a

shoulder problem so it's important to

get that

addressed as you're fixing yourself so

that you don't end up

taking it all the way to a rotator cuff

tear if you've got any questions on this

drop a comment below we'll get to it as

fast as we can

and i hope that you like this video if

you did give us a like give us a thumbs

up

and don't forget to subscribe and turn

on your notifications so you don't miss

any of the helpful videos and tips that

we put out each week have a wonderful

day guys

bye-bye