Mild Rotator Cuff Tendonitis: Rule of Thumb on when to start throwing/serving again?

[Raul_SJ]

Full MRI Report:

Mild tendinosis of the supraspinatus and infraspinatus tendons, without high grade partial or full-thickness tear.
The subscapularis tendon, teres minor and long head biceps tendon are intact. Muscular bulk is maintained.

Labrum: There remains grossly intact.
Acromioclavicular joint: anatomic in alignment.
Subacromial and subdeltoid bursa: Normal.
Glenohumeral joint: No joint effusion or synovitis.
Soft tissues: Remaining visualized soft tissues are unremarkable.
Osseous structures: Normal.


Impression:
1) Mild superior rotator cuff tendinosis, without high grade partial or full-thickness tear.
2) Remaining rotator cuff, long head biceps tendon and labrum are intact.

 

[tennis347]

Full MRI Report:

Mild tendinosis of the supraspinatus and infraspinatus tendons, without high grade partial or full-thickness tear.
The subscapularis tendon, teres minor and long head biceps tendon are intact. Muscular bulk is maintained.

Labrum: There remains grossly intact.
Acromioclavicular joint: anatomic in alignment.
Subacromial and subdeltoid bursa: Normal.
Glenohumeral joint: No joint effusion or synovitis.
Soft tissues: Remaining visualized soft tissues are unremarkable.
Osseous structures: Normal.


Impression:
1) Mild superior rotator cuff tendinosis, without high grade partial or full-thickness tear.
2) Remaining rotator cuff, long head biceps tendon and labrum are intact.

It depends how long you have had these symptoms. I some tendonitis in my shoulder before and I would say that it takes at least 4-8 weeks to go away. I would recommend alot of stretching, icing and going for messages to speed up the recovery. I would also try and determine the cause of the tendinitis. It could be doing too much playing/working out or you are over exerting your shoulder. Lastly, look at your technique and equipment. Just my two cents.

 

[tonylg]

Do you need to throw? Throwing is actually worse than serving.

Take your doctor's advice, but maintaining flexibility is important. There are specific stretches and exercises you should be doing.

My experience is that gentle serving, concentrating on technique is actually good for recovery .. but as above, listen to your doctor, not a forum.

 

[Raul_SJ]

Do you need to throw? Throwing is actually worse than serving.

Take your doctor's advice, but maintaining flexibility is important. There are specific stretches and exercises you should be doing.

My experience is that gentle serving, concentrating on technique is actually good for recovery .. but as above, listen to your doctor, not a forum.

I was thinking of extremely light throwing from baseline to opposite service box and whether that would help recovery. Normally I can tennis ball throw from baseline to back fence 22 feet behind opposite baseline. Now I can barely throw to opposite service line.

The guideline seems to be to get normal range of motion before light throwing.

My shoulder extension is almost normal. My shoulder forward flexion is about 30 degrees shy of vertical.
Outward Rotation (ESR) and Inward Rotation(ISR) is only about 45 d instead of the normal 90 d.
Shoulder abduction is about 35 degrees shy of normal 180 degrees vertical. Painful at end of that restricted range. Pain starts at around 120 degrees abduction until 140 degrees. Can't get past that.

Most painful is behind the back like pic of this guy. (That is not me). I can't even get close to his restricted position.

I feel only slight pain on groundstrokes. Only occasionally it hurts on groundstrokes. I use one hander.
But it is very painful on serving. So when I hit around, I only play groundstrokes and skip the serve. But I am anxious to get back to serving.
My normal serve is 90mph. But now it is like 35mph.

 

[tonylg]

I haven't been able to put my right arm behind my back like that for over 30 years.

For me, throwing is a no no. I was a javelin champion and could throw a cricket ball almost 100m .. and they are what did the damage. It's the extra extension of the throw and lack of resistance. Rolling a racquet over is less dangerous, particularly for my shoulder.

After having a killer throwing arm, I now won't even throw a tennis ball the length of the court.

 

[S&V-not_dead_yet]

Full MRI Report:

Mild tendinosis of the supraspinatus and infraspinatus tendons, without high grade partial or full-thickness tear.
The subscapularis tendon, teres minor and long head biceps tendon are intact. Muscular bulk is maintained.

Labrum: There remains grossly intact.
Acromioclavicular joint: anatomic in alignment.
Subacromial and subdeltoid bursa: Normal.
Glenohumeral joint: No joint effusion or synovitis.
Soft tissues: Remaining visualized soft tissues are unremarkable.
Osseous structures: Normal.


Impression:
1) Mild superior rotator cuff tendinosis, without high grade partial or full-thickness tear.
2) Remaining rotator cuff, long head biceps tendon and labrum are intact.

I would ignore your thumb and pay attention to your shoulder.

if it hurts, don't do it. There's a difference between discomfort and pain; you probably know what it is intuitively.

I'm assuming you have a regimen of exercises to build the muscles around the affected area. You should at least be able to do those without pain before you think about throwing.

When I did rehab, the PT had a bike contraption that one "pedaled" with one's hands. Great warmup for the shoulder.

 

[S&V-not_dead_yet]

I was thinking of extremely light throwing from baseline to opposite service box and whether that would help recovery. Normally I can tennis ball throw from baseline to back fence 22 feet behind opposite baseline. Now I can barely throw to opposite service line.

I'd forget about throwing for now, no matter how light. Work on strengthening those supporting muscles.

 

[tonylg]

I'd forget about throwing for now, no matter how light. Work on strengthening those supporting muscles.

Same. Are you going to a sports physio? They are generally a good source of what you should be doing at various stages of recovery.

 

[Raul_SJ]

I would ignore your thumb and pay attention to your shoulder.

if it hurts, don't do it. There's a difference between discomfort and pain; you probably know what it is intuitively.

I'm assuming you have a regimen of exercises to build the muscles around the affected area. You should at least be able to do those without pain before you think about throwing.

When I did rehab, the PT had a bike contraption that one "pedaled" with one's hands. Great warmup for the shoulder.

Yes, google indicates that ROM must first reach normal before throwing/serving. But I was just curious about the guy reaching behind the back. Right now that move
is very painful but I think improvement there would be a good predictor of the serve readiness. Again, I have stopped serving/throwing but curious of the predictors.

 

[Raul_SJ]

Do you need to throw? Throwing is actually worse than serving.

Take your doctor's advice, but maintaining flexibility is important. There are specific stretches and exercises you should be doing.

My experience is that gentle serving, concentrating on technique is actually good for recovery .. but as above, listen to your doctor, not a forum.

It's been going on for 2.5 months. I have experimented with weeks w/o serving and it seemed to get worse versus gentle serving.
Have not gone to physio as insurance has not yet approved.
I wonder if someone slightly pushing the behind-the-back move a few inches would help recovery.

 

[tonylg]

It's been going on for 2.5 months. I have experimented with weeks w/o serving and it seemed to get worse versus gentle serving.
Have not gone to physio as insurance has not yet approved.
I wonder if someone slightly pushing the behind-the-back move a few inches would help recovery.

In my experience, no. Best way to do that is with a towel or rope behind your back, gently pulling the lower arm up with the other.

The rotation diagram (third one) above is also key. It's generally easier to do with your upper arm by your side and elbow bent to 90 degrees (to keep the joint stable) - rotate the hand about the elbow, while keeping the elbow fixed. Start off with no weight, then either add very light weight or use a band. It's important that you don't try to force beyond your possible range, but that you constantly improve that range, slowly over time.

 

[Raul_SJ]

In my experience, no. Best way to do that is with a towel or rope behind your back, gently pulling the lower arm up with the other.

The rotation diagram (third one) above is also key. It's generally easier to do with your upper arm by your side and elbow bent to 90 degrees (to keep the joint stable) - rotate the hand about the elbow, while keeping the elbow fixed. Start off with no weight, then either add very light weight or use a band. It's important that you don't try to force beyond your possible range, but that you constantly improve that range, slowly over time.

Yes, I am doing some simple pendulum exercises. Sometimes there is a tickling "pain" for a few seconds...

Have never been to physio but this guy says his therapist forces him painfully. Although he had rotator surgery, so it might be different.

My S&M Dominatrix From Poland.​

​

I recently began a program of physical rehab for the surgery performed on a particularly nasty shoulder injury. My physical therapist's name is Yolanta. She was born in Poland. She's a formidable woman, with a deceptively sweet smile. She is quite capable of inflicting some of the most intense pain I have ever experienced, while smiling beatifically. It's all part of her determined effort to break up my scar tissue.​

​

It seems that scar tissue is one of the unavoidable--and yet desirable--byproducts of arthroscopic surgery. After you rip your shoulder apart, by doing something stupid, the scar tissue from the surgery knits everything back together.​

​

The problem is, your body has just experienced an extremely invasive procedure, and it wants to protect everything that was touched by the surgeon's tools. So it goes nuts with the scar tissue.​

​

As a result, I have scar tissue in places that should never see scar tissue. And I've spent the last month keeping my arm very, very still, so my body was able to grow all sorts of scar tissue, good AND bad.​

​

But now, I have to rip apart the bad scar tissue, while leaving the good scar tissue intact. This is where my Polish S&M Dominatrix Goddess comes in. She knows the best ways to break up that bad scar tissue, while inflicting the maximum amount of pain. Sometimes, when she is twisting my shoulder into a position that it has not been able to approach for the last three months, I look up through a haze of barely-repressed tears and notice her beatific smile. She's enjoying this.​

​

The thing that worries me is: because she is helping me regain the use of my shoulder, I am also enjoying this.​

​

Physical therapy is kinky as hell.​

​

http://www.9timezones.com/r.htm

 

[tonylg]

I know how painful recovery from that surgery is, literally half my playing mates have had it and it's a large part of why I've never gone under the knife.

There's a difference between a professionally managed return to proper articulation and flexibility and just hurting yourself though.

Physio is great if you can find a good one. Even if you only go once a month to manage the recovery, it's probably money well spent.

 

[E46luver]

how did this injury become ?

 

[S&V-not_dead_yet]

It's been going on for 2.5 months. I have experimented with weeks w/o serving and it seemed to get worse versus gentle serving.
Have not gone to physio as insurance has not yet approved.
I wonder if someone slightly pushing the behind-the-back move a few inches would help recovery.

Like throwing, I believe the behind-the-back arm position is more of an indicator of how strong/flexible your shoulder is as opposed to actually helping it.

I'm assuming it's external rotation that's the problem: assuming your right shoulder is the problem and you're driving in a left-side steering wheel car, can you pull your seat belt across your body in an arc with your elbow pinned to your rib cage? That will be painful if you've got a messed up rotator cuff. That motion, with no weight, might be a good place to start your rehab. Enough to fatigue but not enough to hurt.

You can do the same motion but lying down on your left side: now you have to work against gravity. At some point, hold a can of soup or something very light and build your way up. Use the behind-the-back move to gauge your progress.

I fear your physio.

 

[Raul_SJ]

Like throwing, I believe the behind-the-back arm position is more of an indicator of how strong/flexible your shoulder is as opposed to actually helping it.

I'm assuming it's external rotation that's the problem: assuming your right shoulder is the problem and you're driving in a left-side steering wheel car, can you pull your seat belt across your body in an arc with your elbow pinned to your rib cage? That will be painful if you've got a messed up rotator cuff. That motion, with no weight, might be a good place to start your rehab. Enough to fatigue but not enough to hurt.

You can do the same motion but lying down on your left side: now you have to work against gravity. At some point, hold a can of soup or something very light and build your way up. Use the behind-the-back move to gauge your progress.

I fear your physio.

Can't do the seat belt... It is both ESR and ISR. Can only go about halfway outward and halfway inward. This is why serving is painful in two positions; (1)around the trophy phase racquet drop phase and then (2) from "Big L" to contact. Ouch!

The weird thing is that lot of the returners were not able to do much with my dinky 35 mph serve. Thought they would be killing it, but even some 4.0 guys were not really attacking it and making errors.

how did this injury become ?

It could be repetitive stress injury... The other theory is that it happened when I was experimenting with "scapula loading" on the serve.

 

[megamind]

I've had this before, but I guess when I did this, I never had an "active" recovery

I basically rested it for 5 weeks - no tennis / serving
After that I began going to gym, with a focus on rotator cuff strengthening
Another 2 months later, I started playing tennis again (I wasn't really rushing to the court at the time, because life had me busy with other things)

Not sure if that helps, but sharing my experience

 

[Raul_SJ]

I've had this before, but I guess when I did this, I never had an "active" recovery

I basically rested it for 5 weeks - no tennis / serving
After that I began going to gym, with a focus on rotator cuff strengthening
Another 2 months later, I started playing tennis again (I wasn't really rushing to the court at the time, because life had me busy with other things)

Not sure if that helps, but sharing my experience

Did you start strengthening only after you were close to normal range of motion? Did you have trouble going behind the back like the guy in the pic?
Which shots were painful? I only feel it mainly on the serve (pain scale 7/10)... One hand backhand (2/10). Forehand (3/10).

 

[megamind]

Did you start strengthening only after you were close to normal range of motion? Did you have trouble going behind the back like the guy in the pic?
Which shots were painful? I only feel it mainly on the serve (pain scale 7/10)... One hand backhand (2/10). Forehand (3/10).

> Did you start strengthening only after you were close to normal range of motion
I was probably about 85-90% normal when I started

> Did you have trouble going behind the back like the guy in the pic?
tbh I never tried that at the time

> Which shots were painful?
Serve (8/10)
Forehand (4/10)
I have a 2 handed backhand, so that was a 0/10