Finally a fantastic explanation. Everything in this video I had done. I had this Op 5 week ago and am pleased to say the Op worked a treat. I was back to work within 3 weeks. I still have a little discomfort but what a massive improvement. Hats off the professionals who do these Ops.
Thank you for taking the time to put this together. It clearly explains what I have been suffering with for 3 years now. I've been put on the waiting list for surgery today. Great explanation. It's so much easier to make sense of it at home in your own time.
You have to start by retraining shoulder girdle recruitment patterns. Restore posterior tilt by working on serratus anterior, and start re-working movement patterns slowly, following progressions that eventually end up with you performing your normal exercises correctly. You have to start with easy enough exercises to avoid 'forcing' the body to use its ingrained motor pattern, which the recruitment pattern that is likely currently causing most of your problems.Remember, muscles move bones.
I like the information with the visual aids. This gives the viewer a great look of how the Shoulder Impingement occurs as well as how to treat it. Thank you!
Andrea Satebak, MD (St. Croix Orthopaedics) is in Stillwater MN and Bill Morin, MD (Midelfort Sportys Medicine) is in Eau Claire, WI both are Hawkins trained surgeons. Hope this helps!
I sublaxed my shoulder and went to hell and back with pain couldn't get a full night sleep for 3 months, I had a cortisone injection and had magical relief within 3 days. I was over the moon 2 years later no pain until I had an operation last week and some how during surgery it got sublaxed again, even more pain but I never realised until it popped back in 5 days later, then the pain went immediately, shoulder pain is no joke.
Great video for massage therapists wanting to learn more about this condition! Dr. Hawkins' explanation was wonderful. I have seen images in textbooks and on charts, but the way he used the model to show the condition really made things click for me!! I will look for more of his videos and post them for my LMT friends!!
I enjoy the video as to why the symptoms will happen. Dr. Hawkins explained in details to how SI develops associated with the skeleton model. The only thing I wish he would add to the video is some basic exercises to help relieve the pain symptoms. But overall, it is an excellent video. Thanks for sharing.
Thank You Dr. Hawkins for such a clear explanation. Today I was diagnosed with this syndrome and given an injection. I am hoping to understand what can I do to help myself get well as soon as possible. Thank you again.
Thank you, Doctor. I have been suffering for months. My knees are also painful. I am losing my quality of life as of late. I was told "probably torn rotator cuff", but I have not stressed or injured that area. I believe it is impingement disorder. I appreciate this very informative thread. Be Well.
Thank you for this wonderfully informative video, I am awaiting a consultation to see if I need this operation. I feel much happier now I know what may happen. I wish you were here in the UK!
We are not far from Atlanta, however if you don't wish to travel may we suggest you look into Dr. Spero Karas at the with Emory Orthopaedics and Spine Center. Dr. Karas is a Hawkins trained surgeon and very respected in his field.
Great video doc, thanks for posting. I have no insurance so I have to fix myself. I'm trying to understand the anatomy of my shoulder pain and what to do about it. This is another piece of the puzzle.
Thanks Dr. Hawkins for your wealth of information,as a 68 yr old physdo jock playing lots of tennis with shoulder pain ,I feel better knowing that all isn't lost,and maybe the subacromial decompression will do the trick
I'm 53 and have a tendency to sleep on my right side. Recently I started experiencing pain in my right shoulder while sleeping. I just have a little stiffness while I'm awake,but no pain.
this looks to be just one part of the surgery I am having friday. he is also going to release the actual bicep and remove a piece of bone. he told me recovery time is 10-12 weeks if not longer.
Awesome video. So happy I found it. Learning MSK ultrasound, and also, having a lot of pain in right shoulder. I learned about the impingement test and heard/felt the pop, so now I'm seaching to find out all I can about it! Is this happening to any other fellow sonographers out there?
Thanks for another clear and consise video. Question: Can you clear the impingement and at the same time leave a rutured supraspinatus alone? Reason: I don't have the resorces for recuperation from the supraspinatus re-attachment.
hello Dr Richard first of all thank you for how you explain everything i have this problem for over 2 years and i have try all exercise and therapy but i still have this problem and i so tired of this that doctor say AC of my shoulder some how its swelling and he say just do exercise but nothing is helping and im so tired, if you can help me some how please ? thank you again
Hi Dr. Hawkins, do you have anyone you can recommend in the Milwaukee area? I've had labral/cuff repair and still have enormous amounts of impingement/pain and improper biomechanics b/c of it. Need to find an expert.
Thanks for the great video! Could you please advise if the injections are a permanent fix or just a temporary? i.e. will the pain return after few months? Thanks
on away from the shoulder. She says this won't affect my work and will probably reduce my shoulder pain. Would you recommend this type of surgery? A: There are many different causes of shoulder pain. Any problem inside or around the joint can create pain. One of the more common sources of shoulder pain occurs when there is some type of pathology of the long head of the biceps tendon (LHBT). The biceps tendon attaches between the elbow and the shoulder. It helps you lift your arm straight up and bend the elbow. There are two parts: the short- and long-heads of the biceps. Each one attaches in a slightly different place on the arm. Pathology of the long-head of the biceps causing shoulder pain could be a partial tear of the tendon or tenosynovitis (inflammation of the sheath or lining around the tendon). Another injury of the long head of the biceps causing shoulder pain could be a SLAP lesion. SLAP stands for superior labral tear from anterior to posterior (from front to back). The labrum is a rim of fibrous cartilage around the shoulder socket. The word "superior" tells us the injury is to the cartilage that covers the top part of the shoulder socket. Treatment for any of these causes of biceps tendon problems may consist of surgery called a tenotomy. It sounds like that is the type of procedure your surgeon has recommended for you. During a biceps tenotomy, the long-head of the biceps tendon is released from its attachment to the shoulder. Surgically cutting this portion of the tendon allows it to retract or move away from the shoulder. A tenotomy of this type removes the damaged, inflamed tissue from the joint. This particular tendon has a rich supply of pain nerve fibers so releasing it helps reduce shoulder pain. Despite all good intentions in treating the shoulder pain by performing a tenotomy, sometimes after tenotomy surgery, the patient develops complications. The most common problems are a cramp-like arm pain, loss of normal elbow strength (flexion or bending), and a change in the shape of the upper arm. This altered appearance of the upper arm is called a Popeye deformity. Studies show that tenotomy of the biceps tendon is most common in men. It is not recommended for young, active patients or anyone with concerns about appearance. Age is not a factor in predicting who might experience this type of complication but being male is a strong predictor. Therefore, men who are involved in work or recreational activities that require strong elbow flexion and forearm supination (turning the palm up towards the ceiling) should be forewarned that strength loss could affect them. This type of information may be of particular interest to folks like yourself who are carpenters, woodworkers, mechanics, and gardeners. Likewise, anyone who uses the forearms and elbows repetitively to complete daily work tasks will must be told of the possible complications of this procedure. Reducing shoulder pain in order to improve overall arm function may be worth the trade off.
The surgeon can either 1. leave the biceps (the long head) to drop down to the upper arm (Biceps TENOTOMY). The Biceps has two heads and the other one which is the short head is still attached anyway) 2. re attach the long head of the biceps to the humerus bone by a screw, away from the labrum, out of sub acromial roof (Biceps TENODESIS)
Nathan Tsuji I asked my surgeon that, she said it only does about 10% of the work anyway and it just drops down, next to working one, I ask that they fix mine, if it's torn, but mine never has neen
The function of the long head of the biceps muscle - and its role in the shoulder girdle - is not fully understood. The first stage in the rehabilitation process would consist of exercising within the free pain range of motion. This statement is based on the expertise and experience of physical therapists and surgeons. I quote: "The Long Head of the Biceps clearly has some role in the shoulder, but, based on current information, the loss of this function is much less detrimental than retaining a diseased tendon." www.jospt.org/doi/full/10.2519/jospt.2009.2802
The biceps has 2 tendon's. One of them (the long head) is cut, the other one stays intact. The most important function of the bicep which is flexion and supination of the elbow stays strong. There is
thanks very informative, I cant lift my arm past 90 degrees without it clicking, painful but more depressing if anything having it on your mind 24/7 judging what you can and cant do. hopw to get this sorted soon, was offered botox injections but I don't think that will help, thanks again for the video
Saeid Momtahan Thank you so much for making this video. I have this impingement because of a grade 2 AC joint dislocation playing hockey. I've had it for almost 5 years. Can you please give me some exercises to create more space between the bones. Thanks, Corey
there is only one question after I have seen the video. I believe that I have shoulder pain an impingement and to make sure I am in the right path I just would like to know if one of the signs of impingement is also not having power to lift any weights, which for me has been impossible since this pain started a 2 months ago, I have no power to lift a weight with my left arms, specially any king of press up exercises. Please help!
yes it can be, I've just had the operation 2 days ago. I found that lift any weight at arms lenght was impossible, even lifting a carton of juice. if you have this condition you will notice a lose in the range of movement. also when doing fast movement under load you may irritate the tendons. this will greatly reduced the range of movement and increase the pain. I would suggest getting it checked out sooner rather than later, it's a miserable condition to have as it gets worse with time. hope this helps.
that is not typical of just impingement syndrome, unless the only reason you dont have power is because of too much pain, or if you have a full thickness tear. But if your shoulder is actually significantly weak, you should get that checked out. Could be that the impingement syndrome is secondary to the weakness, which could be due to a peripheral nerve problem. Impossible to diagnose over the internet, so visit a good shoulder doc or PT.
Yes it was I only have a little muscle pain, which will decrease as I do the physio. I was able to start moving my arm after 2 weeks, by 4 weeks I was riding my bike. I won't be rock climbing till after the 6 month period.
The BEST video on Shoulder Impingement and subacromial decompression. THANK YOU!
Agreed. The best by far.
He is an expert!
Finally a fantastic explanation. Everything in this video I had done. I had this Op 5 week ago and am pleased to say the Op worked a treat. I was back to work within 3 weeks. I still have a little discomfort but what a massive improvement. Hats off the professionals who do these Ops.
Thank you for taking the time to put this together. It clearly explains what I have been suffering with for 3 years now. I've been put on the waiting list for surgery today. Great explanation. It's so much easier to make sense of it at home in your own time.
Probably the best presented medical video I've seen on youtube, and I've seen hundreds.
Thank you. Great video. After three years I finally understand what's going on with my shoulders.
You have to start by retraining shoulder girdle recruitment patterns. Restore posterior tilt by working on serratus anterior, and start re-working movement patterns slowly, following progressions that eventually end up with you performing your normal exercises correctly. You have to start with easy enough exercises to avoid 'forcing' the body to use its ingrained motor pattern, which the recruitment pattern that is likely currently causing most of your problems.Remember, muscles move bones.
Terrific video! I have an awful time trying to understand things without visual aids and having you demonstrate with a model was the best!! Thank you.
Best explanation of shoulder impingement I have seen yet.
I like the information with the visual aids. This gives the viewer a great look of how the Shoulder Impingement occurs as well as how to treat it. Thank you!
Andrea Satebak, MD (St. Croix Orthopaedics) is in Stillwater MN and Bill Morin, MD (Midelfort Sportys Medicine) is in Eau Claire, WI
both are Hawkins trained surgeons. Hope this helps!
The best explanation I've seen . I fully understand. The model really brought it home for me.
I sublaxed my shoulder and went to hell and back with pain couldn't get a full night sleep for 3 months, I had a cortisone injection and had magical relief within 3 days. I was over the moon 2 years later no pain until I had an operation last week and some how during surgery it got sublaxed again, even more pain but I never realised until it popped back in 5 days later, then the pain went immediately, shoulder pain is no joke.
Great video, very informative, and showing the shoulder model was helpful
Yes, Dr. Misty Suri is a Hawkins trained surgeon. He is with Ochsner Sports Medicine
Great video for massage therapists wanting to learn more about this condition! Dr. Hawkins' explanation was wonderful. I have seen images in textbooks and on charts, but the way he used the model to show the condition really made things click for me!! I will look for more of his videos and post them for my LMT friends!!
Thank you for your explanation. Very clear even for an English as a second language speaker like me.
thx! im 15 and i probally got this problem, wanted to know more info, u helped me alot!
Very informative Dr. Hawkings. Clear and concise - thanks for the great video
I enjoy the video as to why the symptoms will happen. Dr. Hawkins explained in details to how SI develops associated with the skeleton model. The only thing I wish he would add to the video is some basic exercises to help relieve the pain symptoms. But overall, it is an excellent video. Thanks for sharing.
Thank You Dr. Hawkins for such a clear explanation. Today I was diagnosed with this syndrome and given an injection. I am hoping to understand what can I do to help myself get well as soon as possible. Thank you again.
This is a very helpful video....especially the discussion of surgical repair and the mechanics of PT maneuvers.
Great video and explanation. Using a shoulder model was crucial (for me) to understand the root cause of this shoulder syndrome. Thank you.
Thank you, Doctor. I have been suffering for months. My knees are also painful. I am losing my quality of life as of late. I was told "probably torn rotator cuff", but I have not stressed or injured that area. I believe it is impingement disorder. I appreciate this very informative thread. Be Well.
Thank you for this wonderfully informative video, I am awaiting a consultation to see if I need this operation. I feel much happier now I know what may happen. I wish you were here in the UK!
THe side-by-side video with the model is very helpful in showing the internal structure. Thanks.
We are not far from Atlanta, however if you don't wish to travel may we suggest you look into Dr. Spero Karas at the with Emory Orthopaedics and Spine Center. Dr. Karas is a Hawkins trained surgeon and very respected in his field.
Great video doc, thanks for posting. I have no insurance so I have to fix myself. I'm trying to understand the anatomy of my shoulder pain and what to do about it. This is another piece of the puzzle.
very good video. it took me a few years to learn about all these things after being diagnosed with shoulder impingement syndrome
Fantastic video! I especially enjoyed the clarity of the model combined with surgical video. Thanks!
I'm thinking about having this surgery, your explanation with the model etc was very informative, thank you!
Thank you so much for this post I have been going crazy with pain in both shoulders.
great video, the best of any on impingement syndrome, thank you
Thanks Dr Hawkins, makes an impending cortisone injection seem a little less daunting :-)
Thank you that sounds exactly like my symptoms, feels better when my arm is pulled down toward the floor because tendon is being impinged on. Thank u!
Best explanation of the issue I have found so far. Thank you so much.
Extremely helpful and now very hopeful I have a solution to my problem, I hate pain, especially if is my pain! Thank you!
Thanks Dr. Hawkins for your wealth of information,as a 68 yr old physdo jock playing lots of tennis with shoulder
pain ,I feel better knowing that all isn't lost,and maybe the subacromial decompression will do the trick
I'm 53 and have a tendency to sleep on my right side. Recently I started experiencing pain in my right shoulder while sleeping. I just have a little stiffness while I'm awake,but no pain.
Great information.
Thank you Doctor Hawkins.
Excellent tutorial. So clear and helpful.
Excellent explanation. Great Job Doctor.
Thanks very much for this wonderful and precise information.
Thank you, this was the best explanation I have seen for my impingement problem.
Thank you for this video. This is exactly for what I am being operated on next week. Thanks again.
this looks to be just one part of the surgery I am having friday. he is also going to release the actual bicep and remove a piece of bone. he told me recovery time is 10-12 weeks if not longer.
So much thanks for the info. I'm building up a real picture of why I hurt now but there's light at the end of the tunnel.
Great job explaining things to us Doctor! I now have a better understanding.
Fantastic video. Thanks so much for sharing your knowledge and expertise.
Thanks very much. It helped me a lot to understand my problem. I got an injection in my shoulder yesterday. Hopefully it will work.
Yep!! Best explanation yet. Thanks so much!!
Great video, was exactly the amount of information I wanted.
Awesome video. So happy I found it. Learning MSK ultrasound, and also, having a lot of pain in right shoulder. I learned about the impingement test and heard/felt the pop, so now I'm seaching to find out all I can about it!
Is this happening to any other fellow sonographers out there?
prob the best video ive seen on this. very good!
Cutting the biceps tendon? Would you please explain more why do you do that for?
Thanks for another clear and consise video. Question: Can you clear the impingement and at the same time leave a rutured supraspinatus alone? Reason: I don't have the resorces for recuperation from the supraspinatus re-attachment.
what are the sites for injection in the shoulder? any videos please
well structured and informative video. thanks!
Thank you I really enjoyed this video, I have to have Surgery tomorrow for tissue in my shoulder.
Thank you very much for the info ... Is the Celebrex capsules is safe for anti inflammatory?
hello Dr Richard
first of all thank you for how you explain everything
i have this problem for over 2 years and i have try all exercise and therapy but i still have this problem and i so tired of this that doctor say AC of my shoulder some how its swelling and he say just do exercise but nothing is helping and im so tired, if you can help me some how please ?
thank you again
Hi Dr. Hawkins, do you have anyone you can recommend in the Milwaukee area? I've had labral/cuff repair and still have enormous amounts of impingement/pain and improper biomechanics b/c of it. Need to find an expert.
best video on Rotator Cuff problems
i m having this done on my shoulder in a couple of weeks
Thank you for the nice e-lecture. May I ask what happens to the biceps when you cut the tendon? Thx
well structured and informative video. thanks!
Thanks for the great video! Could you please advise if the injections are a permanent fix or just a temporary? i.e. will the pain return after few months?
Thanks
Excellent video! Very helpful!!!
Brilliant ..very helpful and informative
Are there any special steps that you would take for a combat and strength athlete?
This is a really good video. I like that guy.
Great video, thank you for the information!
so what happens after you cut the biceps tendon?
on away from the shoulder. She says this won't affect my work and will probably reduce my shoulder pain. Would you recommend this type of surgery?
A: There are many different causes of shoulder pain. Any problem inside or around the joint can create pain. One of the more common sources of shoulder pain occurs when there is some type of pathology of the long head of the biceps tendon (LHBT).
The biceps tendon attaches between the elbow and the shoulder. It helps you lift your arm straight up and bend the elbow. There are two parts: the short- and long-heads of the biceps. Each one attaches in a slightly different place on the arm. Pathology of the long-head of the biceps causing shoulder pain could be a partial tear of the tendon or tenosynovitis (inflammation of the sheath or lining around the tendon).
Another injury of the long head of the biceps causing shoulder pain could be a SLAP lesion. SLAP stands for superior labral tear from anterior to posterior (from front to back). The labrum is a rim of fibrous cartilage around the shoulder socket. The word "superior" tells us the injury is to the cartilage that covers the top part of the shoulder socket.
Treatment for any of these causes of biceps tendon problems may consist of surgery called a tenotomy. It sounds like that is the type of procedure your surgeon has recommended for you.
During a biceps tenotomy, the long-head of the biceps tendon is released from its attachment to the shoulder. Surgically cutting this portion of the tendon allows it to retract or move away from the shoulder. A tenotomy of this type removes the damaged, inflamed tissue from the joint. This particular tendon has a rich supply of pain nerve fibers so releasing it helps reduce shoulder pain.
Despite all good intentions in treating the shoulder pain by performing a tenotomy, sometimes after tenotomy surgery, the patient develops complications. The most common problems are a cramp-like arm pain, loss of normal elbow strength (flexion or bending), and a change in the shape of the upper arm. This altered appearance of the upper arm is called a Popeye deformity.
Studies show that tenotomy of the biceps tendon is most common in men. It is not recommended for young, active patients or anyone with concerns about appearance. Age is not a factor in predicting who might experience this type of complication but being male is a strong predictor.
Therefore, men who are involved in work or recreational activities that require strong elbow flexion and forearm supination (turning the palm up towards the ceiling) should be forewarned that strength loss could affect them.
This type of information may be of particular interest to folks like yourself who are carpenters, woodworkers, mechanics, and gardeners. Likewise, anyone who uses the forearms and elbows repetitively to complete daily work tasks will must be told of the possible complications of this procedure. Reducing shoulder pain in order to improve overall arm function may be worth the trade off.
The surgeon can either
1. leave the biceps (the long head) to drop down to the upper arm (Biceps TENOTOMY). The Biceps has two heads and the other one which is the short head is still attached anyway)
2. re attach the long head of the biceps to the humerus bone by a screw, away from the labrum, out of sub acromial roof (Biceps TENODESIS)
Nathan Tsuji I asked my surgeon that, she said it only does about 10% of the work anyway and it just drops down, next to working one, I ask that they fix mine, if it's torn, but mine never has neen
The function of the long head of the biceps muscle - and its role in the shoulder girdle - is not fully understood. The first stage in the rehabilitation process would consist of exercising within the free pain range of motion. This statement is based on the expertise and experience of physical therapists and surgeons.
I quote: "The Long Head of the Biceps clearly has some role in the shoulder, but, based on current information, the loss of this function is much less detrimental than retaining a diseased tendon."
www.jospt.org/doi/full/10.2519/jospt.2009.2802
The biceps has 2 tendon's. One of them (the long head) is cut, the other one stays intact. The most important function of the bicep which is flexion and supination of the elbow stays strong. There is
Thank you for a great video! It helps me understand my shoulder much better.
thanks very informative, I cant lift my arm past 90 degrees without it clicking, painful but more depressing if anything having it on your mind 24/7 judging what you can and cant do. hopw to get this sorted soon, was offered botox injections but I don't think that will help, thanks again for the video
Great video, very informative!
I love this video; I've been looking for a good shoulder model and love yours, where is it supplied from?
Thank you from Aus Dr. Hawkins. Great summary for a MD student. ^_^
I did many Rotator cuff exercises and have no more pain in my shoulder but why can't I still flex my left pec as much as my right pec?
Great video. Thanks
Saeid Momtahan Thank you so much for making this video. I have this impingement because of a grade 2 AC joint dislocation playing hockey. I've had it for almost 5 years. Can you please give me some exercises to create more space between the bones. Thanks, Corey
Do you know of anyone in the New Orleans area that you would recomnend?
Is there anyone in Minnesota that you would reccomend?
Thanks very much for this very informative video
Thank you for sharing this information.
Can shoulder impingement develop into adhesive capsulitis?
Thanks doc, very informative.
I'm guessing you re-attached the biceps tendon lower on the humeral head so less of a chance for impingement??
such a clear explanation; thanks!
Excellent video thank you very much
what a brilliant video thank you
Big thank you for the explanation.
excellent video.
This is the best I've seen!
excellent video realy interesting and helpful
Very well explained.
How are you Dr Hawkins? Worked with you in Vail in the late 90's...
I am enlightened, thank you.
Very helpful! Thank you for doing this!!
thank you
thank you.
Thanks, extremely helpful!
there is only one question after I have seen the video. I believe that I have shoulder pain an impingement and to make sure I am in the right path I just would like to know if one of the signs of impingement is also not having power to lift any weights, which for me has been impossible since this pain started a 2 months ago, I have no power to lift a weight with my left arms, specially any king of press up exercises. Please help!
yes it can be, I've just had the operation 2 days ago. I found that lift any weight at arms lenght was impossible, even lifting a carton of juice. if you have this condition you will notice a lose in the range of movement. also when doing fast movement under load you may irritate the tendons. this will greatly reduced the range of movement and increase the pain. I would suggest getting it checked out sooner rather than later, it's a miserable condition to have as it gets worse with time. hope this helps.
that is not typical of just impingement syndrome, unless the only reason you dont have power is because of too much pain, or if you have a full thickness tear. But if your shoulder is actually significantly weak, you should get that checked out. Could be that the impingement syndrome is secondary to the weakness, which could be due to a peripheral nerve problem. Impossible to diagnose over the internet, so visit a good shoulder doc or PT.
So, after 4 months now, Edward, how about a report? Was the procedure a success for you?
Yes it was I only have a little muscle pain, which will decrease as I do the physio. I was able to start moving my arm after 2 weeks, by 4 weeks I was riding my bike. I won't be rock climbing till after the 6 month period.