Partial Subscapularis and supraspinatus detachment

[i3lack0ut]

Hi Guys

After ten years of lifting three times a week I managed to mess up my shoulder and it‘s bugging me very hard mentally as I don‘t dare to do anything right now.

My stats
33 years old, no previous injuries on that shoulder
I train monday, wednesday and friday
Approximate 5 rep maxes:
175 lbs OHP
265 lbs Bench
400 lbs Squat
440 lbs Deadlift

Day of the injury
Wednesday 22nd of novemer 2023. Did squats, bench, weighted pullups, lying triceps extensions, dumbbell preacher curls, lateral raises and some forearm work.
I didn‘t feel pain during the training but i felt it afterwards in the shower and i definitly felt it the next day. I tried doing ohp on friday but went home as it was too painful. I rested a week and then went to the doctor who sent me to de specialist.

Symptoms
I feel pain in the front of the shoulder during regular activities like cleaning a table. Sometimes there is snapping in the front of the shoulder and the shoulder just sounds terrible. It always had some noise but there is a significant difference to before the injury. Also sometimes light bicep pain.

Diagnosis from Specialist
He did an x-ray which told him i had beginning osteoarthritis. He did the belly press test aswell as the lift off test and both were positive and there was a big difference in strength between the injured and uninjured side. No pain during the tests though. He then did an ultrasound and later an mri which both showed a partial detachment of the subscap and supraspinatus tendon of the humerus. The first step now according to the specialist is to get a cortisone shot to get rid of the pain and then take it easy at the gym.

Now we all here know that we like to train and we wanna get back into it as soon as possible and also want to train heavy.

My question now is do you have any tips? Should I get surgery as soon as possible or is there a chance of it healing on it‘s own? What exercises should i avoid as soon as i can get back and is there a chance of it getting well at all? I know ripp has had a rotatorcuff tear aswell so maybe you have a personal experience that is of value.

Many thanks and best regards from switzerland.

[Mark Rippetoe]

Was the specialist a therapist or an orthopedic surgeon?

[Will Morris]

Hi Guys

After ten years of lifting three times a week I managed to mess up my shoulder and it‘s bugging me very hard mentally as I don‘t dare to do anything right now.

My stats
33 years old, no previous injuries on that shoulder
I train monday, wednesday and friday
Approximate 5 rep maxes:
175 lbs OHP
265 lbs Bench
400 lbs Squat
440 lbs Deadlift

Day of the injury
Wednesday 22nd of novemer 2023. Did squats, bench, weighted pullups, lying triceps extensions, dumbbell preacher curls, lateral raises and some forearm work.
I didn‘t feel pain during the training but i felt it afterwards in the shower and i definitly felt it the next day. I tried doing ohp on friday but went home as it was too painful. I rested a week and then went to the doctor who sent me to de specialist.

Symptoms
I feel pain in the front of the shoulder during regular activities like cleaning a table. Sometimes there is snapping in the front of the shoulder and the shoulder just sounds terrible. It always had some noise but there is a significant difference to before the injury. Also sometimes light bicep pain.

Diagnosis from Specialist
He did an x-ray which told him i had beginning osteoarthritis. He did the belly press test aswell as the lift off test and both were positive and there was a big difference in strength between the injured and uninjured side. No pain during the tests though. He then did an ultrasound and later an mri which both showed a partial detachment of the subscap and supraspinatus tendon of the humerus. The first step now according to the specialist is to get a cortisone shot to get rid of the pain and then take it easy at the gym.

Now we all here know that we like to train and we wanna get back into it as soon as possible and also want to train heavy.

My question now is do you have any tips? Should I get surgery as soon as possible or is there a chance of it healing on it‘s own? What exercises should i avoid as soon as i can get back and is there a chance of it getting well at all? I know ripp has had a rotatorcuff tear aswell so maybe you have a personal experience that is of value.

Many thanks and best regards from switzerland.

If you are over the age of about thirty, degenerative tears of the rotator cuff are extremely common. Go back to your initial onset of symptoms and ask yourself if an acutely torn tendon would present with pain hours afterwards instead of the moment it happens.

Biceps pain is not really consistent with rotator cuff pathology. I’d be willing to bet you have some anterolateral shoulder pain syndrome and the MRI findings are largely an incidental finding, since they did not offer surgery immediately. The cortisone shot is not entirely safe for an already partially torn rotator cuff, as it does increase the chance of a full rupture down the road.

Even if the partial tear is rotator cuff in origin, it isn’t likely to improve with rest. We treat RTC partial tears exactly the same way we treat tendinopathy which is heavy, slow resistance training.

[i3lack0ut]

Thanks for the fast help. It is very appreciated.

Was the specialist a therapist or an orthopedic surgeon?

He was a surgeon specialised on the shoulder. I actually got a second opinion (physical tests and review of x-ray and MRI) of a shoulder surgeon aswell and this one said nothing was damaged but just couldn't explain where the significant weakness on the belly press and lift off test came from.

If you are over the age of about thirty, degenerative tears of the rotator cuff are extremely common. Go back to your initial onset of symptoms and ask yourself if an acutely torn tendon would present with pain hours afterwards instead of the moment it happens.

Biceps pain is not really consistent with rotator cuff pathology. I’d be willing to bet you have some anterolateral shoulder pain syndrome and the MRI findings are largely an incidental finding, since they did not offer surgery immediately. The cortisone shot is not entirely safe for an already partially torn rotator cuff, as it does increase the chance of a full rupture down the road.

Even if the partial tear is rotator cuff in origin, it isn’t likely to improve with rest. We treat RTC partial tears exactly the same way we treat tendinopathy which is heavy, slow resistance training.

Yeah the fact that I didn’t notice immediatly is throwing me off aswell. To be fair it wasn’t hours later but I already noticed it in the shower after the training. But yes I could finish the training without any pain but I noticed noise from the shoulder on the triceps extensions, that wasn’t normal.
As far as my research goes bicep pain can actually be a symptom of a subscap tear as the bicep tendom runs «through» it.
How would you explain the weakness in the belly press and liftoff test without the tear?

[Will Morris]

Thanks for the fast help. It is very appreciated.




He was a surgeon specialised on the shoulder. I actually got a second opinion (physical tests and review of x-ray and MRI) of a shoulder surgeon aswell and this one said nothing was damaged but just couldn't explain where the significant weakness on the belly press and lift off test came from.




Yeah the fact that I didn’t notice immediatly is throwing me off aswell. To be fair it wasn’t hours later but I already noticed it in the shower after the training. But yes I could finish the training without any pain but I noticed noise from the shoulder on the triceps extensions, that wasn’t normal.
As far as my research goes bicep pain can actually be a symptom of a subscap tear as the bicep tendom runs «through» it.
How would you explain the weakness in the belly press and liftoff test without the tear?

Do you agree that when something hurts, it is much harder to produce force against something that is causing it to hurt more? Special tests for the shoulder are not nearly as specific as we clinicians would like them to be. Most of them are borderline useless, by themselves, but we still are obligated to do them.

[i3lack0ut]

Do you agree that when something hurts, it is much harder to produce force against something that is causing it to hurt more? Special tests for the shoulder are not nearly as specific as we clinicians would like them to be. Most of them are borderline useless, by themselves, but we still are obligated to do them.

Yes, I agree with that. The thing is that those two particular tests don‘t hurt. I just have weakness.
But as I understand your recommendation is continuing to train the basic lifts as long as it doesn‘t hurt too much and your wrote slow. Is that in slow reps or slow weight progress?

[Will Morris]

Yes, I agree with that. The thing is that those two particular tests don‘t hurt. I just have weakness.
But as I understand your recommendation is continuing to train the basic lifts as long as it doesn‘t hurt too much and your wrote slow. Is that in slow reps or slow weight progress?

Slow tempo reps that load the structure in question.