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-   -   Shoulder Issues -- Therapies, Surgeries, Etc. (http://tt.tennis-warehouse.com/showthread.php?t=179256)

Spittle 02-03-2008 02:00 PM

Shoulder Issues -- Therapies, Surgeries, Etc.
 
[This is a little long-winded. Thanks in advance for reading! :) ]

Hello! I've used the 'search' tool extensively and haven't found anything that seems to fit my problem. I'm hoping someone here will have encountered the same pain and issues I have and will have some input!

I am a 37 year old right-handed 5.0 tennis player with a fairly strong serve. After taking a break from tennis for a few years (work), I dove back into it by playing 3-4 times per week and doing some minor strength training on a home gym. I had also changed from my old heavy Head racquet to a newer, lighter Wilson racquet (very stiff frame with stiff Polyester strings).

About six months ago, I started having pain on the outside of the shoulder/upper arm which I could reproduce by holding my palm downward and raising my arm upward from the side of my body. The ortho doc said I had an inflamed bursa that was impinging the tendons in my upper arm and gave me a cortisone shot. This shot masked the pain for perhaps 2 weeks. During that time, I tried more rest and some exercises geared towards folks with rotator-cuff problems. There was no change in my condition and it eventually became more painful.

At that point, I decided to try physical therapy. After two months of PT 3 times a week, my condition is worse than it has ever been. For the first two weeks, I assumed I was supposed to work through the pain and that probably made it worse. Now, I have even less mobility in the arm (can only reach a certain amount across the body - like if you wanted to scratch your back) and tennis serves and strokes hurt to the point of a stabbing pain at any point my arm is above my shoulder. It has completely ruined my game and has me very frustrated as I was finally getting back into tennis and enjoying myself.

I recently had an MRI and an arthrography done on this shoulder and no tears were apparent with only slight tendinitis. The doc noticed a small cyst on my shoulder bone that could indicate a chronic rubbing of a tendon against that area. The only two options that seem to be available to me are another cortisone shot with more PT-type exercises (the previous 2 months didn't help any, so I'm dubious) and bone decompression via shoulder arthroscopy surgery (which I'm leaning towards - they'll shave a bit of the bone away to give the inflamed tendons more room).

Has anyone here had these symptoms and gone through similar steps to the same result? Do you think that my racquet choice (stiff and light) and string choice might have contributed to my shoulder problem? I'm considering going to a more flexible racquet and string - even if it means changing the way I play. Any tips/suggestions would be greatly appreciated as I am hoping to call the surgeon this coming week.

Many thanks,
Ray

SystemicAnomaly 02-04-2008 05:23 AM

Sorry to hear about the shoulder problems, Ray. You say that inflammation is involved so I assume that you've been icing it regularly. Have you also tried ice massage?

Sounds like your racket-string combination could definitely be a significant contributing factor. I know quite a few people that have developed shoulder and other arm problems from rackets that are too light. Most of these troublesome light rackets were also very stiff. The general rule of thumb is to go with the heaviest racket that feels comfortable for you, not the lightest. Seems like a lot of ppl that were using rackets weighing under 10 oz are now opting for rackets in the 11-12 oz range.

I've also seen a number of ppl in these forums that have complained about shoulder or arm problems from using polyester strings. Apparently, some of the new polys are better than others. Ppl often use poly strings for only half of of the stringbed -- either the mains or the crosses. They will use a gut or a softer synthetic string for the other half. It is also common to string looser for polys -- at least 10% looser.

Basic Facts About Frames & Strings

Spittle 02-04-2008 06:02 AM

Thanks for the info! I had been icing it fairly regularly (especially after physical therapy exercises), but stopped as it just didn't seem like it was doing much at all. The physical therapists were massaging frequently during the sessions. However, they seemed to be more interested in poking their boney little fingers into the most painful areas and going "This hurts doesn't it?".

I really have enjoyed the lighter/stiffer racquets since they have improved my volleying and control. However, I think you may be correct that they're not treating my body terribly well. Along with the shoulder problems, I also have a recurring tennis elbow-ish type of pain when gripping or twisting and a lower hand/wrist pain. Even though I was using dampeners, I think the impact vibrations were rattling through my hand, up my arm, and into my shoulder.

I plan on calling the surgeon's office today, asking a few questions about the procedure, and then making an appointment for the operation. The arthroscopy seems to be the least invasive option. Since my team and I made it to the state finals (we play in late May), I might be back on my feet by then as well.

Phooey on getting old!

ladude1957 02-04-2008 06:09 AM

Quote:

Originally Posted by SystemicAnomaly (Post 2067680)
Sorry to hear about the shoulder problems, Ray. You say that inflammation is involved so I assume that you've been icing it regularly. Have you also tried ice massage?

Sounds like your racket-string combination could definitely be a significant contributing factor. I know quite a few people that have developed shoulder and other arm problems from rackets that are too light. Most of these troublesome light rackets were also very stiff. The general rule of thumb is to go with the heaviest racket that feels comfortable for you, not the lightest. Seems like a lot of ppl that were using rackets weighing under 10 oz are now opting for rackets in the 11-12 oz range.

I've also seen a number of ppl in these forums that have complained about shoulder or arm problems from using polyester strings. Apparently, some of the new polys are better than others. Ppl often use poly strings for only half of of the stringbed -- either the mains or the crosses. They will use a gut or a softer synthetic string for the other half. It is also common to string looser for polys -- at least 10% looser.

Basic Facts About Frames & Strings

Great post. Moving to a frame in the 100 head size range, flex in the low 60s, weight 11.5 or so with a decent SW (say 320-330) and a softer string set-up would really help. I would also stay away from frames over 27 inches as that could add to your pain. Since you are a 5.0, I am guessing you swing on the faster side and have a long swing. With a frame with more mass (and softer), the frame would be doing more work and take more of the shock than with a stiffer lighter frame. Icing down after playing is also very good advice as it will help control inflammation.

Maybe Frames Like These:

http://www.tennis-warehouse.com/desc...ER-MP198S.html
http://www.tennis-warehouse.com/desc...LKL-VDNX9.html
http://www.tennis-warehouse.com/desc...SA-T32016.html
http://www.tennis-warehouse.com/desc...OP-200P06.html

Good Luck,
Dude

Spittle 02-04-2008 06:23 AM

Awesome! Thanks for the good and specific information folks!

Part of me is still thinking I should give my shoulder time to heal naturally. But, with the 2-3 month break I took from tennis and all the therapy, it only got worse. Guess I just need to suck it up and let em poke holes in me.

Thanks again for all the info so far! Keep it comin! :)

Japanese Maple 02-04-2008 08:08 AM

Spittle, sorry to hear about your shoulder. The first thing that should go is your stiff, light racquet and polyester strings. As a 5.0 player I am surprized that you would play with such a light racquet. Try a 11.5-12.5 racquet with a soft multi filament or even better use gut. Is the doc you saw a sports medicine specialist who's expertise is shoulders or is he a generalist? Definitely get a second opinion from a sports shoulder specialist before considering an operation-common sense 101. Its good that you had an arthegram MRI but have someone else look at it-viewing films are very subjective, what one doc sees someone else may see something entirely different. This injury should not be such a mystery if you see a shoulder specialist. Do not even consider an operation until you know exactly what the problem is backed by a second opinion. Also, did your shoulder get better after rehab regarding pain and strength, only to be reaggravated once you started playing? This would indicate a racquet and string problem. Did your pain start gradually after you made an equipment change-strings or racquet? How did the pain come on, suddenly or over time? If after rehab you did not have any improvement in strength or pain, you may have definitely torn something and need an operation. Has anyone said it might be a rotator cuff problem. I am surprized your doc gave you a cortizone shot so quickly without an Mri-sounds odd.

Spittle 02-04-2008 09:06 AM

Thanks for the reply! I had taken a few years off from tennis and noticed that my old, heavy Head racquet was getting a little long in the tooth. Figured I'd try what all the whippersnappers were using these days. A year ago, I started back at 4.0 level and gradually worked my way up.

Initially, I went to a general practitioner (prescription of NSAIDs of course). Then, I went to a hand and upper extremity specialist three times. At the time of the first visit, all I had was a fairly mild pain on the outside of my shoulder/upper arm area. After doing various resistance exercises with the doc, he suggested that I had an inflamed bursa and should give it rest and do various exercises to strenghten the muscles surrounding the bursa. He offered to give me a cortisone shot and I accepted. One shot is my limit as I've heard what repeated shots can do.

After the second session with the hand/upper extremity specialist, he referred me to a sports surgeon that has good experience with shoulder sports injuries. Both of these specialists are with Resurgens Orthopaedics in Lawrenceville GA. Upon examining the me, the MRI, and arthogram xray, he said I had two options. I could give it time, rest more, do non-paining exercises, and see if it improves. Or I could have an arthroscopy done where they poke a few holes in my shoulder and shave a little bit of bone to give the inflamed tendons room to move and room to heal. Since I had already gone through 2 months of physical therapy while avoiding tennis with no favorable result, I'm seriously considering the surgery.

Unfortunately, it's hard to tell what exactly triggered my problem. Around the same time, I dove heavily into tennis, did a good amount of heavy yard work (120 40lb bags of stone), and did some strength training on the home gym. I'm convinced the racquets had something to do with it, but my vigorous return to activity may have contributed as well. :) But, yes, the pain was gradual until it got to the point that serving and overheads are fairly excruciating. Fortunately, I won't have to worry about using my current racquets (Wilson KSurge) as I have 'dispatched' them in frustration. :shock:

So far, I've had 3 doctors look at the MRI (all from Resurgens however). Their impression is that I have mild tendinosis of the supraspinatus tendon, no partial or full thickness rotator cuff tear and an intact labrum and biceps tendon. The sports specialist believes that the cyst that shows up on the MRI is from chronic rubbing of a tendon on that area.

Nothing is stopping me from taking a break for 2 months and postponing any decision about surgery until then. I'm just an impatient person lol.

Thanks again for the feedback/questions. Definitely something I need to think about.

bronco_mba 02-04-2008 09:43 AM

I had a similar pain my shoulder as described in your original post. I did the cortisone injection with no relief and PT, also with no relief. I had x-rays and MRIs, which revealed an impingement. I was referred to an orthopedic surgeon for a procedure called sub-acromial decompression/distal clavicle excision, which is an arthroscopic procedure. Having received no relief from conservative treatments, I elected to have the surgery.

The surgeons shaved the underside of the acromion, cleaned out some fraying of the posterior labrum, and cleaned out the inflamed bursa.

I am now three days post-op. My shoulder a littlel sore, but I'm actually moving it around pretty good. The doctors expect I can get back on court for light rallying in two weeks, and back to serving in about a month. Best of all, the pain I had is expected to be gone...permanently.

I'd recommend considering the SAD/DCE surgery if ALL conservative methods fail. Assuming you can go without tennis for a few weeks, it may be a viable, long-term solution to get rid of your shoulder pain.

Spittle 02-04-2008 10:46 AM

Thanks for the info, bronco_mba! I just read the other thread (near this one at the moment) and would like to get all the details that you feel might be important to know (surgery itself, rehab, etc). I'm guessing you chose to go under general anesthesia? Good to hear you went through the surgery without complication! Any info you think I might need to know, I'm all ears! Thanks again!

bronco_mba 02-04-2008 02:39 PM

The surgeon didn't give me much of a choice...so yes, the procedure was done under general anesthesia. The whole thing took 33 minutes, though in my world, it took no time at all.

You can contact me offline at mgbrown23atgmail.com with specific questions.

Rickson 02-04-2008 03:48 PM

Quote:

Originally Posted by Spittle (Post 2066368)
Any tips/suggestions would be greatly appreciated as I am hoping to call the surgeon this coming week.

Many thanks,
Ray

Do you feel tingling in your fingers and does your hand get numb? If so, you may have an inflammed nerve. If you stop playing for a while, the symptoms should subside. I recommend icing the shoulder constantly and if you decide to play anyway, use some sort of menthol rub before you play and make sure you ice the shoulder after you play.

Robbnc 02-05-2008 05:36 AM

I had rotator cuff repair and decompression done about 3 years ago. It took
me about 4 months to regain full range of motion and strength.

My shoulder has been absolutely pain free since then. In fact it has better
range than my non dominant shoulder. Unfortunately I can't say the same for
my elbow and wrist. I'm going tomorrow to have PRP done on both joints.

bronco_mba 02-05-2008 07:32 AM

Excellent news! That gives me a lot of hope.

Spittle 02-05-2008 11:31 AM

Rickson, unfortunately my symptoms seem to be much like those of bronco_mba. I can't reach across my chest to scratch the back of my other shoulder without considerable pain. Overhead motions and various twistings of the arm give me a sharp twinge in the upper front/side of the shoulder. The lowest the pain has gone is maybe halfway down my bicep/tricep on the outside of my arm. Currently, even stirring a pot of soup will give me a good bit of pain.

My problem now is trying to find a surgeon that will take the time to discuss my options. I finally decided to follow my gut feeling and give this last surgeon a pass (personality conflict, not having things explained, if I see these folks for more than 5minutes - after waiting for 75mins - I'm lucky).

Does anyone know of a good orthopedic surgeon in the Atlanta area (or even southeast)?

Again, thanks for all the feedback and info.

Japanese Maple 02-05-2008 12:59 PM

Quote:

Originally Posted by Spittle (Post 2070783)
Rickson, unfortunately my symptoms seem to be much like those of bronco_mba. I can't reach across my chest to scratch the back of my other shoulder without considerable pain. Overhead motions and various twistings of the arm give me a sharp twinge in the upper front/side of the shoulder. The lowest the pain has gone is maybe halfway down my bicep/tricep on the outside of my arm. Currently, even stirring a pot of soup will give me a good bit of pain.

My problem now is trying to find a surgeon that will take the time to discuss my options. I finally decided to follow my gut feeling and give this last surgeon a pass (personality conflict, not having things explained, if I see these folks for more than 5minutes - after waiting for 75mins - I'm lucky).

Does anyone know of a good orthopedic surgeon in the Atlanta area (or even southeast)?

Again, thanks for all the feedback and info.

Spittle, its good that you are taking your time. Find out who the top sports medicine specialists are who concentrate mainly on shoulders and schedule an appt. Before you consider an operation, know exactly what the problem is-a good specialist should be able to take the guess work out of the diagnoses and give you the best options and prognoses. Also, besides your racquet and strings, how is your technique on the serve? Have someone check that out to see if that also may have caused your problem-maybe toss not out front, hitting behind you, ect. Good luck!

bronco_mba 02-05-2008 02:08 PM

I went with David J. Chao @ OASIS MSO in San Diego. My primary care doctor works with him on the San Diego Charger's medical staff and referred me.

If it were me (and it recently was), I'd go with the surgeon professional athletes go to. I ran a quick Google search for the orthopedic surgeon of the Atlanta Falcons and came up with Plas T. James, M.D. in Atlanta. From the look of his website, it appears his practice focuses primarily on the spine, but I bet with a quick call to his office they could refer you to the best shoulder surgeon in the Atlanta area. Ultimately, you may be constrained based on your insurance company, but if you get to choose your provider, why not go with the best?

A note on doctor personalities: the best surgeons don't always make the most time for their patients or have the nicest demeanor. Ultimately, I'll take the one that does the best work, gets the best results, and has the fewest complications!

Just my 2 cents...

bronco_mba 02-05-2008 02:15 PM

It might be worth giving this guy a call:

Dr. Xavier A. Duralde
Peachtree Orthopedic Clinic
Orthopedic Surgeon to the Atlanta Braves since 1998
Specializes in shoulders

Credentials are impressive (Harvard A.B., Columbia M.D.)

Offices in Atlanta and Peachtree

http://www.pocatlanta.com/content.cfm?page=duralde

wao 02-05-2008 02:44 PM

Quote:

Originally Posted by Spittle (Post 2066368)
[This is a little long-winded. Thanks in advance for reading! :) ]

Hello! I've used the 'search' tool extensively and haven't found anything that seems to fit my problem. I'm hoping someone here will have encountered the same pain and issues I have and will have some input!

I am a 37 year old right-handed 5.0 tennis player with a fairly strong serve. After taking a break from tennis for a few years (work), I dove back into it by playing 3-4 times per week and doing some minor strength training on a home gym. I had also changed from my old heavy Head racquet to a newer, lighter Wilson racquet (very stiff frame with stiff Polyester strings).

About six months ago, I started having pain on the outside of the shoulder/upper arm which I could reproduce by holding my palm downward and raising my arm upward from the side of my body. The ortho doc said I had an inflamed bursa that was impinging the tendons in my upper arm and gave me a cortisone shot. This shot masked the pain for perhaps 2 weeks. During that time, I tried more rest and some exercises geared towards folks with rotator-cuff problems. There was no change in my condition and it eventually became more painful.

At that point, I decided to try physical therapy. After two months of PT 3 times a week, my condition is worse than it has ever been. For the first two weeks, I assumed I was supposed to work through the pain and that probably made it worse. Now, I have even less mobility in the arm (can only reach a certain amount across the body - like if you wanted to scratch your back) and tennis serves and strokes hurt to the point of a stabbing pain at any point my arm is above my shoulder. It has completely ruined my game and has me very frustrated as I was finally getting back into tennis and enjoying myself.

I recently had an MRI and an arthrography done on this shoulder and no tears were apparent with only slight tendinitis. The doc noticed a small cyst on my shoulder bone that could indicate a chronic rubbing of a tendon against that area. The only two options that seem to be available to me are another cortisone shot with more PT-type exercises (the previous 2 months didn't help any, so I'm dubious) and bone decompression via shoulder arthroscopy surgery (which I'm leaning towards - they'll shave a bit of the bone away to give the inflamed tendons more room).

Has anyone here had these symptoms and gone through similar steps to the same result? Do you think that my racquet choice (stiff and light) and string choice might have contributed to my shoulder problem? I'm considering going to a more flexible racquet and string - even if it means changing the way I play. Any tips/suggestions would be greatly appreciated as I am hoping to call the surgeon this coming week.

Many thanks,
Ray

Ray, I just went through the surgery. My diagnosis was a partial tear of the rotator, bone spur and burcitias(?). After 8-10 weeks of rehab, I am back to playing. Good luck in what ever you choice.

TheShaun 02-05-2008 02:55 PM

Quote:

Originally Posted by bronco_mba (Post 2068074)
I had a similar pain my shoulder as described in your original post. I did the cortisone injection with no relief and PT, also with no relief. I had x-rays and MRIs, which revealed an impingement. I was referred to an orthopedic surgeon for a procedure called sub-acromial decompression/distal clavicle excision, which is an arthroscopic procedure. Having received no relief from conservative treatments, I elected to have the surgery.

The surgeons shaved the underside of the acromion, cleaned out some fraying of the posterior labrum, and cleaned out the inflamed bursa.

I am now three days post-op. My shoulder a littlel sore, but I'm actually moving it around pretty good. The doctors expect I can get back on court for light rallying in two weeks, and back to serving in about a month. Best of all, the pain I had is expected to be gone...permanently.

I'd recommend considering the SAD/DCE surgery if ALL conservative methods fail. Assuming you can go without tennis for a few weeks, it may be a viable, long-term solution to get rid of your shoulder pain.

bronco, glad to hear you're doing well after surgery and the better news is that you're not too far off from hitting the courts again. my impingement has been a long slow process but i have noticed improvement in the last month. at the advice of my physio i have stepped up the resistance on the bands i've been using for strengthening. after our next visit later this month she will recommend to my gp that i have an mri done. and thanks to canada's universal health care it will be 5-8 months before that happens so i'll continue what i've already been doing till then and see how it goes.

can i make a request that you keep a log here on the forums as to the progress of your recovery. i'm certainly and interested party.

Spittle 02-05-2008 02:57 PM

Again, thank you all very much for your tips, information, and support! Tomorrow will be a busy day of calling various physicians and dropping the ol' pooch off for stitch removal (she recently had ACL surgery).


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