Rehabilitation Medicine

Let me start with the most common misconception: Rotator cuff tears are very common, they aren’t always what’s causing the pain, and they don’t always require surgery. I wrote this for anyone whose shoulder hurts, who can’t lift their arm, or who’s been told after an exam that “your rotator cuff is torn” or “you have calcification in your shoulder.” What exactly is the rotator cuff? The bones in your shoulder are shaped a lot like a golf ball sitting on a tee: the ball is large, and the tee is shallow. ...

Let me start with the most common misunderstanding: De Quervain’s is not “weak wrists,” nor is it “sore muscles from holding a baby too long." Instead, it’s about two tendons at the base of your thumb. The tunnel they share gets narrow and thick, and the tendons can’t glide through. So resting makes it hurt less, but as soon as you go back to the original movement, the pain comes right back. It won’t resolve itself just because you sleep a few more days. ...

Let me start with something a lot of people don’t know: if you get an X-ray for heel pain and see a bone spur, that spur usually has nothing to do with your pain. One study looked at a thousand random foot X-rays. Thirteen percent had bone spurs, and of those, only 40 percent had ever experienced heel pain. Conversely, many people in agonizing pain have completely normal X-rays. So the spur isn’t the culprit. What’s actually hurting is the fascia attached to your heel bone, which has been repeatedly pulled until it developed micro-tears and degeneration. ...

Let me open with a sentence that makes a lot of people relax: knee osteoarthritis is not a one-way street where the cartilage grinds away and that is the end of it. It is closer to an imbalance — the body’s rate of repairing the joint has fallen behind the rate of wear. That gap can be narrowed, and the things that narrow it happen to be the cheapest things on the list. ...

Let’s start with the most common misunderstanding: the place that hurts is usually not the place that’s broken. Almost everyone with a trigger finger points to their middle knuckle and says, “It gets stuck here.” But the real problem is at the base of the palm, that ring where the finger meets the palm. This is why the doctor presses your palm, not the spot you’re pointing at. This is written for those whose fingers get stuck in the morning, who feel pain when gripping things, or who have already been told they need an injection. ...

Let me say the most important thing first: sarcopenia is not “just what happens when you get old.” It’s a disease that can be detected—and one that actually improves with exercise and diet. This post is written for two kinds of people: you, if an older adult at home has recently started walking slower or can’t open jars; and you, if you’re past fifty and starting to feel your stamina isn’t what it used to be. The second group is actually more important, because the latest 2025 Asian consensus pulled the age to start paying attention forward to fifty. ...

Let’s start with the most important point: If a senior’s shoulder repeatedly swells with fluid, and you can draw out a large bottle every time, it’s mostly not “simple degeneration,” but another disease. This post is for you if you have an older family member whose shoulder repeatedly fills with fluid, has been aspirated several times, but always swells up again quickly. What is this disease? Inside the shoulder is a group of tendons called the “rotator cuff,” which is responsible for hanging the arm steadily in the shoulder socket. As we age, this tendon group can tear completely. After it tears, the humeral head moves upward, and bone rubs directly against bone. The fine calcium salt crystals ground off fall into the joint cavity, which in turn stimulates the joint lining to inflame and continue the destruction. ...

Recently I was spending time with an older adult, and he said to me: “Life really doesn’t need to be that long. I’m already in my 80s, why would I still go exercise and work out? I already go out and walk several times a day, that’s already very good!” Honestly, the first half—“life doesn’t need to be that long”—stumped me. That’s a question about the meaning of life, not something I can answer in a few sentences in clinic. But the second half—“walking several times is enough”—happens to be my own specialty, and I’m confident about this: walking is great, but for an 80-something older adult, relying just on walking really isn’t quite enough. I’ll start from here in the rest of this post. ...

While prepping for the PM&R board examination, I used an engineer’s approach to solve an old problem for myself: how exactly should I practice past exam questions so I don’t forget them right after? I ended up building a small tool called “Exam Navigator,” and figured I’d tidy it up and open it up to share with anyone who needs it. 🔗 Live Demo (built-in demo account, ready to play): https://exam-demo.drpwchen.com 🔗 Source code: https://github.com/drpwchen/exam-practice ...

Last December, I took Neurodynamic Solutions (NDS) Level 1 and Level 2, taught by Michael Shacklock himself in Taiwan. Shacklock is the founder of the clinical neurodynamics system, and having him walk us through demonstrations step-by-step was a rare opportunity. After finishing both levels, I had taken over a hundred pages of notes, and it completely changed the way I look at “nerve pain.” To be honest, very few courses out there truly target nerves for treatment, which is one of the reasons I went out of my way to take NDS. ...