What might this pain be?

sstchur

Hall of Fame
I have significant shoulder pain (have for a while). Interestingly, it often doesn't hurt very badly (and sometimes not at all) while I'm playing.

It mostly hurts when I'm done playing. There also seems to be a correlation between serving/overheads and pain. Forehand motion would be the other thing that seems to aggravate it. Backhand produces no pain at all (I am 2hbh).

Another interesting tidbit is that if I ever lunge for a shot that is out of reach (like trying to poach but can't quite get there), or if I ever shank or completely wiff on an overhead, my shoulder hurts rather a lot in such instances.

The pain is on the top/front part of my right shoulder. It especially hurts if I try to move my right arm across my body to touch my left shoulder. In fact, I tested it as I was typing this, and I can barely touch my left shoulder with my right hand b/c of the pain.

It also hurts quite a bit when I lift my right arm up (above my head) and towards the back (as I often do to try to stretch/open up my shoulders a little bit).

Additionally, when the pain is particularly bad, as it is now, the pain sort of "creeps" into my neck -- not exactly the back of my neck, but sort of the right side of my neck near the back side of my ear, all the way up and down.

Stretching tends to help make it feel better even though the process of stretching it hurts. It's sorta like a "good pain," though I often feel like there is nothing I can do to stretch it as much as I'd like. When I do really force a stretch, I can often feel it not only in my shoulder, but also in my right bicep (I feel absolutely nothing in my left shoulder or bicep). It almost feels as if the bicep is tearing (obviously, it's not, but I can't think of any other way to describe the sensation).

I've been to PT in the past. I never got a really good explanation for the problem and none of the exercises seems to help so I quit going.

I've been to an orthopedist. He was a little terse and wasn't all that helpful and told me to go to PT. I did and told him it didn't help. He said my only options really were surgery or cortisone injections. He never took and MRI. I don't feel that he really listened to me describe where I was having pain. He just did a series of quick motion tests and made up his mind.

I may try to look for someone who will listen and talk with me a bit more. But in the meantime, I was wondering if the pains I've described ring a bell with anyone on these forums?

I'm not asking for a diagnosis. I realize that is not possible in this manner. But I am still interested to hear from knowledgeable people who may have some relevant insight.

Thanks!
-Stephen
 
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Spokewench

Semi-Pro
I'm not going to hazard a guess as to a diagnosis, but IF you have significant pain, STOP PLAYING, get a new doctor that you can deal with and who you think will listen to you; and become proactive with your health care. Do something; it may not be surgery, but it might, it may be a good PT (how long did you do PT?) Sometimes, the recovery with PT takes a while; especially shoulders. It may be cortisone, but myself, I think cortisone is just a stop gap measure to really helping yourself medically in other ways.

But, you are not doing yourself a favor if you have SIGNIFICANT PAIN and you are still playing.
 

ollinger

G.O.A.T.
This is the second thread I've read here in the past few days where someone had already been to the orthopod and had no clue about diagnosis. Seems odd. I would think he'd offer at least a guess. Ask questions when you go to a doc!!
 

sstchur

Hall of Fame
This is the second thread I've read here in the past few days where someone had already been to the orthopod and had no clue about diagnosis. Seems odd. I would think he'd offer at least a guess. Ask questions when you go to a doc!!
I did ask questions. It was nearly a year ago now that I went to him. He seemed "rushed." He said something about a labrum but didn't really go into much detail.

What annoyed me was that I felt the various things I described in this thread were relevant (precisely how and what movements cause me pain and what that pain feels like). He seemed to have made up his mind without really listening to me.

I dunno. Maybe he's THAT good that he doesn't have to listen to me and all he needs to do is grab my arm and quickly move it this way and that.

But it didn't really leave me with a feeling like I had a good plan of action, other than his recommended PT.

The PT I saw was really nice. She explained in a bit more detail, again something about a deteriorating labrum, which acts as a "breaking mechanism" and the need to stabilize the other muscles around it since it will not repair itself.

After several weeks of PT (4 to 6 -- don't remember exactly), and after about 6 to 8 weeks of not playing at all, the pain came right back just as much as ever the very next time I played. Even the PT felt that it was probably it wasn't going to get much better by just continuing the therapy.
 

r2473

G.O.A.T.
When I hurt my shoulder a number of years ago, I had about the same experience with the "sports orthopedist" I went to. Actually, he didn't really even look at me (couldn't be bothered). I was "examined" by one of the residents and told to go to the PT.

I never did much of the PT stuff, but I did stay away from pretty much everything (except for running) for 6 months. I would say I felt "pretty good" after a few month, but didn't want to risk anything. I didn't lift weights (except for PT stuff) for 12 months.

After a year, I was for sure good as new.

Last year I dropped a barbell with about 500 lbs. on my knee. Basically, I missed "racking it" after a deadlift, it bounced off the rack and glanced off my knee on the way down. Something blew up to pretty big size (I think I burst a bursitis sack or whatever they are called). I called the orthro office and asked for advice (which of course they cannot give over the phone). But "off the record" the resident I was talking to basically told me to save the trip and my money (which I very much appreciated).

So, what does this all mean to you? Nothing. But, not knowing anything about your situation specifically, I would suggest taking more time off and letting everything slowly heal 100%. But then again, I am extremely risk averse.

EDIT: By the way, my shoulder injury was from lifting too much weight on the bench press with too wide of a grip. I tore something in my shoulder pretty bad. Could not raise my arm above my head and could not bring my arm across my body (I could hit a forehand sort of). I took at least two months off and did nothing. After two months I started running again. I would test it from time to time by shadow serving or shadow the backhand stroke. If I felt ANY pain, I decided that was too much and to just rest longer. Like I said, I started back to tennis after ~6 months (but I don't think I served for the first ~6 months back), but did not risk weight lifting for 12 months. But like I said, I'm very risk averse and quite extreme when it comes to injury avoidance / rehab.

FYI: Specifically where I had pain was in my right, front shoulder. Just where the chest or pec connects to the shoulder (if this even happens.....I don't know much about anatomy).
 
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ollinger

G.O.A.T.
Orthopedists follow the credo laid down by (the nephew of) Hippocrates -- "no slash, no cash." They tend to view office hours as an inconvenience that prevents them from spending more time in the OR.
 

tennisenthusiast

Hall of Fame
Orthopedists follow the credo laid down by (the nephew of) Hippocrates -- "no slash, no cash." They tend to view office hours as an inconvenience that prevents them from spending more time in the OR.
I am a software developer and I assume everything (including user training issue) as a glitch in the software until unless I troubleshoot and conclude that it is not a software issue.

I have nothing but respect for doctors but the orthopedists whom I have visited have tested my patience and I am no longer going to visit them. I had the same experience as OP.

If you are not going to spend time listening to your patients and making sure that nothing else is going on then why do you have to be in the office, go to OR.
 

corners

Legend
I'm not a doctor but it souns like rotator cuff. Could be supraspinatus tear or impingement. If it's torn partially more tennis will make it worse and you could even rupture it. Every time I read threads like this the wise advice is Stop Playing! You can't play through this injury. Orthopods are often crap, if you can find a physiatrist you'll be in luck. They are like orthopods - their specialty is orthopedics- but they are not surgeons, more like super PTs. A good PT can diagnose injuries as well as an orthopod, but you have to find a keen one.

In any case if you have rotator cuff injury chances are you have some postural issues to address. Do you sit at a desk? If so, you probably have hunched shoulders, which goes by the name of scapular dyskinesis. This is also very common in elite pitchers as well, and when you hear of any top athlete with rotator problems you can be sure that they get teated for scapular dyskinesis. Google "blackburn exercises" and start doing them. Getting your shoulder blades back and down creates more space for the supraspinatus tendon under the acromium. This will help for overhead activites but you will still need significant rest if you have tissue damage. Good luck finding a good doc.
 

sstchur

Hall of Fame
I'm not a doctor but it souns like rotator cuff. Could be supraspinatus tear or impingement. If it's torn partially more tennis will make it worse and you could even rupture it. Every time I read threads like this the wise advice is Stop Playing! You can't play through this injury. Orthopods are often crap, if you can find a physiatrist you'll be in luck. They are like orthopods - their specialty is orthopedics- but they are not surgeons, more like super PTs. A good PT can diagnose injuries as well as an orthopod, but you have to find a keen one.

In any case if you have rotator cuff injury chances are you have some postural issues to address. Do you sit at a desk? If so, you probably have hunched shoulders, which goes by the name of scapular dyskinesis. This is also very common in elite pitchers as well, and when you hear of any top athlete with rotator problems you can be sure that they get teated for scapular dyskinesis. Google "blackburn exercises" and start doing them. Getting your shoulder blades back and down creates more space for the supraspinatus tendon under the acromium. This will help for overhead activites but you will still need significant rest if you have tissue damage. Good luck finding a good doc.
I am a programmer and yes I sit at a desk and type all day long. However, I do have a sit/stand desk, but I use it sitting more than I use it standing.

I do have poor posture. I try to sit up straight from time to time but it tires out my lower back.

The thing about stopping playing is that I've tried stopped for as much as 8 weeks. And then the day I played, it was RIGHT back to the pain. Not gradual. Not little by little. Right back to it. I don't think the rest did much at all.
 

BMC9670

Hall of Fame
I did ask questions. It was nearly a year ago now that I went to him. He seemed "rushed." He said something about a labrum but didn't really go into much detail.

What annoyed me was that I felt the various things I described in this thread were relevant (precisely how and what movements cause me pain and what that pain feels like). He seemed to have made up his mind without really listening to me.

I dunno. Maybe he's THAT good that he doesn't have to listen to me and all he needs to do is grab my arm and quickly move it this way and that.

But it didn't really leave me with a feeling like I had a good plan of action, other than his recommended PT.

The PT I saw was really nice. She explained in a bit more detail, again something about a deteriorating labrum, which acts as a "breaking mechanism" and the need to stabilize the other muscles around it since it will not repair itself.

After several weeks of PT (4 to 6 -- don't remember exactly), and after about 6 to 8 weeks of not playing at all, the pain came right back just as much as ever the very next time I played. Even the PT felt that it was probably it wasn't going to get much better by just continuing the therapy.
I'd find a better orthopod, preferably one who specializes in sports injuries or works with pro/college level sports teams.

Your symptoms sound like a labrum problem (I've had labrum and RC surgery). That's why it seems crazy that your doctor did not even look at the MRI. Mine not only took an MRI (which is standard for RC diagnosis), but once the labrum was suspected, had an MRA (Arthrogram) taken, which is an MRI with dye injected into the joint for more clarity deeper in the joint capsule.

I would keep looking until you find a doctor you feel comfortable with. IMO, a doctor that communicates well is just as important as his skill in medicine.
 

rjg007

Semi-Pro
Go see a sport physiotherapist, they will be able to tell you exactly what is wrong with your shoulder, give you exercises to help it heal. That is much better than us hazarding a guess as to what you might have done to it.
 

rjg007

Semi-Pro
Go see a sport physiotherapist, they will be able to tell you exactly what is wrong with your shoulder, give you exercises to help it heal. That is much better than us hazarding a guess as to what you might have done to it.
 

sstchur

Hall of Fame
I'd find a better orthopod, preferably one who specializes in sports injuries or works with pro/college level sports teams.

Your symptoms sound like a labrum problem (I've had labrum and RC surgery). That's why it seems crazy that your doctor did not even look at the MRI. Mine not only took an MRI (which is standard for RC diagnosis), but once the labrum was suspected, had an MRA (Arthrogram) taken, which is an MRI with dye injected into the joint for more clarity deeper in the joint capsule.

I would keep looking until you find a doctor you feel comfortable with. IMO, a doctor that communicates well is just as important as his skill in medicine.
Thanks. Yeah, I believe the labrum is part of my problem as that term has come up repeatedly. But yeah, it's odd that he didn't want to do the MRI (and he was certainly resistant about it).

Maybe, I will, as others have suggested, look for a psysiotherapist.
 
this actually sounds eerily like my rotator cuff tendinosis. Tendinosis is the degeneration of the tendon (rather than inflammation as in tendinitis), so the pain seems to reoccur even after rest. I too did 12 sessions of PT spread over around 6-7 weeks, but the pain came back when I played again.

After research, it seems like therapeutic ultrasound and ASTYM are the 2 main treatments for it but im not sure. I have a doctors appointment later this week to ask about it.
 

sstchur

Hall of Fame
this actually sounds eerily like my rotator cuff tendinosis. Tendinosis is the degeneration of the tendon (rather than inflammation as in tendinitis), so the pain seems to reoccur even after rest. I too did 12 sessions of PT spread over around 6-7 weeks, but the pain came back when I played again.

After research, it seems like therapeutic ultrasound and ASTYM are the 2 main treatments for it but im not sure. I have a doctors appointment later this week to ask about it.
Do post back with what you find out. I will be interested to hear about it and see if we have any similarities.

What is ASTYM?
 
Do post back with what you find out. I will be interested to hear about it and see if we have any similarities.

What is ASTYM?
ASTYM is something I just learned about earlier this week while researching about my tendinosis. For ASTYM, they use 3 tools (looks like plastic/glass or something) and they scrape it against the skin where the injured area is. Apparently it smooths out the tendons and makes blood go there, im not quite sure. They have more info at their homepage, ASTYM.com. They have a lot of good reviews, but im still a little skeptic so I'll have to wait and see what my doctor thinks about it.

The trouble with doctors are that they learn ALL about the body (all the general things), so they are not great at a particular subject. Last summer was when my pain started, and my symptoms matched that of tendinosis so i asked them about it. They assured me I did not have it. The pain has been lingering for months, they finally let me take a MRI, and sure enough, tendinosis. Doctors are great, im not saying they are bad, its just that they are not perfect.

I'll post more on this after my doctor's visit this weekend to see what they think.
 

sstchur

Hall of Fame
ASTYM is something I just learned about earlier this week while researching about my tendinosis. For ASTYM, they use 3 tools (looks like plastic/glass or something) and they scrape it against the skin where the injured area is. Apparently it smooths out the tendons and makes blood go there, im not quite sure. They have more info at their homepage, ASTYM.com. They have a lot of good reviews, but im still a little skeptic so I'll have to wait and see what my doctor thinks about it.

The trouble with doctors are that they learn ALL about the body (all the general things), so they are not great at a particular subject. Last summer was when my pain started, and my symptoms matched that of tendinosis so i asked them about it. They assured me I did not have it. The pain has been lingering for months, they finally let me take a MRI, and sure enough, tendinosis. Doctors are great, im not saying they are bad, its just that they are not perfect.

I'll post more on this after my doctor's visit this weekend to see what they think.
Sounds like we have similar experiences. I'll be interested to see how each of our scenarios plays out.
 

tennisenthusiast

Hall of Fame
ASTYM is something I just learned about earlier this week while researching about my tendinosis. For ASTYM, they use 3 tools (looks like plastic/glass or something) and they scrape it against the skin where the injured area is. Apparently it smooths out the tendons and makes blood go there, im not quite sure. They have more info at their homepage, ASTYM.com. They have a lot of good reviews, but im still a little skeptic so I'll have to wait and see what my doctor thinks about it.

The trouble with doctors are that they learn ALL about the body (all the general things), so they are not great at a particular subject. Last summer was when my pain started, and my symptoms matched that of tendinosis so i asked them about it. They assured me I did not have it. The pain has been lingering for months, they finally let me take a MRI, and sure enough, tendinosis. Doctors are great, im not saying they are bad, its just that they are not perfect.

I'll post more on this after my doctor's visit this weekend to see what they think.

How was the diagnosis (tendinosis) confirmed? I mean can MRIs confirm that? How confident was the doctor with his/her diagnosis?

How old are you? How old are you sstchur?
 
How was the diagnosis (tendinosis) confirmed? I mean can MRIs confirm that? How confident was the doctor with his/her diagnosis?

How old are you? How old are you sstchur?
I got an MRI and it showed up as mild bursitis as well as mild tendinosis.

Bursitis is a 2 week thing (as most inflammations are)...tendinosis is a 3-6 month thing. Im not sure how confident the doctor was, but i trust the MRI people.

I'm 17. Kinda young for a degenerative injury, i know. That's why it sucks.
 
How was the diagnosis (tendinosis) confirmed? I mean can MRIs confirm that? How confident was the doctor with his/her diagnosis?

How old are you? How old are you sstchur?
Misread part of post so editing...

I was too lazy to read the thread, so excuse me if this is out of place. This isn't my area of expertise, but I don't believe tendinitis per se can really be seen on an MRI. Edema (swelling) as well as other signs may suggest chronic inflammation. However, I think tendinosis has more characteristic findings that can be seen, although it's still not 100%: hypoechoic tendon signals, increased tendon size, neovascularization, etc.
 
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To build onto my last post...

It seems like many doctors and nurses dont know the difference between tendinitis and tendinosis. When the MRI place sent the results back to my family doctor (general doctor), the nurse called me with the report saying that I had tendinitis and bursitis. It was only a few days later when I called back asking if tendinosis was mentioned, since i did not believe that tendinitis could last 6 months, and that is when the nurse mentioned that the report "also lists that i have mild tendinosis"

So...Im guessing the nurse thought the two (tendinitis and tendinosis) were the same, because why would she fail to tell me that i have mild tendinosis the first time? It's just a long and confusing road...I just really want my shoulder to heal up, but its tough when you are not even certain what you NEED to fix.
 
I was too lazy to read the thread, so excuse me if this is out of place. This isn't my area of expertise, but I don't believe tendinitis per se can really be seen on an MRI. Edema (swelling) as well as other signs may suggest chronic inflammation. If your doctor told you that you have tendinosis after the MRI, it was likely a diagnosis of exclusion (as in, the MRI was done and nothing else awful can be seen that would explain your signs and symptoms). MRI is excellent at looking at soft tissue, ligaments, and tendons, and radiologists know much more about this than I do, so I would think that you really don't have anything that stands out and so tendinitis is most consistent. This is good news.
Isn't tendinosis (different from tendinitis) bad news? Just the term "degeneration" itself is scary. Add that to the fact that it can take months to heal, and that's pretty much a tennis player's nightmare (but not as bad as a torn tendon of course)
 

sstchur

Hall of Fame
How was the diagnosis (tendinosis) confirmed? I mean can MRIs confirm that? How confident was the doctor with his/her diagnosis?

How old are you? How old are you sstchur?
I'm 31. I played tennis in high school. I was also a weight lifter in high school and college. I'm not super tall or big (about 5'10"), but back in college, I was reasonably well built for my size. My lifting partner and I were dumbbell pressing with 80lbs dumbbells in each hand.

Fast forward 10 years. I don't lift weights anymore (haven't in many years). I picked up tennis again about 3 years ago. I've been playing regularly (about 2 to 3 times a week) since.

I had some elbow pain at first, but it went away (it wasn't tennis elbow).

I eventually got the shoulder pain and it has never gone away.
 

tennisenthusiast

Hall of Fame
I'm 31. I played tennis in high school. I was also a weight lifter in high school and college. I'm not super tall or big (about 5'10"), but back in college, I was reasonably well built for my size. My lifting partner and I were dumbbell pressing with 80lbs dumbbells in each hand.

Fast forward 10 years. I don't lift weights anymore (haven't in many years). I picked up tennis again about 3 years ago. I've been playing regularly (about 2 to 3 times a week) since.

I had some elbow pain at first, but it went away (it wasn't tennis elbow).

I eventually got the shoulder pain and it has never gone away.
Looks like we both are in the same boat. I am 31 and a soft. dev. I slouch a lot at work and have been trying real hard not to do that. I have recently got a keyboard tray and changed chair.

Based on my limited knowledge about these shoulder-related injuries, most of them can be prevented if proper preventative exercises/stretches are done religiously. I stopped going to gym well before I started playing tennis vigorously. By vigorous I mean 4 hrs-a-day/7-days-a-week. I am now paying the price with an overuse injury.

Something happened in September and I am still recovering from it. I stopped playing tennis completely since January and things seem to be settling down slowly. However I am not sure if I would be able to play again at the risk of aggravating subsiding pain/inflammation. God only knows when I will heal completely.

My frustration is I do not know what the problem area is. No one is able to give me a confirmed diagnosis. My shoulder blades ache (when I sit in front of desk for extended periods), have intermittent neck stiffness (people suggested that it might be Thoracic Outlet Syndrome (TOS)) which I believe is a confirmed diagnosis based on the symptoms I am exhibiting. But I do not know why my shoulder blades ache. I do not know if it there is a tear in brachioradialis muscle but that region manifests dull ache when I stretch my arms.

I cannot cycle, cannot bike, cannot swim...etc.
 

tennisenthusiast

Hall of Fame
Isn't tendinosis (different from tendinitis) bad news? Just the term "degeneration" itself is scary. Add that to the fact that it can take months to heal, and that's pretty much a tennis player's nightmare (but not as bad as a torn tendon of course)

i_hear_id, you are too young to have a degeneration. You should seriously get a second opinion. In the meantime you should stop playing tennis and any other physical activity that puts strain. These injuries are frustrating but you should be patient.
 
i_hear_id, you are too young to have a degeneration. You should seriously get a second opinion. In the meantime you should stop playing tennis and any other physical activity that puts strain. These injuries are frustrating but you should be patient.
Hmm...that's what my friend said too.

What do you think it could be though? The MRI showed a problem with a rotator cuff tendon, and they confirmed that it was not a tear. It should not be tendinitis because I've had it since July (so it's been 9 months).

I am one confused soul...
 
Continuing on my last post...

Does anyone know at what age tendinosis becomes a possibility? I read that 35+ years old is when you are at greatest risk. At age 17, is it impossible for me to get tendinosis, or just extremely rare?

Back when I got the injury, I was playing tennis probably 2-3 hours a day for 6 or sometimes 7 days a week. Practicing for my school tennis team, so was playing a lot. Like you two as well, I also slouch. Apparently that limits the space in the rotator cuff and can cause injuries easier...not quite sure.
 
Continuing on my last post...

Does anyone know at what age tendinosis becomes a possibility? I read that 35+ years old is when you are at greatest risk. At age 17, is it impossible for me to get tendinosis, or just extremely rare?

Back when I got the injury, I was playing tennis probably 2-3 hours a day for 6 or sometimes 7 days a week. Practicing for my school tennis team, so was playing a lot. Like you two as well, I also slouch. Apparently that limits the space in the rotator cuff and can cause injuries easier...not quite sure.
Tendonosis, like tendonitis, can vary from mild to severe.

Tendonosis certainly can occur at 17 in someone playing 2-3 hours a day, 6-7days a week. I would think that an MRI of many tennis players playing this much at this age, if really examined closely, would show early signs of tendonosis.


We don't think of it, but each arm weighs a about 10 pounds. "Slouching" forward can cause the weight of the arms to pull at the shoulder joint tendons and ligaments, and can "trap" the supraspinatus (the most superior of the rotator cuff muscles) tendon anteriorally against the coracoid process or acromioclavicular ligament. This can cause mild tendonitis or exacerbate tendonitis that is already present. This is also called the "impingement syndrome" because the head of the humerus [arm bone] is pushing or "impinging" on the supraspinatus muscle/tendon.


Tennis players develop a muscle imbalance where the forward hitting muscles get much stronger than the resisting or stopping muscles. This tends to cause a stretching of the non-elastic ligaments and tendons at the shoulder joint. Tennis players often develop the impingement syndrome, which includes supraspinatus (rotator cuff) tendonitis, and "looseness" around the joint.

Specific exercises need to be done to make the "resisting" or "braking" muscles stronger, to prevent the all too common overuse injuries that occur in tennis players . This set of exercises is known as the Thrower's Ten: http://www.asmi.org/SportsMed/throwing/thrower10.html
 
I'm 31. I played tennis in high school. I was also a weight lifter in high school and college. I'm not super tall or big (about 5'10"), but back in college, I was reasonably well built for my size. My lifting partner and I were dumbbell pressing with 80lbs dumbbells in each hand.

Fast forward 10 years. I don't lift weights anymore (haven't in many years). I picked up tennis again about 3 years ago. I've been playing regularly (about 2 to 3 times a week) since.

I had some elbow pain at first, but it went away (it wasn't tennis elbow).

I eventually got the shoulder pain and it has never gone away.
The pain indicates that clearly "something is not right".

You can and should request the medical records from your orthopods office. Reading them should give you a diagnosis of what the orthopod thought you had. Having the records can also help if/when you get a second opinion.

It sounds like you did not have a good experience with that orthopod. But "it takes two to tango". Did you really push the doctor for more of an explanation? Believe it or not, some people really could care less about trying to know the details of their problem - all they care about is to make it go away.


Some shoulder problems, like a severely torn labrum, recquire surgery if tennis or other shoulder stressing activities are planned on in the future.

But many tennis players problems do respond to "physical therapy". That is because the most common problem in tennis players is the muscle imbalance where the forward hitting muscles become stronger than the "stopping" muscles. Joint laxity then occurs with the impingement syndrome and supraspinatus (rotator cuff) tendonitis occurring.

As a former weight lifter, you probably find the physical therapy exercises relatively "wimpy".
That is because in the first phase, while active inflammation is present, the term "exercises" is really a misnomer. What is really being done is just range of motion "movements" designed to prevent scar tissue from forming (as a result of the inflammation) and ending up with a "frozen shoulder".
No more than these "movements" are done until the pain/inflammation subside. [There is no treatment, pill, ice to effectively decrease inflammation other than a cortisone injection, but that can interfere with later healing and strengthening.]

The next phase of shoulder physical therapy is very slowly building up the shoulder strength with a regimen like the thrower's ten: http://www.asmi.org/SportsMed/throwing/thrower10.html
The reason for going slowly is to prevent a quick recurrence of inflammation, which would mean having to start all over again from square one.

Only after getting significantly stronger in the "braking" or "stopping" muscles in back of your shoulder, should you even think to about playing tennis.

Return to tennis should be gradual, with short hitting sessions, and no serving for a long time. A flexible not-too-light frame with soft (natural gut or multifilament) strings should be used to absorb shock. If there is any chance that there may be problems in your technique, then it must be corrected or risk early recurrence, as is discussed in this USTA video on shoulder injuries: http://www.tennisresources.com/index.cfm?ATT=&area=video_detail&basicsearch=1&media_name=&rv=1&vidid=3712

Hopefully armed with additional information, you can now finally get to the bottom of what your problem is, and start getting better over the next few months.

Good luck!
 

sstchur

Hall of Fame
The pain indicates that clearly "something is not right".

You can and should request the medical records from your orthopods office. Reading them should give you a diagnosis of what the orthopod thought you had. Having the records can also help if/when you get a second opinion.

It sounds like you did not have a good experience with that orthopod. But "it takes two to tango". Did you really push the doctor for more of an explanation? Believe it or not, some people really could care less about trying to know the details of their problem - all they care about is to make it go away.


Some shoulder problems, like a severely torn labrum, recquire surgery if tennis or other shoulder stressing activities are planned on in the future.

But many tennis players problems do respond to "physical therapy". That is because the most common problem in tennis players is the muscle imbalance where the forward hitting muscles become stronger than the "stopping" muscles. Joint laxity then occurs with the impingement syndrome and supraspinatus (rotator cuff) tendonitis occurring.

As a former weight lifter, you probably find the physical therapy exercises relatively "wimpy".
That is because in the first phase, while active inflammation is present, the term "exercises" is really a misnomer. What is really being done is just range of motion "movements" designed to prevent scar tissue from forming (as a result of the inflammation) and ending up with a "frozen shoulder".
No more than these "movements" are done until the pain/inflammation subside. [There is no treatment, pill, ice to effectively decrease inflammation other than a cortisone injection, but that can interfere with later healing and strengthening.]

The next phase of shoulder physical therapy is very slowly building up the shoulder strength with a regimen like the thrower's ten: http://www.asmi.org/SportsMed/throwing/thrower10.html
The reason for going slowly is to prevent a quick recurrence of inflammation, which would mean having to start all over again from square one.

Only after getting significantly stronger in the "braking" or "stopping" muscles in back of your shoulder, should you even think to about playing tennis.

Return to tennis should be gradual, with short hitting sessions, and no serving for a long time. A flexible not-too-light frame with soft (natural gut or multifilament) strings should be used to absorb shock. If there is any chance that there may be problems in your technique, then it must be corrected or risk early recurrence, as is discussed in this USTA video on shoulder injuries: http://www.tennisresources.com/index.cfm?ATT=&area=video_detail&basicsearch=1&media_name=&rv=1&vidid=3712

Hopefully armed with additional information, you can now finally get to the bottom of what your problem is, and start getting better over the next few months.

Good luck!
Wow! SOOOO much of what you say rings true for me.

It's been a while since I've been to an orthodpod or a PT, but hearing you lay everything out, much of what they said came back to me (especially the PT) and you pretty much nailed it!

Yes, I was told that I need to strengthen the "braking" muscles (exact term she used). And the labrum was also mentioned. And yes, I do find the "exercises" wimpy. I feel like I'm doing absolutely nothing.

I think a big part of it is that I don't want to hear that this has to be long an gradual and involve not playing at all. That doesn't sound like fun.

Granted, some will argue that playing with pain isn't fun either, but I say it's more fun than not playing at all!

Edit: By the way, the thrower's ten was also something that the PT had mentioned.
 
Tendonosis, like tendonitis, can vary from mild to severe.

Tendonosis certainly can occur at 17 in someone playing 2-3 hours a day, 6-7days a week. I would think that an MRI of many tennis players playing this much at this age, if really examined closely, would show early signs of tendonosis.


We don't think of it, but each arm weighs a about 10 pounds. "Slouching" forward can cause the weight of the arms to pull at the shoulder joint tendons and ligaments, and can "trap" the supraspinatus (the most superior of the rotator cuff muscles) tendon anteriorally against the coracoid process or acromioclavicular ligament. This can cause mild tendonitis or exacerbate tendonitis that is already present. This is also called the "impingement syndrome" because the head of the humerus [arm bone] is pushing or "impinging" on the supraspinatus muscle/tendon.


Tennis players develop a muscle imbalance where the forward hitting muscles get much stronger than the resisting or stopping muscles. This tends to cause a stretching of the non-elastic ligaments and tendons at the shoulder joint. Tennis players often develop the impingement syndrome, which includes supraspinatus (rotator cuff) tendonitis, and "looseness" around the joint.

Specific exercises need to be done to make the "resisting" or "braking" muscles stronger, to prevent the all too common overuse injuries that occur in tennis players . This set of exercises is known as the Thrower's Ten: http://www.asmi.org/SportsMed/throwing/thrower10.html
Thanks! You explained that a lot better than my PT did. When i went to my physical therapist a few months ago, he also thought that it was the imbalance of muscles.

But I also had a question. Are those muscles tiny muscles inside the shoulder such as the supraspinatus, or is the imbalance of muscles the uneven ratio of chest (pecs) to back muscle?

Thanks
 
Thanks! You explained that a lot better than my PT did. When i went to my physical therapist a few months ago, he also thought that it was the imbalance of muscles.

But I also had a question. Are those muscles tiny muscles inside the shoulder such as the supraspinatus, or is the imbalance of muscles the uneven ratio of chest (pecs) to back muscle?
Thanks
The "forward throwing muscles" involve all the muscles around the shoulder and in the arm used in swinging forward. So that includes the chest muscles, triceps and internal rotatators of the shoulder. All these muscles fire every time you hit a serve or groundstroke, so they get stronger and stronger.
The muscles at the back of the shoulder, the scapula stabilizers, and the external rotators (including the rotator cuff muscles) all need to be strengthened with the thrower's ten.

The rotator cuff muscles by themselves are way too small to overcome all the forward force. The supraspinatus as the smallest of the rotator cuff muscles, really depends on the stronger surrounding muscles for its continued health and integrity. And even then, it depends on proper technique to prevent being "pinched" during the serve.
 
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The "forward throwing muscles" involve all the muscles around the shoulder and in the arm used in swinging forward. So that includes the chest muscles, triceps and internal rotatators of the shoulder. All these muscles fire every time you hit a serve or groundstroke, so they get stronger and stronger.
The muscles at the back of the shoulder, the scapula stabilizers, and the external rotators (including the rotator cuff muscles) all need to be strengthened with the thrower's ten.
Oh alright that makes sense.

Also, you mentioned "range of movements" exercises to prevent scar tissue (I heard tendinosis makes a lot of scar tissue), so what are some examples of these exercises?

And can you do them while you are "resting", or should I wait a few weeks before I start doing them. Thanks a bunch man.
 

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The "forward throwing muscles" involve all the muscles around the shoulder and in the arm used in swinging forward. So that includes the chest muscles, triceps and internal rotatators of the shoulder. All these muscles fire every time you hit a serve or groundstroke, so they get stronger and stronger.
The muscles at the back of the shoulder, the scapula stabilizers, and the external rotators (including the rotator cuff muscles) all need to be strengthened with the thrower's ten.

The rotator cuff muscles by themselves are way too small to overcome all the forward force. The supraspinatus as the smallest of the rotator cuff muscles, really depends on the stronger surrounding muscles for its continued health and integrity. And even then, it depends on proper technique to prevent being "pinched" during the serve.
But what would be the connection between all of this and a symptom (like I have) of this "tearing" (for lack of a better term) sensation I get in my bicep when I try to stretch the shoulder/chest area?
 
Wow! SOOOO much of what you say rings true for me.

It's been a while since I've been to an orthodpod or a PT, but hearing you lay everything out, much of what they said came back to me (especially the PT) and you pretty much nailed it!

Yes, I was told that I need to strengthen the "braking" muscles (exact term she used). And the labrum was also mentioned. And yes, I do find the "exercises" wimpy. I feel like I'm doing absolutely nothing.

I think a big part of it is that I don't want to hear that this has to be long an gradual and involve not playing at all. That doesn't sound like fun.

Granted, some will argue that playing with pain isn't fun either, but I say it's more fun than not playing at all!Edit: By the way, the thrower's ten was also something that the PT had mentioned.
It sounds like though you don't like it, you are willing to push through the pain, and continue to compete.

The quality of perseverence and succeeding despite adversity is much to be admired.

But this quality has to be tempered by a realization that you could be severerly shortening your tennis career. Indeed it could cause you to be "old" way before your time, if being "old" means you can no longer use your arm to pursue sports, or even do necessary chores around the house.

The continued pain means ongoing inflammation is present. The end stage of inflammation could mean eventual irreversible scarring, arthritis, or tendon rupture.

Is it really worth risking all of this if you could redirect your efforts with a strategy of rest, followed by strengthening exercises, followed by a return to pain free tennis?

Is an ounce of prevention now, worth a pound of cure later?
 
Oh alright that makes sense.

Also, you mentioned "range of movements" exercises to prevent scar tissue (I heard tendinosis makes a lot of scar tissue), so what are some examples of these exercises?
And can you do them while you are "resting", or should I wait a few weeks before I start doing them. Thanks a bunch man.
Unlike the knee and elbow which permit only flexion and extension, the shoulder allows for motion in multiple planes.

The idea behind the range of motion movements is to move your arm through all the normal motions that your shoulder is capable of. With just this information, you could then devise your own set of range of motion movements for the shoulder, but this web site will take you through them: http://ohiohealth.com/documents/orthopedics/L26_arm_range_of_motion_exercises.pdf

Because these movements are not done with weights, they should not stress the shoulder and should not cause added inflamation - unless - there is some more serious structural damage or really bad inflammation present.

So you should be able to do these movements now. If they are too painful, that is all the more reason to seek medical attention.

And as always, working with a a local "expert" therapist can give you instant feedback about when to step back and when to go forward with the next stage of rehab.
 
But what would be the connection between all of this and a symptom (like I have) of this "tearing" (for lack of a better term) sensation I get in my bicep when I try to stretch the shoulder/chest area?
If you look at that picture of the shoulder above, you can see that the [long head of the] biceps tendon wraps right over the top of the humerus [arm bone] and is inserted at the top of the labrum.

So the biceps can be involved in the impingement syndrome.

Indeed, the biceps tendon is at risk from the repetitive stress of hitting high topspin forehands and in serving.

Once inflamed, any stretching of the chest/shoulder area will stretch this tendon as it travels over the humerus, and can cause the kind of tearing/stretching pain sensation you describe.

Again, thankfully, this usually responds to rest, followed by strengthening exercises. But as always, the best results usually come from working with a local expert that can help guide you down the path of recovery.
 
The pain indicates that clearly "something is not right".

You can and should request the medical records from your orthopods office. Reading them should give you a diagnosis of what the orthopod thought you had. Having the records can also help if/when you get a second opinion.

It sounds like you did not have a good experience with that orthopod. But "it takes two to tango". Did you really push the doctor for more of an explanation? Believe it or not, some people really could care less about trying to know the details of their problem - all they care about is to make it go away.


Some shoulder problems, like a severely torn labrum, recquire surgery if tennis or other shoulder stressing activities are planned on in the future.

But many tennis players problems do respond to "physical therapy". That is because the most common problem in tennis players is the muscle imbalance where the forward hitting muscles become stronger than the "stopping" muscles. Joint laxity then occurs with the impingement syndrome and supraspinatus (rotator cuff) tendonitis occurring.

As a former weight lifter, you probably find the physical therapy exercises relatively "wimpy".
That is because in the first phase, while active inflammation is present, the term "exercises" is really a misnomer. What is really being done is just range of motion "movements" designed to prevent scar tissue from forming (as a result of the inflammation) and ending up with a "frozen shoulder".
No more than these "movements" are done until the pain/inflammation subside. [There is no treatment, pill, ice to effectively decrease inflammation other than a cortisone injection, but that can interfere with later healing and strengthening.]

The next phase of shoulder physical therapy is very slowly building up the shoulder strength with a regimen like the thrower's ten: http://www.asmi.org/SportsMed/throwing/thrower10.html
The reason for going slowly is to prevent a quick recurrence of inflammation, which would mean having to start all over again from square one.

Only after getting significantly stronger in the "braking" or "stopping" muscles in back of your shoulder, should you even think to about playing tennis.

Return to tennis should be gradual, with short hitting sessions, and no serving for a long time. A flexible not-too-light frame with soft (natural gut or multifilament) strings should be used to absorb shock. If there is any chance that there may be problems in your technique, then it must be corrected or risk early recurrence, as is discussed in this USTA video on shoulder injuries: http://www.tennisresources.com/index.cfm?ATT=&area=video_detail&basicsearch=1&media_name=&rv=1&vidid=3712

Hopefully armed with additional information, you can now finally get to the bottom of what your problem is, and start getting better over the next few months.

Good luck!
I have a question about that bolded part.

If the doctors say that due to my tendinosis, there might be some scar tissue forming, how can I stop that? I heard therapeutic ultrasound works but I really have no idea.
 
I have a question about that bolded part.

If the doctors say that due to my tendinosis, there might be some scar tissue forming, how can I stop that? I heard therapeutic ultrasound works but I really have no idea.
There is no way to really stop "scar" formation from occuring to at least some extent as part of the inflammatory response. With inflammation, white blood cells at the area release chemicals (chemo-attractants) that attracts the type of cell (fibroblasts) that makes the proteins (fibrin, collagen) involved in scar tissue.

That is why REST is so important to let the inflammation subside.

Range of motion "movements" prevent the "scar tissue" from sticking to muscles, ligaments, tendons, bone and cartilage. Otherwise, the "scar tissue" will bond all these structures together so they can't move normally past each other. (When all these structures do bond together, a "frozen joint" results.)


Ultrasound represents a form of energy that can warm the area so that movement may be easier. At higher energy levels, it may even help break down some scar tissue - but this is very tricky, because the higher energy levels can also result in internal "burns" that could trigger more inflammation, and ultimately more scar tissue.


Cortisone injections can essentially halt the inflammatory process, and hence "scar formation". But cortisone also stops the healing process, with scar tissue being a natural part of the healing.


It is important to realize the initial trigger for all this was that microscopic tears in your tendon at the elbow (likely due to tennis) was the reason the inflammation started in the first place. The tendon is largely collagen, the same material of "scar tissue". But the collagen that results from inflammation it is not laid down in the same nice orientation as in your highly structured original tendon fibers. The somewhat disorderly array of the collagen is able to be picked up on an MRI. (Over time (months) your body has the amazing ability to better and better align and crosslink the collagen making it more and more like your original tendon structure!)


So the biggest takehome measure is that the simple things here work the best, and are the most powerful treatment you can use. That is, REST with some range of motion movement initially, followed by strengthening exercises when the inflammation/pain subsides. There then has to be some rest built into your tennis routine so you do not have an early recurrence.

And the best, most powerful way of preventing overuse injuries of other tendons of the shoulders or knees is off court conditioning, and treading the fine line between practice and rest. Believe me, every single pro has to build rest into their routine, or they all would be out with injury. (And I think you can see that all-too-many push it just a little too far and lose their source of income when they do suffer an overuse injury.)

If you want to read more, I highly recommend the USTA easy-to-read 40 page booklet on Recovery in Tennis http://www.usta.com/tennisrecovery/
 
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