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Old 04-08-2009, 11:38 PM   #11
Steven Low
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Re: Shoulder popping/cracking/clicking sound

1. Well, the lateral raise with thumbs down is the supraspinatus test....

2. the moving anterior/posterior when abducted is probably moving against the anterior labrum which they suspect is torn. That's the one causing the pain obviously.

Moving on....

3. Labrum tears vary from individual to individual. If they're interfering with normal activity then surgery pretty much always recommended. In some people they can lift and do whatever they want, and they barely get any pain or no pain.

Your case seems to be a milder one... maybe something close to a partial SLAP lesion.

4. The thickening of your posterior supraspinatus is probably due to the bone spur rubbing which causes inflammation and then the body tends to create scar tissue to help avoid that.

Basically, similar to getting calluses on your hands from holding/rubbing a lot on pullup bars and barbells.

"What to do...."

5. Um, that second opinion would probably be good.

IF it is a labrum tear, and you are ****ed off that you can't do certain stuff without pain then you might want to get that repaired and possibly the spur removed (although spurs have the tendency to come back even if removed). But that's really up to you...

It SEEMS like your ortho's been pretty good about exploring non-surgical options, AND if it is a labrum tear it's not that bad. But on the other hand it is hindering you in exercising so.....


Note: I am NOT a doctor... nor should any of this be taken as medical advice.
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Old 04-09-2009, 12:41 AM   #12
Ahmad Sharif
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Re: Shoulder popping/cracking/clicking sound

Quote:
Originally Posted by Steven Low View Post
1. Well, the lateral raise with thumbs down is the supraspinatus test....

2. the moving anterior/posterior when abducted is probably moving against the anterior labrum which they suspect is torn. That's the one causing the pain obviously.

Moving on....

3. Labrum tears vary from individual to individual. If they're interfering with normal activity then surgery pretty much always recommended. In some people they can lift and do whatever they want, and they barely get any pain or no pain.

Your case seems to be a milder one... maybe something close to a partial SLAP lesion.

4. The thickening of your posterior supraspinatus is probably due to the bone spur rubbing which causes inflammation and then the body tends to create scar tissue to help avoid that.

Basically, similar to getting calluses on your hands from holding/rubbing a lot on pullup bars and barbells.

"What to do...."

5. Um, that second opinion would probably be good.

IF it is a labrum tear, and you are ****ed off that you can't do certain stuff without pain then you might want to get that repaired and possibly the spur removed (although spurs have the tendency to come back even if removed). But that's really up to you...

It SEEMS like your ortho's been pretty good about exploring non-surgical options, AND if it is a labrum tear it's not that bad. But on the other hand it is hindering you in exercising so.....


Note: I am NOT a doctor... nor should any of this be taken as medical advice.
Thanks a lot, Steven. My only "hope" is that since it doesn't pain unless it's weighted, the tear is not that severe. I will post here once again once I get the second opinion (and this particular ortho's opinion as well, since I have an appointment in a month with him) and see if anyone has any other suggestions.
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Old 05-24-2009, 03:52 PM   #13
Ahmad Sharif
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Re: Shoulder popping/cracking/clicking sound

Summary of my left shoulder issues:

August 2007: First symptoms appear, shoulder clicking/popping with certain movements. Mostly painless, sometimes painful. Feels like tendons moving over bones.

October 2007: Regular doctor says it's nothing and recommends band therapy.

Problem persists and I go to a sports doctor in August 2008: He says it's the AC joint clicking and says not to worry about it.

January 2009: I go to another doctor who diagnoses impingement and recommends PT. I go for this PT.

March 2009: I go to a specialist orthopedic surgeon who takes some xrays and diagnoses bone spur.

March 2009: I get the MRI done. First opinion from orthopedic surgeon is that there is a labral tear. I get cortisone shot which doesn't help.

May 2009: Second opinion from a different orthopedic surgeon is that there is a labral tear. He takes some xrays and says there is no bone spur.

May 2009: I get an MRA (contrast MRI) done, which says no labral tear(??). Now the first orthopedic surgeon says that the bone spur is causing the problems. I keep doing PT with no help.

Here is the MRA report:

Technique:
Routine mulitplanar and with sequence MR arthrographic images of the left shoulder were obtained after the intra-articular injection of a mixture of gadolinium under fluoroscopic guidance.

Findings:
The glenohumeral joint is well distended. No gadolinium contrast material is detected outside the confines of the joint to suggest the presence of a rotator cuff tear.
There is mild tendinosis of the supraspinatus without imbibition of contrast. The infraspinatus, subscapularis, teres minor, and biceps tendons show normal morphology and signal intensity.
No contrast is identified extending through or beneath the labrum to suggest the presence of a labral tear. No macroscopic cartilage defects are identified.
Incidentally noted sclerotic subchondral lesion within the mid aspect of the glenoid with apparent fatty center may represent an atypical bone island unchanged since prior study.
No Hill-Sachs lesion is detected. No obvious bone marrow edema is present. There is an air bubble in the superior aspect of the joint. No evidence of atrophy or infiltration in the rotator cuff musculature. The acromioclavicular joint appears normal.

Impression:
1. Mild tendinosis of the supraspinatus tendo.
2. No evidence of rotator cuff or labral tear.
3. Incidently noted benign appearing small sclerotic lesion in the glenoid as described may represent an atypical bone island.

Steven, or someone else, what do you make of this MRA? The first surgeon recommends scope to see what's going on and wants to shave the acromion spur which the second surgeon doesn't admit I have. I am going to a third surgeon to get yet another opinion.

It seems like diagnosis is an art and not science. The two opinions are very different and can't be both right! My symptoms of clicking when holding the arm laterally are still there. There is sharp pain sometimes under certain positions.
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Old 05-25-2009, 07:08 AM   #14
Steven Low
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Re: Shoulder popping/cracking/clicking sound

If this

"There is diffuse thickening of the posterior aspect of the supraspinatus tendon, without focal tearing."

Is related to this

"Incidentally noted sclerotic subchondral lesion within the mid aspect of the glenoid with apparent fatty center may represent an atypical bone island unchanged since prior study."

Then you may have your answer.

The contrast one is probably more accurate so... I'd go with whatever that one says.

But I would take ALL of your MRIs to an ortho if you're going to get a third opinion.
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Old 03-27-2010, 08:36 AM   #15
Ahmad Sharif
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Re: Shoulder popping/cracking/clicking sound

So I went to a different ortho now and he actually took the time to get an xray done. I have attached it. According to the ortho, I can't do anything about it other than rc exercises which I have been doing.

Looks like I had a shoulder separation (Work and family safe: http://j.imagehost.org/view/0451/image)! Also isn't the distal end of the clavicle supposed to be flat? I believe the growth at the end combined with the separation was causing all the clicking. And against this ortho's opinion, I think because of the separated shoulder the scapula drooped a bit and decreased the subacromial space, causing impingement and degradation of the RC.

What do you think, Stephen? I know you're not a doctor, but I'd like to get your expert opinion on the xray.

I am really surprised the other orthos ordered MRI/MRA without even telling me about the shoulder separation I had. Although I never had pain the ac joint and I don't remember any trauma whose pain lasted for weeks at the ac joint in the past 2-3 years. I do remember an injury that gave me a crick in the neck for 3-4 days (I couldn't turn my head without pain) which was caused by heavy military pressing (maybe some trap fibers got torn which might have contributed to scapula being lowered?)

My conclusion so far: orthos are strange beasts. And no ortho will give you any attention unless you tell them you're having a pain of around 8-9 on the 0-10 scale!

Last edited by Ahmad Sharif : 03-27-2010 at 08:39 AM. Reason: Added link to xray.
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Old 03-27-2010, 02:27 PM   #16
Steven Low
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Re: Shoulder popping/cracking/clicking sound

Quote:
Also isn't the distal end of the clavicle supposed to be flat?
Pretty variable from person to person. Hard to tell from X-ray too depending on angle. Yours looks fine though.

Quote:
I believe the growth at the end combined with the separation was causing all the clicking.
It is possible this is the case... may also be other problems such as muscle imbalance, posture, etc. or a combination thereof

Quote:
And against this ortho's opinion, I think because of the separated shoulder the scapula drooped a bit and decreased the subacromial space, causing impingement and degradation of the RC.
Again, it's possible, yes. Separated shoulder makes everything there more unstable which leads to things getting injured easier.

Doesn't necessarily decrease subsacromial space -- posture and/or poor biomechanics usually does.

Shoulder separation usually occurs from acute trauma from an explosive movement or impact.... Probably not heavy military pressing unless you received the bar back down hard....


In any case, fix the posture... get the tight muscle kinks worked out, strengthen RC, take your fish oil, etc. Let it heal.
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