Physical Therapy Without a Diagnosis?

[Luv Bunnies]

I've been having a lot of pain in one of my shoulder for at least a year. I thought perhaps I'd pulled something and it would eventually get better but it's just been getting worse. I saw my primary care doctor last week and talked to her about it. She prescribed ice and Motrin three times a day, an x-ray to look for calcium deposits on the bone and six sessions with a physical therapist. I've never been to a PT before so I admit to having no experience and not knowing how it works. But doesn't a PT need to know the diagnosis before working on a shoulder? My doctor said it could be tendonitis, bursitis, arthritis or a rotator cuff injury. Wouldn't the type of therapy they do depend on the diagnosis, or is it all basically the same? The doctor said if PT and the other things don't help, she would send me to an orthopedist who would probably have me get an MRI. Any experiences or advice would be appreciated.

 

[wdwmom2]

My co-worker has lower back pain. Not sure what is causing it. The insurance company will not authorize an MRI before she does PT. Could that be why they are sending you to PT?

ETA: you do have a diagnosis, shoulder pain. Even though it is not very specific, it is a diagnosis. ICD-9 719.41

 

[mjkacmom]

I saw a PT for 2 months with no diagnosis (even though she recommended an MRI for a suspected tear, but a tear I probably wouldn't do anything surgical about). It was for knee pain (which is still there now that I'm not getting PT - however, I had to pay a $40 co-pay for each session, 3 a week).

 

[dejr_8]

I've been having a lot of pain in one of my shoulder for at least a year. I thought perhaps I'd pulled something and it would eventually get better but it's just been getting worse. I saw my primary care doctor last week and talked to her about it. She prescribed ice and Motrin three times a day, an x-ray to look for calcium deposits on the bone and six sessions with a physical therapist. I've never been to a PT before so I admit to having no experience and not knowing how it works. But doesn't a PT need to know the diagnosis before working on a shoulder? My doctor said it could be tendonitis, bursitis, arthritis or a rotator cuff injury. Wouldn't the type of therapy they do depend on the diagnosis, or is it all basically the same? The doctor said if PT and the other things don't help, she would send me to an orthopedist who would probably have me get an MRI. Any experiences or advice would be appreciated.

A good PT is going to give you a better diagnosis than an average Primary Care Physician.

 

[bumbershoot]

A good PT is going to give you a better diagnosis than an average Primary Care Physician.

I agree. They should be able to do all the orthopedic tests and really narrow down what's going on. I'm not even a PT, but I'm definitely on their side with this!

 

[Psychodisney]

I'm a PT. We frequently see patients with a diagnosis like"shoulder pain", "kee pain", etc. You will be evaluated and the PT will see what your problems might be-areas of instability, weakness, tightness, etc. We do more thourough evals than most primary care MDs and have more orthopedic experience than most family practice/internal med docs. He/she will address your symptoms and plan an attack from there. Neck issues might be ruled out as well. Go into it with an open mind and be glad your MD sees the value in PT! Good luck!

 

[The Mystery Machine]

How old are you? I just have to ask because someone we knew died of a heart attack from "shoulder pain".

She kept going to her doctor and he kept sending her away with pain meds for her "bursitis". This was a long time ago and before info was out on how women are misdiagnosed when they have heart attack symptoms.

Pain for over a yr. certainly needs to get a diagnosis. Hopefully the PT can help. Be persistent and figure it out.

 

[I loveStitchnippyjon]

Well, my Dr. sent me to PT 3x a week and after 3 weeks my shoulder was so very much worse that I had an MRI. I have a torn rotator cuff and bone spurs, so I am now waiting to hear when my surgery will be!

 

[RNMOM]

I believe PT's goal is also to restore you to normal, natural function. This can be very telling as the above poster states. Work with the PT and tell them exactly how what you are instructed to do feels. Give it a chance and this will lead to further diagnosis, if needed.

 

[carejo]

Another PT checking in . a physical therapist will do a thorough evaluation and be able to give you more information regarding your problem.. Certain test will indicate a rotator cuff tear vs tendonitis or bursitis or what is referred to as an impingement syndrome ( pain within a certain range of motion of your shoulder often giving you nighttime pain ) Check with a few physical therapy clinics regarding co-pays they can vary a lot. If you find within a few sessions you are getting worse and they are still putting you through the same procedures and exercises let them know. If after the 6 sessions there has been no improvenent , the plan is then to proceed with an MRI Good luck

 

[Luv Bunnies]

How old are you? I just have to ask because someone we knew died of a heart attack from "shoulder pain".

She kept going to her doctor and he kept sending her away with pain meds for her "bursitis". This was a long time ago and before info was out on how women are misdiagnosed when they have heart attack symptoms.

Pain for over a yr. certainly needs to get a diagnosis. Hopefully the PT can help. Be persistent and figure it out.

I just turned 45. I don't think it's a cardiac issue since I just had a full work up by a cardiologist in August. I have a benign condition where my heart speeds up sometimes (brought on by anxiety) but the doctor didn't see any signs of heart disease. I even mentioned the shoulder pain to him and he didn't think it was a heart problem. But thanks! It was a good thought!

Sounds like many of the posters have had experience with PTs and that they will be able to help figure out the issue. I will definitely go into it with an open mind and do whatever they tell me to do. I want this pain gone! Thanks to everyone who responded.

 

[minkydog]

A good PT is going to give you a better diagnosis than an average Primary Care Physician.

I agree. Physical therapists do their own assessment. It is based on symptoms, not a medical diagnosis. Shoulder pain can have multiple causes. The PT will devise a program for strenghtening and improving function. You don't necessarily have to have a definitive diagnosis for them to help you.

DH saw a PT several years ago after he went to the doctor with the complaint of hip pain. The doctor diagnosed him with a sprained hip, despite the fact that he had no known injury. DH faithfully saw the PT and did a home program for several weeks. After a couple weeks with no improvement, the PT went to the physician about it. Clearly there had to be something else going on. They sent him for a CT . DH has an auto-immune disorder which usually attacks the lungs, so he has taken large doses of prednisone for the last 7 years. The prednisone had caused the hip joints to deteriorate so that there is a debris field in the socket. The lung disease had also migrated to his hip joints and asserted itself like arthritis. After that diagnosis, the PT(not the doctor, who just wanted to throw pills at it!) advised that DH spend time in a warm water pool walking. Nothing will cure this disease, but the warm water helps him so much that he has been able to reduce his use of anti-inflammatories.