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Old 05-24-2014, 11:57 AM   #1
Alastair Bland
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Minor subscapularis fray becomes serious--ADVICE??

Hi all - I'm new to here but have been reading posts for about 6 months, as I've found the information here on injuries to be very insightful. So, now I want to describe my situation, which has lasted more than a year now and has totally ended my athletic life. I am 35. I have been doing low-intensity crossfit for about three years but before that was always athletic (lots of pullups, pushups, yoga, rock climbing). In May of 2013, I was at the top of a pushup and felt a ping in my right shoulder, followed by immediate burning that lasted several days. I had full ROM -- just a nagging burn, with no pain associated with movement. It went away over a week, and in the next month I slowly resumed pullup bar-based workouts. Perhaps I returned too soon, as over the next three months the injury never got back to normal. By July, I was feeling a regular "snappity" feeling if I moved my shoulder just so (shifting tendon??). Still no pain associated with movement, but a feeling of instability and inflammation in the front of the shoulder following some workouts. By late August, I totally quit pushups, as they were beginning to cause a gnawing pain in the shoulder. Got an MRI and was diagnosed with a partial tear (fray) of the subscapularis and some tendinosis in the supraspinatus.

Two rounds of PT over 4 months led to no improvements (all the usual inward rotation, outward rotation stuff). I visited with several surgeons. Not one was convinced they would even SEE the tear if they went in, let alone know what to fix. They suggested I try and adapt and see if I could resume my old lifestyle. In March-April, I seemed to be improving, doing small workouts and yoga with no ill effects. Then, in the last few weeks, it's gone downhill again. Burning and inflammation in the front of the shoulder, sporadically, unpredictably, even with rest. The discomfort (hot feeling) extends all the way to my fingertips. Still, FULL RANGE OF MOTION, and no immediate pain caused by any particular movements (which has been part of the reason it's been so hard for the docs to diagnose).

So---what to do? What's wrong? If I go the summer, at least, without surgery (and without working out), will I be making things worse? Is the inflammation, perhaps, part of the healing process of a tendon? Can I work out and ignore the warm inflamed feeling? Again, I don't need advice on regaining ROM. I have full ROM.

I'm totally bummed out by this (imagine quitting all workouts for a year!). I'd appreciate all feedback. Thanks.
Alastair

P.S. I should add I was in top form--strong, flexible, able--when I first sustained the injury. I could do 20 pullups, and handstand pushups were a breeze.
Also, I want to make clear that no exercises cause immediate pain. That is, I would be able to do pullups now. But hours to a day later, I would feel tightening and inflammation.
P.P.S. Never pain at night.

Last edited by Alastair Bland; 05-24-2014 at 01:21 PM..
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Old 05-24-2014, 06:49 PM   #2
Frank E Morel
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Re: Minor subscapularis fray becomes serious--ADVICE??

Go see. Kevin stone. In the marina.

Stone clinic.com.

K star used to work for him......hence all the pt there are pretty solid.
Kevin himself is .... Well. Genius... 43 medical patents, Including pop mechanics mag. Inventor of the year.
A lot of his patient are pro level , world wide athletes.
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Old 05-24-2014, 08:44 PM   #3
Alastair Bland
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Re: Minor subscapularis fray becomes serious--ADVICE??

Thanks Frank. I've looked him up, and he looks promising. I'm still curious if anyone else can shed light on my situation based on their own experiences. Basically, what is the inflamed feeling in my shoulder (combined with mild pain down to my hand) trying to tell me? Especially given that the pain does not restrict my ROM and that no movements cause sharp, immediate pain. I try and listen to my body but I just can't translate these signals!
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Old 05-26-2014, 07:27 PM   #4
Sean Rockett
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Re: Minor subscapularis fray becomes serious--ADVICE??

So some things to talk about. Noises, clicking and feelings of instability usually mean labral tears or pathology. If MRI was not done with contrast may not see these tears. Or if it was done with contrast you sometimes still do not see them. MRI is not the gold standard. Sometimes as surgeons we go in and look, usually with a game plan in mind even with a "normal MRI" and find things that do not show up on MRI that confirm our diagnoses.
Radiation of pain is normal often down the arm.
The position you were in when you felt the pop suggests maybe the posterior labrum or capsule is involved in your instability.
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Old 05-26-2014, 11:05 PM   #5
Alastair Bland
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Re: Minor subscapularis fray becomes serious--ADVICE??

Quote:
Originally Posted by Sean Rockett View Post
So some things to talk about. Noises, clicking and feelings of instability usually mean labral tears or pathology. If MRI was not done with contrast may not see these tears. Or if it was done with contrast you sometimes still do not see them. MRI is not the gold standard. Sometimes as surgeons we go in and look, usually with a game plan in mind even with a "normal MRI" and find things that do not show up on MRI that confirm our diagnoses.
Radiation of pain is normal often down the arm.
The position you were in when you felt the pop suggests maybe the posterior labrum or capsule is involved in your instability.
Hi Sean. Thanks for the word. There was no contrast with the MRI. I wish they had mentioned the option at the time, before I did all my research on the topic and learned about the possibility myself. I saw an excellent PT for a while who was unable to restore me to health but who also never mentioned the labrum. I suppose the labrum is possible but I'd be surprised. There is no "catching" or "sticking" feeling associated with the snappity-poppity sensation I get at times.

When you say radiation of pain is normal (down to the hand, in my case), normal for what injury?

And I may go for surgery, but I can't until October (based on some work issues). Will waiting risk compromising my recovery at this point?

Thanks!
Alastair

Last edited by Alastair Bland; 05-26-2014 at 11:23 PM..
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Old 05-27-2014, 08:54 PM   #6
Sean Rockett
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Re: Minor subscapularis fray becomes serious--ADVICE??

The nerves that pass through the shoulder can refer pain into hand for a number of conditions. Too many to list.
Does waiting on surgery risk worsening your outcome? Tough question to answer on the internet, it does depend on what your diagnosis is and how much you can avoid modify what you do to avoid pain.
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Old 05-28-2014, 10:26 AM   #7
Alastair Bland
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Re: Minor subscapularis fray becomes serious--ADVICE??

Thanks Sean. This hand pain and warmth/inflammation in the shoulder certainly is frustrating. I had heard there was a particular nerve that passes through the region of the subscapularis. I just wish I knew why the muscle/tendon keeps getting irritated and how this, in turn, is affecting the nerve.
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Old 11-22-2014, 09:05 AM   #8
Alastair Bland
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Re: Minor subscapularis fray becomes serious--ADVICE??

Hello again. I often wish that injury threads finished with a conclusion, so I decided would update mine, 6 months after posting: My injury/symptoms were more of an annoyance than a handicap (it had been one year since the initial injury), so I finally said, "Screw it, I'm doing pullups" back in May. This was after 8 months of NO EXERCISE. I started at 1, then hit 2 or 3 a week later, by July was at 5, 6. By late August I could do 10, September 12. A week ago I did 13 pullups with no rest time. On top of this, I had a 1-year-later MRI. The result was "complete healing" of the frayed subscap. Scarring was visible, but the tendon is no longer torn (so I'm told). I still have some bouts of mild inflammation in the shoulder, and pain in my hand/forearm, and I am not brave enough to try pushups yet, but I'm happy with the nonsurgical recovery. Thanks to those who offered advice.
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