Seeking a 'guess' :)

[Matt A. Windsor]

Have seen Mr. Low ask enough of these questions that I thought I'd pre-empt by answering them at the outset. Doc says I have 'biceps tendonitis,' so yeah, that's obvious; I guess what I'm seeking is a 'swag' (scientific wild @$$ guess) as to the probability of it being something like a labral tear. I've always been the one who feels 'some pain' and then we find out I've got damage. Anyways:

1. Google a pic and mark where it hurts. For the computer illiterate (use MS paint to mark it, and imgur.com to upload). Tell me what tissue(s) it feels like it's hurting in, or if it's more superficial or deep in the joint?

It's already fairly obvious where it is, being as the doc diagnosed me with biceps tendonitis. If the top of my shoulder is the 12 o'clock position, then it hurts from about the 12 to the 4 o'clock position, deep within (e.g., 'the joint.')

2. What exercises hurt? Which shoulder articulations hurt? Make sure you check both with passive motion (you moving the leg without it moving itself) and resistive/active motion (you moving it, and you moving it against force). Also tell me when and what movements during these exercises are eliciting the pain?

Pretty much anything requiring, ah, what did my wife call it....arms extended and abducted, and overhead (unless directly overhead). E.g., heavy snatches (more than 135#) would hurt, and ANYTHING requiring a widegrip overhead or partially overhead grip, such as OH squats, squat snatch, handstand pushups, etc. In other words, anything where my arm is at an angle.

It's not just weights, though. For instance, if I'm on my left side, and lift myself on that arm (say, if I was actually lying my head ON my arm, and used my upper arm to lift myself up to turn over or something), that causes the same kind of pain.

3. What type of pain is it? Burning? Ache? Tingling? Sharp?

Would probably say burning/somewhat sharp.

4. What would you rate the pain at on a 0/10 scale? 0 being no pain, 10 being go to the emergency room.

Normally about a 0 or 0.5, unless I do what hurts it, at which point it's anything from a 3 to a 6.

5. Acute or chronic (chronic more than ~8+ weeks)? What date was onset? How has the pain improved since the initial injury?

Chronic; tough to say when onset was, because I can (unfortunately) easily ignore pain. I'd say I've had it for a few months, but only seriously noticed it soon as I began to CrossFit about a month and a half ago, when I began doing OH movements and the like. Pain has not improved.

6. Have you been training through pain? If so, how long?

No; I still CrossFit, but if it hurts, I don't do it. I find an alternate activity.

7. What have you been doing for recovery purposes? Do these recovery methods help?

Staying away from OH movements requiring anything more than, say, the olympic bar; have also done some icing, taken aspirin, etc. Generally, no.

8. What seems to help? What seems to make it worse? Is it constant? Does it increase/decrease with certain activities?

In order of questions: Not doing movements that hurt it; DOING movements that hurt it (as outlined above), it's not constant unless I aggravate the crap out of it, and it increases with any OH movements requiring weight.

9. Check the tissue quality of the surrounding muscles. Which ones are tight? Which ones are tender? Is there any swelling?

Pain/tenderness where the tendon joins the shoulder; confirmed by the doc and by my massage therapist (also a former EMT). The muscles generally are alright unless I use it a LOT, in which case the pain/tenderness radiates down my biceps.

10. How does it feel after exercise (if any)? How does it feel at the beginning of the day? How about the end of the day?

Fine, so long as I don't do the things I shouldn't do.

11. Any previous injury history?

To the shoulder? Subacromial decompression and acromioplasty on the same shoulder in 2007. That part is fine - e.g., the pain type/area for that problem is no longer existent; this pain is in a different part of the shoulder.

To other body parts - L5/S1 microdiscectomy in 2005, bilateral carpal release and left first dorsal release in 2006, left subacromial decompression and acromioplasty in 2007, right subacromial decompression and acromioplasty in 2008, and part of my left lateral malleolus was removed in December 2010 after it was discovered an injury in May 2010 had actually completely broken it off.

12. How's your posture?

Probably could be better - posture is alright when I'm standing, but my shoulders may be thrown forward some of the day, as I am an IT specialist.

13. What is your current workout routine for that bodypart? Do you play any sports?

Pretty much unlimited CrossFit WoDs - whatever is scheduled for the box that day. EXCEPT that ANYTHING requiring OH movements is dropped by at least 50% regardless; and if there's pain, then I flat out don't do that exercise.

[Steven Low]

Was your doc an orthopedic doc?

It really does sound like you may potentially have a SLAP lesion or labral tear.... and it's possible that you can have both of those with biceps tendonitis.

Might not be a bad idea to get a second opinion. There are some specific SLAP lesion tests that an ortho or PT or qualified professionals can do on you.

[Matt A. Windsor]

Originally Posted by Steven Low

Was your doc an orthopedic doc?

No, sports medicine doc. Which is part of the reason why I wanted a bit of 'backup knowledge' by requesting a guess here.

It really does sound like you may potentially have a SLAP lesion or labral tear.... and it's possible that you can have both of those with biceps tendonitis.

Might not be a bad idea to get a second opinion. There are some specific SLAP lesion tests that an ortho or PT or qualified professionals can do on you.

I might just do that; I will say that while I'm not sure specifically what tests you mean (unless you're referring to specific abductions, arm movement tests and the like); and every time he said "If you have or might have ____, this might hurt" it did indeed hurt.

Then at the end he says "If you have a labral tear or biceps tendonitis, it should hurt HERE" and presses his thumb into my shoulder. After he pried me off the ceiling I agreed that it did hurt. I felt like saying "If you have nads, it should hurt when I kick HERE..."

I originally went to see him April 2nd or something; he prescribed '4 weeks of physician directed physical therapy' (in other words, 4 weeks of the band stretches, 50% reduction in max weights during CrossFit, and stay away from anything that hurts the shoulder) to satisfy insurance requirements. I go back May 5th and if it's not getting better (which it's not) an MRI with contrast is scheduled.

Considering this....should I continue, or would it be advisable to seek out my own appointment with an orthopedic surgeon?

[Steven Low]

Well, it sounds like he did put you through a bunch of the specific tests to try to determine some of the issues.

If it's been getting a bit better the second opinion may not be a bad idea though because if you went right after it started getting really bad any palpation and movement could hurt and it may not be what is actually messed up if anything.

So, second opinion would seem like a good idea to me, especially before any type of surgery.

Though, MRI with contrast would indeed show if there's any structural damage.

So it's your chocie there.

[Matt A. Windsor]

I would say that it's not gotten better at all. Sure, if I do NOTHING, the pain doesn't hurt; but I define 'nothing' as just standing there with arms @ my sides.

Problem is, that's not real life. One has to lift arms over their head in real life and so on and so forth...and I have to say that I've noticed that the pain has very little to do with weight and almost EVERYTHING to do with position. E.g., if you take your arms, hold them parallel to the ground, bend @ the elbows so your forearm is perpendicular to the ground, and then rotate your left arm so your upper arm is still parallel, and your forearm is now facing forward and also perpendicular, that hurts the joint. That's with no weights or anything.

I know it got 'worse' when I started doing the overhead movements; but if I'm honest with myself, I think all I did was 'expose' the pain. E.g., I've got a VERY high pain threshhold, and it's easy to ignore some pain. I can say I've had pain in my joint for months...but it's been simply very low level. I hadn't worked out in the last year or two until February.

I'm leaning towards the MRI ONLY because it will show damage, and probably because any orthopedic guy will want one, I think.

[Steven Low]

The MRI might be a good option then.

Though I'm kinda wary since he suggested biceps tendonitis whiel it seems like it might be SLAP or something. But either way MRI would be useful there.

[Matt A. Windsor]

Originally Posted by Steven Low

The MRI might be a good option then.

Though I'm kinda wary since he suggested biceps tendonitis whiel it seems like it might be SLAP or something. But either way MRI would be useful there.

Wary of continuing with the guy? If so, I don't plan on continuing treatment with the guy. I mean, yeah, I'll go back to him for reevaluation on the 5th, to get the MRI, but considering what might have to be done (either a SLAP repair or a biceps tenodesis, I think), I'll probably be seeking a doctor out who's well known in the field; I want to continue lifting as much as possible (after the repair, of course).

[Steven Low]

Well, either way, you want someone who's done thousands of whatever surgery you need IF you need surgery. So if he's not the guy then you can see someone else.

[Matt A. Windsor]

Originally Posted by Steven Low

Well, either way, you want someone who's done thousands of whatever surgery you need IF you need surgery. So if he's not the guy then you can see someone else.

Good point. Regardless of the outcome, I believe I will begin 'shopping around' for an actual ortho. Thanks for the advice.

[Daniel Pope]

Cool thread,

I'm curious what your 4 weeks of PT looked like. You said it made no difference? Did the PT do a full eval and come up with his/her own diagnosis/thoughts?

All they did was band stretching? No Manual Therapy? No strengthening?

Dan Pope