Frustrating Shoulder Injury (Possible Tendinopathy)

[Devyn Stewart]

Thanks for your post, Will. I hear this kind of thing is kind of what you do. The suprascapular pain and clavicular pain are muscular/tendinous pains as far as I can tell. That's just where I feel the pain. I doubt it's some sort of contusion on the bones themselves.

Ideas of tendinopathy come because I don't believe it's particularly inflammatory, and movement through the pain seems analgesic. I'd appreciate your thoughts on what it might be.

[Dust Devil]

Thanks for your reply, Dust Devil.

I see. Well, one of the things that made me think it was a tendinopathy is that when I move through the range of motion that is painful, the pain tends to lessen and go away, at least temporarily. I was of the understanding that that was kind of telltale for a tendinopathy. Did you experience this as well?

I don't remember. But looking for trigger points is something you can do while looking for other solutions, so it seems worth pursuing, IMO.

[Devyn Stewart]

That's interesting. How would I go about looking for trigger points?

[Will Morris]

Thanks for your post, Will. I hear this kind of thing is kind of what you do. The suprascapular pain and clavicular pain are muscular/tendinous pains as far as I can tell. That's just where I feel the pain. I doubt it's some sort of contusion on the bones themselves.

Ideas of tendinopathy come because I don't believe it's particularly inflammatory, and movement through the pain seems analgesic. I'd appreciate your thoughts on what it might be.

The first place to start would be taking a look at the area of pain, then bouncing that off of the pain pattern and the aggravating and easing movements. Bring out your anatomy book, and study this area. You identified yourself as a Pre-PT student, so we are going to turn this into an educational process on differential diagnosis.

[Devyn Stewart]

The first place to start would be taking a look at the area of pain, then bouncing that off of the pain pattern and the aggravating and easing movements. Bring out your anatomy book, and study this area. You identified yourself as a Pre-PT student, so we are going to turn this into an educational process on differential diagnosis.

I'm more than happy to oblige. Surface level, my shoulder hurts. Specifically, I feel pain around my clavicle and nonspecific scapular pain (though I expect it's actually the spine of my scapula. Just hard to pinpoint). Pain occurs during elevation, retraction, and depression along with retraction. These are pretty textbook for the trapezius. So, I'm nearly certain that the trapezius insertions are affected. I'd say I'm 90% sure that the specific pathology is a tendinopathy. I guess where I'm seeking guidance is how to proceed from here. I know in the clinics at which I volunteer, they'd probably do a lot of the kinds of movements I specified with therabands and such. Then they'd tell me not to participate in the movement that aggravated it and/or aggravates it currently. I don't feel like this is the right approach because halting training entirely seems to very rarely be the answer. So, I'm asking what would be a wise way of training while I'm rehabbing (and if the rehab I'm doing is intelligent. I'm still very much a beginner with these kinds of things).

[Will Morris]

I'm more than happy to oblige. Surface level, my shoulder hurts. Specifically, I feel pain around my clavicle and nonspecific scapular pain (though I expect it's actually the spine of my scapula. Just hard to pinpoint). Pain occurs during elevation, retraction, and depression along with retraction. These are pretty textbook for the trapezius. So, I'm nearly certain that the trapezius insertions are affected. I'd say I'm 90% sure that the specific pathology is a tendinopathy. I guess where I'm seeking guidance is how to proceed from here. I know in the clinics at which I volunteer, they'd probably do a lot of the kinds of movements I specified with therabands and such. Then they'd tell me not to participate in the movement that aggravated it and/or aggravates it currently. I don't feel like this is the right approach because halting training entirely seems to very rarely be the answer. So, I'm asking what would be a wise way of training while I'm rehabbing (and if the rehab I'm doing is intelligent. I'm still very much a beginner with these kinds of things).

What sits just superior to the spine of the scapula and is more often indicated as a pain generator in shoulders?

[Devyn Stewart]

I believe what you’re wanting me to say is the supraspinatus. I guess what I wouldn’t understand about that is that I have no pain with abduction (except at end ranges of motion when the scapula is involved), and the pain is never on my humerus. Along with that, I don’t see how it would cause pain around my clavicle. Could you tell me where I went wrong in my thinking?

[Will Morris]

I believe what you’re wanting me to say is the supraspinatus. I guess what I wouldn’t understand about that is that I have no pain with abduction (except at end ranges of motion when the scapula is involved), and the pain is never on my humerus. Along with that, I don’t see how it would cause pain around my clavicle. Could you tell me where I went wrong in my thinking?

What is deep to the trap and supraspinatus?

[Devyn Stewart]

What is deep to the trap and supraspinatus?

Uh...deep to the supraspinatus? The only thing that comes to mind is the subscapularis. I feel like I’m misunderstanding you.

[Devyn Stewart]

Perhaps what you’re referring to isn’t a muscle? Maybe a bursa or something?