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sstchur
02-14-2010, 09:01 AM
I don't really know what it is, but another member mentioned it in a thread I started (in the wrong section -- oops!)

Here is my original thread:
http://tt.tennis-warehouse.com/showthread.php?t=312735

I don't know how to move a thread so I'm just posting a link to the original here (in the section I think it should be in).

Any advice appreciated.
Thanks,
-sstchur

SystemicAnomaly
02-14-2010, 09:55 AM
I'd expect a TW moderator to move the thread once they discover it. Perhaps you could contact them directly (not sure how). If that doesn't happen, you could always COPY-PASTE that original post to this forum.

charliefedererer
02-14-2010, 10:06 AM
You may have an "impingement syndrome" or pinching of the rotator cuff tendons.
http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/19614.jpg
"When tendons become trapped under the acromion, the rigid bony arch of the shoulder blade, it can cause shoulder pain called impingement syndrome. The tendons become compressed, damaged, and inflamed leading to rotator cuff tendonitis. This can occur from general wear and tear as you get older, or from an activity that requires constant use of the shoulder like baseball pitching, or from an injury."
-http://images.google.com/imgres?imgurl=http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/19614.jpg&imgrefurl=http://www.nlm.nih.gov/medlineplus/ency/imagepages/19614.htm&usg=__Sc9gOKvp9GohR0GhIkJEq3jJl38=&h=320&w=400&sz=29&hl=en&start=1&itbs=1&tbnid=ujBlecO7BA0Z_M:&tbnh=99&tbnw=124&prev=/images%3Fq%3Dimpingement%2Bsyndrome%26gbv%3D2%26hl %3Den

It is this very problem that tennis players and baseball pitchers have to work so hard at doing their Thrower's 10 exercises to avoid.

The first phase of treatment is rest and ice to decrease the inflammation. Then there has to be a period of physical therapy before return to play. All out hitting and hard serving usually first require a period of more intensive muscle strenghthening of the muscle that act to brake the forward momentum of our arm at the shoulder level as we bash the ball.

Of course all this is conjectural, because only a doctor can examine you and diagnose you. It sounds like your orthopod has started this process, but I sense a disconnect. Maybe he is really telling you that it is going to take more time and more therapy and you just don't want to hear that. (That's understandable, its very frustatrating that this process could take a long time to resolve.) If it's a total disconnect, you may even have to change orthopods, but don't do this too hastily. Also you will have to really connect with your physical therapist to get a good result. Most physical therapists are dying to be more helpful and work with a cooperative patient, and understand your frustration as well that with inflammation you can't do just all out work, but must let the recurring inflammation subside as you go through the steps that it will take to get totally well. And from the sounds of your current problem, you are going to have to resolve yourself that this is going to be a process that likely takes months to resolve, and will include some backslides rather than a smooth path to resolution. (I'm hope I'm wrong on this and it goes really smoothly and quickly.) Good luck.

Fee
02-14-2010, 12:05 PM
If you need a thread moved, click on the red triangle in the first post and report it so that the mods will see it. They don't have time to read every thread in every section of the forum.

I have frozen shoulder with severe pain in many areas of my arm and shoulder, including occasional numbness. I was officially diagnosed on Friday and referred to PT, which I expect to start later this coming week. I can barely lift my left arm to shoulder level and cannot push it behind me at all. I know I have a long road ahead, but I expect to be fully functional by summertime.

I am going to take Naprosyn for a few weeks and see how that helps. I know that getting a cortison injection is an option, but my doctor doesn't think we need to do that yet.

mmaster
02-14-2010, 01:10 PM
don't worry, they don't moderate on weekends

sstchur
02-14-2010, 02:28 PM
....
Of course all this is conjectural, because only a doctor can examine you and diagnose you. It sounds like your orthopod has started this process, but I sense a disconnect. Maybe he is really telling you that it is going to take more time and more therapy and you just don't want to hear that. (That's understandable, its very frustatrating that this process could take a long time to resolve.)
....

You're actually right about this. He did say that the amount of time I spent in PT wasn't really long enough. The thing is, I just didn't feel like it was doing anything. And my time available for PT is limited (mostly early morning before work, which is my tennis time). In other words, if I'm doing PT, I'm not playing tennis (which is what I want to be doing). And if the PT isn't helping, then what's the point? I'd rather just play tennis, shoulder pain be damned.

I guess I don't have much faith in PT. I went for an elbow issue for a LONG time, and it never ever got any better. I finally decided I was through with PT and just quit. I kept on playing tennis, but I would just take it easy if my elbow hurt. Eventually, the elbow pain "just disappeared." I didn't change a thing. I don't think PT had anything to do with it.

And so with this shoulder issue, I don't want to waste my time with PT if it isn't going to help.

There is a disconnect between me and doc. I really want to get a more definitive sense that he knows exactly what is happening and cause pain. I want something a bit more specific than "irritation" or "possible minor tear." That's kind of why I'm searching in these forums and online. I'm hopeful to find someone whose had symptoms like mine, and who determined exactly what the issue was. Then, maybe I can make a reasonable guess if I have the same symptoms.

The most frustrating thing is taking off a jacket. I never want to reach behind and grab my right jacket sleeve with my left hand and pull, b/c while the sleeve is sliding off my right arm, it's also pulling on my arm, and that hurts.

Other than that (and also taking a shirt off -- same kind of symptom) I really don't experience any day-to-day pain, and as I said in my other thread, I really don't feel any pain during play. I can even lift light weights and do shoulder exercises (like lateral raises or military press) without pain (5 or 10lb weights).

It seems bizarre to me that the weights don't hurt, but that "pulling" which occurs when taking off a jacket does. Isn't that a little strange?

charliefedererer
02-14-2010, 09:09 PM
That symptom of pain on grabbing your sleeve is typical for the impingement syndrome. The reason this motion triggers the symptoms is that you are rotating the head (end of the bone that is round) of the humerus (the uper arm bone) so that the truned head is now pushing into the narrow canal through which the ligaments of the rotator cuff pass. There just is not enough room in that narrow canal when you do that motion for there not to be "pinching" of the bursa (the sac that lines your shoulder joint).

So the first step in your therapy was to let the inflammation subside. It sounds like that had happened.

The second step was building up the muscles that stabilize the shoulder and the the area in back of the shoulder. It sounds like the physical therapist started this process, but did not finish.

Because of the shape of the head of the humerus, hitting low tennis shots, or using the arm without lifting it, usually does not result in symptoms. Raising the arm slowly to do a military press may not even cause the symptoms. But raising the arm with internal rotation at the shoulder (like reaching to grab your sleeve) rotates the head of the humerus into that narrow canal so that maximal pressure is exerted there, and you syptoms appear. A rapid movement with the shoulder like serving or throwing a baseball causes only momentary narrowing here (with resultant pinching of the bursa), but at the end of serving or pitching, the accumulated "pinches" of the bursa causes enough inflammation to give you pain the next day.

So you really should return for more PT. This will be a delicate dance between doing enough work in your exercises that you are developing strength in the muscles that are too lax that stabilize how much the humeral head can rotate into that narrow canal. Again, this is likely to be a process of many more weeks. It will be frustrating. But unless you do the therapy, you will have little chance of getting back to serving (you have a better chance of getting back to just hitting groundstrokes of low balls as the humeral head does not rotate in a way that puts as much pressure on the bursa from this type of motion.) It is generally agreed that 60-90% of people should respond to the full course of physical therapy. Without response, surgery can then sometimes be needed. But guess then what? There is time away from tennis, and many other activities, to heal, and then you still have to do the physical therapy anyway.

So despite the frustrations, you really should be doing the physical therapy. If you don't, this is the type of problem that ends tennis player's and pitcher's careers.

sstchur
02-14-2010, 10:17 PM
That symptom of pain on grabbing your sleeve is typical for the impingement syndrome. The reason this motion triggers the symptoms is that you are rotating the head (end of the bone that is round) of the humerus (the uper arm bone) so that the truned head is now pushing into the narrow canal through which the ligaments of the rotator cuff pass. There just is not enough room in that narrow canal when you do that motion for there not to be "pinching" of the bursa (the sac that lines your shoulder joint).

So the first step in your therapy was to let the inflammation subside. It sounds like that had happened.

The second step was building up the muscles that stabilize the shoulder and the the area in back of the shoulder. It sounds like the physical therapist started this process, but did not finish.

Because of the shape of the head of the humerus, hitting low tennis shots, or using the arm without lifting it, usually does not result in symptoms. Raising the arm slowly to do a military press may not even cause the symptoms. But raising the arm with internal rotation at the shoulder (like reaching to grab your sleeve) rotates the head of the humerus into that narrow canal so that maximal pressure is exerted there, and you syptoms appear. A rapid movement with the shoulder like serving or throwing a baseball causes only momentary narrowing here (with resultant pinching of the bursa), but at the end of serving or pitching, the accumulated "pinches" of the bursa causes enough inflammation to give you pain the next day.

So you really should return for more PT. This will be a delicate dance between doing enough work in your exercises that you are developing strength in the muscles that are too lax that stabilize how much the humeral head can rotate into that narrow canal. Again, this is likely to be a process of many more weeks. It will be frustrating. But unless you do the therapy, you will have little chance of getting back to serving (you have a better chance of getting back to just hitting groundstrokes of low balls as the humeral head does not rotate in a way that puts as much pressure on the bursa from this type of motion.) It is generally agreed that 60-90% of people should respond to the full course of physical therapy. Without response, surgery can then sometimes be needed. But guess then what? There is time away from tennis, and many other activities, to heal, and then you still have to do the physical therapy anyway.

So despite the frustrations, you really should be doing the physical therapy. If you don't, this is the type of problem that ends tennis player's and pitcher's careers.

Well, I have to admit that you do present a fairly convincing argument here. And in fact, many of the terms you mentioned ring a bell (the Doctor did mention something about "bursa" when he looked at the x-rays), so I'm inclined to think you really know what you're talking about! :-)

Thanks for the advice... maybe I'll revisit the PT.

mike53
02-15-2010, 07:56 AM
The most frustrating thing is taking off a jacket. I never want to reach behind and grab my right jacket sleeve with my left hand and pull, b/c while the sleeve is sliding off my right arm, it's also pulling on my arm, and that hurts.

Other than that (and also taking a shirt off -- same kind of symptom) I really don't experience any day-to-day pain, and as I said in my other thread, I really don't feel any pain during play. I can even lift light weights and do shoulder exercises (like lateral raises or military press) without pain (5 or 10lb weights).

It seems bizarre to me that the weights don't hurt, but that "pulling" which occurs when taking off a jacket does. Isn't that a little strange?

Sometimes this stuff goes away completely on its own and sometimes it continues to get so bad that you can't get dressed in the morning.

If you have 100% range of motion in your shoulder and 100% strength though the entire range of motion, then you are well and you don't need any treatment. If not, then you need to get yourself to 100% range of motion and make sure you have strength through the entire range of motion.

Maybe you can do this all on your own, and maybe you can use some help. Depends on your ability to persevere and persist through pain and hold yourself to an objective standard. But if you leave yourself with limited strength or limited range of motion, you risk eventually loosing that motion for good, this is the "use it or lose it" principle.

Myself personally, I had PT for diagnosed bicipital tendonitis with limited success. I was finally able to break through the limited shoulder ROM and pain by swimming a program of 10x50 yard sprint intervals using the "butterfly" stroke. After the 5th or 6th sprint, my shoulder would "pop" and it was like everything would loosen up. Wouldn't work for any other stroke. After 6 weeks of this, three times a week, I've probably got 95% ROM in both shoulders pain free and 100% strength through the entire ROM.

charliefedererer
02-15-2010, 07:37 PM
Sometimes this stuff goes away completely on its own and sometimes it continues to get so bad that you can't get dressed in the morning.

If you have 100% range of motion in your shoulder and 100% strength though the entire range of motion, then you are well and you don't need any treatment. If not, then you need to get yourself to 100% range of motion and make sure you have strength through the entire range of motion.

Maybe you can do this all on your own, and maybe you can use some help. Depends on your ability to persevere and persist through pain and hold yourself to an objective standard. But if you leave yourself with limited strength or limited range of motion, you risk eventually loosing that motion for good, this is the "use it or lose it" principle.

Myself personally, I had PT for diagnosed bicipital tendonitis with limited success. I was finally able to break through the limited shoulder ROM and pain by swimming a program of 10x50 yard sprint intervals using the "butterfly" stroke. After the 5th or 6th sprint, my shoulder would "pop" and it was like everything would loosen up. Wouldn't work for any other stroke. After 6 weeks of this, three times a week, I've probably got 95% ROM in both shoulders pain free and 100% strength through the entire ROM.

Now the butterfly stroke is definitely the hardest, most exhaustive stroke in swimming.
But the power portion of the stroke is very similar to a triceps pulldown, and in the recovery of the stroke, the biceps are not being taxed, so while your swimming was certainly vigorous, it was a reasonable approach to work on your range of motion and strengthen your shoulder even though you had bicipital tendonitis. (The backstroke and crawl have more of a "reaching" component to the strokes as the arms are alternativly extended, rather than both at the same time as in the butterfly. It makes sense that you would have put more stress on the biceps tendon with these strokes.)

However with an impingement syndrome, the laxity in the shoulder would cause irritation of the bursa as each stroke moves the head of the humerus forward "pinching" the bursa. The butterfly likely would be problematic for sstchur. But this just illustrates how cooperation between an orthopedic evaluator, good physical therapist who works with throwing/swimming athletes AND a nondiscouraged, motivated patient can yeild the best chance of success, rather than just trying to push through with an activity that worked for one, but won't likely work for others.

For inflammatory conditions it is best not to have the "warrior" mentality that serves most of us so well in sports. Perhaps the perspective of a rock climber is a better view to take. Rock climbers are in great shape, but have to approach their climbs slowly, deliberatly and with great concentration. They know that a path that initially seemed promising may have to be abandoned, and a different path taken, even though considerable time and energy was exerted down that now clearly dead end path. They learn to push past the frustrations and reach their goal through perseverence, a willingness to consider other possibilities, and being clever enough to outhink their rock.

charliefedererer
02-15-2010, 07:52 PM
Sometimes this stuff goes away completely on its own and sometimes it continues to get so bad that you can't get dressed in the morning.

If you have 100% range of motion in your shoulder and 100% strength though the entire range of motion, then you are well and you don't need any treatment. If not, then you need to get yourself to 100% range of motion and make sure you have strength through the entire range of motion.

Maybe you can do this all on your own, and maybe you can use some help. Depends on your ability to persevere and persist through pain and hold yourself to an objective standard. But if you leave yourself with limited strength or limited range of motion, you risk eventually loosing that motion for good, this is the "use it or lose it" principle.

Myself personally, I had PT for diagnosed bicipital tendonitis with limited success. I was finally able to break through the limited shoulder ROM and pain by swimming a program of 10x50 yard sprint intervals using the "butterfly" stroke. After the 5th or 6th sprint, my shoulder would "pop" and it was like everything would loosen up. Wouldn't work for any other stroke. After 6 weeks of this, three times a week, I've probably got 95% ROM in both shoulders pain free and 100% strength through the entire ROM.

Now the butterfly stroke is definitely the hardest, most exhaustive stroke in swimming.
But the power portion of the stroke is very similar to a triceps pulldown, and in the recovery of the stroke, the biceps are not being taxed, so while your swimming was certainly vigorous, it was a reasonable approach to work on your range of motion and strengthen your shoulder even though you had bicipital tendonitis. (The backstroke and crawl have more of a "reaching" component to the strokes as the arms are alternativly extended, rather than both at the same time as in the butterfly. It makes sense that you would have put more stress on the biceps tendon with these strokes.)

However with an impingement syndrome, the laxity in the shoulder would cause irritation of the bursa as each stroke moves the head of the humerus forward "pinching" the bursa. The butterfly likely would be problematic for sstchur. But this just illustrates how cooperation between an orthopedic evaluator, good physical therapist who works with throwing/swimming athletes AND a nondiscouraged, motivated patient can yeild the best chance of success.

tennytive
02-16-2010, 07:42 AM
Here's the most helpful link I found about my frozen shoulder last year:
http://orthopedics.about.com/cs/frozenshoulder/a/frozenshoulder.htm

Page two describes the stages. If you're still in Stage 1, PT/rehab won't be very effective, you need to wait until Stage 2 IIRC.

By the time I saw a doc it was 5 months into mine, so the exercises did start to help, but slowly. You have to keep at it, at least 2 to 3 times a day, and I did more than that on most days. The doc had me stand with my arm out to the side with my thumb pointing toward the floor. He then put his hand on the top of my arm and asked me to lift my arm up. As soon as I did, he ruled out rotator cuff damage and diagnosed me with the frozen shoulder. Did your doc perform the same test for you?

As mentioned in my other post, swinging a racquet with the cover on was helpful as well as the butterfly stroke in the standing position. The swimming motion was also an easy way to gauge progress.

The hardest movement to recover is the ability to reach behind my back. That's just starting to approach normal after a year.

Again I wish you luck. Time and patience is mandatory if you want to heal naturally. My view is to avoid any surgery unless there's no other option.

mike53
02-16-2010, 09:48 AM
But this just illustrates how cooperation between an orthopedic evaluator, good physical therapist who works with throwing/swimming athletes AND a nondiscouraged, motivated patient can yeild the best chance of success, rather than just trying to push through with an activity that worked for one, but won't likely work for others.


That's what we would hope. I shared my personal experience at the request of the op because my symptoms have been almost identical to those he describes and this after I had spent many many hundreds of dollars for treatment. Neither my doctor nor any therapist recommended swimming for me and I fell into it by accident while I was teaching my kids. My good luck, and who knows whether or not it would work for anyone else. Certainly the PT was only partly effective and and a series of prescribed ultrasound treatments did nothing at all.

sstchur
02-16-2010, 09:14 PM
That's what we would hope. I shared my personal experience at the request of the op because my symptoms have been almost identical to those he describes and this after I had spent many many hundreds of dollars for treatment. Neither my doctor nor any therapist recommended swimming for me and I fell into it by accident while I was teaching my kids. My good luck, and who knows whether or not it would work for anyone else. Certainly the PT was only partly effective and and a series of prescribed ultrasound treatments did nothing at all.

Definitely appreciate all the feedback and opinions from everyone. This is just what I wanted -- not asking for definitives from anyone. Just trying to learn from others who've had similar symptoms.

I am going to try to go and get a 2nd opinion and possibly an MRI.

One thing I noticed today when I was playing is that the forehand motion actually hurts a little more than I realized (maybe because this was the 2nd day in a row of playing and perhaps my shoulder is inflamed). But I use a full western grip and I lay my wrist back pretty good when I take the racquet back. I also have a windshield wiper motion forehand, and I noticed that this motion actually puts a fair amount of stress on my shoulder. The pain isn't excruciating by any means, but this motion definitely aggravates my symptoms.