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Repetitive Strain Injury/Severe shoulder pain radiating into neck/arm

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So about nine months ago I picked up a light plastic part with my left arm stretched out directly in front of me. I picked the part up with a bit of a jerking motion upwards.  In doing so, I felt not so much a pop in my shoulder but more of a shift of the shoulder.   It sounds weird but that's the best way to describe what happened.  I immediately had severe pain deep within the shoulder accompanied by some extremely irritating pain radiating up into the neck to the ear and pain shooting down the side of my arm to about the wrist.  Also, I have some burning pain around the rhomboid muscle area and my shoulder painfully cracks everytime I raise my arm above my head. When I do raise my arm above my head it almost feels like my shoulder joint is not being limited to how far up I can reach and it almost seems to slip out of place when I'm at full extension.  This produces some pain and extreme weakness in the shoulder an the arm. The symptoms have not changed in severity in nine months.  Since then I have had an mri of my spine which came back okay. I have had an mr anthrogram of my shoulder which came back ok.  I have had an mri of of the brachial plexus which came back ok. I have also had an emg done because since the injury my scapula has been winging quite a bit, and that came back ok as well.  I am going back and forth between a sports injury doctor and a pain management specialist, and they seem to be giving up on me.  I was seeing a chiropractor for about 3 months who was cracking my back,performing some active release therapy on me and doing some acupuncture in the rhomboid muscle area. He eventually told me that there was nothing more he could do for the pain.  During the nine months , I have also dealt with three different physiotherapists who have been focusing on strengthening the serratus anterior muscle and the rotator cuff muscles, but I have been having a hard time with the exercises simply because I am in too much pain to do them. For the past ten weeks I have been undergoing some inter muscle treatments, and I am not seeing any results really, although for some odd reason I enjoy havin the needles stuck into my shoulder.  As or medication, I have tried lyrica, which did not help whatsoever, and now I am popping t3s like tic tacs just so that I am not bed ridden because of this injury, of which I was for a couple weeks because the pain was just too bad to even bother getting it of bed.  Next up I'm going for a cortisone shot into the joint of my shoulder, which I'm about 99% sure that it will do nothing. With everything that has been done, I don't understand why I haven't been referred to a surgeon yet. I am beyond sick of being in pain every day, and don't know how much longer I can love with this for.  Every day is the new worst day of my life. Nothing excites me anymore.  Do you have any idea what could be going on? Any recommendations of what to do next? Is it possible for this pain to never go away? Any input will be greatly appreciated.  Btw, I am a twenty nine year old male auto worker who USED to enjoy playing hockey and baseball.

Answer
Hi Brian,

First of all, I'm very happy that you have been through all the tests, that proves that your problem is muscular because there aren't any tests for muscle spasms. As a result, muscle spasms (also called trigger points) are ignored when looking for an answer to pain.  And I'm even happier that you haven't been sent to a surgeon, they haven't been able to find anything, so what would they surgically cut?  You'd end up in worse shape.

Let's talk about muscle spasms.  It will help if you go to http://www.julstro.com and read the sections titled "Muscles and Pain" and "What's Happening Exactly," as that will give you a lot of basic information.  The analogy I use with my clients is, if you pull your hair at the end it will hurt at your scalp, but you don't need to get a scalp massage, or take pain pills, or have brain surgery, you just need to let go of your hair.  This is what I believe is happening to you.  The muscles that either originate within your shoulder (especially the biceps, triceps, teres minor, and teres major) or insert into your shoulder (ie: serratus anterior, pectoralis minor, infraspinatus, supraspinatus) or have a direct effect on your shoulder (pectoralis major, latissimus dorsi, trapezius, and deltoids) are in spasm.  

From what you said I would especially suspect the infraspinatus (needs to stretch for you to move your arm toward the front and refers pain to the shoulder and down your arm into the back of your hand), biceps (needs to stretch for you to have your arm straight), latissimus dorsi (needs to stretch in order for you to pick up your arm over your head and will refer pain into your shoulder - this is probably where the clicking comes from when you lift your arm).

I don't believe you should be strengthening any of these muscles because they are already tight, and strengthening them will shorten them even further. Instead I would find the trigger points and hold the pressure on each point for a minimum of 30 minutes and then release the pressure for a few seconds, and then press down again. Keep doing it until the pain releases.

Brian, I have worked with thousands of athletes, and non-athletes, and I've seen situations just like yours get successfully resolved by releasing the trigger points. When you eliminate the trigger points you'll be back to playing sports again, I've seen it over and over.

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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