Front Shoulder Pain

[Toby from MO]

1. When did the pain begin?
It’s hard to say…maybe 3-4 weeks ago. It seems that I occasionally have a minor ache or pain somewhere whether it is an ankle, knee, wrist, shoulder, etc…(joint). Typically I’ll stretch and begin my workout (lifting or running) and I can usually work it out.

2. What were you doing at the time? Or did the pain come on gradually over time?
The progression is gradual. My first thought is this is the result of starting my lifting but it may be coincidence. It could be the driveway shoveling that followed the past few snow storms.

3. Where, anatomically, is the pain?
The pain is in the front of my right shoulder. With my arm hanging straight down the horizontal location is about 45 degrees between square front and the right side…vertically, it’s about 45 degrees between square front and the top of my shoulder.

4. What does the pain feel like? Sharp? Dull? Aching? Stabbing? Shooting?
I describe the pain as aching going to sharp…depending on the range of motion at the time.

5. Is the pain constant, or intermittent, or only on certain motions?
For the most part the pain is non-existent. I would categorize it as dull/aching, at most, while performing normal/household activities. It is not a persistent issue during rest/sleep.

6. What motions make your pain worse?
During stretching I notice the pain progresses to sharp when I stretch/pull my right arm across the front of my chest. I can also feel it very slightly during incline presses. I normally do not feel a progression of pain during flat or decline presses.

7. What, if anything, makes your pain better?
Hard to say. As I stated earlier…my typical aches/pains will usually disappear. This thing seems to be hanging on.

8. Does your pain radiate to any other part of your body?
No.

9. What things could you do before, that you cannot do now because of your injury?
Stretch without discomfort. Progress though my workouts without being cognizant/careful not to overdo it and further aggravate the pain.

10. What is your main concern regarding the pain and its consequences?
That I may aggravate it further and that it will hamper/slow my physical fitness progress/routine. To get it diagnosed, i.e. muscle, joint…arthritis, and begin understanding/adjusting my fitness routines to accommodate it.

11. Have you ever injured that part of your body before? If so, how?
I am right handed. I played baseball (catcher) from childhood through college, i.e. until about 23yrs old…I’m now 34yrs. My baseball career ended due to shoulder pain, i.e. front shoulder pain. My options were full reconstructive shoulder surgery or stop playing…I stopped. I forgot what medical term was used for my condition but in laymen’s terms my shoulder socket is larger than the ball that sits in it. When my shoulder shifts rearward it stretches/aggravates the muscles, tendons and ligaments in the front of the shoulder. Doctor’s advised me no harm would come of not doing the surgery. They warned though surgery would fix the shifting problem it would severely limit my range of motion…possibly leading to further/different issues. They warned me that arthritis would a likely long term issue in either case.

12. Is your pain getting worse over time? And if so, how much worse over what time period?
Not really…at least thus far.


Comment appreciated.
Toby

[UConnJulie]

It sounds like you have some impingement, possibly of the biceps tendon. It's common in folks with laxity. Take some static pictures of your torso side view and back view and front view. I'd like to see what your shoulderblades are doing.

[Toby from MO]

Originally Posted by UConnJulie

It sounds like you have some impingement, possibly of the biceps tendon. It's common in folks with laxity. Take some static pictures of your torso side view and back view and front view. I'd like to see what your shoulderblades are doing.

I'll try to get some photos. What exactly is laxity?

[UConnJulie]

Laxity = looseness of the muscles/ligaments/capsule

Thank you for PMing me your photos.

It appears to me that you have some scapular stabilzation issues as your scapulae are anteriorly tilted and protracted.

I can certainly point you in the right direction regarding corrective exercise, but in something like this which has been problematic in the past, in person care is best.

Do you have a good therapist that you trust? If not, let me know where you live and I can point you in the right direction ...

[Toby from MO]

Originally Posted by UConnJulie

Laxity = looseness of the muscles/ligaments/capsule

Thank you for PMing me your photos.

It appears to me that you have some scapular stabilzation issues as your scapulae are anteriorly tilted and protracted.

I can certainly point you in the right direction regarding corrective exercise, but in something like this which has been problematic in the past, in person care is best.

Do you have a good therapist that you trust? If not, let me know where you live and I can point you in the right direction ...

Thanks a lot for your help. In laymen’s terms…can you describe what you see vs. what is "normal"?
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I do not have a therapist at this time. I could look into finding one but would rather follow your recommendation if you could assist.

I Live in ffice:smarttags" />Imperial, MO 63052

In the meantime, any exercises/lifts I should or should not be doing would be appreciated.

Thanks again,
Toby

[UConnJulie]

What I see vs What is "Normal"? Your shoulder blades are slouched forward. And it also appears that the muscles between your shoulder blades aren't working properly.

I will give you some stuff to try, but if it is not significantly better after 2 weeks of consistent effort, then you will need to see someone in person.

1. No overhead pressing.
2. No bench pressing. Really no pressing of any kind except in what is outlined below.
3. Do an extensive warm up. This video is a good example of a comprehensive scapular stabilizer warm-up ...


4. This is also a good detailed rehab program also by the boys at the Diesel Crew ... you really need to focus only on scapular stabilizer exercises at this point (ie no need to do curls or tricep press or anything else). I promise your arms won't shrivel up into nothingness.

[Toby from MO]

Julie,

Thanks again for the input. I can't see the videos while here at work...I will be able to do so from home.

I googled many of the excercises and the DieselCrew "Youtube" link comes up as the first choice for many of them. Do the videos show/demonstrate the exercises you've detailed in each circuit...or...one of the websites you listed better to show how each exercise is performed?

In other cases I got a host of other websites that are related to these type exercises but it seems they may not be calling them by the same name/terminology.

Here is a link to a word document that I found that appears to be fairly inclusive but I'm not sure they are the same exercises (called out by different names) or something entirley different.

http://orthodoc.aaos.org/JonathanEFo...0EXERCISES.doc

In regard to my existing workout programs I have two questions. Can I contiue my lower body/mid core workouts...squats, lunges, step-ups, deadlifts, etc? What upper body exercises (if any) can I continue. You mentioned stopping most "pushing" exercises but what about "pulling" type exercises, i.e. pull-ups or lat pull downs or the various rowing exercises?

Any help you could provide with identifying a reputable therapist (local)would be appreciated. Due to the requirements of my health insurance I'm sure I would have to see my primary care first then be recommended to someone...to be covered. Hopefully I have a say in who is recommended.

Thanks again,
Toby

[UConnJulie]

The videos demonstrate all the exercises ... check it out when you get home.

The document you linked has many common shoulder rehab exercises, but many of them for the rotator cuff which does not seem to be your problem.

Absolutely continue your lower body/core workouts. I think pulling exercises are fine to continue as long as they are pain-free.

Midwestern geography is not my strong-point ... how far are you from Springfield?
There's a Shawna Townsend in Springfield, MO that I would recommend.

Others who may be good ...

Shawn Everson, PT, MHS, OCS
Everson Orthopedic Physical Therapy Services
763 S. New Ballas Road
Suite 200
St. Louis, MO 63141
314-991-2562

Earl Brasfield, PT, OCS
Telegraph Road Physical Therapy
Suite 107
St. Louis, MO
314-894-9008

Michael Cibulka, PT, DPT, MHS, OCS
Jefferson Country Rehab and Sports Clinic
1330 YMCA Drive
Suite 1200
Festus, MO
636-931-7600