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Repetitive Strain Injury/not rotator cuff tear .. tendon ripped off the bone

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QUESTION: hello,
on 5 13 13 i was trying to prepare a large dead limb to be snapped off tree when it slipped from my grip & yanked my L arm.  
i had 7 out of 10 pain so did r.i.c.e
(had systemic cortisone injecton in this L deltoid 5 7 13 for multiple pain issues)

5 27 13 -1.5 pain in L arm down to wrist, by bicep ,L pec muscle near shoulder intermittently just while i'm sitting so immobilized arm with a sling to avoid using it to see if that expedites healing
(have been using celebrex 200mg 1-2x daily and/ or neurontin since injury and r.i.c.e to help healing)
the pain had been pretty bearable until to mysterious intermittent pain today so i'm asking for your help in clarifying how long i should give until i have to be seen for this.  
i had a wrist injury that i didn't get examined until i had insurance which ended up being a break that required surgery as it was past the point where it could be set.
am i foolishly risking making matters worse by waiting?
my doctors office said i have to pick one issue to address with the doctor at a visit so i feel there's a message that i have to only consult with them about the most pressing problems so i'm asking you whether this is something i should just nurse for a couple months & only see the doctor if it's more painful than i can bear or if by delaying treatment i'm making matters worse.  i can't judge so i need some help.
thank you,
m

(i've been diagnosed with fms so the doctor seems to attribute problems i see him for to the fms)

ANSWER: Hi M,

It's very possible that the injury you sustained could have caused a tear in the ligaments of your rotator cuff, and it's also very possible that the muscles pulled so hard that they are straining your tendons. I am surprised at your doctor's office telling you that you have to pick one issue to address with the doctor, I've never heard of a doctor not wanting to hear the whole story. I would consider looking for a more caring physician.

If the tendon or ligament is torn, than yes, it will get worse by not getting medical attention. Do you have insurance now?  I totally understand when a person delays too long because of not having medical insurance.  

You can do some preliminary checking on the muscles to see if they are painful.  If they are then it's a good chance that they are the problem.  If you go to http://www.julstro.com and read the sections titled "Muscles and Pain" and "What's Happening Exactly," that will give you a lot of good information.  After you read that information, do an internet search and look for graphics of the pectoralis minor, infraspinatus, serratus anterior, teres minor, teres major, deltoids, biceps and triceps muscles.  Each of these could be involved in this injury.

Meanwhile, try this test: press your right fingers into each of the muscles mentioned above. Basically, press straight down onto every muscle that surrounds your shoulder.  You shouldn't feel pain, just pressure, if they aren't in spasm.  If they are painful it means that they are pulling on their tendons which all insert into the shoulder.  If they are extremely tight they can tear the tendon.  

You'll see when you go to the website that you can learn to self-treat each of these muscles, and if nothing is torn, that will eliminate the pain.  If the muscles are tight and the tendons are torn, it's very important to release the tension in the muscles because they are putting a strain on the tendons and they won't heal properly, even if they are surgically repaired.  Think of it like pulling on your hair and your scalp hurts, this is what happens when muscles are tight.  Another analogy is: if you pulled material so hard on either side that the material starts to tear in the middle, and then you sew the middle pieces together but continue pulling on each side, you can see where your stitches won't make a nice clean repair.  Again, it's the same with muscles.

Personally, I would do both - treat the muscles and see the doctor.  Treating the muscles will help either way, and if a tendon/ligament is torn, it won't repair by itself. With treatment I believe you'll be just fine again.

BTW, is FMS how your doctor is labeling fibromyalgia syndrome?  If so, be aware that in many, many cases, spasms in the muscles are causing a great deal of the pain, and releasing the tension in the muscles will ease (or even eliminate) the pain.

Wishing you well,
   Julie Donnelly

---------- FOLLOW-UP ----------

QUESTION: hi julie,
thank YOU for your expert advice & thank you for validating my feelings about being made to choose 1 issue to be seen for at this office (which is staffed by 1 nurse practitioner/no doctors). i have medicare advantage insurance& am sure that the compensation issue informs this poor kind of treatment.  
most of the dozens of medical professionals i've seen have treated me like a head of cattle.  one of the med professionals finally confided in me that pacific nw cities with offices that accept medicare participate in an agreement not to prescribe pain relievers as part of a strategy to address the substance abuse problems in the cities.
consequently, they said, all people who are complaining of pain are seen as drug-seekers. i have experienced such hostility.  unfortunately, people like me with chronic pain problems go without care and have developed a distrust of medical professionals.  i hate going to ask for medical help. i should say that this np has been one of the better practitioners i've seen in that he mostly honors my requests.
he has a sister with fms so perhaps he has some empathy. funny you should mention about the link between fibromyalgia & spasms as i did do a trial of baclofen where i titrated all the way up to 80mg per this study evidencing it's efficacy for ptsd but didn't realize any benefits.

i did look at your site & checked these muscles but couldn't find the source of pain so i did get into see the np and convinced him to order an xray which showed a fracture.  i just got back from seeing a physicians asst at the orthopedists who said the tendon pulled off a portion of my greater tuberosity on the humerus where the tendon connects.  fortunately, it should heal on it's own in 6-8 weeks. i took a megadose of vitamin d (in case my level is low) as it's so important for bone growth and will keep off the nsaids until after this has healed.

you are very generous for replying to my question. i hope my questions/ your answers will help others who are trying to help themselves & their loved ones.

thanks again,
m

Answer
Hi M,

I would add some Shaklee (I LOVE this brand much better than any other brand on the market because my family has had some pretty amazing results with Shaklee) Ostoematrix as the vitamin D is vital, but so is the calcium.  If you know a Shaklee distributor in your neighborhood you can ask him/her about it, or go to http://ultimate-performance.myshaklee.com/us/en/category.php?main_cat=Nutrition&.

I hope you find a doctor/NP who is in the field for the right reason - because s/he has a love of helping people. You seem to have had a bad run, but there are a lot of really caring physicians out there, it just takes a bit of detective work.

I suggest you try to not use your shoulder as much as possible while it is healing, that will help to prevent more strain being put onto the tendon.

Wishing you well,
   Julie Donnelly

Repetitive Strain Injury

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Julie Donnelly, LMT

Expertise

I can accept questions that relate to chronic or acute pain caused by muscle spasms and contractions. Repetitive Strain Injury is actually Cumulative Trauma to muscles. Releasing the spasm &/or contraction will relieve the strain that is felt at the insertion point on the bone. I am the co-developer of the unique safe-stretching program "Focused Flexibility Training," which combines easy instruction for self-treating spasms throughout your body with proven yoga stretches. I have recently authored two new books: "The 15 Minute Back Pain Solution," and "The Secret to Your Best Golf Game EVER!

Experience

Since 1989 I have been working with endurance athletes and individuals suffering from chronic pain conditions. I have authored seven self-treatment books and three self-treatment DVDs and I have developed the Julstro System for the treatment of carpal tunnel syndrome, Trigger Finger, and other Hand/Wrist pain. I am a national and international presenter at conventions, seminars, and workshops. Principle topics are "Work Shouldn't Hurt," and "The Pain Free Athlete." In 2005 and 2006 I was the massage therapist for ultracyclists competing in the Race Across America (RAAM) 3000+ mile race from San Diego, CA to Atlantic City, NJ. I've taught the Julstro techniques to physical therapists at the Cleveland Clinic, to massage therapists in areas around the USA, and I've taught Julstro self-treatment clinics to dancers at Juilliard School of Performing Arts (NYC),the sprinting team at NC State, and I am working closely with several Olympic-hopeful. We have successfully eliminated the repetitive strain injuries that could keep them out of the Olympic Games, and the best part is they know how to do the self-treatments so they can stay pain-free and flexible.

Publications
Triathlete Magazine, Endurance Magazine, multiple national and international trade journals.

Education/Credentials
Swedish Institute of Allied Health, NY, NY - Initial education in massage therapy Licensed NYS Massage Therapist since 1989. SUNY Empire State College, Saratoga Springs, NY - B.Sc. degree in Interdisciplinary Health Education I was an Associate Professor helping to develop the massage training program for SUNY Rockland Community College

Past/Present Clients
Privacy prevents me from filling in this section without prior consent from my clients. Life Experience: I have been specializing in the treatment of chronic pain and sports injuries since receiving my NY massage license in 1989. A personal bout with carpal tunnel syndrome was the catalyst to my developing a self-treatment that heals the symptoms of carpal tunnel syndrome quickly and without surgery. My work with endurance athletes was the inspiration to teach people how to self-treat so they could stop pains even during a race or heavy training day. Both of these situations ultimately became the products that are sold on my websites: http://www.FlexibleAthlete.com and http://www.julstro.com. I currently treat people in my offices in Sarasota, FL, Cary, NC, or Pearl River, NY

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