Shoulder Pain

[benihanna_77]

I finally went to my family doctor about my shoulder pain. He sent me for x-rays, knowing that it won't show anything, but is needed in order for my insurance to pay for an MRI.

Here is my problem. I have limited mobility with my right arm, especially when raising it to the side. I am only able to raise it to around 80 degrees before the pain appears and it stays there until 120 degrees. The doctor was able to move it the rest of the way with minimal discomfort. The doctor mentioned I could try some physical therapy, but said it's a 50/50 shot on if it helps.

I had been working on doing light presses. Raising the bar up feels okay, but when I lower it I will feel a sharp pain in this shoulder.

Any suggestions?

[Nick D'Agostino]

I would keep doing presses and benches in a partial ROM. Stop the ROM before you feel the sharp pain. I like to use pins to control this. Use your judgment to gradually increase the ROM and load as you adapt (one pin setting at a time). You have to shift your mindset to nudging or poking at the pain. Both plowing through it and altogether avoiding are not the best strategies. Use a tempo (3-1-3) up the reps to around 8-10, complete 3-5 sets per session, and train every 48-72 hours. Hope this helps man.

[benihanna_77]

Thanks Nick. I will check back in once I have the results of the MRI. By chance, have you dealt much with mouse shoulder? I am a desk jockey and spend 10-12 hrs a day sitting/standing, constantly using a mouse.

[Nick D'Agostino]

I have helped people with various occupational overuse problems and postural strains (including shoulder pain related to their work habits). With the history you have provided so far, I would not put too much stock in what the MRI has to say. There is an excellent chance there will be some anatomical deviation from normal that is most likely unrelated to your symptoms but will medically be attributed as the cause. I would keep your attention on the process of rehab.

If your shoulder is bothering you as you work, you may want to temporarily try a different mouse or keyboard setup. Don't think of this as you have been in the wrong position, and you need to be in the right posture. It is better to think that you have become sensitive to your current work habits, and strategically interrupting them may help to change your practices to something you are less sensitive too. There is a very good chance this will resolve in a few months if you stay the course.

[benihanna_77]

MRI results came in.

Findings: Minimal AC joint osteoarthrosis is present, with very small degenerative subchondral cysts. There is a type II acromion, with mild lateral downsloping.

A 1.2 cm AP by 1 cm transverse full-thickness rotator cuff tear is noted in the anterior distalmost supraspinatus tendon, with surrounding severe supraspinatus tendinopathy and moderate distal tendinopathy. No tendon retraction or muscular atrophy. A 0.7cm transverse by 0.5cm craniocaudal intermediate grade partial-thickness articular surface tear is noted in the superior distalmost subscapular is tendon, involving approximately half the tendon thickness, with surrounding moderate tendinopathy. The trees minor tendon is intact. Small reactive subcortical cysts are noted in the greater tuberosity of the humerus.

The long head of the biceps tendon appears intact.

No labral tear is seen.

No significant glenohumeral joint arthritis is seen. A small glenohumeral joint effusion is present, and the fluid extends into the subdeltoid bursa.

IMPRESSION
1. A 1.2 cm x 1 cm full-thickness rotator cuff tear in the anterior distalmost supraspinatus tendon, with surrounding severe supraspinatus tendinopathy and moderate distal infraspinatus tendinopathy. No tendon retraction or muscular atrophy.

2. A 0.7cm x 0.5cm intermediate grade partial-thickness articular surface tear in the superior distalmost subscapular is tendon, with surrounding moderate tendinopathy.

3. Minimal AC joint osteoarthrosis and lateral downsloping of the acromion.

4. Small glenohumeral joint effusion; the fluid extends into the subdeltoid bursa.

I'm a tool and die maker, not a medical person, so I have a few words to look up to understand what everything means

[Nick D'Agostino]

It looks like both your clinical presentation and the MRI both confirm you have a tendinopathy and a tear in your supraspinatus. The good news is the results do not change the management strategy. I would keep doing what you're doing, sticking to the plan above. Many people get full function back through a progressive loading strategy using presses, benches, and some pulldowns. If things are not improving after a few months of this strategy, then other options become more viable. Keep us updated on how things are progressing.

[benihanna_77]

Hey Nick, I just wanted to touch base on my progress. I've been working on my press and bench per your advice and have gained back quite a bit of my mobility and strength. My press numbers are up to 90 lbs. (10 lbs. short of where I was prior to injury). The biggest goal I have achieved is being able to throw the football with my son again. While it's nothing impressive for distance, the smile on his face is worth it. Thanks for the help on getting me back on track.