The Curbsiders Internal Medicine Podcast #439 Shoulder Pain: Impingement, Bursitis, Tendonitis, Cuff Tears, and Arthritis with Dr. Ted Parks
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May 13, 2024 
Orthopedic surgeon Dr. Ted Parks discusses shoulder pain, from impingement syndrome to cuff tears. Topics include shoulder anatomy, MRI indications, AC joint pathology, and differentiating arthritis from frozen shoulder. The conversation covers practical tips for diagnosis, treatment options, and the significance of early recognition for effective management.
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Use Strength Tests Plus Anesthetic
- Assess rotator cuff strength with resisted external rotation, resisted internal rotation, and the empty-can test.
- If pain relief from a subacromial anesthetic restores strength, weakness was pain-related; persistent weakness suggests a tear.
PT Before Immediate Surgery
- Try physical therapy first for chronic rotator cuff problems, even if MRI shows a tear.
- Strengthen scapular and rotator cuff muscles and avoid repeated overhead loading until symptoms improve.
Be Selective With MRI
- Don't order MRIs reflexively; use injections and exam to confirm impingement before imaging.
- If surgery is planned many insurers require MRI, so expect to obtain one for preauthorization.