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Old 03-05-2009, 12:03 AM   #1
Patrick Brown
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Shoulder injury, pain at bottom of pullup

I injured myself in Nov. '08. I'm not sure how exactly, it was either heavy overhead squats, a set of deadhang pullups, or a max effort set of ring dips.

The initial pain I experienced was in the front of my shoulder and was associated with pullups (I didn't experience any pain in the above mentioned workouts). At the bottom of the pullup, when hanging, I felt a sharp pain. When I initiated the movement, I would feel a popping sensation and experience significant pain. I also experienced a sharp pain when reaching overhead, more toward the back of my shoulder. When I was not hanging or reaching, I still had pain in my shoulder, but to a much lesser degree. I also felt tightness and the need to stretch in the area between my shoulder blade and spine. I have not done pullups since early November, and since early January I have been avoiding all shoulder involved exercise movements.

I have seen an othopedic doctor/surgeon and an ART and HMT certified Chiro. The Ortho Dr. diagnosed me with shoulder impingement. He prescribed naproxen for two weeks, after that didn't help, he gave me a cortisone injection in the back of my shoulder. The injection was about 4.5 weeks ago. That helped with the general pain, but not the pain associated with a pullup. For example, I can hang on the bar without much of a problem, but as soon as I start the pullup, I feel the popping and pain. Also, if I swing forward as if starting a kipping motion (and my arms go back behind my head) I experience pain. I did a few green band dead hang pullups yesterday, and still felt the popping and a bit of pain. I could avoid the pain if I started the pullup with a tight/flexed shoulder, but if I "let go" and hung without the flexion, i would feel the pain. Definitely cant do kipping pullups.

I was able to palpate the front of my shoulder and could create similar sensations to the pullup pain. I feel like there is a problem in the front of my shoulder that the Dr. didn't address or diagnose, different from the shoulder impingement he treated with the shot. Basically, I feel like the initial problem, pain during pullups, has not changed after all the rest and treatment.

Could there be some other dysfunction besides the impingement? Or should I expect to wait longer for any improvement? Any advice, suggestions?

Thanks
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Old 03-05-2009, 08:30 AM   #2
Bryan Gates
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Re: Shoulder injury, pain at bottom of pullup

If you have been able to function pain free before than it is most likely tightness in your rotator cuff caused by injury/triggerpoints or cessation of regular stretching.

If you have not been able to function pain free then your rotator cuff is inflexible and needs stretched out.

The fact that you can touch spots and produce pain leads me to beleive that it is an injury/triggerpoint. Pain at the back of the shoulder typically points to the subscapularis, teres minor/major, and possibly the supraspinatus. Pain in the front of the shoulder points to the infraspinatus and possibly the supraspinatus. The rotator cuff is one of those spots where massaging the area that hurts may not solve the problem as they all tend to refer pain away from the actual problem spot. You wont know what to actually hit until you put some pressure on it. Also if you put enough pressure on it you should feel the referred pain flare up. Its not fun but it helps confirm that that is the problem spot.

You can check your entire rotator cuff using the instructions below.

1. Reach your opposite hand over your shoulder and locating the scapula. Locate the spine of the scapula. Search the small area above the spine of the scapula with your fingers. If you have pain in this area it is the Supraspinatis.

2. Take a tennis ball or some other hard rounded object and place it below the spine of the scapula. Roll it over the entire surface of the scapula below the spine of the scapula. If you have pain in this area it is the infraspinatis.

3. In the same positioning as 2 roll to the outer edge/off of the scapula. If you have pain here it is either the Teres minor/major or perhaps the long head of the tricep. If you roll off the bottom point of the scap and feel pain its probably the lat.

4. Bring your arm with the hurt shoulder across the front of your body such that the scapula shifts to the outside of your body and the underside can be accessed with your fingers/knuckles. Probe the area under the scapula for tender spots. If you have pain here it is the subscapularis.
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Old 03-05-2009, 10:22 AM   #3
Patrick Brown
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Re: Shoulder injury, pain at bottom of pullup

Thanks for the response.

So the popping I feel in the front of my shoulder could be related to the infraspinatus or supraspinatus?

The ART Chiropractor went over the back of my shoulder pretty thoroughly. She found some problem areas and really laid into me at some points. She helped the pain I felt in the back of my shoulder, but she didnt affect the pain in the front.

One thing I forgot to mention was that the majority of the pain I feel is when I use a wide overhand grip. An underhand grip, especially a narrow one, does not cause the pain I feel on the wide overhand. Not sure if that makes a difference.

You are telling me basically what the doctors are saying, but since treatment hasn't been working, and my problems are in the front of the shoulder, I feel like it might be something else. Of course, the more I learn about the shoulder, the more I find out that many of the complexities of the joint are still beyond me. And I guess I'm just being hopeful that there is something the Dr.s missed so I can get that treated and start seeing improvements. Not being able to do pullups right now is the bane of my existence!!

Thanks again for your input.
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Old 03-05-2009, 11:29 AM   #4
James Mazzarisi
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Re: Shoulder injury, pain at bottom of pullup

I think you're having subluxation. I just posted a new thread as mine slightly acted up. A subluxation is like a minor dislocation. It basically pops out but pops back in. The tendons/ligaments holding the joint in socket have probably weakened. The sharp pain you fell is probably the joint going in and out of place. Did you have an old injury. Mine was an old football injury that I've reaggravated maybe 5 times over the years. Ice it during the acute phase, and then once the pain has subsided and the range of motion has returned, add shoulder rehap exercises to your daily warmup ritual and do them for the rest of your life. Over time ot should strengthen. Mine was reinjured basically pushed to hard and/or wasn't adequately warmed up.
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Old 03-05-2009, 01:21 PM   #5
Patrick Brown
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Re: Shoulder injury, pain at bottom of pullup

This is a new injury. I was not doing anything I had not already done when the injury occured. Is there a test for subluxation?

Thanks

Last edited by Patrick Brown; 03-05-2009 at 01:26 PM..
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Old 03-05-2009, 05:43 PM   #6
James Mazzarisi
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Re: Shoulder injury, pain at bottom of pullup

You'll know if there's a subluxation problem. You can basically feel it go in and out and it hurts horiibly for that brief second or two, then it is sore and unstable for a few days, and will remain so if not attended to. Basically if you feel you're shoulder will pop out when you do pushups, dips, push press, etc., you likely have a subluxation problem. The fact that your's is occuring on a "pull-type" exercise is a bit different, nut not unheard of.
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Old 03-05-2009, 07:39 PM   #7
Steven Low
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Re: Shoulder injury, pain at bottom of pullup

Do massive amounts of massage and tennis ball rolling of ALL the muscles in your shoulder and scapulae.

Ice if there's swelling and pain. External rotator cuff work.

Avoid exercises that hurt.

If it's muscular or imbalanced that should help. Otherwise, might be an injury to something else...... if so, might want an MRI.
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Old 03-06-2009, 06:36 PM   #8
Jake Thompson
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Re: Shoulder injury, pain at bottom of pullup

If I had to guess I would say its the long head of your biceps. Its truly a pain in the A$$, and difficult to fix. Which is why the professionals you have gone to have not fixed it to your satisfaction.

The ortho is correct, impingement but he assumed it was the wrong structure. That is if I am right of course.

DId the ART practitioner release your subscapularis?

Wide grip vs. close supinated? The close supinated (chin up) grip actually clears the long head of you biceps from under the acromion which is most likely why you can perform it, compared to wide grip where you are cramming the humeral head into the acromion where the long head originates.

http://shoulderpaininfo.com/shoulderBicepsTend.html WFS
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Old 03-06-2009, 08:15 PM   #9
Steven Low
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Re: Shoulder injury, pain at bottom of pullup

Jake:

Why would you think long head of the biceps?

Just curious.
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Old 03-07-2009, 06:16 AM   #10
Jake Thompson
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Re: Shoulder injury, pain at bottom of pullup

Just a guess like I said.

A competent ortho can diagnose a SLAP lesion with close to the same accuracy as an MRI without contrast. So, I assume that is ruled out.

The rest comes from the history and anatomy.

Without evaluating him myself, difficult to diagnose for certain. After a while you start to get a feeling about where the history leads you, and what others have already ruled out. Again I am basing that on the fact the others are competent?
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