Supraspinatus relapse and suicidal tendencies...

Discussion in 'Health & Fitness' started by Pacific lefty, Feb 21, 2012.

  1. Pacific lefty

    Pacific lefty Rookie

    Joined:
    Nov 3, 2011
    Messages:
    272
    Location:
    Europe
    I never thought I'd be back on this forum so fast...I had my tendonitis/impingement well under control with my PT and after seven weeks I was ready to start hitting. I had one hitting session and on Jan 30 did some extremely light weighted lat pulldowns and sitting chest presses in gym. From that day on the pain was right back. Impossible to do any external rotation exercises, even isometric, or stretch arm across body. And even three weeks later it is still the same.

    I can't believe I could have caused the problem to come straight back. My PT says that must mean that the impingement is so bad that I do need surgery. I just feel at the moment that I am never going to play competitive tennis again (not to mention having nightmares about crashing my car into a wall)...

    So next week I am trying two things...accupuncture, and meeting the dreaded cortisone happy ortho. surgeon. Has anyone found accupuncture helpful? I guess I will probably have another mri to see exactly what is going on here..


    Please anybody, a word of encouragment as I've been spending most of this week just reminding myself to keep breathing in and out...
     
    #1
  2. r2473

    r2473 Legend

    Joined:
    Aug 14, 2006
    Messages:
    7,122
    The guy I played with this morning has shoulder problems. He's had them for years (from what he's told me). He got a cortisone shot last week and says he "feels like new", though he knows its temporary.

    In the meantime, I'd strongly advise that you "keep breathing in and out"...........

    Personally, I tore the hell out of my shoulder bench pressing 4 or 5 years ago. Couldn't serve for a year (and didn't). It actually hurt to raise my arm above my head for quite a while. When I "shadow hit" a forehand, I couldn't follow through and cross my body. What I mean to say here is, this injury really f***ing hurt. I actually couldn't even run for a while (hurt too much to swing my arms). I went to the sports ortho and he basically said "mmmmm....tough ****. Hurt your shoulder. Rest for a while. Then, here's some worthless PT. Now get away from me". Gee, thanks doc.

    About a year ago I messed up something in my shoulder doing ring dips. I couldn't hit a proper forehand for about 6 months. Shifting my 5 speed into reverse was too much for me (I have an older BMW, and reverse is where the European reverse is. On the left of first gear). Oddly enough, serving was no problem. I hit all slice forehands for 6 months. Now, I'm fine. Like nothing ever happened.

    My advise. Rest. Not "sorta rest". But truely rest. It sounds like you have not been doing this over the past few months and you are now paying for it with a longer recovery. Use the time to get into better shape (I mean running). You'll come back fitter.

    Well, you'll just have to wait to see what the MRI and your doc say.
     
    Last edited: Feb 21, 2012
    #2
  3. ollinger

    ollinger Legend

    Joined:
    Nov 24, 2004
    Messages:
    6,157
    We in fact are in the peak suicide months now (Feb., March, April) so consult a mental health practitioner at your earliest convenience. Beyond that, I'm not sure what your inability to do chest presses and lat pulldowns has to do with whether you can play tennis. It's not uncommon to struggle with those types of exercises with an impingement but still be able to play tennis. Has happened to me twice in the past 25 years, pain doing those things in the gym but no trouble on the tennis court.
     
    #3
  4. ab70

    ab70 New User

    Joined:
    Mar 17, 2009
    Messages:
    97
    Assuming it is just impingement, the surgery is not a bad option... they will clean it up, open space for RC tendons and you should be back on the court in 3 month for groundies... I can't recall whether you had an MRI done and what it has shown... Sounds like you tried all conservative options...
     
    #4
  5. ollinger

    ollinger Legend

    Joined:
    Nov 24, 2004
    Messages:
    6,157
    (addendum -- perhaps being located in Europe while using the name "Pacific lefty" also contributes to your sullen mood and feelings of alienation)
     
    #5
  6. Pacific lefty

    Pacific lefty Rookie

    Joined:
    Nov 3, 2011
    Messages:
    272
    Location:
    Europe
    Ha ha ollinger very funny. That is what happens when you transplant a Californian girl to a wet and windy place like Ireland...

    I am truly learning the meaning of the idea of rest. I do go the gym and I have done a lot of running in the past but for me it certainly does not beat tennis as being a fantastic sport (as well we haven't got great weather here for road running every day).

    In...out...in...out, thanks r2473, we'll see what the Dr says next wk.
     
    #6
  7. r2473

    r2473 Legend

    Joined:
    Aug 14, 2006
    Messages:
    7,122
    ^^ You have to "test it" from time to time. But that doesn't mean hitting serves or bench pressing. That is (obviously) WAYYYY too much for your shoulder right now.

    As I did the rehab I invented for myself, I could "feel" my shoulder getting better and stronger every week / month. But I didn't try anything as stressful as hitting a full serve or bench pressing until I was "pain free". And that took a long time.

    But, I'm VERY risk averse, so I probably rehab / rest longer than is really necessary. I just don't want to re-tear anything and have to go through THE ENTIRE process again (and risk further damage).
     
    #7
  8. Limpinhitter

    Limpinhitter Legend

    Joined:
    Jun 10, 2010
    Messages:
    9,277
    I resolved my impingment syndrome with a combination of daily rotator cuff exercises with a "Theraband," daily NSAID therapy, and daily ice therapy. I still do 5 exercises almost every day to maintain joint stability and prevent further impingment and inflamation. The most important exercises for me are vertical rotation, inner rotation and outer rotation (bent arm and straight arm). It took about 3-4 months before I could play with confidence.

    In addition, for me, the key to ice therapy is to use one of those round fabric covered rubber/pleated ice bags and apply it for ONE HOUR at a time, not 20 minutes as generally prescribed by PT's. However, it is important to use a fabric covered ice bag and to apply it over a t-shirt so that the cold doesn't cause a cryogenic burn.
     
    #8
  9. Say Chi Sin Lo

    Say Chi Sin Lo Legend

    Joined:
    Aug 30, 2005
    Messages:
    9,273
    You know, I've been in your shoes twice. Injured, had surgery, injured again, another surgery. Both times with the supraspinatus.

    I will honestly say after the 2nd surgery, my shoulder didn't feel right at all. Surely on an anatomical level, the damages were repaired but it just doesn't didnt feel right. I had nagging pain and constant soreness each time served.

    I kept at it, I kept working out, doing the rehab exercises as instructed by my PT. You'll be amazed by work is needed to strengthen a rotator cuff.

    I could hit groundstrokes all day long, but I couldn't serve out an entire set without pain and soreness. I realized no rehab exercise would ever replicate the motion and stress that a shoulder goes through during a service motion. I call this "serve stamina", so I worked at it.

    Started off with 50 balls nonstop, then 75 balls nonstop, 100 balls, so on and so on until I could serve anywhere from 200-300 nonstop and not be hurting.

    After that, I worked on my motion. I could have the strongest shoulder in the world, but if my technique is flawed, then no amount of rehab will preserve my shoulder. I have since made slight changes in my original motion to take away as much of my shoulder as I can, while incorporating more legs and core while increasing power and spin on my serves.

    In the end, if you're determined and willing to put in the work, the human body can come back from any non-disabling injury.

    Tips for you based on my own experiences:
    1) Rest until you're not in pain.
    2) Work and rehab the injury. Follow the PT down to the T. If some fool at the gym shows you some random shoulder exercise that makes you raise an eyebrow or two, chances are your gut instinct is right.
    3) Court stamina/serve stamina is huge I think. Muscle memory accounts for a lot of the strength/flexibility.
    4) Think about your technique, if something's hurting then chances are, you're over-stressing that particular body part.

    I also advise against the cortisone shot. Surely it'll relieve you of the pain, but it turns off the inflammation that starts and facilitate the healing process!
     
    #9
  10. charliefedererer

    charliefedererer Legend

    Joined:
    Feb 13, 2009
    Messages:
    5,639
    You can definitely impinge your supraspinatus doing lat pull downs (and hopefully you weren't pulling the bar behind your head, where maximal impingement would occur.)

    [​IMG]


    I'm not sure exactly what the sitting chest press was, but it also could have pinched the supsraspinatus, even if holding the dumbells the "right way":

    [​IMG] "Wrong way" to hold dumbells because it positions the humeral head to maximize the potential for impingement.

    [​IMG] "Right way" to hold dumbells to turn the humeral head so that impingement is minimized.


    And certainly avoid machines where the pushing angles up:
    [​IMG]


    References for future use (obviously too early to do any of these exercises now):
    What Exercises Cause Shoulder Impingement? by Emma Roberts http://www.livestrong.com/article/395015-what-exercises-cause-shoulder-impingement/

    "Contraindicated Exercises
    Professional or recreational athletes with a history of shoulder instability, shoulder injuries, or pain and inflammation in the shoulder girdle need to avoid overhead and military presses, especially with a barbell; dumbbell side raises performed with thumbs pointing toward the floor, upright rows wherein the bar is lifted above the height of the shoulder, the incline bench press, and lat pull-downs with the bar placed behind the neck. Each of these exercises place inordinate stress on the shoulder and may cause impingement in vulnerable joints."


    Pressing and the Overhead Athlete by Eric Cressey http://www.elitefts.com/documents/overhead_athlete.htm
    "With respect to the glenohumeral joint—one of several articulations comprising the shoulder girdle—there are five different characteristics of any exercise that I take into account.

    1. Traction versus approximation: Pull-ups and pull-downs (like most cable exercises) are an example of traction exercises. They pull the head of the humerus away from the glenoid fossa (shoulder socket). Conversely, pressing exercises are approximation exercises. They drive the humeral head into that socket. Approximation exercises increase the likelihood of rotator cuff impingement far more than traction, and this is why exercises like pull-downs, pull-ups, and shrugs can be integrated into rehabilitation programs before various presses. It also explains why many people with external impingement respond well to traction work with bands. They’re basically giving the rotator cuff tendons room to breath.

    2. Adduction/extension versus abduction/flexion: Does the movement have the arm further away from the body (elevated) or close to the side? We know that an elbows-tucked (more adducted) bench press is much safer for the shoulders than an elbows out (abducted) style of bench pressing. The same can be said for overhead pressing (scapular plane versus frontal plane).

    3. Closed-chain versus open-chain: Movements where the distal segment is fixed and the proximal segment is moving (closed-chain; e.g. push-ups) will always be safer for the shoulder than movements where we are stable proximally and moving distally (open-chain; e.g. Bench Press). For this reason, you’ll always be able to integrate push-up variations in a shoulder rehabilitation program before you move to barbell and dumbbell pressing variations. [note that Cressey's audience is largely heavy weight body builders/ahletes, so elastic bands and very light dumbells will likely be more appropriate for you than pushups eventually.]

    4. Dumbbells versus barbells: We know that external rotation of the humerus repositions the humeral head and gives the rotator cuff tendons more room to “breath” without impingement as we elevate our arms. We also know that external rotation of the humerus ties in closely with forearm supination—just as internal rotation is associated with pronation.

    A barbell fixes us in a pronated position so we’re locked into more of an internally rotated position. Dumbbells allow us to supinate a bit more. In turn, we are able to get more external rotation during the pressing motion, therefore protecting the rotator cuff a bit more than with barbells.

    5. Isometric versus ballistic (and everything in between): It should come as no surprise that low velocity movements pose less injury risk than those performed ballistically. We don’t play sports at a snail’s pace, though, so it’s important that we prepare our athletes for the dynamic nature of their sports. However, we still need to recognize that isometric and lower velocity movements have merit in certain instances, especially if we’re looking to deload the athlete."




    The good news is that you already have a couple of months of rehab therapy under your belt so you are not starting from square one. You are much more of an "expert" now on how to proceed in with your rehab.

    But the bad news obviously is that pain/inflammation has recurred.

    As pointed out above, a cortisone shot has the potential to turn off the inflammation. But at the expense of turning off healing of any small tear that may have occurred.


    I don't think you have to consider yourself a failure of "conservative" therapy and therefore automatically need surgery. (Realise coming back from surgery could easily mean a year or more before getting back to serving/tennis.)

    But I agree with the others above that the rehab therapy back will have to be slow, incremental, and not to be tempted to try new exercises without consulting with your therapist.


    I know you are eager to get back to tennis. But while in Ireland, your preparations for THE big holiday should be taking precedence over tennis anyway.
    So, how are your St. Patrick's Day preparations coming along?
     
    Last edited: Feb 22, 2012
    #10
  11. Chas Tennis

    Chas Tennis Hall of Fame

    Joined:
    Feb 17, 2011
    Messages:
    4,388
    Location:
    Baltimore, MD
    As CF points out those exercises are very questionable if you have impingement. Did a physical trainer or physical therapist suggest those exercises?
     
    #11
  12. Pacific lefty

    Pacific lefty Rookie

    Joined:
    Nov 3, 2011
    Messages:
    272
    Location:
    Europe
    Gym

    I definitely trusted the "trainer" in my gym a little too much I think in doing these exercises, but as well, when I had a light hit to test my shoulder last week I felt the pain too. I think I was crazy to have done the gym work (I didn't do the lat pulldown in back anyway) but now I have definitely learned not to do that again. On the positive side, which I can start to see now, I know better what I need to do for rehab and I am staying well away from the cortisone.

    And yes charliefedererer, I will be getting ready for Paddy's Day (as we call it here). Or tennis club may even be marching in our local parade. Oh, and I will definitely be having a guinness and making a toast to you and all you great guys who have given me fantastic advice and moral support!
     
    #12
  13. charliefedererer

    charliefedererer Legend

    Joined:
    Feb 13, 2009
    Messages:
    5,639
    [​IMG]

    "May your joys be as bright as the morning,

    And your sorrows merely be shadows that fade,

    In the sunlight of love.

    May you have enough

    happiness to keep you sweet.

    Enough trials to keep you strong.

    Enough sorrows to keep you human.

    Enough hope to keep you happy.

    Enough failure to keep you humble.

    Enough success to keep you eager.

    Enough friends to give you comfort.

    Enough faith and courage in yourself to banish sadness.

    Enough wealth to meet your needs.

    And one thing more: enough

    determination to make each day a more wonderful day

    than the day before."
     
    #13
  14. Pacific lefty

    Pacific lefty Rookie

    Joined:
    Nov 3, 2011
    Messages:
    272
    Location:
    Europe
    An Irish Blessing for you too!

    Thanks charlief!!! I feel better already

    Go n-éirí an bóthar leat
    Go raibh an ghaoth go brách ag do chúl
    Go lonraí an ghrian go te ar d'aghaidh
    Go dtite an bháisteach go mín ar do pháirceanna
    Agus go mbuailimid le chéile arís,
    Go gcoinní Dia i mbos A láimhe thú.
     
    #14
  15. aaandrew

    aaandrew New User

    Joined:
    Nov 4, 2011
    Messages:
    4
    Hi Pacific Lefty, you might remember me from your first thread

    I had the same issues as you, also went through cortisone and found it had no benefit outside of the few weeks it was active

    Ended up having shoulder decompression surgery to resolve severe tendonitus - less than 1 day in a sling and have regained full strength/range of motion.

    Its no biggy, better having the surgery then living without tennis.
     
    #15
  16. Pacific lefty

    Pacific lefty Rookie

    Joined:
    Nov 3, 2011
    Messages:
    272
    Location:
    Europe
    Hey Andrew, I do remember your post. I think this is getting to be more and more an option for me now. I am really frustrated at waking up in the morning with pain in my arm and really I haven't even played this month and it is not improving at all.

    I am seeing my cortisone obsessed ortho surgeon on Thu to discuss options. If it is still mere tendonitis I will probably wait it out if I can, but if he sees a definite improvement from surgery I may take that option. It is just all the stopping and starting that is driving me crazy...And major tennis withdrawal. I can't even manage a game of table tennis in my games room at the moment...
     
    #16
  17. waves2ya

    waves2ya Rookie

    Joined:
    Mar 10, 2005
    Messages:
    296
    Lat pulldowns...

    Enuf said.

    Never...
     
    #17
  18. Pacific lefty

    Pacific lefty Rookie

    Joined:
    Nov 3, 2011
    Messages:
    272
    Location:
    Europe
    So right you are...
     
    #18
  19. drew2002

    drew2002 New User

    Joined:
    Mar 1, 2012
    Messages:
    1
    PacificLefty,

    I've also suffered for years with RC troubles, and after seeing a number of PT experts, I've finally gotten relief with chiropractic adjustment and coordinated PT. I've also been able to get back to lifting. A few things that my PT said that you might want to consider:
    1. Bench Presses: Don't. Just don't. I know, you want to do them, so did I. Eventually you can probably work in flys to your routine like I did, but bench presses put an enormous load on the shoulder.
    2. Military Presses - My PT said not to these either. Basically he said that anytime you are lifting above your shoulder level, you're also putting a lot of stress on your shoulder. Instead he recommended this dumbbell exercise: Standing, start with your arms at your side. Lift the dumbbells with your elbow straight until your arms are parallel with the floor, then lower. You should raise your arms in a plane about 45 degrees in from your side, so that from a birds eye view, at the high point of your motion, it would look like a 90 degree "V" with your body at the vertex.

    PT-prescribed workout routine: After your pain subsides a bit, have your PT put together a workout routine for you that will protect your shoulder. If they are reluctant to, find another PT. (I've noticed a wide range of skill sets in PT's.) And I'd recommend to try some more PT's before you even consider surgery. Good luck.
     
    #19
  20. Pacific lefty

    Pacific lefty Rookie

    Joined:
    Nov 3, 2011
    Messages:
    272
    Location:
    Europe
    I have realised too late that I should have avoided doing those exercises in the gym, but at the time, my shoulder felt great, and there was no pain at all...See acupuncture and arthroscopy thread...I am just waiting for the pain to go away so I can get away with some isometric strengthening, but still not sure I will be able for a couple more weeks.
     
    #20
  21. ec51

    ec51 Rookie

    Joined:
    Apr 16, 2012
    Messages:
    110
    Interesting story, thank you for the information.

    To the OP, I myself also began dealing with a shoulder injury recently.

    I started having pain in the outside deltoid area while serving and then usually at night after playing - especially while in bed when I would lift the blanket up.

    I started reading and knew something was up - I went to an ortho and after a bunch of "oh its probably just some inflammation - here's a cortisone shot, get out of here..." - I went home knowing I shouldn't have gotten the shot. I knew any pain would be hidden. The doc said to start paying after a week and if I was good, great - see ya later. I knew there probably wouldn't be much pain after only a week since the cortisone would probably still be working. Though I have read its different for everyone.

    After the week I gave it a go and playing was fine, serving was great. I took it easy and called the office and told them the pain was still there, I want an MRI.

    Have the MRI done and what do you know, interstitial tearing of the supraspinatus and some nice bursitis. Go back to the ortho, only to have him look at MRI report and not the films. Great. Here's a PT script and out the door I go.

    After some more reading, I knew with this type of tear - PT should be next. This is where I am now. Ive had 4 PT sessions - but no matter what, after the next 4-6 weeks, I will be seeing a new ortho.

    PT for me, consists of electro stimulation (TENS unit I believe), ultrasound treatment, light weight/stretch band exercises. The PT recently applied some kinesiology tape. Here's a video on that:

    http://www.youtube.com/watch?v=LQQBbmRjvqQ&list=FL2VbEnEjfo3yL-EvyX4vcyw&index=4

    I have also been doing stretch band exercises at home. Heres another video with some exercises and A LOT of good information:

    http://www.tennisresources.com/index.cfm?area=video_detail&vidid=3712&ATT=&reso=hi

    Another thing I have found to help is checking your posture. You should always be standing straight because when you slouch - your shoulders naturally roll forward which is bad for impingement type injuries. Good posture will help keep your shoulders back, where they belong. Here's a good video on that:

    http://www.youtube.com/watch?v=abj2oNeH_0g&list=FL2VbEnEjfo3yL-EvyX4vcyw&index=3

    I try to do that exercise whenever I can. Also stretching is very important.

    I have started playing once a week and after the first few serves there is a slight ache/pain but once warmed up, the shoulder feels pretty good.

    I hope with some time, more PT and some less playing time - I will get through it.

    I wish you the best.

    Eric
     
    Last edited: Dec 22, 2012
    #21
  22. Pacific lefty

    Pacific lefty Rookie

    Joined:
    Nov 3, 2011
    Messages:
    272
    Location:
    Europe
    8 Months later and going Great!

    Hi ec51, can't believe my thread has re-surfaced. I had the "subacromial decompression" procedure in April (ac debridement and bursectomy), and after 8 months now I can really say tennis is going great. The best things I have found are resistance band exercises, Pilates, being aware of posture, and dynamic warm ups. I have found that a great benefit of all the rehab and strengthening has been much improved power in my forehand and wow, I even hit a couple overhead smashes the other day!

    THis forum has been especially helpful as well, with lots of posters who have experienced something similar. The ortho surgeons can say all they like about recovery but you really have to experience it first hand to know how it will go.

    In my experience things to avoid are: playing again when there is still significant pain when serving, listening to inexperienced gym instructors, letting a GP give you a cortisone shot!

    Best of luck and Merry Christmas to everybody early !
     
    #22
  23. ec51

    ec51 Rookie

    Joined:
    Apr 16, 2012
    Messages:
    110
    Im glad the procedure ended up working out for you.

    Im curious though, what did your MRI end up coming back with originally?
     
    #23
  24. FastFreddy

    FastFreddy Semi-Pro

    Joined:
    Aug 8, 2008
    Messages:
    755
    Help

    I think I can help u since I had shoulder surgery four times for my cuff. Twice on my left shoulder one open and scope and twice on my right shoulder one open style and one scope. Have u had any surgery yet? A shot or pt will not fix a tear in a tendon so surgery is the only way to go if u want to play sports again at a high level. As far as movements go always keep your elbows close to your midline so no lat pulldowns. Get the mri done and see whats up but even those don't show everything. My doc thought it was just impingment but when he cut me open I had a 2x3cm tear and 2 bone spurs. Surgery is not the end all u need to do 15 weeks of pt after then it takes another year to slowly build up your strength. I been a Master Trainer and Strength Coach for 22 years so if u have a question u can pm me.
     
    #24
  25. Pacific lefty

    Pacific lefty Rookie

    Joined:
    Nov 3, 2011
    Messages:
    272
    Location:
    Europe
    Hi EC, the mri showed an inflamed supraspinatus, no tear. I tried the cortisone and pt for 18 months and nothing seemed to work. I think the surgery certainly made more space for the tendon because after rehab and now that I am playing again I definitely am not getting that catching "impingement" feeling. Somebody on this forum pointed out to me that some people just don't have enough space for the tendons to move around freely.

    Certainly it is a lot of committment to complete the rehab and be patient while everything heals. That is why I definitely wouldn't recommend it unless all other options were tried first.
     
    #25
  26. FastFreddy

    FastFreddy Semi-Pro

    Joined:
    Aug 8, 2008
    Messages:
    755
    type

    I would stay away from cortisone since it's really bad fr your tendon. I have a type 3 ac joint so it's shaped like a hook so their is very little room for the tendon.

    Possible Causes of Shoulder Impingement


    Outlet impingement

    Subacromial spurs

    Type 2 and type 3 acromions


    Osteoarthritic spurs of acromioclavicular joint (includes subacromial spurs)


    Thickened or calcified coracoacromial ligament

    Nonoutlet impingement

    Loss of rotator cuff causing superior migration of humerus (tear, loss of strength)

    Secondary impingement from unstable shoulder

    Acromial defects (os acromiale)


    Anterior or posterior capsular contractures (adhesive capsulitis)


    Thick subacromial bursa

    Normal anatomic variants can cause compression. Three distinct types of acromion (Figure 2) can readily be seen on radiographs, especially on the angled outlet Y view. The type I acromion, which is flat, is the “normal” acromion. The type II acromion is more curved and downward dipping, and the type III acromion is hooked and downward dipping, obstructing the outlet for the supraspinatus tendon.3 Cadaveric studies have shown an increased incidence of rotator cuff tears in persons with type II and type III acromions.2,3
    The coracoacromial ligament can also calcify, usually secondary to trauma, and cause impingement. In most cases, acromioclavicular joint arthritis is the culprit, resulting from previous trauma (separations) or, most often, nontraumatic osteoarthritis. The os acromiale (an unfused acromial apophysis) has also been associated with impingement.4

    Impingement may occur as a result of loss of competency of the rotator cuff. Pain from any cause, such as overuse or injury, may lead to disuse or weakness of the cuff. The weakness results in cephalad migration of the humeral head due to loss of depressors. This superior migration of the humeral head increases the impingement, thus reinforcing the cycle.

    Classification of the Impingement Syndrome

    Several classification systems are used with the impingement syndrome. Neer5 divided impingement syndrome into three stages. Stage I involves edema and/or hemorrhage. This stage generally occurs in patients less than 25 years of age and is frequently associated with an overuse injury. Generally, at this stage the syndrome is reversible. Stage II is more advanced and tends to occur in patients 25 to 40 years of age. The pathologic changes that are now evident show fibrosis as well as irreversible tendon changes. Stage III generally occurs in patients over 50 years of age and frequently involves a tendon rupture or tear. Stage III is largely a process of attrition and the culmination of fibrosis and tendinosis that have been present for many years.

    History and Physical Examination

    Pain, weakness and loss of motion are the most common symptoms reported. Pain is exacerbated by overhead or above-the-shoulder activities. A frequent complaint is night pain, often disturbing sleep, particularly when the patient lies on the affected shoulder. The onset of symptoms may be acute, following an injury, or insidious, particularly in older patients, where no specific injury occurs.

    The key feature of the physical examination is an assessment for signs of impingement. All the impingement tests involve moving the shoulder passively (through forward flexion, internal and external rotation with the arm abducted 90 degrees, and adducted) with approximately 5 to 10 lb of force directed inferiorally on the acromion, thus narrowing the subacromial space. The examiner tests to see if pain appears with these maneuvers and disappears when the examiner removes the downward acromial push.6

    The shoulder assessment in Figure 3 is a modification of a form developed by the Research Committee of the American Shoulder and Elbow Surgeons.7,8 Since the development of this form, studies on rotator cuff muscles show that the supraspinatus is more effectively tested with the thumb-up position (i.e., “full can”) rather than the thumb-down position as shown in the form and that Gerber's lift-off test recruits the sub-scapularis better than forceful internal rotation does.9 (In Gerber's lift-off test [not depicted], the patient places the hand over the spine posteriorally at the belt line with the palm facing posteriorly. The patient is then instructed to “lift off” the hand in a posterior direction against resistance and this movement is compared with the contralateral arm.)
     
    #26
  27. dlam

    dlam Rookie

    Joined:
    Aug 3, 2010
    Messages:
    380
    im currently undergoing the same shoulder pain/rehab
    I woke up with pain in my shoulder , just reaching to grab a cup beside table causes pain
    Notice a pattern
    Shoulder pain worse in the am after lying on that side better by the end of the day.
    Diagnosis with impingment syndrome and had PT
    Pain got worse , started to have difficulty just getting my overcoat on.
    Quit sports for 4 weeks
    Pain resolving with PT and massage .
    It takes forever to wait for MRI in my country
    During my off time I developed adhesive capsulitis
    I suspect that I likely started with had a either a rotator cuff tear or posterior labial tear causing the pain.
    What I found helps is
    1) no tennis and just rest during painful episodes.
    2) pain resolves but stiffness develops, so I do self stretching and specific RMT treatment for my shoulder.
    3)Have not considered cortisone or surgery
     
    #27
  28. drak

    drak Professional

    Joined:
    Feb 20, 2004
    Messages:
    1,256
    Forget cortisone, if you want to give something a "shot" (pun intended) get a PRP shot, I would try that before surgery. Have used them (both legs) successfully for a chronic case of Achilles tendonosis
     
    #28
  29. drak

    drak Professional

    Joined:
    Feb 20, 2004
    Messages:
    1,256
    LOL, sorry, did not realize this thread had a big gap and was reborn, but for anyone with tendon isues and not a full tear. PRP should definitely be in the non surgical initial treatment options IMO
     
    #29

Share This Page