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Simbah2004
09-23-2004, 04:16 PM
Well guys, here's my profile: 32 year old male, fit never had problems playing tennis. However, I've been diagnosed with impingement syndrome of the right shoulder and started physiotherapy about 3 months ago. It's been helping, but my biceps tendon is still inflamed and does not respond to "conservative" treatment. Went to the doctor and he suggested me to take a cortisone shot. Has anybody taken one of those? Did it work? Please let me know. Thanks.

Mike Hughes
09-23-2004, 07:33 PM
They work for a short while (a few months) to help reduce / eliminate inflammation; however, they do not correct the underlying cause. If the bicepital tendon is involved, it might have slipped out of the bicepital groove (there is a procedure you can do at home to help this if this is what it is). Does it hurt to take your arm up and back, as in preparing to throw a baseball, or taking your arm back for a serve? What shape do they say your various rotator cuff muscles are in?

bcaz
09-23-2004, 11:38 PM
I had two shots in my shoulder. The first one, under the acromium, did little good. THe surgeon assumed I had an inflamed/frayed rotator cuff. THe second shot was right into the A/C (acromioclavicular) joint and eliminated my pain. Along the way, I had a couple of months of PT and an exercise prescription for the shoulders (back) and upper back. My case, I think, was relatively uncommon. Most tennis shoulder problems are cuff problems, with rest, drugs, PT, shots, and surgery the options.

Simbah2004
09-28-2004, 08:16 AM
I have been exercising for the past 4 months, my rotator cuff muscles are stronger than ever. The problem is that there is a little bit of constant pain on the biceps tendon that doesn't go away.

netman
10-01-2004, 09:54 AM
I'm digging deep into the past but this is how I remember it.

Had the same problem at 35 years of age. Tried the shot, tried the PT, tried the rest. Nothing worked. This is what the surgeon told me. There are three types of collar bone endings found in the general population. First (and most common) is the rounded one we all see in the drawings, second has a slight edge to it, and finally No. 3 looks like a bird's beak. There are varying degrees of sharpness to the point. Anyway, if you've got number 3 you'll eventually end up with impringement if you do activities that involve raising your arm above your shoulder.

Mine looked like a falcon's beak. As I aged the tolerances got tighter bringing the sharp end of the bone into contact with the acromium ligament. Inflammation ensued, ligament swelled further reducing clearance, abrasion got worse, and so on. A vicious cycle. Surgery broke the cycle. Surgeon took off the sharp end of the collar bone and cleaned out scar tissue. All done arthoscopically. 5 weeks later I'm back playing bball and its like I'm 18 again. Also added about 10-15 mph to my serve. 8 years later and never have had problems.

Try the shot, do the PT and give it some rest. If the inflammation recedes you've bought time and may never have to have surgery. If not, the surgery is not bad (outpatient) and recovery is quick if you do the PT religiously. I even came away with a full set of color photos showing the entire procedure through the scope. :D

Good luck.

Simbah2004
10-01-2004, 05:19 PM
Took the shot yesterday. Boy, it still hurts. Weird, not the kind of pain I was feeling before - pain from the shot itself. For the first time in months my shoulder did not click. Doc told me it takes about 2 to 3 days for the cortisone shot to kick in. Then is pt for 3 weeks and another appointment. Thanks and hope this works out.

bcaz
10-01-2004, 10:56 PM
Hang in there Simbah. It will be sore for a couple of days before the cortisone does its thing. With luck, it will eliminate pain, reduce swelling, and allow healing to begin. If the bicep tendon is your problem, do some surfing/browsing on SLAP lesions and tears. Ask your doctor about this region of your arm & shoulder.

Netman's hooked acronium is a common problem among tennis players and pitchers and can be corrected. My own X-ray was relatively normal, although I had some arthritis (wear and tear) in the A/C joint. For better or worse, orthopedic surgeons always exhaust conservative therapies before breaking out the knife. I had sympoms similar to Netman, and when that inflammation and swelling sets in, it settles in. There is very, very little clearance under the acronium even in a healthy shoulder. Just a little irritation and swelling can set off a cycle of inflammation, swelling and pain. Even a healthy shoulder is at risk. Overuse and/or weight training that overdevelops the front of the shoulder, the chest and the arm pulls the scapula and acronium forward and down and reduces the clearance of the rotator assembly. Part of the solution, if you play tennis or pitch, is to avoid overdeveloping the front of the body and focus on strengthening, while emphasizing endurance, the back of the shoulder and arm and scapula area to literally pull the scapula back and lift the acronium a little higher, not to mention stabilize the cuff that holds the head of the humerus up and back into its socket so it can rotate properly without fraying the tender tendons connecting it to the muscles.

Simbah2004
10-02-2004, 06:49 AM
Thanks a million guys. Well, probably what happened is that I started PT and done exercises without nailing this bugging pain on my tendon biceps. I was very disciplined with the treatment and a couple of weeks ago I didn't want to take the shot (you know, I was not informed but did some research). Doc performed some tests and told me my rotator cuff is quite strong, the pain is just on one spot.
I don't know if any of you guys felt like this before. Tennis is my "way out" of the pressures and stresses of everyday life and keeps me in great shape - I feel cranky and frustraded when I don't play. But I only will go back on the court when I feel cured this time.

Tim
10-11-2004, 12:52 PM
I am just starting out with a similair problem, and haven't yet seen the physical theropist. Mine started out feeling like it was around the bicipital tendon but after having aggrevated it playing a few weeks, now the whole thing aches all the time and I can't really sleep on that side or it gets worse. Is this on par with what you have? The doctor I saw thought it was either tendonitis or burcitis both of which they treat the same way.

netman
10-11-2004, 01:03 PM
Tim,

Yes. Your symptoms are similiar. Are you icing it after you play? Try 10 minutes of ice, then let it warm back up to normal body temp. Ice again for 10 min. Do this 2-3 times, but never more than 10 minutes and no ice unless the shoulder is warm. Use Ibuprofen to help knock down the inflammation. Most importantly, give it a few weeks off. Then play again. If the problem returns you should definitely see a doctor.

One of my symptoms was strange. I'd play a match or some bball and feel fine. Then afterwards I go to push on the metal bar to open a door and could barely generate enough strength to get it moving. Sleeping was also very difficult.

Good luck

Tim
10-12-2004, 06:36 AM
Thanks for the info Netman. I have been icing it and taking Ibuprofen which indeed helps in the short term but I think I will have to give it a long rest. One of my problems is after having not played in a few weeks and taking Ibuprofen it will feel markedly better and then I'll put my coat on and if I move my arm too fast the same pain will be there in a second. Its very frustrating and totally annoying. I did have x-rays taken and the doctor didn't see anything untoward but I wonder if I should ask him about what you mentioned in regard to the shape of the bone.

Simbah2004
10-15-2004, 02:03 PM
Tim, I have treated the problem and tried to come back twice. Tennis is so addictive that I found myself playing for hours right after I got better. As a result, I never healed completely. This time after my shot (which really worked) I decided not to play for as long as it takes. Don't let it get as far as I did, otherwise this becomes a chronic problem. Even after you feel no pain, make it as strong as possible and wait even longer before you hit the court... The more competitive you are, the more likely you will forget the symptons during a match and start blasting away like I did. Just my two cents.

Tim
10-15-2004, 04:05 PM
I think your advise is correct simbah, its just so difficult to make yourself stop playing for a long time. I still have to see the PT person next tuesday I will see what they think.

Fidelica
10-15-2004, 09:29 PM
I went through a major PT series for shoulder impingement, and I too took two shots of cortisone along the way. After the first one I foolishly returned to the court too early. My advice - as other have noted - it to be very very disciplined about the rehab and see a great and very informed therapist and then do the exercises religiously and above all -- ICE! My PT is a big-time dude in that world (many Olympic athletes and tennis players, including signed thank-yous from a certain Pete Sampras) and one day during a session he was adjusting an ice bag and he took a hold of it, held in front of me and said "You know what? If people used this - I mean really used it - I would be out of business." Ice is critical. Number two: lay off using your arm for any above the shoulder movement for a few months. Yes, I know that hurts to hear but think long-term. Do the re-hab. Get better, get stronger, like the 6-million dollar man. I balked at the layoff and paid the price and then finally straightened up and obeyed and now I am stronger than ever and have no shoulder problem whatsoever and serve at a decent 110+ (for someone who really only took tennis seriously at 37). And now even though I am all better, I am still very afraid of a recurrence and still do the little rotator cuff exercises with 3-5lb weights a few times per week, always with the thumb up, internal and external rotations and arm lifts with shoulders dropped.

Good luck.

Simbah2004
10-16-2004, 07:15 AM
Good post Fidelica. Looks like you had the same problem. I also came back too soon and impingement is a pain in the neck to treat... For me it came back twice. I do the exercises with 3 and 5 pound dumbbells and the rubber band every single day and ice it for 15 minutes 2 times a day.
I will only come back to playing tennis next year, hopefully stronger than ever.

bcaz
10-16-2004, 03:57 PM
Amen, Fidelica -- my expericences, and advice, are the same. Hang in there, Simbah -- you'll be glad you did.

netman
10-17-2004, 04:22 PM
Great advice all.

You know what really sucks? Getting old. Once you are past 25, everything breaks easier and takes longer to heal. Each ten years after that doubles things on both sides of the injury equation. Making the mental adjustment to this fact is the hardest thing athletes must do. Yeah, there are genetic freaks like Lance Armstrong, Andre Agassi and Jerry Rice, but for the common man, sufficient rest and rehab commiserate with age are the only cure. So relax, do the rehab, enjoy the break and work on the mental side of your game.

Good luck.

bcaz
10-17-2004, 10:30 PM
Netman, regardless of their genetic gifts, even Agassi and Rice have struggled with recovery time in the last few years. As for me ... my experiece, using a routine sprained/turned ankle as an example ... when you're 12, it heals in 2-5 days. When you're 18-20, it takes a week to 10 days. When you're 25-30, it takes 2-6 weeks. When you're 40, it takes 3-6 months. When you're 45-55, it takes a good six months to a year. Older than that, it may or may not ever heal.

NoBadMojo
10-18-2004, 07:50 AM
i think thats about right Bcaz..that's why i quit playing hoops when i got in my mid 40's....too many chances for rolling an ankle and other stuff, and too long to heal. i've had very chronic achilles tendonitis in both since 95 tho, and finally eliminated the problem....it was a 8 year path to a cure ;) my opinion on the cortisone is to avoid entirely unless absolutely no choice.

Simbah2004
10-18-2004, 09:43 AM
I agree, but for me there was no choice. I'm a teacher and need to write on the blackboard all day long...
At least the shot worked quite well. I will begin exercises and wait until I feel no pain at all.

netman
10-18-2004, 09:51 AM
Nothing wrong with the shot. Sometimes you need to break that vicious cycle of inflammation, swelling and more abrasion. I think what all of us were agreeing on is that the key is to not assume the shot is permission to go right back out and play. Age really does slow down the healing process. Doesn't mean we have to like it though. :)

serveboy
10-21-2004, 11:31 PM
Before doing something like that I HIGHLY recommend you try a few sessions of Active Release Therapy with a licensed practitioner near you. It's becoming more and more the preference of injured professional athletes. It can be a little expensive but it works wonders.

Simbah2004
10-22-2004, 04:48 PM
Thanks serveboy. But I had gotten to a point where the pain was interfering too much on my work.
I feel much better and have been doing the exercises. It was foolish of me to return so soon, and I've done it twice... I know that once I come back to the court, I'm gonna play safe in the beginning and later start blasting serves and forehands. I'd rather wait as long as it takes, make it pain free and as strong as possible.

serveboy
10-22-2004, 07:38 PM
Thanks serveboy. But I had gotten to a point where the pain was interfering too much on my work.
I feel much better and have been doing the exercises. It was foolish of me to return so soon, and I've done it twice... I know that once I come back to the court, I'm gonna play safe in the beginning and later start blasting serves and forehands. I'd rather wait as long as it takes, make it pain free and as strong as possible.

Exactly. I suffered with a recurring injury simply because I didn't do strengthening before returning to the game. This summer I went to physio 3x a week for strengthening and to improve flexability. After completing it, I started playing nice and slow. After a few weeks I worked my way up to 100%. I'm now 100% pain-free. Good luck!

PS: Under no circumstance play with pain.