Possible shoulder Impingement

[cward76]

Ok, I guess I should lock myself in a padded room after breaking my ankle, my foot, and now I seem to be having pain in the location that the line in the picture below points to.

I first felt the pain while doing military press to the front today. I did my three warm-up sets and my first work set of 4 reps. The weight I was using I probably could of done 6 reps just to give you and idea of how heavy I was going. I was using a military press station in which you sit down at with the barbell setting behind me and slightly above my head. On the second work set I barely had lifted the barbell off the supports when my left shoulder/Arm gave out. The area that the line points to hurt pretty bad. I unloaded the barbell and tried to see if I could push up off the supports, I couldn't, my left arm/shoulder felt pretty weak. It has been a couple hours since and there is a burning sensation in that area but the pain has decreased somewhat. I feel like a little strength has returned. At this point I have not taken any pain medicine.

I have never had any shoulder problems in the past. On the second work set I was not concentrating as I normally would, and almost wonder if I used bad form lifting the weight off the supports and this made had lead to the injury.

Does this seem like a shoulder impingement? If the burning sensation and pain go away in a couple of days am I out of danger? Is there different severities of shoulder impingements?

Keep in mind if I continue to have pain for more than a week (if it is real bad I will go sooner) I will go to the doctor regardless of what I am told here, just trying to get an idea of what is going on so I don’t panic.


Thanks for any help that can be provided.

[Bill Hartman]

The position that you had to put your shoulder in to unrack the weight is murder on shoulders.

RICE and over the counter anti-inflammatories should help with pain.

Shoulder instability which can result in impingement is progressive which is why no one ever has shoulder problems until something happens (the straw that breaks the camel's back).

You are wise to see the doc.

Bill

[cward76]

Bill

Thanks for the quick response. I have been seeing an orthopedic for my foot problem, so getting in for an appointment want be a problem.

(I have expensive, but good health insurance, thank god because I have had one hell of a year for injuries )

Is it true that I can do exercises to fix this problem? From what I have read this problem is created by instability in the shoulder joint resulting from an in balance in the muscles that support the shoulder joint. If so do you have any recommendations? Keep in mind they have to be sitting exercies do to my ankle/foot injury.

Also, is bench press consider overhead pressing?

Thanks

[cward76]

Is there a such thing as minor shoulder injuries? I am asking because both of my shoulders are now hurting as I described above.

I have made an appointment to the orthopedic, but it not until 11/19.

[Bill Hartman]

Bench pressing is not overhead pressing. You'll see it described as a horizontal press in many areas of the forum. It does have it's hazards. I don't usually recommend straight bar bench press for anyone with shoulder instability (except for testing) because of the tendency to rely on passive stability (long explanation required here) although dumbbells with elbows closer to the body are acceptable.

You can sort of fix the problem with exercises (search for rotator cuff strengthening and scapular stabilization). Stability changes when active and passive stabilizers adapt to whatever activity you do on a regular basis. Issues such as posture, flexibiltiy, and strength changes can influence function. Once passive stability is changed it's relatively permanent (treat it as such).

If passive instability increases, you must compensate with greater dynamic stability which falls on the rotator cuff and scapular stabilizers.

To give you an idea how strong this dynamic stability can be. Most good baseball pitchers will test like a major instability problem, yet they can throw at 90+ MPH and stop their arm in a fraction of a second without pain.

You need to be assessed to determine what you need to correct the problem. It could be flexibility, strength, posture, training program, or all of them.

Bill

[cward76]

I have decided that I will limit physical activity as much as possible until I see a doctor. I am on crutches so I am unable to eliminate physical activity totally.

As of right now I fill the most pain when I raise my arms to chest level. Once I get them past that point the pain decreases sharply. I am kind of panicked because I feel the pain in both shoulders now. Last night I only felt pain in the left shoulder.

I will let you know what the doctor finds.
Thanks for the help.

[Bill Hartman]

Your crutches may be contributing. It's kinda like hanging on dip bars all day.

You're also describing what's called a painful arc in your shoulders where you feel the pain. It's an indication of impingement.

Bill

[cward76]

Yeah, I kind of figured the crutches didn't help matters. I work in office with nice people that have helped me out a lot since I broke my foot.
That has helped minimize how much I have to be on the crutches while at work. At home I roll around on my desk chair alot.

[cward76]

Looks like I just have a minor impingement. Doctor seems to think it just needs rest and anti inflammatory to reduce the swelling that is pushing against the accronim(sp)

The pain that I experienced initially is virtually gone. I have lost some range of motion and if I try to push my arms above my head with my hands fixed shoulder width apart I feel some minor pain. The doctor didn’t think that it was chronic. When I see him again in Dec for foot cast removal we will reevaluate the situation with my shoulders.

Basically told me not go do anything that causes pain or discomfort in my shoulders.

[Bill Hartman]

Swelling pushing into the acromion??? Wha? Was this an orthopod who works on shoulders?

Bill

[cward76]

Originally posted by Bill Hartman:
Swelling pushing into the acromion??? Wha? Was this an orthopod who works on shoulders?

Bill

I'm not sure if shoulders were his specialty. I guess that sounds way off. Maybe I miss understood him. He had a chart and pointed to that area. I think he said something about inflamation of the rotator cup area causing the problem. I guess once he started pointing to the chart, I started visualizeing instead of concentrating on what he said. I will look for a picture and see if I can't point post with the area he was talking about.

[bryanc]

Well, it might or might not be swelling, but there are structures that can contribute to the 'impingement' of supraspinatus up against the acromion, which is the muscle of complaint in impingement syndrome.

You could have inflammation of the subacromial bursa, which lies between the supraspinatus and the acromion. This decreases the subacromial space and might cause impingement symtptoms.

You could have inflammation of the tendon from your injury (if you had genuinely traumatized the tendon), which would also decrease the subacromial space.

A painful arc can also be suggestive of a partial rupture of supraspinatus--but that's only really diagnosable through MRI.

[cward76]

Bryanc,

The painful arc is pretty much gone. In fact I feel very little pain even in the most painful positions, if that makes sense. He talked about having a MRI done if I still had any pain on Dec 15 which is when I will have my cast taken off.

He had me put my arms in various position, then he had me put them in those positions against resistance. Most of the positions I did not feel any pain. He also pushed on my shoulders in different places. I felt minor pain in some places. I'm not sure if he used the term swelling, he may have said the inflammation was causing the pressure on the acromion. I have always thought inflammation lead to swelling so that is were I may have got the term swelling from.

Based on these things he felt like that I had a strain of some sort that resulted in the inflammation. I do remember him specifically saying he did not believe I tore or ruptured anything.

I have mixed feelings about this whole deal. I want to believe the problem is minor, so what the Doc told me was music to my ears. Based on the lack of pain I feel now, I tend to think that diagnosis is right. At the same time though the pain I felt when this first happened was unbelievable. I broke my ankle and foot a few weeks back, I felt like the pain from the shoulder injury was worse than the pain from the broken foot. I actually got dizzy from the pain of the shoulder injury. The initial pain I felt makes me think that is something more problematic.

If I start to think I have been misdiagnosed than I will seek a second opinion.

Thanks for the interest, I will keep you all posted. Keep leting me know your opinions.

[cward76]

Doctor did a MRI, the radiologist and the doctor said my shoulders were normal and showed no signs of injury.

Maybe the time between the initial injury and the date the MRI was taken gave time for the injury to heal? The injury happened on Nov 7. The MRI was done on Dec 16. If it healed that quickly it was probably pretty minor. Kind of amazing considering the amount of pain I felt initially. (Maybe I am a wimp, and have a low tolerance for pain)

I felt some pain on Dec 16 at the time of the MRI, but that could have been from being on crutches for 8 weeks. As or right now I do not feel any pain.

I'm assuming that if there was any problem with my shoulders the MRI would have showed it, and I would still have pain. Is this assumption correct?

This whole ordeal is enough to scare me away from military press. I will not be doing MP any more.

[russ]

Originally posted by cward76:


I'm assuming that if there was any problem with my shoulders the MRI would have showed it, and I would still have pain. Is this assumption correct?

Not exactly. MRI can demonstrate the structural damage that results from impingement syndrome or certain anatomic abnormalities which predispose to impingemnt, but symptoms may precede the structural abnormalities seen on MRI. But a normal MRI is still reassuring in that it indicates that there is no major injury. You should be able to make a full recovery, although you may have to think carefully about your selection of exercises.

[cward76]

Thanks Russ


I'm trying to figure out what exercises I should do. In addition to military press I'm also afraid of barbell bench press. I really enjoy barbell bench press, but if it is going to put me at a significant risk of injury I will leave it out of my routine.

Dips have never caused any problem for me in the past, but they seem to be a big no-no if you have shoulder problems, so I'm going to leave them out at first. Then I might try to do them once have recovered, as long as they don't cause any pain or problems.

Pull-ups, I have not seen anything negative about doing pull-ups with regards to shoulders. I really enjoy doing pull-ups and chin-ups. Should these be off limits? If not I will start off using a lat machine, then pull my weight and eventually add weight as I was doing before the injury occurred.

I have also considered using some of the exercises in the routine below. I would leave the Cuban press out since it includes over head pressing.
http://www.ruggedmag.com/index.php?type=Article&i=2&a=5

I have read some of the other threads from other people who have had shoulder problems, these threads scared the crap out of me. It is for that reason that I’m going to proceed with extreme caution. I count myself lucky that I did not injury myself worse. I will start out with extremely light weights on any exercises. If anyone has suggestions on do’s and don’ts in regards to shoulder injury your input would be greatly appreciated.

[russ]

Originally posted by cward76:
Thanks Russ

No problem.

I'm trying to figure out what exercises I should do. In addition to military press I'm also afraid of barbell bench press. I really enjoy barbell bench press, but if it is going to put me at a significant risk of injury I will leave it out of my routine.

When I started having rotator cuff issues about 7 years ago, I basically eliminated all barbell presses (bench, incline, military) and have gone exclusively with dumbbells. I have been happy with the results, but my recent injury could put a damper on that. I'm not sure how my left shouler (dislocated it 2 months ago playing hockey) will respond to heavy presses of any type

Dips have never caused any problem for me in the past, but they seem to be a big no-no if you have shoulder problems, so I'm going to leave them out at first. Then I might try to do them once have recovered, as long as they don't cause any pain or problems.

That sounds like a good approach. Wait until you're stronger and pain free, and see how your shoulders respond to dips.

Dips always gave me pain in my A-C joints, so I don't do them anymore. I think that my technique was fine, but my shoulders just didn't respond well to them.

Pull-ups, I have not seen anything negative about doing pull-ups with regards to shoulders. I really enjoy doing pull-ups and chin-ups. Should these be off limits? If not I will start off using a lat machine, then pull my weight and eventually add weight as I was doing before the injury occurred.

Also a smart plan. Behind the neck pullups are probably a no-no, but you should be able to do pullups without to much difficulty. They haven't caused any problems for me.

I have also considered using some of the exercises in the routine below. I would leave the Cuban press out since it includes over head pressing.
http://www.ruggedmag.com/index.php?type=Article&i=2&a=5

Those all look OK, though it's not quite my routine. Have you seen a physiotherapist? Would your insurance cover that? I have found physiotherapists to be helpful with regards to setting up an appropriate rotator cuff/scapular stabilizer strenghtening program.

I have read some of the other threads from other people who have had shoulder problems, these threads scared the crap out of me. It is for that reason that I’m going to proceed with extreme caution. I count myself lucky that I did not injury myself worse. I will start out with extremely light weights on any exercises. If anyone has suggestions on do’s and don’ts in regards to shoulder injury your input would be greatly appreciated

Shoulder problems really blow, and they're very common. A cautious approach is the intelligent way to proceed, but you should be able to find a routine that works for you.

[cward76]

Those all look OK, though it's not quite my routine. Have you seen a physiotherapist? Would your insurance cover that? I have found physiotherapists to be helpful with regards to setting up an appropriate rotator cuff/scapular stabilizer strenghtening program.

I'm actually seeing a physical therapist for the rehab of my broken foot/ankle. I have an appointment today. I will ask them if they can help me with a routine. I'm pretty sure I could get the doctor to refer me. Actually I may not even need a referral.

I have been happy with the results, but my recent injury could put a damper on that. I'm not sure how my left shouler (dislocated it 2 months ago playing hockey) will respond to heavy presses of any type

Your injury occured about same time my shoulder injury occured (early November) correct me if I am wrong. How has your recovery been going?

It was a big downer for me because I could not do any exercise once the shoulder injury occurred. This basically forced me to learn how to be a couch potato, I'm not very good at it or happy doing it.