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Old 01-31-2010, 06:59 PM   #1
Alex Curtis
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Popping in joints

To kind of explain the background of the situation, I will say this. I had surgery for a labral tear about 7 months ago and prior to this situation I was still doing physical therapy on BOTH sides which involved mainly external rotation and scaption. This was on top of studying over a desk many hours every day (bad posture perhaps). On to the actual problem...

About a month and a half ago I woke up with a feeling of tingling down my arm into my fourth and fifth fingers (ring, pinky). I had all my strength and there was never any pain but basically it was annoying and felt odd. I don't really even know how to describe it. Starting at this same time, I noticed my shoulder popping. It would pop every time I did transverse abduction and straight up abduction. It would pop when I did larger diameter reverse arm circles. I basically noticed this and it was very annoying. The tingling/odd sensations subsided for the most part when I took tylenol regularly for a week and a half and stopped all exercises. After all of this I ended up going to a sports medicine doctor who couldn't find a problem. My shoulder still felt odd and popped all the time. I went to a physical therapist and they gave me some exercises for poor posture and told me to keep doing the external rotation and scaption (as well as y's and t's) and it seems to be helping a little bit but I still have this restless feeling across my shoulder. I also noticed that more joints started popping (shoulder, elbow, wrist, neck, chest) and even joints on the other side occasionally pop. I've started doing some trigger point work on my own and it seems to be helping but am I doing the right thing?! I'm worried because the popping doesn't seem to really be going away. Sorry for the essay haha and I appreciate all help GREATLY. Thank you so much.

(Edit: Forgot to mention that the shoulder popping is MUCH more frequent during backwards arm circles if my elbow is bent at 90 degrees. Not sure if that is important but I want to include that)

Last edited by Alex Curtis; 01-31-2010 at 07:07 PM.. Reason: Forgot Information
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Old 01-31-2010, 07:15 PM   #2
Steven Low
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Re: Popping in joints

Quote:
Originally Posted by Alex Curtis View Post
To kind of explain the background of the situation, I will say this. I had surgery for a labral tear about 7 months ago and prior to this situation I was still doing physical therapy on BOTH sides which involved mainly external rotation and scaption. This was on top of studying over a desk many hours every day (bad posture perhaps). On to the actual problem...

About a month and a half ago I woke up with a feeling of tingling down my arm into my fourth and fifth fingers (ring, pinky). I had all my strength and there was never any pain but basically it was annoying and felt odd. I don't really even know how to describe it. Starting at this same time, I noticed my shoulder popping. It would pop every time I did transverse abduction and straight up abduction. It would pop when I did larger diameter reverse arm circles. I basically noticed this and it was very annoying. The tingling/odd sensations subsided for the most part when I took tylenol regularly for a week and a half and stopped all exercises. After all of this I ended up going to a sports medicine doctor who couldn't find a problem. My shoulder still felt odd and popped all the time. I went to a physical therapist and they gave me some exercises for poor posture and told me to keep doing the external rotation and scaption (as well as y's and t's) and it seems to be helping a little bit but I still have this restless feeling across my shoulder. I also noticed that more joints started popping (shoulder, elbow, wrist, neck, chest) and even joints on the other side occasionally pop. I've started doing some trigger point work on my own and it seems to be helping but am I doing the right thing?! I'm worried because the popping doesn't seem to really be going away. Sorry for the essay haha and I appreciate all help GREATLY. Thank you so much.

(Edit: Forgot to mention that the shoulder popping is MUCH more frequent during backwards arm circles if my elbow is bent at 90 degrees. Not sure if that is important but I want to include that)
Posture is huge. When stuff is out of place in general it will start to crack and pop. When my neck is too forward I can crack it, but when it is in perfect alignment it won't.

Check your internal rotation. How far can you get with the behind the back internal rotation or sleeper stretch (angle)?

Do you have any strength or muscle imbalances? Very tight chest/lats?

I would also get some deep tissue massages. That will likely help as well.


I am writing an article on this and how to evaluate, but it won't be up for another couple weeks probably.
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Old 01-31-2010, 07:27 PM   #3
Alex Curtis
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Re: Popping in joints

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Originally Posted by Steven Low View Post
Posture is huge. When stuff is out of place in general it will start to crack and pop. When my neck is too forward I can crack it, but when it is in perfect alignment it won't.

Check your internal rotation. How far can you get with the behind the back internal rotation or sleeper stretch (angle)?

Do you have any strength or muscle imbalances? Very tight chest/lats?

I would also get some deep tissue massages. That will likely help as well.


I am writing an article on this and how to evaluate, but it won't be up for another couple weeks probably.
My internal rotation is fine. Sleeper stretch too. The PT actually told me to do sleeper stretch and I was doing it properly and getting pretty far down. On top of that he checked IR the last time I went in and he said I could stop the sleepers. I actually got a deep tissue massage and that didn't seem to do much. Perhaps the therapist just sucked but I'm not sure.

For a week or so my lats felt incredibly tight. Actually, scratch that. I'm not sure if it was the lats but something in my armpit region felt incredibly tight and with massage and stretch I seem to have loosened it up but that was just recently so I'm not sure. Chest could be tight. To be honest I just started doing doorway chest stretches because I didn't think it was super tight and we'll see if that helps a lot.

I have been working adamantly on my posture and I seem to be making large improvements there. One thing I noticed is that the rear part of my shoulder seemed to atrophy a little bit when the tingling subsided. It was never really bony before because I had a decent amount of muscle on it but you could start feeling the bone a little bit. This could easily be a postural thing because it has definitely started subsiding. One more thing I forgot to mention, the clicking happens louder when I flex my whole arm during stuff like arm circles and transverse abduction. It feels like it could be coming from the posterior deltoid but that could be my mind tricking me.

Thank you for your help Steven you seem to be incredibly knowledgeable about stuff like this.
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Old 01-31-2010, 07:35 PM   #4
Steven Low
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Re: Popping in joints

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Originally Posted by Alex Curtis View Post
My internal rotation is fine. Sleeper stretch too. The PT actually told me to do sleeper stretch and I was doing it properly and getting pretty far down. On top of that he checked IR the last time I went in and he said I could stop the sleepers. I actually got a deep tissue massage and that didn't seem to do much. Perhaps the therapist just sucked but I'm not sure.

For a week or so my lats felt incredibly tight. Actually, scratch that. I'm not sure if it was the lats but something in my armpit region felt incredibly tight and with massage and stretch I seem to have loosened it up but that was just recently so I'm not sure. Chest could be tight. To be honest I just started doing doorway chest stretches because I didn't think it was super tight and we'll see if that helps a lot.

I have been working adamantly on my posture and I seem to be making large improvements there. One thing I noticed is that the rear part of my shoulder seemed to atrophy a little bit when the tingling subsided. It was never really bony before because I had a decent amount of muscle on it but you could start feeling the bone a little bit. This could easily be a postural thing because it has definitely started subsiding. One more thing I forgot to mention, the clicking happens louder when I flex my whole arm during stuff like arm circles and transverse abduction. It feels like it could be coming from the posterior deltoid but that could be my mind tricking me.

Thank you for your help Steven you seem to be incredibly knowledgeable about stuff like this.
Armpit region I suspected subscap, but if your internal rotation is good then it's probably not that.

Get a basketball and "foam roll" your chest with it specifically the upper portion near the shoulder where the pec minor is. I suspect that will help out significantly as well. keep the shoulder forward when you are doing it as well.

If you can get in there with your hand as well that could help too.

Doorway stretches are OK. May be better to do something like a skin the cat on rings to see if that helps out more though -- you can regulate how much you relax with your feet.

Start doing some wall slides (youtube it) and see how you feel as well.

Poke every centimeter of your biceps and see if you can find any sore/tender spots there. There may be some which you need to work out (biceps long head tendon can be another culprit of limited mobility).

Start doing more rowing/horizontal pulling if you are allowed to.


Soft tissue massage has to be focused on problem areas to help. Unfortunately, most massage therapists aren't as skilled with that as PTs, but most PTs don't know a lot of good massage techniques either. So it's a problem.
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Old 02-01-2010, 12:19 PM   #5
Alex Curtis
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Re: Popping in joints

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Originally Posted by Steven Low View Post
Armpit region I suspected subscap, but if your internal rotation is good then it's probably not that.

Get a basketball and "foam roll" your chest with it specifically the upper portion near the shoulder where the pec minor is. I suspect that will help out significantly as well. keep the shoulder forward when you are doing it as well.

If you can get in there with your hand as well that could help too.

Doorway stretches are OK. May be better to do something like a skin the cat on rings to see if that helps out more though -- you can regulate how much you relax with your feet.

Start doing some wall slides (youtube it) and see how you feel as well.

Poke every centimeter of your biceps and see if you can find any sore/tender spots there. There may be some which you need to work out (biceps long head tendon can be another culprit of limited mobility).

Start doing more rowing/horizontal pulling if you are allowed to.


Soft tissue massage has to be focused on problem areas to help. Unfortunately, most massage therapists aren't as skilled with that as PTs, but most PTs don't know a lot of good massage techniques either. So it's a problem.
I don't have a basketball with me but I tried foam rolling that area with a tennis ball. It was tender and became very sore pretty quickly, which I believe means I am helping it. I also worked at it with the hand a little bit. What exactly is the best way to target the pec minor specifically? Shoulder forward, but what part of the actual chest?

I can start doing rows for sure.

I haven't done the wall slides extensively because I haven't had a good wall to do them on but I will later today and I'll let you know how that goes. Also, rings are unavailable to me so I won't be able to do skin the cat.

There are no sore/tender spots on the actual biceps but where it connects to the shoulder it feels a little tender.

Does this just sound like a case of really tight pecs? They never really felt tight by themselves until I work at them.
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Old 02-01-2010, 06:13 PM   #6
Alex Curtis
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Re: Popping in joints

Ok I got a chance to do some more things.

Wall slides are hard to do and I feel it intensely in my mid back area. It's a good feeling though and it is something I should be working on. It is kind of hard because my left shoulder does not have complete range of motion due to the surgery (since it was instability, they left it a little tight). I will continue to work on it though.

The biceps tendon is definitely sensitive towards the front of the shoulder, right below the front of the shoulder. I massaged the area a little bit and found it to be fairly sore/tender. It's not actually sore anywhere on the biceps though. Is that important?

I suppose that is all. The pec minor stuff is really helpful so I will continue doing it as well.
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Old 02-01-2010, 07:09 PM   #7
Steven Low
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Re: Popping in joints

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Originally Posted by Alex Curtis View Post
I don't have a basketball with me but I tried foam rolling that area with a tennis ball. It was tender and became very sore pretty quickly, which I believe means I am helping it. I also worked at it with the hand a little bit. What exactly is the best way to target the pec minor specifically? Shoulder forward, but what part of the actual chest?

I can start doing rows for sure.

I haven't done the wall slides extensively because I haven't had a good wall to do them on but I will later today and I'll let you know how that goes. Also, rings are unavailable to me so I won't be able to do skin the cat.

There are no sore/tender spots on the actual biceps but where it connects to the shoulder it feels a little tender.

Does this just sound like a case of really tight pecs? They never really felt tight by themselves until I work at them.
1. Pec minor is on the 3,4,5 ribs and goes to the coracoid process on the clavicle. basically up near the shoulder.

Tight pec minor can mess up articulations of the shoulder thus impinging different stuff.

2. You checked every part of your biceps and poked in and move the tissue around?

It's VERY hard to beleive there's no tender spots but you have some biceps tendinopathy.

Regardless, do some deep cross friction massage to all of the biceps + tendons up the anterior shoulder.

Quote:
Originally Posted by Alex Curtis View Post
Ok I got a chance to do some more things.

Wall slides are hard to do and I feel it intensely in my mid back area. It's a good feeling though and it is something I should be working on. It is kind of hard because my left shoulder does not have complete range of motion due to the surgery (since it was instability, they left it a little tight). I will continue to work on it though.

The biceps tendon is definitely sensitive towards the front of the shoulder, right below the front of the shoulder. I massaged the area a little bit and found it to be fairly sore/tender. It's not actually sore anywhere on the biceps though. Is that important?

I suppose that is all. The pec minor stuff is really helpful so I will continue doing it as well.
Yep, wall slides are good.

It's odd that there's no tenderness. Maybe you didn't search correctly maybe you did. Regarldess, do deep cross friction on the whole arm IMO.

Pec minor will def help.
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Old 02-02-2010, 06:00 AM   #8
Everett Steinbarger
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Re: Popping in joints

Another thing to think about is the labrum itself. Did you have a repair, or was the frayed edge just shaved down smooth?

To effect a good labral repair many times the anterior capsule gets "Bumped Up" when repairing the labrum to the glenoid. The bump can het hit or caught on with rotation at the shoulder.

You didn't mention whether or not the popping sensation is painful. Taking tylenol suggests to me that there was a component of pain to the sensation.

Popping in the shoulder could be many things outside of your repair as well. Notably the long head of the bicep, or a thickened subacromial bursa that gets caught under the acromion.

I would suggest that if you are 7 months outside of your repair and are having issues again, to check in with the surgeon that was inside your shoulder for starters.
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Old 02-02-2010, 04:04 PM   #9
Alex Curtis
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Re: Popping in joints

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Originally Posted by Everett Steinbarger View Post
Another thing to think about is the labrum itself. Did you have a repair, or was the frayed edge just shaved down smooth?

To effect a good labral repair many times the anterior capsule gets "Bumped Up" when repairing the labrum to the glenoid. The bump can het hit or caught on with rotation at the shoulder.

You didn't mention whether or not the popping sensation is painful. Taking tylenol suggests to me that there was a component of pain to the sensation.

Popping in the shoulder could be many things outside of your repair as well. Notably the long head of the bicep, or a thickened subacromial bursa that gets caught under the acromion.

I would suggest that if you are 7 months outside of your repair and are having issues again, to check in with the surgeon that was inside your shoulder for starters.
The shoulder that I'm having issues with now isn't the same one. Sorry that I didn't make that more clear. And no, it wasn't painful. There has only been pain like once throughout this entire experience and even it was fairly minor. I took tylenol because I thought something was inflamed that was pressing down on a nerve... and that was all before I knew tylenol wasn't an anti-inflammatory.
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Old 02-02-2010, 04:06 PM   #10
Alex Curtis
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Re: Popping in joints

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Originally Posted by Steven Low View Post
1. Pec minor is on the 3,4,5 ribs and goes to the coracoid process on the clavicle. basically up near the shoulder.

Tight pec minor can mess up articulations of the shoulder thus impinging different stuff.

2. You checked every part of your biceps and poked in and move the tissue around?

It's VERY hard to beleive there's no tender spots but you have some biceps tendinopathy.

Regardless, do some deep cross friction massage to all of the biceps + tendons up the anterior shoulder.



Yep, wall slides are good.

It's odd that there's no tenderness. Maybe you didn't search correctly maybe you did. Regarldess, do deep cross friction on the whole arm IMO.

Pec minor will def help.
Ok cool. It seems to be helping out quite a bit. I have one more quick question. About how long will I need to be doing these things before I see a lasting lengthening in the pec minor? Weeks?
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