Shoulder Impingement

[Sean Murray]

Originally Posted by Sean Murray

Just going to tag my questions on to this. Recovering from a long term shoulder impingement injury. Referred to physiotherapy dept at my local hospital after a lot of treatment by private physio did not stop symptoms coming back (deep pain near the AC over head- akin to someone pushing back down on the area/tightness at top of pecs under clavicle/tightness along side of neck to where muscles attach to clavicle/ severe clipping inside left shoulder as elevated). There was no testing or checking of the mechanics though by this physio of what i did at the gym to give a real picture of the root cause. She wanted me to get an MRI to rule out labrum tear she suspected. Pain was in overhead pressing movements- at first just pressing movements were a problem then got so bad as to causing pain on kipping pull ups/ KB swings/ wall ball.

Hospital physio ruled out need for MRI with pre assessment but did spot some dysfunction in the scapula and so proceeded with just rehab for abduction.
Guys at the gym who had shoulder issues intro'd me to some great rehab exercises and posted them up on our CF board (scap push ups/scarecrows/lateral rotation/external rotation and few others). After doing some work on lateral rotation with a light resistance band I had massive weakness in that movement and could feel the fatigue in the working muscles there (infraspinatus/teres minor??) Something the hospital physio or private one didn't bother to assess with me.

I've basically got on with my own rehab as the UK hospital physio's are only concerned with basic function. As my symptoms diminished (more down to removal of aggravating movements and rest) they're happy to sign me off.
Gradually brought back in all the movements and up to now no reaction. I do feel the fatigue in the (infraspinatus/teres minor area) though on any workouts with a lot of pull ups or pressing. Also, I've noticed a feeling of fatigue/weakness in what i think is my left rhomboid or could it be where infraspinatus/teres minor attaches near the mid back region??? Just a bit inwards from the point of the shoulder blade I'm not sure how to identify which it is. I can feel a little trigger point in there and am wondering if that is what is causing this feeling or if its a deeper issue?

I've got a sports massage booked in for Monday so will get her to look at that for me. I do get a lot of trigger points though in that left shoulder area actually.

Finally got to see a top notch guy about my shoulder. Allegedly this guys website is the most visited site on the web for shoulder info..how true???
http://www.shoulderdoc.co.uk/

Quick exam and got my history with it and he's 99% sure its AC joint osteolysis (stress fracture from heavy loading where bone erodes faster than can be repaired). MRI scan to be sure to come. Been told to stay off all overhead movements for a month to allow it to settle down. Apparently common with weightlifters and people involved in power sports involving maximal loads of shoulder.

[Brad Davis]

Quick tack-on question. Sorry, it's been done once in this thread and I can't resist the temptation, LOL.

I'm wondering if I have impingement also. If I put my left arm forward, bend my elbow so that my finger is pointing up, then internally rotate, I can feel some pain (3-4 on a scale of 1-10) near my max ROM, which is same both arms, probably 30 deg below horiz. It's about under my posterior deltoid head when in the rotated position. Also, if I put my arm down to my side, internally rotate to max ROM, and then raise my arm forward like a front DB raise, I feel pain in the same place when my arm gets to about horizontal. During exercise, feel no pain during pullups or chinups, little or no pain during presses, 3-4 scale pain during bench press warmups, then nothing on the heavier sets.

This started about 2 months ago. I had just done a workout with bench, dips, and pullups. Felt fine. Went to my car and the one next to it was jammed in tight. I didn't think about what I was doing and wedged myself in there and externally rotated my left arm to get the key in the door. Felt a quick and sharp pain in the same area mentioned above. It hasn't improved in 2 months. Might be degrading ever so slowly. Dropped dips a month or so ago. Dropped bench 2 weeks ago until the problem is resolved. Currently am just doing very light presses like the Starr Rehab plan, and ice.

Sound like impingement? Something else?

Advice appreciated as always.
DBD

[Steven Low]

Sounds like internal impingement to me....

Strengthen your RC muscles, do posterior capsule stretch, and sleeper stretch, and do LYTPs. Ice afterwards if needed.

wfs
http://davedraper.com/blog/2009/07/2...-become-lytps/

[Brad Davis]

Thanks Steven. Looking into it.

[Sean Murray]

Have just been signed off with my shoulder issue. MRI with dye in showed no SLAP tear. Consultant decided there was no need for surgery and that the issue was mechanics. Had a physio check me over before discharging me and he believes the impingement overhead is due to an anterior tilt in my left scapula which decreases the subacromial space. Had me on my front and pressed down on the scapula to show me the lack of movement in there compared to the right. Suggested I get it mobilized as pretty tight, as well as strengthening the area.

I'm guessing this is part of the reason I get so many severe trigger points around my left scapula. Just not so happy its taken so long to come to this conclusion.