Shoulder Issues -- Therapies, Surgeries, Etc.

[bronco_mba]

Another update: My partner showed up late to our hitting session last night. While waiting, I decided to hit a few serves. I started out tentative, timing was off a little, and I was expecting pain/discomfort in the shoulder. After hitting five or ten serves, I thought to myself that things felt pretty good. So I gradually ramped up the pace. I ended up hitting about 30 serves before my partner showed.

All I can say is, "wow!" The flat serves were jumping off the strings, kickers were jumping and slices were spinning out wide. Best of all, NO PAIN! I kept waiting for it, but it never showed. I was expecting to want to cut my arm off when I woke up this morning, but it felt good.

My recovery has gone better and faster than expected. The more I get back out on court, the more convinced I am that my pre-op shoulder was holding back from progressing; almost like the shoulder pain was preventing me from going for my serves and shots.

I've got a ways to go before the shoulder is completely healed, but I'm already starting to enjoy the advantages of playing pain free.

[TheShaun]

terrific news bronco!

[Lendl and Federer Fan]

bronco mba
good to hear successful story.
I have little shoulder problem myself. It only hurts when I serve. I am trying ultrasound treatment now.

[bronco_mba]

Another update:

I'm back to unrestricted playing @ 40 days post-op. I played three sets of doubles last night, with very good results. The rust showed a bit on timing, but it was great to get out and compete.

Admittedly, the shoulder was pretty tired in the third set; I had to back off my serve quite a bit. Physical conditioning seems to be the limiting factor. Waking up this morning, the shoulder was just fine. Too bad I can't say the same for my abs, back, etc.!

I play one more time this week before heading out to Indian Wells for the Pacific Life Open. If anyone else is attending, let me know!

I've entered a singles tourney in early April to better guage the progress of my shoulder before heading into Spring League.

[Doulers]

Hi Spittle:

I am in a similar situation as you. I am 35 now. Since graduating high school in 1991, where I was on a tennis team, I had not played regularly since then. So in 2006 at the age of 34 I decided to make the effort to get into playing more. I have had similar shoulder issues as you, however, my symptoms have not gotten as bad as your's sound yet. I was wondering if you may want to share via e-mail what remedies you have tried, and I can let you know what I have tried that helps. I would also be curious to know if you did get the surgery and if it has helped. If you are interested, feel free to email me at doulers@hotmail.com. Thanks.

[kenshireen]

I had a shoulder MRI... Low grade tear of spurpinatus tendon..with resultant mild to moderate bursitis. Ortho recommended PT, NSAID..not surgery...Gave me a cortisone injection.
He didn't specify how much/often to take the ibuprofen...said it would depend on pain...
I do know that NSAIDs also reduce imflammation... So I wonder if any of you have taken 800 mg prescrip ibu 2-3 times for a similar imflammation situation.

thank you,
ken

[Wilson1]

Originally Posted by kenshireen

I do know that NSAIDs also reduce imflammation... So I wonder if any of you have taken 800 mg prescrip ibu 2-3 times for a similar imflammation situation.

thank you,
ken

I was taking 500mg twice a day for two months, along with the PT and Cortsone shot for pretty much the same problems you're having.

[f1 tech]

Originally Posted by kenshireen

I had a shoulder MRI... Low grade tear of spurpinatus tendon..with resultant mild to moderate bursitis. Ortho recommended PT, NSAID..not surgery...Gave me a cortisone injection.
He didn't specify how much/often to take the ibuprofen...said it would depend on pain...
I do know that NSAIDs also reduce imflammation... So I wonder if any of you have taken 800 mg prescrip ibu 2-3 times for a similar imflammation situation.

thank you,
ken

My doc said the same thing. Do PT for 6 weeks. So far PT is working out, the pain isn't as bad. I feel my shoulder is a lot stronger. Make sure you put ice after each session of tennis.

[kenshireen]

Originally Posted by Wilson1

I was taking 500mg twice a day for two months, along with the PT and Cortsone shot for pretty much the same problems you're having.

just curious but ibuoprofen come in 200 mg intervals.... Prescription is 800mg and regular drug store non prescript are 200mg

[Spittle]

Hey folks! Well, it's been a whirlwind so far and I see no light at the end of the tunnel yet. Here's a little update as pertains to my shoulder issues/remedies.

After waiting about 5 weeks to see the shoulder specialist for the Atlanta Braves, he studied my MRIs and took another set of xrays for giggles. According to him, the bone that they normally shave off during the arthroscopic surgery is 'perfect' in my case (the underside of the bone that's on top of your shoulder). I have no abnormality that would be contributing to tendon impingement and the Doc recommended physical therapy instead of surgery at this point.

As a test, he injected me with a diagnostic fluid into the bursa that duplicates the results of a cortisone shot but only for a few minutes. For this doctor, a determining factor whether or not to do surgery is to see if there is less pain after the injection. In my case, there was no change in the pain whatsoever - still felt stabbing on the outer arm when raising it laterally away from my body and a dull pain on the inner right shoulder when reaching across my body to scratch my left shoulder. He prescribed some PT with the specialists that do the PT for the Atlanta Braves pitchers. (The only reason I mention these folks deal with the Braves is that they ought to know what they're doing)

I had my first appointment with them this last Thursday. I had explained to the therapist that I had 6 weeks of 3x/week PT in November and December with no improvement and actual worsening of symptoms. After doing various tests and having my range of motion measured, he had some interesting tidbits of information regarding my situation.

It seems that the muscles in the front of my arm (pecs, front of right shoulder, above shoulder) are overdeveloped in comparison with the girly muscles around my shoulder blade. This problem is causing my entire scapula (the shoulder blade and the boney 'roof' above your shoulder - will call the roof 'upper scapula' from now on) to pivot forward since the rear muscles aren't able to compensate properly for the pull that the front ones have on it. This pivoting is forcing the forward edge of the upper scapula to dip closer to the humerus (upper arm bone) and squeezing the tendons that slide inbetween the two.

So, I am doing various exercises to strengthen the muscles that surround my right shoulder blade at the moment. I've only been doing it for a few days now, but I *think* I can already sense a difference as to where my shoulder rests. I'll be doing 2 weeks of this type of exercise and then progressing to more weight, I assume. I'm told it will still be several weeks before my symptoms start to disappear.

I certainly hope these doctors are on the right track with me. After my first bout of PT, I'm a bit skeptical that MORE of it will do me any good. But, I'm willing to give it the old college try! Thanks again for all the great tips and recommendations from those on the board.

I did have one quick question: Can anyone recommend a good cold/ice shoulder wrap? I'm looking for something that will totally surround the shoulder with icy goodness for after exercises and, eventually, tennis. Thanks!

[Kaptain Karl]

Originally Posted by f1 tech

Make sure you put ice after each session of tennis.

And please use sufficient amounts of ice when you do. A 10-gallon (or is it 15?) trash bag filled "loosely" with real ice and wrapped all around the shoulder is better than the cheesy pre-manufactured "cold paks" IMO.

Originally Posted by Spittle

It seems that the muscles in the front of my arm (pecs, front of right shoulder, above shoulder) are overdeveloped in comparison with the girly muscles around my shoulder blade....

So, I am doing various exercises to strengthen the muscles that surround my right shoulder blade at the moment. I've only been doing it for a few days now, but I *think* I can already sense a difference as to where my shoulder rests. I'll be doing 2 weeks of this type of exercise and then progressing to more weight, I assume. I'm told it will still be several weeks before my symptoms start to disappear.

Very interesting. Many years ago it was actually my CMT (massage therapist) who noticed my similar problem. Her test was simple.

She had me stand "comfortably" before a full length mirror. Notice where your hands hang in relation to your torso. (They should hang at your sides.) Mine hung by my front pockets ... more in front of me than beside me.)

Doing this makes you very self-conscious (and finds you "making" your arms hang right) so she'd have do a squat in front of the mirror with my hands hanging limply ... and stand up. Wow! My hands would be at my pockets again.

More attention to the Rotator Cuff exercises and Lats and Rowing weight training ... AND ... conscientious attention to my posture at all times ... and about six months later the poor posture / arm hang seemed to be fixed.

Can anyone recommend a good cold/ice shoulder wrap?

See the top of this post of mine.

- KK

[El Guapo]

Originally Posted by Spittle

It seems that the muscles in the front of my arm (pecs, front of right shoulder, above shoulder) are overdeveloped in comparison with the girly muscles around my shoulder blade. This problem is causing my entire scapula (the shoulder blade and the boney 'roof' above your shoulder - will call the roof 'upper scapula' from now on) to pivot forward since the rear muscles aren't able to compensate properly for the pull that the front ones have on it. This pivoting is forcing the forward edge of the upper scapula to dip closer to the humerus (upper arm bone) and squeezing the tendons that slide inbetween the two.

So, I am doing various exercises to strengthen the muscles that surround my right shoulder blade at the moment. I've only been doing it for a few days now, but I *think* I can already sense a difference as to where my shoulder rests. I'll be doing 2 weeks of this type of exercise and then progressing to more weight, I assume. I'm told it will still be several weeks before my symptoms start to disappear.

I certainly hope these doctors are on the right track with me. After my first bout of PT, I'm a bit skeptical that MORE of it will do me any good. But, I'm willing to give it the old college try! Thanks again for all the great tips and recommendations from those on the board.

I did have one quick question: Can anyone recommend a good cold/ice shoulder wrap? I'm looking for something that will totally surround the shoulder with icy goodness for after exercises and, eventually, tennis. Thanks!

Very common problem. Be sure that you go to a different PT this time because your last one was almost criminal to have missed that.

[bronco_mba]

Spittle,

Sounds like you're on the right track. I was told to develop my back muscles as well, but I had a bone spur in the acromioclavicular joint that was a greater contributing factor.

As for the cold pack, I worked with a gigantic reusable ice pack, purchased from the drug store in conjunction with a simple ace bandange.

[TTECHH]

[quote=Spittle;2164280]It seems that the muscles in the front of my arm (pecs, front of right shoulder, above shoulder) are overdeveloped in comparison with the girly muscles around my shoulder blade. This problem is causing my entire scapula (the shoulder blade and the boney 'roof' above your shoulder - will call the roof 'upper scapula' from now on) to pivot forward since the rear muscles aren't able to compensate properly for the pull that the front ones have on it. This pivoting is forcing the forward edge of the upper scapula to dip closer to the humerus (upper arm bone) and squeezing the tendons that slide inbetween the two.

So, I am doing various exercises to strengthen the muscles that surround my right shoulder blade at the moment. I've only been doing it for a few days now, but I *think* I can already sense a difference as to where my shoulder rests. I'll be doing 2 weeks of this type of exercise and then progressing to more weight, I assume. I'm told it will still be several weeks before my symptoms start to disappear.

QUOTE]


Spittle, can you describe the type of excercises you are doing...I think I might have a similar problem.

Thanks,
Brian

[Spittle]

I'll try to describe the exercises the best I can.

The most important part in all the exercises below is to 'set your scapula' before every exercise and every rep. This, unfortunately, is actually the hardest part to master because it's pretty much foreign to those of us that have hunched our shoulders forward all these years. It consists of forcing your shoulders/shoulderblades downward almost as far as you can *and* forcing your shoulderblades together 90% of the way. 100% of the way will feel unnatural but a slight release from that will be the ticket. And, all of these exercises should be done with good posture and a firm core.

Seated Rowing
- Sitting on an exercise ball, face a wall where tubing has been affixed at shoulder level. Bring arm out to 90 degrees in front of body and hold tubing with palms down. Pull arms back, squeezing shoulder blades together - but keep arms straight throughout the exercise. Slowly return to starting position.

Prone Extension
- Lie on exercise ball, face down, with a 2lb weight in the hand of the involved arm. Raise arm straight back until even with your body, then lower slowly. (Explaining these w/o pics is tough)

Internal Rotation at 0 degrees - Abduction
- Standing with elbow at side fixed at 90degrees and shoulder rotated out. Grip tubing handle while other end of tubing is fixed. Pull arm until perpendicular to body keeping elbow at side. Return to starting position slowly and controlled.

External Rotation at 0 degrees - Abduction
- Stand with involved elbow fixed at side, elbow at 90degrees. I do isometric holds here where I keep my elbow/arm fixed at the side of my body/90degrees and pivot my entire body to put strain on the lower shoulder muscles (instead of actually reaching across my body and using the arm itself to pull the tubing taut).

I'm hoping you'll be able to google on some of these terms and figure out what will work for you. I also do a Prone Horizontal Abduction exercise and a stretch called 'Sleeper in 90deg of forward flexion'.

You asked!

[TheShaun]

Yes, the setting of the scapula is the hardest part by far. an easy explanation of it given to me by my PT is, "Picture pulling your shoulder blade down towards your opposite back pocket." So your right shoulder blade back down towards your left back pants pocket.

[Chauvalito]

Great thread, and informative posts.

[bronco_mba]

I've started using the USTA Player Development exercises post-op/post-PT to continue building strength in the shoulder:

http://www.playerdevelopment.usta.co...inewsid=249182

There are a number of shoulder/back exercises. The best part of the routine, as a non-gym member, is that I can do the entire routine with exercise tubing and a medicine ball.

This may provide some guidance/suggestion for those not already on a physical therapy program for shoulder issues.

[TTECHH]

Spittle,

Thank you so much for the posts, you are a great asset to this site and this has to be one of the best threads running...maybe a admin will tact the thread to the top.

bronco and others, great posts as well and thanks for the info.

TTECHH

[Spittle]

It has definitely been a community effort! I'm talking to the best folks I can find for this shoulder issue and I really really REALLY hope it gets resolved soon. So far, all the exercises are doing is aggravating those tendons a wee bit. They don't hurt *while* I'm doing the exercises, but certain arm movements afterward give me jabs of pain now and then.

The link from bronco's last post didn't work for me, so I'll repaste it here :

http://www.playerdevelopment.usta.co...inewsid=249182