Rotator cuff/shoulder

[physeek]

First, i've been a "lurker" for some time and have gotten good information from this site. The ART sessions I attended were a direct result of learning of ART from reading Bill Hartman's recommendations to others for shoulder problems. Thanks for the forum.
To be somewhat specific, i've been weight training with a co-worker/friend consistently fo 3 years (something I consider a positive accomplishment). Various routines (a bunch found from this website), changed up often, and always kept push and pull exercises balanced. The last week of December on an airline I lifted a "carry-on" bag in a front raise fashion and felt a strain in my shoulder with pain and soreness that let me know this "wasn't a good move".
I realize that the injury is proably the straw that broke the camels back. Shoulders have seemed to be the "weak link" or "limiting factor" in my bench press progress. The progression of the shoulder issue has been:
1) Last week December - Injury
2) January - Month off, rest
3) February - Try to resume workout, shoulder still bothersome, so decide to do 15 rep/sets hoping to help re-hab.
4) Mid February and March - ART sessions, no workouts for the first 3 visits, then 15 rep/set to give feedback on progress. Some improvement, but after 7- 10 sessions they recommend I see doctor for a MRI, I decide to stop workouts thinking I may be re-irritating the problem.
5) March 31st - Orthopedic surgeon w/ x-ray. "i'm gonna call it rotator cuff tendinitis" and don't really need MRI evaluation. Anti-inflamatory and PT prescribed.
6) April - Month off, rest, anti-inflamatories (naprosyn) fot 10 days. outside of upper arm aches at times on it's own.
7) May - PT, 3 sessions consisting of 20 min. electro stim. and heat followed by massage therapy, arm seems to not ache as often.
The orthopedic surgeon recommended the PT to learn the rotator cuff exercises, and that he trusted I would do them on my own and did'nt need to continue to go to PT. However, the PT told me that we needed to see a decrease in pain before he would give me exercises. Massage therapy wise, things seem good, as there is a decrease in outer arm ache. After the 3rd session, I again asked if there was any streches or exercises I could be doing. The answer was a haphazard demo of lateral side raises, front raises, and a crossover move with dumbells. Given the complexity of the shoulder girdle and the bio-mechanics involved, I was hoping for a more specific exercise plan for my individual case. It seems that I won't be getting any knowledge regarding a plan of attack from this source. Is there a different specialty that deals with this area? I will get a MRI if the condition does not improve, but would like to try a secific rehab exercise plan. Links on this site to an article by Crossgrove and Waterbury titled "8 Weeks to Monster Shoulders" seemed to have a good progession for those with shoulder issues, and Cressey's "Cracking the Rotator Cuff Conundrum" looks good also. Thankfully the pain is not constant or severe and has mostly only affected my workouts. I don't want to make things worse, and would appreciate any advice for this problem thats been going on for 4 months now. (I live on Long Island, NY if going to anyone particular might be suggested)

[GqArtguy]

Your RC might be strained, but it could be an alamgamation of a bunch of other stuff like posture, overactive traps, tight pecs, etc.

What muscles was your Artguy woorking on?

What does your posture look like?

Are you doing work for your scapular retractors, RC, and serratus? You might want to read EC's Shoulder Savers article.

[Bill Hartman]

First, get a new physical therapist who actually knows something about shoulders. Estim and heat don't do a damn thing to help you.

If you have pain deep in the joint at rest, I'd get a new doc and get an MRI to rule out a labrum and/or cuff injury.

Has anyone even done any movement or functional testing with you?

If you have no pain at rest but it comes on as you raise your arm, you've got a mechanical issues that needs to be addressed via exercise, postural modification, etc.

Regardless, at this point, without regular use of you arm, you are getting weaker which will make matters worse. There's a bunch of stuff you can probably be doing to help things like isometrics, closed chain exercises, scapular mobility and strengthening, thoracic spine mobility, etc.

Bill

[physeek]

Wow, that was a long thread/rant. Sorry (I'm not angry about the 4 month problem or anything!) and thanks for reading that book of a thing.
QqArtguy,
- ART guy worked on pretty much everything in the sh. complex, including some that were more bi. and tri. of arm. Hey, the thumb in the armpit and pressing on back/lat. while you move are fun. huhhhh.
- Truth be told, posture is not the best (foward head/neck, some foward sh.round) Trying to be mindful and hold better.
- Haven't done a thing in 11/2 - 2 months
- Gave EC's sh. savers article a quick look, need a more careful read, alot of points to consider for my sh. rehab. plan.

[physeek]

Bill Hartman,
Thanks for responding to my book-like thread/rant and indirectly introducing me to ART as I think it was helpful/beneficial.

- The PT, "deep tissue" massage, myofacial release? (never had PT before) seems beneficial in a similar yet different way than ART. So. I think I'll continue, for a while, as long there's progress. They did some light therapy and ultra-sound once.
- Will go back to doc and get MRI to hopefully find out exactly what's goin on.
He was willing to send me for one, if I really wanted (and after all. I did comply w/ nsaid and PT prescription). Maybe I'll get copies of my X-rays and MRI for my own records/use for future therapy etc.
- Movement and functional testing? Is this when the ART, Ortho, PT asks you to move against them in a particular motion? or is it analysis of movement pattern? (internal rotation moves still cause some pain/ache in belly of arm/humerus and outer arm)
- Sometimes dull ache at rest, reaching up high on shelf is not always painful
strangly, brushing teeth motion can be.
- One time doing "Gray Cook's functional movement screen", a test for mobility and active impingement, from the "Monster Shoulders" article caused quiet a flare up in pain (thankfully short in duration).
- Need to learn and form a routine to impliment your suggestions of isometrics, close chain, scap. mobility/strength, thoracic mobility etc I want to be specific and move away from this problem. Would a different PT evaluate and provide a plan?

[delta]

I've been dealing with a shoulder injury since January myself. Here is what I've learned:

Don't mess around with these online shoulder workouts posted on sites like T-Nation. Some of the things they recommend may actually be dangerous for your shoulder; they are too generically designed and are often too aggressive. You need something customized for whatever problem you have. A good PT should be able to help you. I've been seeing one in NYC in Soho; he's an ART guy and I would highly recommend him if you're interested. I'm still not sure if I'm going to avoid surgery, but if I do, I will credit him.

MRI's are useless unless you feel the pain is bad enough to have surgery. The MRI's (even when they do an arthrogram) are so unreliable and the radiologists often disagree with the ortho's on whether there is a tear. Nobody really knows what's going on until they get in there. The shoulder is just very hard to read. If you have a blatant tear, then it's easy to read, but even if you have a tear you may be able to avoid surgery with some quality PT. I've now had $6,000 worth of imaging done (thank god for insurance); they suspect a labral tear but nobody can definitively tell me.

When you have your exercises and strethes, do them religiously; they really help.

Good luck!

[delta]

oh, and make sure you work on your posture with your PT! It's a pain in the beginning always thinking about it, but it will eventually become second nature. I can't say how much this is helping me, but it makes you look better at the least.

[russ]

Originally Posted by delta

MRI's are useless unless you feel the pain is bad enough to have surgery. The MRI's (even when they do an arthrogram) are so unreliable and the radiologists often disagree with the ortho's on whether there is a tear. Nobody really knows what's going on until they get in there. The shoulder is just very hard to read. If you have a blatant tear, then it's easy to read, but even if you have a tear you may be able to avoid surgery with some quality PT. I've now had $6,000 worth of imaging done (thank god for insurance); they suspect a labral tear but nobody can definitively tell me.

I would agree with the initial statement that MRI probably should be reserved, for the most part, for those in whom surgery is being contemplated. In terms of accuracy, MRI arthrography is actually quite reliable, on the order of 85-90% for labral injuries and >90% for full thickness rotator cuff tears. The caveat is that they should be interpreted by Radiologists with a high level of training and experience in musculoskeletal MRI (this isn't always the case, particularly if you're not having the test at a major hospital). Some orthopedists are competent to make the basic findings on MRI studies, but are generally not as competent as a Radiologist with proper musculoskeletal MRI training.

The problem with having an MRI when surgery isn't being serriously contemplated is that you may detect abnormalities which, under some circumstances, would necessitate surgery. This puts the Orthopedist in a bit of an uncomfortable position, in that he as a documented radiologic abnormality, but the need for surgery is equivocal and it's therefore a situation where it's relatively easy to arrive at the wrong decision.