Physical Rehabilitation Medicine/Shoulder

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Question
Dear Brian,

I'll try to be brief while providing the most info possible:

STATS: 50 y/o male, 5'10", 195 lb, no medical conditions

BACKGROUND: I started training with weights when I was 18, but I'm not a professional or compete, I do it just for myself. No anabolic drugs.

In 2010 we had a new baby, and we also moved, and I stopped training for 2-3 years b/c there were lots of things going on (baby care, remodeling the new and the old properties, etc, etc)

I started training very irregularly. One day I was playing ball with friends, and strained my shoulder while pitching b/c I threw too hard too fast. I felt pain in my shoulder, but it was temporary, and I don't remember feeling anything the next day.

The next month or so we went on vacation. I used the gym at the hotel every day for 1 hr or so, they had those machines that are specific for a single exercise/muscle group, and they use stacks of rectangular weight plates and a pin to select the load. I remember that the machine to do pectoral "flyes" had a very wide range of motion, meaning that in the eccentric part of the movement, my arms were traveling farther back than usual. But I didn't feel any pain or anything. The rest of the time we spent in relaxed water activities

SYMPTOMS: It was like a week after returning from vacation. Standing up with a dumbbell in each hand, I tried to do alternate curls, but my right arm wasn't responding, I couldn't lift the weight. The problem seemed to be the shoulder where it connects with the biceps. My upper arm wouldn't stay in place to support the curling movement. I had pain in the front of the deltoid (in the hollow part between the front and the side parts of the deltoid) and in the back of the shoulder at the same time.
When I was applying deodorant, for example, with my right hand to my left armpit, I wasn't able to lift my right elbow away from the body, I had to keep it pinned to the side of my ribcage. And forget about reaching (from above or below) with my right arm and touching or scratching my back. While lifting my extended arm to the front, there were certain sections of the movement where my shoulder had no strength and it was painfil, and I had to help with my left hand to pass the "sticking" point

MEASURES: I blamed my pillow for not being high enough and when I was sleeping on the side, my shoulder wasn't in a good position, and I thought that might be causing the prob, so I starting using 2 pillows stacked up, which was more comfortable, but the prob didn't disappear. I read online about several shoulder conditions, and I thought what I had could be "impringement"... so I started mild exercise with red therapeutic rubber bands, mostly rotator cuff exercises. I was taking glutamine and glucosamine with condroitin, and doing a bent-over hanging arm "pendulum" exercise from time to time

But I think what worked best was every morning before getting out of bed 30 mins electric heating pad wrapped around the shoulder, then turn it off, and leave it there until it wasn't warm anymore. Then I applied Muscle Rub (a menthol cream) and left it on thru the day. I repeated the same procedure before going to bed

RESULTS: After 2-3 months of this, improvement was minuscule, but consistent... every couple of days some progress was noticeable. It took almost 2 years before I felt I could start training with weights again... very carefully... whole body circuit workouts first... at some point after that I started doing a lot of standing presses as part of my workout (mostly b/c they save time, they're quick to do). When I "clean" the weight from the floor to my shoulders, the right side can't follow the same movement path than the left, and the flexibility to support the barbell across the shoulders is less in the right side... But I was surprised that my right shoulder got even better with the pressing workouts, faster than with the heat/light exercise treatment I had done before

RECOVERED: After 3 years now I'm able to reach and touch my back with my right hand, almost like I do with my left. There's still a cracking/popping in my right shoulder sometimes, but it's I'd say 95% as good as it was before this prob started... In the beginning I thought it was going to need surgery or something

So Brian, I'd like to get your feedback about my story... according to your experience, what do you think happened to my shoulder? Imbalance? Damaged ligaments? Impringement? Something else?

What should be done in such cases? Was the "treatment" I followed apropriate?

Any recommendations for the future? What should I do to continue healing, and what should I avoid?

Thank you for your help, and for helping others

Sincerely,

Richard

Answer
Sounds to me like bicipital tendonitis but more than likely a tear at the bicipital groove.  The biceps tendon runs from the shoulder through a tunnel on the humerus which holds the tendon in place.  Without this tunnel, the tendon would slip around during arm use.  It then travels down the arm and inserts on the radial tuberosity on the radius.  During extreme shoulder abduction or extension the tendon or the tissue holding it in place in the groove can be damaged or stretched out.  Once stretched it is difficult to "shrink" back to its original state.  Therefore, the treatment is rest, heat, massage, etc.  Whatever you can do to increase blood flow to the affected area.

Exercises:  Isometric strengthening.  You probably know about this already but it basically is strengthening a muscle without taking it through the full available range of motion.  All exercise should be pain-free.  Avoid extreme motions such as incline bench press where the bar touches the chest.  It's too much stress on the biceps tendon.  If I were you, I'd back off on heavier, more dynamic strengthening.  Clean and jerk etc. are stressful.  Things that require lots of speed with decreased control can be risky.

You did the right thing.  Most people don't know how to address this so good job!  You aren't the spring chicken you used to be Richard...chill out on the big, crazy stuff.  If you damage it again you will likely need surgery and are lucky to get out of this without it.  I'd say you are fine since it's better but with something like  this it usually isn't what it was pre-injury.  No biggie.

Good luck and I hope this helps.

Physical Rehabilitation Medicine

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Brian Neville, OTR/L, CWCE

Expertise

I can answer questions about both conservative and post-operative rehabilitation for UPPER extremity injuries. These include but are not limited to: fractures, tendon repairs, tendon transfers, nerve repairs, lacerations, tenolysis procedures, TFCC injuries, repetitive motion disorders, reconstructive procedures. I have an advanced knowledge of UPPER extremity anatomy and industrial rehabilitation. I have extensive splinting skills for injuries to the upper extremity. Although not a physician or a surgeon I have worked closely with world renowned upper extremity specialists for over 10 years. I can give general information on what some of the most common upper extremity surgeries involve. I can reference those procedures as well. PLEASE DON'T ASK ME QUESTIONS ABOUT ANYTHING OTHER THAN THE NECK, SHOULDER, ARM/HAND. I'M NOT QUALIFIED AND KNOW ABSOLUTELY ZERO ABOUT BACKS/HIPS/KNEES/ANKLES/ETC. THANK YOU!!!

Experience

10+ years working closely with orthopedic and hand surgeons and their patients. I have treated patients with small lacerations to major reconstructive procedures. My knowledge base includes both conservative and post-operative rehab protocols and care for upper extremity injuries. I have treated patients all the way from day 1 post-op to return-to-work status.

Organizations
Kentucky Occupational Therapy Association American Society of Hand Therapy National Nurses in Business Association Roy Matheson and Associates

Publications
RSD article

Education/Credentials
Occupational Therapist former Certified Hand Therapist (license currently inactive) Deep Physical Agent Modalities Instructor Certified Work Capacity Evaluator

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