Shoulder Issues -- Therapies, Surgeries, Etc.

[FastFreddy]

Shoulder

Have you seen the Todd Ellenbecker video on shoulders, impingement, serving and other issues?

From another thread -

"In my interpretation of the Ellenbecker video the issue involves putting the ball of the humerus and attached tissue (suprispinatus tendon, bursa sack?...) in a more confined space under the acromion and then doing the very violent and perhaps sometimes wobbly internal shoulder rotation as shown in this serve video.
https://vimeo.com/27528701

The space under the acromion is more confined if the upper arm is high.

Acromion illustrations
https://www.google.com/search?q=acro...w=1312&bih=703

"

Good luck.

Nah, I wrecked my right shoulder from ice hockey ie(impact) checking without wearing my shoulder pads in practice. I ripped the tendon right off the bone talk about 72 hrs of pure pain!! I wrecked my left shoulder from 12 hrs a week of clay court tennis. Plus my acromion is a type 3 so there was never alot of room to start with.

 

[Chas Tennis]

From another thread -

"Best to view the Ellenbecker video as I could misinterpret. At minute 8 he describes the shoulder orientation to minimize the risk of impingement.

http://www.tennisresources.com/index.cfm?area=video_detail&vidid=3712&rv=1

Think of the line between the two shoulders and the line of the upper arm. If those lines fell in a straight line, the angle is 180°, and the shoulder internally rotates (upper arm axial rotation) well and impingement risk is low. As the upper arm rises relative to the shoulders the risk increases. I have read that 170° is still OK. Let's say that it is higher than recommended, at 150° for example - then there is more risk of impingement.

You can also visualize the angle by extending the shoulder-shoulder line and considering the complementary angle. Then for example, 0° is upper arm straight out, 10° is the upper arm up slightly and still OK, 30° is the upper arm up and at increased risk of impingement.

I see many players serving well beyond the 10°.

The shoulder orientation requires lateral trunk flexion which may stress the back for some people."

 

[FastFreddy]

Shoulder

I checked out the video what year was it made? Was that dude just a USPTA pro talking about shoulder pt? Nothing new in the video that I did not already know from being a CSCS for the past 23 years. Bottom line is any overhead sport is bad for your cuff. If u are like me and have a type 3 u will get impingement sooner.

First the tendon rubs on the bone the bone protects itself by making a bone spur which cuts the tendon over time. My doc even created more more and even cut off 1cm of my collarbone. Both spurs regrown over a 12 years and so I got both shoulders scoped after having the open style surgery first.

I opted for the open style first since the retear rate was lower compared to scope jobs at the time 1996 and 1999. I got scoped in 2010 and 2012. Looking back my Doc said they could grow back over time but I had no problems until one day it just pooped and made another hole in the tendon. I could have gotten an mri every year on each shoulder but that would have costed me 800.00 out of pocket every year. Plus staying still in a tube for 30 mins for each one is not fun rather get another surgery haha!!

Funny thing I only serve slice and flat no kickers. I think the kick serve and american twist is far worse than slice or flat. What I learned is always wear your shoulder pads even in light practice. Also don't play clay court tennis which is good for your knees bad for your cuff. Hitting 5-6 balls chest height on hard court is way better than 8-12 balls shoulder or above your shoulder height on clay. Knee sugery was about 10 years ahead of shoulder surgery last time I checked.

 

[Chas Tennis]

I don't know when the video was made. He published a paper in 1998 on the subject but I could not locate it.

As long as you understand the shoulder-shoulder to upper arm alignment as you start back to serving that was the main point.

 

[FastFreddy]

cuff

I don't know when the video was made. He published a paper in 1998 on the subject but I could not locate it.

As long as you understand the shoulder-shoulder to upper arm alignment as you start back to serving that was the main point.

Nah, Iam not buying into that. Even if I had perfect biomechanics and perfect muscle balance I would have still have a tear in my cuff. First impact then overuse and a type 3 ac joint caused my problems. Man was build to climb to to throw overhand.

 

[BLUE]

Old thread, but I'll revive it. Might be helpful to others.

Had a rotator cuff debridement, compression, clean up about 5 weeks ago. Therapy is going great and I'm already doing all the things I did before the surgery, including throwing motions, some door push ups etc...Yet I still feel some discomfort in my shoulder and the nerve still seems inflamed. Therapist says it's okay, but it just feels too much like prior to surgery. I've never had real pain, only after playing extended tennis games. That was the only reason why I did the surgery.

Anyone had similar experiences? How long will it take to heal inside?

 

[Say Chi Sin Lo]

Old thread, but I'll revive it. Might be helpful to others.

Had a rotator cuff debridement, compression, clean up about 5 weeks ago. Therapy is going great and I'm already doing all the things I did before the surgery, including throwing motions, some door push ups etc...Yet I still feel some discomfort in my shoulder and the nerve still seems inflamed. Therapist says it's okay, but it just feels too much like prior to surgery. I've never had real pain, only after playing extended tennis games. That was the only reason why I did the surgery.

Anyone had similar experiences? How long will it take to heal inside?

Few things:

If you're able to hit 5 weeks after a debridement and SAD surgery, then you're like me, a fast healer. You also didn't mention anything about serving, which is wise. Hitting balls after surgery has a time frame of weeks, but serving has a time frame of months. BUT, if you do feel discomfort, I really think you should put a halt on whatever tennis games you are playing, and up your rehab game. I know you are probably itching to play, no, not even, just to hit a few balls. But I assure you that your short term pleasure will set you up for long term failure. Rehabilitation from surgery is one of those things where conservatism is desirable. If your therapist and surgeon says you'll be match ready in X months, add another month or 2 to be sure.

How do you know you've irritated a nerve? If you truly did inflamed a nerve, I can't see why your therapist says it's okay. Nerve irritation/damage is one of the most stubborn things to heal from.

Lastly, nice screen name Blue

 

[BLUE]

First, that's exactly where the name Blue came from

Second, I have not started to hit yet, jut doing tennis exercises with the elastic bands. I have tons of strength though and great motion. The only part that hurts still is putting my right hand behind my back. I can't reach as high as the other one. It's also stiffer in the morning and during the day, but always feels amazing after 2 hrs of PT.

I think the nerve is inflamed cause it feels like prior to the surgery, basically the only time it would hurt was when I played too much tennis. So it's somewhere in front of the shoulder, above the biceps. That could also be just the surgery bothering me and not being fully healed. No idea how long it really takes. The shoulder still makes cracking noises which I learned it's probably scar tissue. I'll see the doctor Thu and ask about all these.

I did screw something up though. Was doing awesome after just 2 weeks, but at about 4 weeks in, I slipped on the floor and landed on my back. The arm wasn't extended, but rather alongside my body but I put all my weight on the fingers and dislocated one of them. It's healing slowly, but it freaks me out whether I damaged something in the shoulder and whether this is slowing my progress now.

Again, I have great motion, minimal pain when doing exercises.

Not going to play tennis yet, but at least run and play some soccer maybe

 

[Say Chi Sin Lo]

First, that's exactly where the name Blue came from

Second, I have not started to hit yet, jut doing tennis exercises with the elastic bands. I have tons of strength though and great motion. The only part that hurts still is putting my right hand behind my back. I can't reach as high as the other one. It's also stiffer in the morning and during the day, but always feels amazing after 2 hrs of PT.

I think the nerve is inflamed cause it feels like prior to the surgery, basically the only time it would hurt was when I played too much tennis. So it's somewhere in front of the shoulder, above the biceps. That could also be just the surgery bothering me and not being fully healed. No idea how long it really takes. The shoulder still makes cracking noises which I learned it's probably scar tissue. I'll see the doctor Thu and ask about all these.

I did screw something up though. Was doing awesome after just 2 weeks, but at about 4 weeks in, I slipped on the floor and landed on my back. The arm wasn't extended, but rather alongside my body but I put all my weight on the fingers and dislocated one of them. It's healing slowly, but it freaks me out whether I damaged something in the shoulder and whether this is slowing my progress now.

Again, I have great motion, minimal pain when doing exercises.

Not going to play tennis yet, but at least run and play some soccer maybe

Few things:

Behind your back, you mean where you try to scratch your mid-upper back? That's internal rotation. Everyone loses some internal rotation ROM when they go into surgery. If you're good at breaking up your scar tissue and are naturally more flexible than others, you'll lose less. But internal rotation ROM loss is kind of inevitable with rotator cuff surgery.

The culprit for cracking noises is actually loose pieces of ligament around the joint, not so much scar tissue. As for the nerve issue/possible bicep involvement, I can't comment on those as they are separate issues entirely. Definitely bring it up to your surgeon the next time you see him/her!

I wouldn't worry about that little incident. I had a similar situation. Hurt like hell for 2minutes and then it was fine.

I would caution against running. The pendulum swing of your arms during the running/jogging motion is actually quite tough on a recovering rotator cuff. Think about it, you're (subconsciously) swinging the arm back and forth, and each swing has a downward force on the shoulder. When I was recovering, my surgeon cautioned me about running until I'm near tennis-ready.