Unsolved shoulder issue

Hi all,

since 1.5 years I've had a shoulder problem that neither I nor 2 orthopedists could solve. I guess the problem with those doctors is that each time I go there they send me off to do a MRI that I can then only do weeks later after I rested for all this time and the symptoms might not be that clear anymore.

It all started in December 2011 after 2-3 weeks of daily training. I did the "Building the gymnastic body" routine for Planches, V-Sits etc. and a lot of conditioning stuff like Ring Dips and Pull ups. Too much and rather stupid, I know. One morning then I woke up with pain in the middle/front of my shoulder. It then decreased during the day only to be even more painful the next day. After my first visit to the doctor I then rested for a few weeks and was given Diclofenac (tabs).

February 2012 I started to do Pull ups and Dips again. Dips went great at first, but after 2-3 workouts there was a sharp punctual pain on the front of my shoulder. That pain, especially in the bottom position of the dip increased to an extent that I not only lost a lot of strength in the left shoulder but could no longer do the exercise. It seems that the greater the stretch of a pushing exercise, the faster those symptoms reappear. Pull ups though are no problem. Bench Presses however, that I tried in the gym 3 or 4 times since then, are an absolute No-Go, there is absolutely no strength in my left shoulder

Since then I tried a lot of things. Rest for months, light workouts, just working out the whole rotator cuff, just workout the internal rotators, just working the external rotators. Each and every time I start to train again, those symptoms come to life and I have no chance of achieving any substantial level.

Few weeks ago I recognized a kind of hole on the scapula, a muscle that seemed to have shrunk completely, the Infraspinatus. I can't see however how that would be possible as I finished 2 months of working out my external rotators just a few weeks ago (before going into another short period of rest). Another thing I discovered lately is that the left shoulder/scapula-muscles are not near as flexible as those of the right. Very light stretching over the past couple of days only brought the same pain as it is usual with pushing exercise.

I hope there's somebody out there who can help, as this very long and wasted time brings me to loose hope to ever be able to substantially train again as long as I'm a young man.

Thanks in advance (and excuse me for poor language, I'm german )

The problems with those doctors is that all they can do is compare your images with images in their books (made this experience in Germany and in Switzerland, with so called *shoulder specialists* !). It's pretty clear that they don't see anything on the MRI: When it happened first, you didn't feel a sharp pain while training but the day after. So nothing is broken, but there is some imbalance, bad posture or whatever. Often physical therapists are better in understanding these problems.

Lobster8, Very difficult to make a diagnosis without a physical examination.  Im going to post a link about winged scapula.  See if these signs/symtoms are similiar to what your describing.  http://en.wikipedia.org/wiki/Winged_scapula

What I forgot is, the symptoms always come as soon as I abduct my arm in pushing exercises. As long as I stick with Scap Pushups, where I only move my scapula while arms are straight there is no problem.

You need to find someone who specializes in conservative (nonsurgical) rehabilitation of shoulders and do what it takes to pay for at least a few visits so that you can get properly evaluated and start making a road map for re-education of the shoulder.

There is simply no way to give advice on this over the Internet you need professional evaluation with somebody who is specializes in shoulder work.

Thanks for the advice. Guess I'll have to keep looking.

Found another interesting article.

http://www.t-nation.com/readArticle.do?id=1426252

There is one line on Face Pulls that's kind of familiar.

"In cases where the rotator cuff is known to be weak relative to the deltoid, the posterior deltoid can overtake the rotator cuff as the primary external rotator.

This will show up in the face pull as the humerus (upper arm bone) hyperabducts relative to the scapula. In other words, as you pull horizontally, the scapula stops moving and the upper arm bone continues to be pulled back along the horizontal plane. Rather than the upper arm bone and the scapula ending up in the same plane during the contracted phase of the face pull, the upper arm bone and scapula form an angle. The dead giveaway is a dent or a dimple that forms between the posterior deltoid and the infraspinatus."

Would it be wise in this case to stop any kind of posterior delt work for a few weeks and completely focus on the Infraspinatus and Teres Minor in order for that issue to resolve?

On the left side slightly beneath the scapula, there is that kind of "hole"... Can anyone identify which muscle that is?

Thanks in advance.

I have a hole like that in the front AND back of my shoulder, as well as winged scapulae. Dislocates help a lot, and after a while, I will get better. I used to have really bad pain taking throw-INS in football. So I'm one of those "overhead athletes." mike Reinold's blog is great, as is the Diesel Crew stuff.

Thanks. But do you know which (atrophied) muscles those "holes" actually were?

Could it be the rhomboids in my case? Or is it the infraspinatus?

Wow, in that photo it looks like you are shrugging your right shoulder and depressing your left.  Possibly you or any skilled doctor should be able to diagnose this.  Start searching the web  for rotator cuff tear, infraspinatus tear, supraspinatus tear, etc. and when you find a article that matches your symptoms exactly that is it.  My guess is a torn tendon but you need a diagnosis.

Post a video of how you train internal and external rotation, I would be very curious to see that for both arms under medium load. 

What did the MRI show?

Have you had a simple XR of your shoulder?  

I'd have the radiologist and/or shoulder specialist pay special attention to the clavicle.  You can get osteolysis of the distal clavicle - it's pretty rare, but if it's seen it's seen with the motions you're describing (pain in horizontal flexion).  Because you lose the clavicle strut, you can get abnormal scapular mechanics.  This should be pretty evident on MR.  Other considerations would be labral tear (need MRA to diagnose not just MRI - ie did they inject your shoulder just prior to MRI?), pec tear (partial) - should see on MR, and there are peripheral nerve entrapments but again should see evidence of this on MR.

Good news is pretty much all of these issues are get-by-able with good PT.

I'm sure if you see enough Orthos someone would be more than happy to stick a scope in your shoulder.

Go see a physical therapist.

It's hard to say whether that photo represents atrophy of the infraspinatus or not, but a really simple palpation examination would reveal that, which any good physical therapist would do.

Would that be a MRI of the scapula? Because I always thought it was caused by the shoulder itself so the 2 MRIs both were taken from the front of the shoulder. 

Hmmm, what is your job for a start? Do you spend a lot of time on the computer? Writing quite often? 

 When I had shoulder problems one of my shoulders began to elevate and my shoulders eventually went lopsided as the mouse was on the top desk and the keyboard was on the low desk. I also find that when I'm studying or in school, my writing arm begins to elevate bit by bit while internally rotating, I can be in this position for up to 3 hours a day and usually brings back some symptoms of my old impingement. So basically, study your habits and everyday life actions before carrying on with exercise. this includes literally everything from wiping your behind to cutting vegetables, does one shoulder always Internally rotate or protract more? 

At the moment I don't think rotation exercises will solve your scapula problem, but rather more worsen it as you'll be strengthening them in the positions that they're in, you want them both equal beforehand, so if you experience no pain with push up protractions (serratus anterior strengthening) then go ahead. Obviously when doing anything exercise wise, record yourself from the back, front and both sides so you can see what's going on and attempt to correct your shoulders. 

I definitely won't provide anymore *suggestions* as you've said this has been going on for a good 1.5 years? Honestly, forget doctors, the majority are pathetic when it comes to rehab, I suspect you've heard 'take a few weeks off' or 'give it a rest' or even 'Don't don't that sort of training'. Find a rehab center or database where you can specifically find an expert of the shoulder/back area. Don't wait ANY longer, my impingement is still slightly here, and I've had it about what, 6 months or so now and it was only a tiddly injury. 

One last time, get an appointment with a shoulder rehab expert, and if possible, check if past patients have left feedback and call the center to get information on his past with qualifications and what not.

I mean it, we all mean it, get that god damned appointment. Best o' luck 

Jake Lawrance said:

Hmmm, what is your job for a start? Do you spend a lot of time on the computer? Writing quite often? 

 When I had shoulder problems one of my shoulders began to elevate and my shoulders eventually went lopsided as the mouse was on the top desk and the keyboard was on the low desk. I also find that when I'm studying or in school, my writing arm begins to elevate bit by bit while internally rotating, I can be in this position for up to 3 hours a day and usually brings back some symptoms of my old impingement. (...)

This is off topic, but your post reminded me of a good use of a kitchen timer: when at your desk (or activity where your posture is important but tends to shift, set up the kitchen timer to 20 minutes, when it rings, reset it, adjust your posture, maybe do a few stretches, rinse repeat...

Resetting your posture 3 times per hour costs zip & goes a long way

Jake Lawrance said:

(...) study your habits (...) wiping your behind  (...)

  Preparing a PHD I presume.................

FredInChina said:

This is off topic, but your post reminded me of a good use of a kitchen timer: when at your desk (or activity where your posture is important but tends to shift, set up the kitchen timer to 20 minutes, when it rings, reset it, adjust your posture, maybe do a few stretches, rinse repeat...

Resetting your posture 3 times per hour costs zip & goes a long way

 

 

  Preparing a PHD I presume.................

That is a good idea, everyone has a phone, Ipod on them these days, and a stopwatch if you're a coach  

PHD? Oh yeah

Thanks guys. I have an appointment with a shoulder physio in 2 weeks.

What I did the last couple of days was to do a ton of shoulder band dislocations. First this caused a really weird feeling in the left shoulder while doing it but after a couple of days that feeling went away. The exercise seems to have resolved my issues with Dips. Can even do Ring Dips and don't get pain. Only problem now, the last 3 days I did a lot of HSPU and today I woke up with a slight pain and reduced flexibility.

What muscles do you train with overhead pressing that you do not train with Ring Dips? Could it be something with the upward rotators as you don't have that with Dips? Or could it possibly be a rotator cuff tear? Would it even be possible to do HSPUs and Ring Dips while having this and only get pain a day or two after?