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View Full Version : Extreme Pain Pressing and Lowering from Overhead


James Mazurek
07-11-2010, 11:48 AM
I've been doing CrossFit for about 5 months and I've made some great gains. However recently my right shoulder has been a major limiting factor in WODs. No real problems with pullups, rowing and even pushups (although a little sore), but the pain has been excrutiating when doing anything with an overhead press. The pain is in the front portion of the joint capsule and it hurts both extending the arms and even worse when lowering the weight. I've also realized that I'm pretty much unable to throw anything without the pain being extreme so playing many sports is pretty much ruled out too.

I don't want to have to take an extended break from working out if it's possible to improve this with stretching, etc. Anyone have any ideas on what causes this and if I have any options besides seeing a doctor? Is this tendonitus? Or a potential serious injury?

Any advice is much appreciated!

Jim

Rob St. Croix
07-11-2010, 04:39 PM
That describes exactly the symptoms I had. It was originally misdiagnosed as tendinitis in the shoulder, but later turned out to be a SLAP tear. I would seek the consultation of a Medical Professional because if it is a SLAP tear, the more you use it, the worse it will get and the harder it will be to fix, and more painful and longer the recovery.

In my own case, once I complained that the PT for tendinitis I was told to do wasn't working, and in fact felt like it hurt more, I saw another doctor who immediately gave me a cortisone injection in my shoulder. The idea is that if the pain goes away almost immediately, it was in fact tendonitis, if not, then it's not tendonitis and I should get a MRI ASAP. Well, needless to say, I got a MRI (2) days later and I had a severe SLAP injury.

I hope you just have tendonitis or something even less severe. The good news is though, while the recovery sucks... you can recover!

Steven Low
07-11-2010, 08:22 PM
See an orthopedic doc.

Based on your description I'm thinking severe biceps tendonitis, partial biceps tear, or SLAP lesion like stated above.

James Mazurek
07-12-2010, 06:04 AM
Thanks to both responders. I have an appointment with an ortho this week but honestly was expecting a standard rest/PT plan. Armed with at least the info you've given I can ask better questions.

Rob, what did the recovery entail? Was it surgical? PT? Just wondering what I'm in for if indeed it is this SLAP injury you describe.

Thanks!

Jim

Rob St. Croix
07-12-2010, 03:21 PM
Rob, what did the recovery entail? Was it surgical? PT? Just wondering what I'm in for if indeed it is this SLAP injury you describe.

Jim

To make a long story short... Once the Ortho was able to go in and look around, she discovered that I had not only a front SLAP tear, but a rear one as well...and it was worse than the MRI revealed. I ended up getting (3) anchors in total. My shoulder was immobilized in a sling for (6) weeks, after which the Physical Therapist (PT) slowly started to manually move my shoulder and then at about the (3) month mark, I began to start to start doing PT under my own power.

By (6) months I had 98% of my motion back. I still have trouble getting my right arm back far enough to do a dumbbell snatch while keeping my heels planted, though its getting better. Because of how the surgery works, things are tighter than they were before.

My strength is not yet what it was, but that is due to the fact that I basically had to wait (9) months while I was in Iraq before I redeployed to get the surgery and during that time I was not able to do any upper-body (cause it would aggravate the SLAP tear). My legs are real strong now though!

James Mazurek
07-14-2010, 09:36 AM
Well, went and had an X-Ray today all normal....MRI tomorrow. On a positive note did 135# 7x7 thrusters yesterday and it didn't feel good but not horribly bad.....almost seems like the work made it feel better....I guess I'll know more after the MRI

Steven Low
07-14-2010, 08:29 PM
Well, went and had an X-Ray today all normal....MRI tomorrow. On a positive note did 135# 7x7 thrusters yesterday and it didn't feel good but not horribly bad.....almost seems like the work made it feel better....I guess I'll know more after the MRI
Don't aggravate it. Don't work through pain.

If warming it up helps then it MAY just be a bad bad case of chronic tendonitis.... so that's a positive I guess. But seriously... don't work through pain or do anything that aggravates it.

James Mazurek
07-16-2010, 06:19 AM
Steven,

Yes, that is sound advice. I had an X-Ray (negative) and MRI this week. I'm anxious to get the results next week.

I'm hopeful but we'll see

Steven Low
07-16-2010, 03:16 PM
I hope they did a contrast MRI otherwise it might not be detailed enough...

James Mazurek
07-22-2010, 06:39 AM
Got MRI results. I'm no doctor but I think it's better news than I was maybe expecting.

Interpretation - Moderate to severe tendinosis of the supraspinatus and anterior infrspinatus contributions fo the rotator cuff. These findings are likely in association with partial tearing :yikes: as well of the very anterolateral infraspinatus constituent comprising approximately 50% thickness of the cuff at its bursal aspect. Very mild tendonosis of the superior subscapularis component of the rotator cuff is noted. There is no complete rotator cuff tear. The acromioclavicular joint is unremarkable. The anteriro acromion diplays a Type I configuration. There is no anterialr or lateral acromial downsloping. Nor bursal effusion or thickening is seen. There is no muscular tear, contusion or atrophy.

There are no fractures or regions of abnormal bone marrow signal.

The biceps tendon is normally situated. No complete or partial biceps tendon tear is present

There is noglenohumeral joint effusion or focal hyaline cartilage defect. No Hill-Sachs, reverese Hill-Sachs, or bony Bankart lesions are seen. There is no SLAP lesion or soft tissue Bankart lesion. There are no paralabral cysts. No capsula or ligamentous pahology is seen.

So those are the results. The Dr. said he could offer a cortisone injection, PT, or arthroscopic surgery but that it was kind of a gray area due to the tear only being about 50%. He said some people do fine with that while others end up eventually tearing it and requiring surgery.

Since I did 135# thrusters in a WOD last week I'm pretty confident my shoulder will hold up if the swelling/pain subsides. I chose the cortisone for now but told him if it didn't help that I'd want to look into surgery to fix it so I can have the ability to CrossFit as well as engage in sports and activities with my son.

Any thoughts out there on whether this was more or less a decent call on my part?

Steven Low
07-22-2010, 07:34 PM
Hmmm the fact that there's no edema means that there is likely very little inflammation.

This is backed up by the fact that it's tendonosis (chronic) in which there's no inflammation of the tendinous area and only chronic degeration instead.

Cortisone does help with the pain, but it's not a solution.

Your best bet is to go with eccentric exercise rehab protocol... or some other solutions that help tendonosis such as nitric oxide patches, maybe prolotherapy or autologous blood injection/platelet rich plasma.

John Stone
07-23-2010, 11:47 AM
Is that (50% tear) the sort of thing that can/will heal with RICE and time, or will it always be a problem no matter what?

Steven Low
07-23-2010, 11:11 PM
Is that (50% tear) the sort of thing that can/will heal with RICE and time, or will it always be a problem no matter what?

If there was some inflammation it may scar over with some scar tissue, but since there's none (tendonosis) it's unlikely that it's going to even scar over and help stabilize the tendon.

The good thing is that some people can function well with 50% of tendon.... but some people it just degenerates more and tears like your doc said.

You can always go conservative and see if it heals up fine, or you can talk wth your doc about surgery. Its ultimately up to you what you feel would work best here... theres no real right or wrong answer.

Personally, I'm a fan of non-surgery as much as possible though

James Mazurek
07-24-2010, 12:57 PM
I'm with Steven in trying to avoid a surgical option. I figure if the cortisone and rest alleviate the pain and I can get back to how I was a month or two ago all will be fine. If instead I tear it the remaining 50% than the decision is made for me and I'll be under the knife either way.

After 2 days it feels better....not amazing but definitely better. I guess I'll have a better idea how the corstisone is doing this week.

Steven Low
07-24-2010, 08:58 PM
Remember, cortisone only relieves the pain there. You will still have to do rehab work (not just rest) during this period...

Nitric oxide patches tend to work but its subacromial unlike other tendonosis.. so i'm not sure if that will be as helpful. The only thing that is fairly "proven" is eccentric exercise so you're probably going to do have to do some light supraspinatus slow eccentrics to start helping out.