Shoulder hurts: What should I ask the doc? Shoulder hurts: What should I ask the doc?

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Thread: Shoulder hurts: What should I ask the doc?

  1. #1
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    Default Shoulder hurts: What should I ask the doc?

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    Rip,

    I've tried to be good and searched/read all related threads but I still am unsure.

    What questions should I be asking my doc next week when I go in for a post-MRI on my shoulder?

    Background:
    -I'm 33/6'/218, running 531 full body (squatting 3 times/week)

    -Known so far:
    -it's my left should and i'm right-handed (if that matters)
    -I know my press is not 2.0
    -shoulder ultrasound showed all rotator cuff muscles to be fine; some fluid/inflammation
    around biceps tendon
    -MRI showed "very slight/insignificant tear in labrum" (doc's not worried about it) and
    "arthritic inflammation of AC joint" (which he's most worried about). This was from a
    quick phone call and request to come in for a more thorough discussion/next steps.

    I'm still lifting but the joint has gotten progressively worse since January, when I switched to 531 and added some DB bench presses as assistance. I haven't done dips in over 6 months but am not worried about that as you have said some folk's shoulders need a break from them at times. I get some discomfort when benching and none when pressing. I've subbed incline press for DB bench and that's been much better.

    Thanks in advance for anything you can offer, including rebuke. I'm just not sure what to ask when I go in for the appointment.

  2. #2
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    "Do you see an osteophyte on the AC?"

  3. #3
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    Thank you, sir. I will do just that.

    Is it odd that he hasn't ordered an x-ray yet, or can ultrasound and MRI reveal any bony changes?

    Finally, bone spur or not, would ART be helpful?

    Much appreciated, Benevolent Overlord.

  4. #4
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    The MRI is diagnostic for all orthopaedic pathology, while the conventional x-ray is not.

  5. #5
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    Rip,

    I had the in-office MRI follow-up today and was hoping to get your feedback. My doctor was very patient and thorough in walking me through the MRI and trying to nail down cause of pain. Go figure: he's not a surgical ortho.

    -"significant tendinosis of supraspinatus" "there's no tear but see how it goes from looking nice and solid to being all squished up and messy?"
    -"pretty significant arthritis in AC joint" "see how it looks like mush? there should be a solid black line there" (this was the only bony change identified; no bone spurs/changes whatsoever beyond the AC degeneration)
    -"early arthritis in GH joint; some fraying/tearing at edges of labrum"
    -"biceps tendon is black; see how there's white/fluid all around it?"

    After a lot of head scratching and numerous shoulder drills, he finally settled on the GH/labrum as cause of my pain/discomfort. He injected a mild local anesthetic and then had me repeat the various straight-armed resistance drills: I had much, much higher resistance with the anesthetic and some decreased pain. Also, I was able to lay on my side without pain/discomfort, which I can't normally do.

    He's offered the following treatments, from most to least aggressive (and expensive):

    1) MSC stem cell therapy
    2) Platelet rich plasma
    3) prolotherapy (Jordan's gonna hate it: they inject sugar!)

    He's very open about no guarantees on cures/fixes: everyone's body's different and who knows how you'll respond, blah blah blah. He didn't think that soft tissue/stretching/massage type stuff would make a giant difference. And he was very adamant that it is good to be strong; don't detrain. Which is good cause I wasn't stopping anyway.

    Question:
    In your experience with lifters suffering from similar arthritis shit, what have you found most beneficial in terms of treatment and programming adjustment? I'd especially like to clear up the tendinosis so it doesn't turn into an actual tear.

    Or should I just fuck it and go back for the shoulder replacement he promised in 20 years if I "keep doing what I'm doing with no change"?

    As always, thanks for your time and any feedback.

  6. #6
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    First, how did you do this to your shoulder?

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    Quote Originally Posted by prim fergison View Post
    1) MSC stem cell therapy
    2) Platelet rich plasma
    3) prolotherapy (Jordan's gonna hate it: they inject sugar!)
    From experience, PRP (2) sucks. I had it done to my knees. Having a needle inserted two inches into your patellar tendon, and then filling that space with fluid, is either the most or the second most painful thing I've ever experienced. I'm not sure whether it was worse than breaking my ankle, but if not, it was close.

  8. #8
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    Quote Originally Posted by Mark Rippetoe View Post
    First, how did you do this to your shoulder?
    No singular mechanism: it was CrossFit. Mostly.

    I started back in the good ol' days, when you were still "Coach Rip" and the Glassman craziness hadn't quite surfaced. After a couple years of that, I stumbled onto some mountain climber folk who'd "adapted" CF-type workouts into 1-2 hour sessions, 2-3 times per week. Fun stuff. I was also climbing in/outdoors 2-3 times per week and stairclimbing 2 hours per week. Plus I knew nothing about nutrition or recovery.

    About three years ago, I felt like such a beat up old bastard that I just quit it all and just climbed (shoulder bothering me then, too, but no diagnosis: lousy insurance).

    Two years ago I kinda quit climbing (read: baby) but dusted off SS 1st Edition and started lifting. Paulie Steinman helped me get my lifts unshitty and here we are.

    So, yeah, dramatic overuse with incredibly bad form and no concept of training principles. Wish I could get in that time machine and go punch myself in the nuts.

    Thanks for taking the time, Rip.

    Quote Originally Posted by PEBCAK View Post
    From experience, PRP (2) sucks. I had it done to my knees. Having a needle inserted two inches into your patellar tendon, and then filling that space with fluid, is either the most or the second most painful thing I've ever experienced. I'm not sure whether it was worse than breaking my ankle, but if not, it was close.
    I can imagine. But at this stage (33 years old) I'm down for the pain train if it means a long-term positive outcome. How were/are your knees post-PRP?

  9. #9
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    I should have gone ahead and typed what I was thinking anyway. If I were you, I would stop doing CrossFit, reflect a moment upon what you have done to yourself, and become a Beacon of Warning, a Lighthouse, as it were, against the dangers that lurk therein. Then, stop benching/pushups/dips/ring-anythings, just press and chin once/week, and let your shoulders heal.

  10. #10
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    Quote Originally Posted by Mark Rippetoe View Post
    I should have gone ahead and typed what I was thinking anyway. If I were you, I would stop doing CrossFit, reflect a moment upon what you have done to yourself, and become a Beacon of Warning, a Lighthouse, as it were, against the dangers that lurk therein. Then, stop benching/pushups/dips/ring-anythings, just press and chin once/week, and let your shoulders heal.
    My apologies, Rip: I was unclear.

    I haven't done any CrossFittery in about three years. Two years ago, I started lifting (doing the fucking program). I've gone from 6' 180# to 6' 220#. I have a big ass. I like being useful. Don't climb so much but oh well.

    I will cut out benching and I haven't done any dips in 6 months. I'll cut chins and press to once per week. Should that just some maintenance 5s or triples? Or keep going with the 531 press I've been doing?

    Thanks for your time, sir. And I'd be interested to hear your thoughts on the Dino BBQ when you're out in Brooklyn for the seminar next month. People round here are batshit crazy for it but what do they know.

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