Rotator Cuff Problem

[janm]

Hi guys,

About a month ago I noticed some soreness around my shoulder, it was'nt very bad so I still played but only lightly and last week I felt no pain or soreness anymore and thought I was over it.

I would play but conservatively because I needed to practice for in club tournement...

A few days ago I felt a sudden pain (looking at anatomy diagrams the pain seems to be the teres minor and major tendon region) whilst reaching for a high ball. It felt like muscles tendons rubbing over each other with a lot of force. straight afterwards the pain was so bad I could not move my arm. It felt like my arm was broke at the shoulder when I tried to raise it. I massaged it straight away and the pain went away enough for me to drive home. I felt a light pain/soreness around the area for a few days since.

I have not noticed a notable loss of strength but doing certain things on youtube to test teres major/minor regions give me a bit of pain.

I have made a doctors appointment but that is not for a few days.

I am concerned it may be a tear. Just wondering if anyone knows a test or way to differentiate between rotator cuff tendonitis or a tear.

thanks,

[LeeD]

Could be almost anything, without a sport's doc looksee.....
Wear and tear thru the years could onset that quickly.
A strain or tear could bring it on quickly.
For years, I couldn't brush my teeth with either hand alone, or shave, from wear and tear usage thru the 50 years of sports and injuries. Had to sleep with my arms pinned over my head.
But that's me, old age overuse.
Don't know much about you.

[janm]

I am 34 years old and have been playing for about 3 years. Before that I used to do weights but not very heavy.

Build is 178 pounds and height is 182cm.

I have a GP's appointment tomorrow afternoon but don't think I'll get an answer straight away unless its something obvious. I'm hoping he'll send me for an MRI but that could be months away.

[LeeD]

You advanced age could be a sign of wear and tear.
Everyone wears out differently.
Did you do lots of lifting throughout your years?
And without a sports doc's diagnosis, we can only speculate.

[janm]

A reasonable amount of lifting just to maintain good shape nothing serious.

I will see what the doctor says tomorrow and report back. Reading the internet I guess there is no easy way to diffarentiate a tear from tendonitis.

Thanks for the information, appreciate it.

[LeeD]

Problem here is that if it was so easy, why would we need doctors who charge and see you?
We don't know your threshold of pain, don't know if you wince when you lift your arms, don't know your exersise history, don't know your work and play schedules, or what you look like and what your physical fitness has been and is currently.
A doctor will find the answer to all those questions before answering any of your questions.

[janm]

Yeah I see what you mean, I thought maybe I was missing the obvious and someone who'd had a similar problem would be able to point out something which could confirm one or the other.

Again thanks for your time in replying, I will post what the doctor says tomorrow.

[floridatennisdude]

Originally Posted by janm

Yeah I see what you mean, I thought maybe I was missing the obvious and someone who'd had a similar problem would be able to point out something which could confirm one or the other.

Again thanks for your time in replying, I will post what the doctor says tomorrow.

Unfortunately, the shoulder is a very complex joint. I had a labrum tear go undiagnosed for 3 months of dr visits (crap insurance) before I finally got an MRI that showed the tear.

My experience was that they practice conservative and rule out tendinitis first through medication. Then they can get the go ahead to scope it. Unless you are a college or pro athlete, you kind of are forced into a waiting game.

[Chas Tennis]

I have read that some injuries, including some shoulder injuries, because of the lack of nerves in the injured tissue, may progress for some time without much or any pain.

QUOTE from an earlier reply (http://tt.tennis-warehouse.com/showt...shoulder+video)

" This Todd Ellenbecker video is the best detailed description of shoulder issues that I have found. At minute 8 he describes the orientation to hold your shoulder in serving to minimize the risk of impingement (similar to the Jim McLennan video advice in Reply #3).

http://www.tennisresources.com/index...2&ATT=&reso=hi

There are many recent shoulder injury discussions in the Health & Fitness Forum. Use to inform yourself but it is a very risky approach to diagnose or treat yourself based on the internet.

I have read that with shoulder pain you can be doing damage without much pain so take it very seriously. Some swelling
may also be present that might make any mechanics painful.

Best to stop and see a Dr.

For mechanics you need to study the serve, video your own serve (60p fps video can be useful but high speed video/fast shutter is excellent). A well qualified instructor who can coach the serve is a good idea. In any case, you should especially not be experimenting with your serve if injured. Can one bad motion tear something? "

[Chas Tennis]

Originally Posted by janm

.............................. someone who'd had a similar problem would be able to point out something which could confirm one or the other.
.................

My non-tennis arm rotator cuff injury first appeared at the gym as a loss of strength and some pain on lifting. There was no indication beforehand and I did not ever sense that an acute injury had happened. The MRI showed 'mild supraspinatus tears', the most common rotator cuff injury. No surgery, rested the shoulder and did targeted PT, which I found very effective and informative. Nearly normal now after 6 years with 90% or more strength, no pain except when certain positions and the pain is not bad. Discomfort, for example, if I am lying on my side in bed and try to lift a bed sheet up using just my shoulder, there is pain. This motion might more use the supraspinatus (?) before the medial deltoid has contributed because the arm's abduction angle is too small for the deltoid. (?) Or I could have some other shoulder issue causing that pain. (?)

I have read that by age 70 about 30% of people have had rotator cuff tears that would show up on examination or autopsy. Most do not know that they have ever had these injuries.

I believe that the shoulder joint is the most difficult joint to diagnose due to the complex motions and all the components. For example, inflammation can affect adjacent structures such as bursa sacks, etc. I would not take one person's experience with their injury as applying to yours, but it might.

[janm]

Thanks for the information Chas will look up the serve video when I'm able to get back to playing.

Went to the doctor today and he made me do some arm motions and felt around the shoulder ligaments. He says I have not got a major tear but is unable to give a confident diagnosis to rule out small tears.

He recommends I take break from tennis and other activitys that cause pain in the region for 3 weeks and if the pain persists to see him again.

[Chas Tennis]

Originally Posted by janm

Thanks for the information Chas will look up the serve video when I'm able to get back to playing.

Went to the doctor today and he made me do some arm motions and felt around the shoulder ligaments. He says I have not got a major tear but is unable to give a confident diagnosis to rule out small tears.

He recommends I take break from tennis and other activitys that cause pain in the region for 3 weeks and if the pain persists to see him again.

From your description of the acute injury I would be concerned without a better diagnosis. Can you get a second opinion from an orthopedic specialist or well qualified sports medicine Dr? Unfortunately, many people with HMO type medical insurance seem to have more difficulty getting MRIs or seeing specialists.

Most rotator cuff injuries involve the RC muscles & tendons. I have read that tendon injuries take from 2-6 months to heal. Suggest that you research this point on your own.

I don't know much about the ligaments of the shoulder (don't visualize any ligaments as being part of the rotator cuff). [A ligament connects a bone to a bone.] Did the Dr use the term "ligaments"? Were there any other terms used that you can look up? From the examination, were any injuries identified as possibilities?

The Ellenbecker video is very useful for the shoulder anatomy and injury issues, the serving advice is only a small part of the video.

[FastFreddy]

Get an mri then go PT route or surgey then PT. Your doc and you will decide which is best for u.

[janm]

Hi guys,

I'm in the UK so just seen a GP (general doctor) no chance to seek a second opinion unless I go to the ER. I have to go back to him if the problem persists after 3 weeks.

I used the term ligament myself, I guess a better term should have been muscles and tendons. Anyway he just did the basic arm movements and felt around the shoulder. The only thing he ruled out was a full tear. When I asked questions about weather it was maybe a strain/tendonitis or partial tear he did not want to give an opinion and just kept saying come back in 3 weeks if it does not show signs of clearing up.

Usually for a non urgent case like mine a MRI can take months to a year from the date it was requested. I think GPs cannot request them and only specialists in hospitals can. A GP to specialist referal can take a month or more too.

I just have to hope its not serious otherwise it will be a long wait and convoluted process to get it treated.

[DInosaurTT]

I am also based in hte UK and have had shoulder problems in the past. Without private health cover it could all take a long time as you say and considering the cost of MRI scans, the GP will avoid and dealy sending you for one as long as possible. Unless it is impacting your normal daily life outside of sport they are unlikely to be interested in spending that budget. Hopefully you have an understanding GP who agrees that tennis is important in keeping you healthy.

In terms of the understanding of shoulder injuries I would not expect much int he way of certainty from your GP. I say this with great respect as I am the son of one and as my wife is also a doctor, we have many GP friends. The shoulder is very difficult to diagnose and even the specialists don't find the answers easy.

My story last year involved a visit to the GP to whom I explained my shoulder injury. He asked me to raise it to the side and front, asked where it hurt, how I did it etc. As it only impacted my tennis or ball throwing abilities there was almost no interest. Fortunately they were willing to write me a letter for referral as I have private healthcare. I was then seen by a sports specialist doctor who is now a professor in a shoulder clinic at a private hospital. After unltrasound, examination and MRI, the best guess was SLAP tear, slight impingement and bursitis as a result. There was no certainty despite the MRI and the only way to tell was to let the surgeon scope it with a view to repairing what they were expecting to find or not if their best guess was wrong. In the end they were right and it was repaired and it has all healed over time.

I am lucky as I have private cover, but if you don't and don't fancy running up large bills paying directly, then you will need to make sure you impress on your GP the impact it is having overall. Hopefully they will be helpful, but the NHS is not well set up for sport injuries in many places although there are some specialist clinics I know of in London hospitals. Make sure you research what is nearby if you want to push for a referral.

Best of luck with the injury

[BeHappy]

Originally Posted by DInosaurTT

I am also based in hte UK and have had shoulder problems in the past. Without private health cover it could all take a long time as you say and considering the cost of MRI scans, the GP will avoid and dealy sending you for one as long as possible. Unless it is impacting your normal daily life outside of sport they are unlikely to be interested in spending that budget. Hopefully you have an understanding GP who agrees that tennis is important in keeping you healthy.

In terms of the understanding of shoulder injuries I would not expect much int he way of certainty from your GP. I say this with great respect as I am the son of one and as my wife is also a doctor, we have many GP friends. The shoulder is very difficult to diagnose and even the specialists don't find the answers easy.

My story last year involved a visit to the GP to whom I explained my shoulder injury. He asked me to raise it to the side and front, asked where it hurt, how I did it etc. As it only impacted my tennis or ball throwing abilities there was almost no interest. Fortunately they were willing to write me a letter for referral as I have private healthcare. I was then seen by a sports specialist doctor who is now a professor in a shoulder clinic at a private hospital. After unltrasound, examination and MRI, the best guess was SLAP tear, slight impingement and bursitis as a result. There was no certainty despite the MRI and the only way to tell was to let the surgeon scope it with a view to repairing what they were expecting to find or not if their best guess was wrong. In the end they were right and it was repaired and it has all healed over time.

I am lucky as I have private cover, but if you don't and don't fancy running up large bills paying directly, then you will need to make sure you impress on your GP the impact it is having overall. Hopefully they will be helpful, but the NHS is not well set up for sport injuries in many places although there are some specialist clinics I know of in London hospitals. Make sure you research what is nearby if you want to push for a referral.

Best of luck with the injury

Perhaps the OP should exaggerate how much it's hurting him? Pretend he can't drive etc? That sounds like it would get him the treatment he needs? Or would the doctors not fall for that?

[DInosaurTT]

It is important no to be too British about it and understate the issue. I would make sure to emphasis the fact it has stopped all sport and if it is making practical things hard then definitely highlight. If you want to stretch things a bit, it might be worth saying it is keeping you awake at night as that is probably the easiest stretch and if getting to sleep had not been my main strength in life would certainly have been true with my shoulder injury.

I have always kept my private healthcare in the UK as I played a lot of rugby for many years before returning to more tennis and golf and have always been concerned about tearing cruciates etc. It is an important expense for me, but becomes less affordable each year as costs rise.

Assuming money is not unlimited as for most of us, then try and be as patient as possible and not rush back. I wish I had not pushed some injuries in the past as they certainly took longer to heal as a result.

[janm]

Hi guys,

thankyou very much for your information.

Its been about a week now and i'm starting to notice more pain.
I have not gotten much sleep last night. I went to bed approx 2am and woke at 4am in agony. Its been a few days like this now with the most severe pain occuring when i'm sleeping.

It feels like a broken bone in my shoulder. The exact same type of pain when I broke my arm a few years back and the broken bones would rub against eachother.

Also I'm starting to feel pain when driving. I have a gear shift car and changing gears is causing a pain. Sometimes so much that I cannot get it into the gear i'm intending to when changing. Also getting pain when changing clothes and especially trying to put my socks on.

I cannot see any swelling or brusing. The pain is worst when i'm doing a similar motion to a windsheild wiper follow through.

I'm going to try and get another appointment with the GP in the morning.

I'm hoping i'm not causing more damage to the injury just doing everyday tasks like driving etc...

[Chas Tennis]

Originally Posted by janm

.................................................. .......
.................................................. ....................
A few days ago I felt a sudden pain (looking at anatomy diagrams the pain seems to be the teres minor and major tendon region) whilst reaching for a high ball. It felt like muscles tendons rubbing over each other with a lot of force. straight afterwards the pain was so bad I could not move my arm. It felt like my arm was broke at the shoulder when I tried to raise it. I massaged it straight away and the pain went away enough for me to drive home. .................................................. ...............................

When you talk to the Dr again emphasize this part of what happened to you. This sounds as if some acute injury took place. What possible injuries might it have been? Since you are having more issues indicate that you need a more definitive diagnosis. If you can influence the choice of Dr, do you have any friend who can recommend one based on their first hand experience? Don't consider how far you must travel just your chance of getting a well qualified Dr. Hospital with good reputation? Good luck in finding the Dr.

[DInosaurTT]

Janm

It sounds like you should be able to push for a referral given the problems described. If it is impacing sleeping and normal daily activities please highlight it to the doctor. As Chas Tennis says above, if you can go prepared with where you would like to go in terms of referral that would be a good idea. GPs are sometimes a good source of knowledge on specialists and in many cases a bit useless. Unfortunately I only know London and the people I dealt with only seem to be in private practice and it really depends on where you are in the country. I know there are a few decent NHS hospital sports clinics in different London hospitals, but ask around and search online depending on where you are based.