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Old 01-17-2012, 03:21 PM   #1
Josh Pasternak
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Yet another AC joint inflammation thread

So, I'm a 24 year old male, who, other than this, has zero history of injury or illness. I've been working out and lifting since I was about 17 or 18 years old. Like probably most here, I consider maintaing my fitness a major part of my life so dealing with this chronic injury for over half a year now has been quite a bummer.

I first developed pain in my left shoulder about 7 months ago in June of '11. I was benching and felt a sharp pain in the front/top of my shoulder. I pushed through another set and felt it getting worse so I called it a day and headed home. I got home, took some ibuprofen, applied some ice to the area and thought I felt okay. The next morning I woke up and knew something was seriously wrong (sleeping on my sides has been awful these past months). The pain in my shoulder got way worse. Pushups were next to impossible, driving with only my left arm was out of the question too.

I immediately cut off all training and went to see a specialist. After a short chat and a couple passive and active tests she told me this was likely inflammation in my AC joint and that it's fairly common in weight lifters. She told me my options (aside from the obvious rest and ice methods) were anti-inflammatory drugs, cortisone, and surgery. She prescribed me an anti-inflammatory (I forget which) and told me to come back to see her. Loooong story short (and many doctor visits later), after two months of rest and medication, I had practically zero improvement and decided to get an MRI and cortisone shot. In retrospect, getting the shot THEN getting an MRI 3 days later was pretty silly, but the MRI did come back and confirm the diagnosis.

Following the shot, I felt suuuper sore; however, 6 days later I felt like I had a brand new shoulder. The feeling was actually incredible as it was the first time in months that I was pain free and could sleep through a full night. I rested another 4 weeks and was given the okay by my doctor to return to the gym, obviously starting carefully and slowly. So I did, and within two months I was back to full strength and feeling no ill effects at all. I tapered my benching and shoulder training to be much more low weight and high rep and thought I was good to go, until one day I woke up and suddenly felt just as I did before. Again, I cut off all training and went to go see my doctor. At this point, I was even feeling some pain in my right shoulder, a result we both assumed came from compensating and sleeping on that side for so many months.

So here I am now. My last trip to the doc resulted in being prescribed Nabumetone 750 mg, which I felt actually helped me somewhat. However, I'm off that now since I don't want to be on antri-inflammatories for such a prolonged time frame. I haven't worked out since November and still wake up every morning with a supremely sore shoulder. The pain subsides as the day goes on and I can do pushups without really feeling much pain. I banged out a set of 100 last week just to see if I could handle it. I've gone to see an acupuncturist several times and haven't really noticed any difference there. Another thread on a similar topic recommended taking excessive amounts of fish oil, so I plan on upping my intake a little and see if that does anything.

I guess my question is, do I have any other options left or is surgery the way I should go? Is it out of the question or stupid to even consider doing the surgery on both shoulders? I kind of feel like I should get an MRI on my right shoulder as well at this point. Has anyone here had experience with recovering from a mumford procedure or any arthroscopic surgery where they shave down/remove your joint?

This has been quite the long-winded post for my first thread, but I wanted to provide as many details as possible about both myself and the extent of my injury. My thanks go to those who have made it this far.

I'd really appreciate any input on the matter. If any of you smart folks out there want to read the results of my MRI, I can post that up here too (I'm looking at you, Steven Low). Annnnd if you need any more info on what specific articulations hurt I can provide those details too. Thanks again, everyone.

- Josh
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Old 01-17-2012, 04:08 PM   #2
Steven Low
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Re: Yet another AC joint inflammation thread

Are there any specific exercises that make it hurt? Also, weight and/or repetitions?

MRI would be useful.. same with the specific articulations that hurt.

How would you rate the mobility of your t-spine, scapulas, and shoulders? If it's poor, that can put more stress on your AC as well

Sleeping on the side is a huge issue that likely aggravates it a lot though. That's kinda hard to change however.

It may be that high rep movements aren't in your future though.
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Old 01-17-2012, 06:31 PM   #3
Josh Pasternak
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Re: Yet another AC joint inflammation thread

Steven, thanks for the quick response.

Specific exercises that make it hurt: Bench press. Like I said, I haven't lifted in 3 months, but the weight was 205, 6-7 reps, when the injury surfaced. Front shoulder raises are also painful and that's actually the articulation that hurt the most when I was evaluated by my doctor. Flys, rows, and shrugs were painful as well.

Painful articulations: Flexion (especially when there's resistance like pushing down with my other arm), transverse flexion, transverse extension, and the O'Brien's test is ESPECIALLY painful in both arms.

Mobility: My shoulder mobility is in bad shape ever since I got hurt, especially on my left. T-spine and everything else is still fine.

Sleeping can be rough. I've been doing better and staying on my back at night, but I'm not always good at that. I'm not sure what you meant about high rep movements not being in my future. There's been no movements in my past or planned for my future since early November. In fact, after a bunch of articulations and that damn O'Brien's test, pushups are pretty painful.

I only have my MRI on film, but here's a copy of the report with all those fancy and big words. P.S. This was a regular MRI, contrast was not administered.

Quote:

A very mild marrow edema pattern is noted surrounding an otherwise intact acromioclavicular joint. There is some superiorly directed spurring and capsular hypertrophic change at the articulation which may be developmental, degenerative, or post traumatic in origin. No abnormal AC joint seperation is seen and the acromioclavicular and coracoacromial ligaments appear intact. The anterior acromion process is noted to be somewhat low-lying, and may be a source of impingement clinically. However, no abnormal signal is seen within the distal supraspinatus or infraspinatus tendons and no significant amount of fluid is seen within the adjacent subacromial/subdeltoid bursal plane.

There is a mild increased signal intensity to the distal subscapularis tendon at its insertion and just proximal to its insertion, where the tendon is surrounded by a small but disproportionate amount of fluid within the subscapularis/subcoracoid bursal plane region. The proximal long head of the biceps tendon appears intact. The glenoid and its labrum appear unremarkable and there is no evidence of Hill-Sachs or Bankart lesion.

IMPRESSION:
1. Mild degenerative or post traumatic changes involving the acromioclavicular, without evident of acromioclavicular joint speration or ligamentous injury.
2. Tendinopathy of the subscapularis tendon with associated subscapularis/subcoracoid bursitis.
3. Low-lying anterior acromion process which may be a source of impingement clinically
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Old 01-17-2012, 09:37 PM   #4
Michael Ko
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Re: Yet another AC joint inflammation thread

I didn't read anything about physical therapy or chiropractor. Did you use any of those people?

Any numbness/tingling in the hand?

If your MRI is showing signals in the subscapularis tendon, that's telling me that you likely have anterior instability or your humeral head is set anterior. So your subscapularis is always on tension and trying to keep in place. If you have AC joint issues, you are likely to also have scapular positioning issues and upper thoracic mobility issues. There really is no way for you to tell if you don't have upper thoracic mobility issues, you'll need a professional to check that out (ie. PT or chiro, not MD).

Message me if you need a recommendation for a PT, I may be able to help.
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Old 01-17-2012, 09:52 PM   #5
Josh Pasternak
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Re: Yet another AC joint inflammation thread

There has been absolutely zero numbness or tingling in my hands. I went to a chiropractor several times when the injury first happened in the summer, but did not see any results. I've never had anyone mention those issues to me, but if it's common and something you guys think I should have a PT check out then I'll absolutely do that and could use a recommendation if you have one in the NYC/NJ area.
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Old 01-18-2012, 07:39 PM   #6
Steven Low
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Re: Yet another AC joint inflammation thread

It may not be a bad idea to have a PT look at it. I don't see anything horrible that you need to have surgery (but then again I'm no doc)

I know of a good PT in the Philadelpha area, but not in the NYC area though.

Ask around for who the local sports teams use as their go-to PTs
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Old 01-18-2012, 11:10 PM   #7
Josh Pasternak
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Re: Yet another AC joint inflammation thread

The last thing I want to do is go for surgery. I'm just skeptical of getting it fixed in another fashion at this point. It's been 7 months since the injury, including the last 3 of complete rest. I intend on going for a second opinion next week, but do you know of anyone on the boards here or in real non-internet life that has dealt with AC joint problems with the surgery and what the experience was like?
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Old 01-19-2012, 07:33 AM   #8
Steven Low
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Re: Yet another AC joint inflammation thread

Yeah, use the search button on this forum there's probably been at least 20 AC joint threads that you can take a look at if you want to see some more experiences
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Old 01-20-2012, 07:46 AM   #9
Arturo Garcia
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Re: Yet another AC joint inflammation thread

Hey there Josh.

I used to sit for hours and hours a day, very leaned back on a chair, with my keyboard/mouse ending up at Shoulder Height, so my arms were horizontal (parallel with the floor) for hours a day. I suspect that this caused some major changes in my structure. I say this because when I started working out, it didn't take long to develop AC Joint pain, and I wasn't even decently strong yet. So I couldn't blame years of working out on my pain, not at all. Funnily enough, my doctor told me he had done surgery on a guy who played some very tall drums that also required him to have his arms horizontal, while seated, for long periods of time. I concluded then, that we're just not meant to have our arms extended out in front like that, not for very long periods of time. But I could be wrong, and maybe the cause of my AC joint pain was something else.

Things that REALLY brought out my AC Joint pain:
-Reaching behind me with that arm (think you're in your car, driving, your right AC joint is the painful one, and you reach with your right arm to the back seat to grab something, while your torso still faces the front).
-Reaching across me very hard (think hugging yourself??)
-Popping up my Trapezius muscle... you know, like trying to bring them upwards in order to make them look big?? Don't know how to describe it. It's like bodybuilders do for certain poses, they stick them out. That REALLY hurt.

As I couldn't find good PT's or chiros or anything... after extensive reading, I went on and had surgery. Nobody in my country did it in the least invasive way (artrhoscopy?) so now I have two beautiful 2-3 inch scars on top of both ac joints. I got one shoulder done in 2008, the other in 2009. A few weeks of rehab exercises later, I was able to start back up. I regained full mobility, ROM, and strength, and went on to set PR's in the pressing movements (bench, press, etc.).

Luckily I almost never sleep on my side. I wish I could have avoided surgery.... but after dealing with pain and fighting my will to train properly and not being able too.... surgery really was the last resort. There might have been a way to "fix" me, but I could not find it.

This long post is just to tell you that the AC joint surgery doesn't seem complicated. From the research I did (and my own experience), they just shave off a bit off the end of the clavicle (and/or the acromion) creating more spcae, scar tissue then forms there, acting like a cartilage betwen those two bones (clavicle and acromion... A and C of AC joint of course).. and you get two new "shoulders" apparently. I found guys on forums who had it done in the 80's and were still lifting 20+ years later so it gave me some confidence to go ahead with it. I don't regret it right now as I can do anything. I hope I don't regret it in the future either

Hope this helps.
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Old 01-20-2012, 11:17 AM   #10
Sean Rockett
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Re: Yet another AC joint inflammation thread

Quote:
Originally Posted by Josh Pasternak View Post
The last thing I want to do is go for surgery. I'm just skeptical of getting it fixed in another fashion at this point. It's been 7 months since the injury, including the last 3 of complete rest. I intend on going for a second opinion next week, but do you know of anyone on the boards here or in real non-internet life that has dealt with AC joint problems with the surgery and what the experience was like?
Hi guys I am new to posting here but I am an orthopedic surgeon and do see a lot of AC joint issues. One thing not mentioned is a SLAP tear and it can look and smell a lot like AC joint issues. I have seen some people at the time of surgery who have a SLAP in their shoulder when I and everyone else thought it was an AC joint issue. Sean
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