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Old 04-17-2012, 03:28 PM   #1
Justin Ludwig
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SLAP and Supraspinatus

I finally had an MRI taken on my left shoulder. Initial injury in 1996 (fell rounding first base), re-injured in 1998 (drunk knee-boarding and dislocated), subluxation of the adjoining clavicle in 2008 from lowering a 200# 8x8 log into a hole. I didn't go to the doctor for any of those injuries. Young and dumb...

Started CF last Sept/Oct time frame and KStarr's Mobilitywod in November. All the while, knowing my shoulder is doing Rice Krispies when I work out. I think finding mobilitywod and this forum is the only thing that saved me from truly jacking up my shoulder.

I'm going to give the doctor's write up of my injury and then ask my question.

FINDINGS: There is mild edema in the anterior deltoid muscle from the injection procedure with a small amount of extravasated contrast in the subscapularis muscle. The subscapularis tendon is intact. the anterior and posterior labrum is intact. There is a prominent sublabral foramen in the upper aspect of the anterior labrum. The biceps tendon courses normally in the bicipital groove. The infraspinatus and teres tendons are intact. There is subacromial/subdeltoid fluid and contrast. This extends under the lateral aspect of the supraspinatus tendon. There is dense heterogeneous signal seen throughout the full thickness of the distal supraspinatus tendon near its insertion. There is large marginal inferior osteophyte at the tip of the acromion process. The contacts the superior surface of the supraspinatus tendon, although i see no discrete abnormal signal at this level. The acromioclavicular joint is essentially unremarkable. There is hyperintense signal in the inferior half of the superior labrum with partial separation from the glenoid anteriorly.

IMPRESSION: 1. Heterogeneous signal in the distal fibers of the supraspinatus tendon consistent with sever partial yet near full-thickness tear of the distal fibers of the majority of the supraspinatus. There is additional evidence of rotator cuff instability and discontinuity with subacromial/subdeltoid contrast.
2. Tear of the superior labrum, particularly anteriorly. Large marginal osteophytes from the tip of the acromion process inferiorly that contacts the superior surface of the supraspinatus tendon.

Question - I have my choice of any doctor that accepts TriCare (I'm Army). Am I looking at full blown "lay me open" or orthoscopic surgery? I'm extremely active and want full mobility of my shoulder back with no loss of strength. Might be asking too much, but with my shoulder as is I can: Push Press 185#, do 30+ kipping pull ups, Snatch 145# (technique still sucks), HSPU, Clean and Jerk 185# (form lacks), etc.

Also, how can I make sure I'm getting a surgeon that excels at shoulders?
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Old 04-17-2012, 06:50 PM   #2
Daniel Pope
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Re: SLAP and Supraspinatus

Looks like you've got some shoulders issues my man!

It seems that you aren't too bad though. If you can still do all of those exercises I'd think there's still hope for you, maybe even without surgery. Did your surgeon refer out for physical therapy? Would be a smart idea to link up your therapy from mobility wod with advice from a professional. Maybe cut out any exercises that give you pain for a while to let things heal and pain subside. Address any flexibility limitations before going back to previous offending exercises, promote lots of scapular stability. Let that poor supraspinatus heal and normalize motion within the shoulder joint!

Let me know how it goes brother,
Dan Pope
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Old 04-18-2012, 08:02 AM   #3
Justin Ludwig
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Re: SLAP and Supraspinatus

Advise from the ortho was to have surgery if I want full strength and to stop the cracks and pops, fix the clavicle, and reduce inflammation. They said my supraspinatus has 80% full tear through.

As for mobility, the only thing I'm lacking is "biceps behind the ears" on OH lockout. I can be biceps even with my ears, but not behind. That tightness is predominately in my lats and pecs. Oddly, I can do anything with my shoulder as long I start in a good position (externally rotated and locked). Whereas, something as simple as swatting at a fly randomly can bring me to my knees.

Because of the age of the injuries, it's probably too late for PT until post-surgery.
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Old 04-18-2012, 01:40 PM   #4
Daniel Pope
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Re: SLAP and Supraspinatus

PT before surgery can be one of the best things you could possibly do. It'll help speed recovery after surgery. Never too late for physical therapy. Physical therapy isn't just for immediately after an injury. most people don't see a therapist until they're had an injury for so long that they can no longer deal with it on a daily basis.

Let me know how the surgery goes. Interesting injury.

Dan
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Old 04-18-2012, 07:57 PM   #5
Steven Low
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Re: SLAP and Supraspinatus

It's never too late for "PT" (e.g. strengthening and stability work) before surgery.

Significantly speeds up recovery
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Old 04-18-2012, 08:35 PM   #6
Justin Ludwig
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Re: SLAP and Supraspinatus

Quote:
Originally Posted by Steven Low View Post
It's never too late for "PT" (e.g. strengthening and stability work) before surgery.

Significantly speeds up recovery
Well, I follow mainsite coupled with Wendler 5/3/1 and I do KStarr's mobility work everyday I workout; in warm up and cool down. I don't take NSAIDs and only use ice when it hurts. I hope that's what you both have in mind for PT. Since getting the MRI, I turned off my firebreathing during workouts because I'm now skiddish.
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Old 04-18-2012, 11:26 PM   #7
Gravel Brown
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Re: SLAP and Supraspinatus

The surgery is worth it mate. I'm 10 months post SLAP surgery with 4 anchors. My ROM is near 100%, slightly stiff reaching behind my back but everything else is very much as normal.

I'm avoiding any loaded overhead movements still but exercises like deadlifts, bench press etc are back to pre op standards... so in short 10 months post op I'm pretty much back to normal.

It's amazing how quick your strength returns once you start lifting again.
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Old 04-19-2012, 12:30 AM   #8
Graeme Beath
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Re: SLAP and Supraspinatus

Go with gravel's advice. I've a had a SLAP repair & a spur shaved from acromion. A little different to Gravel I've had the bicep tendon relocated & only 7 weeks out so still quite stiff etc but hopeful.
It seems to me you may also have some spurs there & my Ortho told me that is where most the pain is coming from, also what is most likely rubbing on & causing the supraspinatus problem.3
Different guys do the proceedure differently but most these days use keyhole method so you'd have 3-5 small incisions. It's a little rough the first week or so & very restricted on what you can do for a while. Rehab process is long but if you want a reasonably permanent fix it's a must.
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Old 04-19-2012, 05:51 AM   #9
Justin Ludwig
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Re: SLAP and Supraspinatus

No spurs and no osteo problems, thankfully. I don't get pain from movement, just inflammation from overuse. Overuse is 220 pullups in one week (found out the hard way). My shoulder felt shattered for days during sleep.
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Old 04-19-2012, 11:52 AM   #10
Daniel Pope
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Re: SLAP and Supraspinatus

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Originally Posted by Justin Ludwig View Post
Well, I follow mainsite coupled with Wendler 5/3/1 and I do KStarr's mobility work everyday I workout; in warm up and cool down. I don't take NSAIDs and only use ice when it hurts. I hope that's what you both have in mind for PT. Since getting the MRI, I turned off my firebreathing during workouts because I'm now skiddish.
Ya, was meaning more along the lines of finding a therapist and listening to their advice. Continuing training full bore along with the advanced intense stretching from MWOD that is meant for healthy shoulders is probably doing more harm then good.
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