Just had a PRP injection in the rotator cuff today.

[RogueFLIP]

do you really think posterior scalene tightness could cause a cascade that presents as frozen shoulder? I could see neurogenic symptoms due to compression on the brachial plexus or pain that limits motion or inhibition of muscles in the area, but why would a person lose passive ROM in all directions?

I don't necessarily know if I would have needed to get that specific in terms of which head of the scalene it is, it's not like you can ask the person to just move the posterior head and not the other 2 LOL.

But in terms of some area causing a cascade of problems into other areas, oh sure absolutely. Those are my typical patients.

By why would it cause a loss of passive ROM, I guess I couldn't fathom one unless I saw the person. I've seen stranger things with "weirder" symptoms believe me.

But in the end, it doesn't really matter eh? If you restored the patients function and reduced their pain, then you've done your job. You put that patient in the back of your mind the next time you come across another difficult "frozen shoulder" diagnosis.

 

[yossarian]

I don't necessarily know if I would have needed to get that specific in terms of which head of the scalene it is, it's not like you can ask the person to just move the posterior head and not the other 2 LOL.

But in terms of some area causing a cascade of problems into other areas, oh sure absolutely. Those are my typical patients.

By why would it cause a loss of passive ROM, I guess I couldn't fathom one unless I saw the person. I've seen stranger things with "weirder" symptoms believe me.

But in the end, it doesn't really matter eh? If you restored the patients function and reduced their pain, then you've done your job. You put that patient in the back of your mind the next time you come across another difficult "frozen shoulder" diagnosis.

Not just the cascade of problems, but the specific cascade of problems that that person saw. I get that impaired length tension and inhibition of the serratus will affect scapular stability and motion, but I don't understand how you get from that to lat facilitation/strengthening to stabilize the scapula (considering it barely attaches to it and doesn't have a direct role in scapular motion) and supraspinatus inhibition. Or why supraspinatus inhibition would severely limit ROM of the shoulder in all directions.

 

[RogueFLIP]

Not just the cascade of problems, but the specific cascade of problems that that person saw. I get that impaired length tension and inhibition of the serratus will affect scapular stability and motion, but I don't understand how you get from that to lat facilitation/strengthening to stabilize the scapula (considering it barely attaches to it and doesn't have a direct role in scapular motion) and supraspinatus inhibition. Or why supraspinatus inhibition would severely limit ROM of the shoulder in all directions.

I'm not sure what to tell you. I just don't know. Maybe there's another neurologic aspect that could explain things. Maybe it's not just about the muscles and their origins/insertions/function - if you read my past posts, I'm a fascia guy.
Maybe oversimplified that the scalene issue raised the whole upper shoulder complex and working the lats helped lower it to restore a better length tension relationship and function. Maybe the therapist wasn't so "passive" in his passive ROM which caused some muscle guarding which lead to his feeling that the ROM was restricted.

Too many "maybe this, maybe that". Again, it'd prob make a lot more sense if you could examine the patient yourself, which of course isn't happening anytime soon bc hopefully they're not in need of therapy!

 

[Raul_SJ]

I do not have frozen shoulder.

The test is not worthless. But remember, it's just one piece of the puzzle. Clinicians use provocative/special tests to further come up with a differential diagnosis along with other pieces of information that they've obtained during their evaluation.

I just wouldn't want someone who's lost some ROM and do this test to self diagnose themselves with having frozen shoulder. Then who knows what they'll do to self treat.

Okay... But out of 100 patients with true frozen shoulder we would expect 96% to test positive for this test since this study claims 96% sensitivity.

Coracoid Pain Test: A New Clinical Sign of Shoulder Adhesive Capsulitis - PubMed

Patients with adhesive capsulitis were clinically evaluated to establish whether pain elicited by pressure on the coracoid area may be considered a pathognomonic sign of this condition. The study group included 85 patients with primary adhesive capsulitis, 465 with rotator cuff tear, 48 with...

pubmed.ncbi.nlm.nih.gov

.

 

[tennis tom]

3. Like I mentioned before, there's ALWAYS a mind-body connection to pain and injury. Some of these "spontaneous" recoveries can happen bc of all of a sudden the mind can "let go" of whatever it's holding onto and allows the muscle guarding to un-guard, so to speak. Some of these subconscious holding patterns can be VERY VERY powerful and strong and no matter what stretch, exercise or manual work you do, it won't make a lick of difference.

Dr. John E. Sarno, the famous "back doctor" has written four books on this topic, "THE MIND-BODY CONNECTION" and the "DIVIDED MIND" explain the phenomenon of psychosomatic conditions.

 

[undecided]

Interesting thing happened today. Woke up in bed, still lying down and kind of moved my arms in the same manner as if I were making snow angels. I look to my right side and my arm is elevated by like 6 inches, I am like wth?
So I perform the same movement while looking this time and I noticed that as the arm passed the plane of the shoulder the arm started to lift off the bed, by the time my hand pointed to the back wall, it was 6 inches of the ground. It seems that the arm is following a smooth slope upwards. There was no pain or anything but leaving it suspended like that started to feel uncomfortable after a few seconds.

 

[RogueFLIP]

Dr. John E. Sarno, the famous "back doctor" has written four books on this topic, "THE MIND-BODY CONNECTION" and the "DIVIDED MIND" explain the phenomenon of psychosomatic conditions.

Haven't read his book in ages, but yes there are many folks out there that understand this:

One of the first books I read about it was "Waking the Tiger" by Peter Levine. Didn't read his other books.

 

[ollinger]

Sarno walked the walk on mind and body......I recall he died the day before he was to turn 94.

 

[tennis tom]

Sarno walked the walk on mind and body......I recall he died the day before he was to turn 94.

He was a tennis player too!

 

[ollinger]

He was a tennis player too!

SarYes!!

 

[Say Chi Sin Lo]

Sure, I've seen countless videos. A lot say PRP is bunk as far as the shoulder is concerned because there are no 'good' studies on it yet, most studies are too small or don't have a true control, etc, etc, but then you have a lot of anecdotal evidence that it does do something positive.

Took a while, I guess I'm not on these forums much these days, but these are good studies on the effectiveness of current PRP/Stem Cell therapies:

 

[undecided]

So, the shoulder is effectively pain free within the range of movement that the frozen shoulder allows. Of course that is with less weight/resistance that the good shoulder can use.
I've been doing pendulums and walk the wall exercises for 9 days now and the frozen shoulder is also starting to loosen up at least in the external rotation direction. One incident that happened last night while sleeping has me worried though. Yesterday I kind of massaged my shoulder myself, I dug into the tendons. At night I had two incidents where I felt a spasm and felt the humerus internally rotate and felt impingement pain as well. That's similar to what was happening in the early days at the onset of this condition. This has stopped happening while the shoulder was fully frozen and now that it's starting to loosen up, it's happening again.

 

[undecided]

So, although as I posted yesterday the shoulder has been pain free for daily activities and rehab in the gym, today I attempted to use the racquet single handed. Unfortunately, a single FH is all it took to feel a sharp shooting pain go through the shoulder and it still hurts now. So, not really pain-free. Very disappointed and not looking forward to the inevitable surgery it seems.

 

[Say Chi Sin Lo]

So, although as I posted yesterday the shoulder has been pain free for daily activities and rehab in the gym, today I attempted to use the racquet single handed. Unfortunately, a single FH is all it took to feel a sharp shooting pain go through the shoulder and it still hurts now. So, not really pain-free. Very disappointed and not looking forward to the inevitable surgery it seems.

Surgery for what, what anatomical structure will they address?

 

[undecided]

Surgery for what, what anatomical structure will they address?

I have no idea, when they go in there with the arthroscope they will start fixing whatever needs fixing. Sometimes just diagnosing from the outside and with MRI doesn't capture everything. The arthroscope can see so much more detail.
The pain I feel now is diffuse and travels down to the bicep head. The MRI said there was no issue with the bicep tendon or its path through the rotator cuff area, yet it hurts, that means something is messed up in there.

 

[Raul_SJ]

Unfortunately, a single FH is all it took to feel a sharp shooting pain go through the shoulder and it still hurts now.

What is your approximate range of motion?
My flexion and abduction is about 80% but internal and external rotation is less than 50%.

My serve is very limited due to the limited ISR and ESR. About 40mph instead of normal 80mph plus. But interestingly, serve has slow slice and topspin on it that I could never get before. Don't exactly know what I am doing but no doubt related to limited ISR... But it will go flat again after I get complete 100% ISR and ESR.


For the forehand, the pain is related to whether one has an ATP style or WTA style wherein the ISR occurs on the take back in one style.


chale translation

 

[undecided]

What is your approximate range of motion?
My flexion and abduction is about 80% but internal and external rotation is less than 50%.

My serve is very limited due to the limited ISR and ESR. About 40mph instead of normal 80mph plus. But interestingly, serve has slow slice and topspin on it that I could never get before. Don't exactly know what I am doing but no doubt related to limited ISR... But it will go flat again after I get complete 100% ISR and ESR.


For the forehand, the pain is related to whether one has an ATP style or WTA style wherein the ISR occurs on the take back in one style.


chale translation

Flexion is same as good shoulder.
Abduction is about 80 degrees but the elbow is in front of the scapular plane, I cannot bring elbow close to being parallel to the torso and abduct at the same time.
External rotation is 90 degrees but again the elbow is not parallel to to the body.
Internal rotation is about 45 degrees which is terrible. It's half of what it's supposed to be.
All the pics above show elbow parallel to the torso, my elbow cannot go that far back. It doesn't hurt, it just won't go. Even if push it, it just forces the rest of the body to rotate with it.
My doc did say than when you have frozen shoulder you feel the shoulder doing 'weird' things.
He also said that because of the weird movements it makes you do, it can cause secondary impingement.

 

[Raul_SJ]

Background info on scapular plane.

The scapula are not flat to the back in their neutral position. This is known as the plane of the scapula. There are terms for exercises that are in this plane. Scapular plane and 'scaption' I believe but check as I just learned some of this stuff.

Scapular Plane Arm Raises.
http://conquerthecrux.com/prevent-shoulder-injuries/

 

[undecided]

Background info on scapular plane.

Yes my elbow has an issue getting to zero degrees. The good arm has no such issue. The bad shoulder seems to get stuck to 30 degrees.

 

[Raul_SJ]

Yes my elbow has an issue getting to zero degrees. The good arm has no such issue. The bad shoulder seems to get stuck to 30 degrees.

That limitation is caused by the severe Internal Rotation restriction?

What happens if you try to serve? I believe serve entails ~110 ° Abduction and ??? °
Flexion and ??? ° ISR.

 

[undecided]

That limitation is caused by the severe Internal Rotation restriction?

What happens if you try to serve? I believe serve entails ~110 ° Abduction and ??? °
Flexion and ??? ° ISR.

Try to serve? I am so far away from even considering that. Trying to toss something like a tennis ball across the room hurts. The weird thing is that there is no pain if I perform that same motion slowly. I just tried it in slomo and I do hear some noises emanating from the shoulder when I do it but no pain.

 

[Say Chi Sin Lo]

I have no idea, when they go in there with the arthroscope they will start fixing whatever needs fixing. Sometimes just diagnosing from the outside and with MRI doesn't capture everything. The arthroscope can see so much more detail.
The pain I feel now is diffuse and travels down to the bicep head. The MRI said there was no issue with the bicep tendon or its path through the rotator cuff area, yet it hurts, that means something is messed up in there.

That is true. Prior to the 2nd surgery, MRI revealed that I have partially re-torn my supraspinatus. I was given the option of immediate surgical intervention or rehab first. I think my surgeon understood I was a young athlete and I told him that prior to my 1st surgery, rehab didn't do a whole lot. So I was scheduled for surgery the week after the MRI diagnosis.

I woke up to this: "Your supraspinatus was repaired, we also did a SAD. Oh and, we found that you had a partially torn posterior labrum. And we repaired that as well."

I'm not advocating everyone to rush into surgery like I did, there's certainly merits to going the conservative route and rehab the injury first. I spoke to my surgeon from the perspective of having a prior surgery and where that got me.

(The labrum probably added another 2 months for my post-op rehab too)

 

[undecided]

So, I am going back to doctor tomorrow as I have unanswered questions
1) Deltoids on the affected shoulder are misshapen
2) I was doing some back stretching on the foam roller and felt some discomfort at around the bottom of the scapula.
After that stretching, the shoulder felt better. So something is going on with the back/scapula so the impingement and tendon fraying may have been due to something else. We will see.

 

[yossarian]

Deltoids on the affected shoulder are misshapen

do you have sensation on the outside of your shoulder

 

[undecided]

do you have sensation on the outside of your shoulder

If you mean the skin, yes, it's same as the other shoulder. From an overall 'sensation' perspective though, it does 'feel' different when I put it under stress like when I am doing PT.