Anterior Shoulder/Bicep Pain. No clear diagnosis

[FrancoL]

Hello there!

I'm 24. I've been dealing with constant nagging anterior shoulder pain for 4 months now, right on the long head of the biceps portion. Pain does not extend into the lower part of the bicep muscle or elbow, stays right at the front of the shoulder. The shoulder feels weak and sore through the day. Neck and back of the shoulder feel tight. The pain resembles from what I've googled: "Mouse shoulder". If I leave my arm static for a period of time and I move it upwards, I feel a small short painful pinching right in that area that quickly dissipates. I don't know if the bicep tendon that gets inflamed and starts to pinch or if I have a shoulder impingement somewhere else causing the biceps pain.

Started gradually as soreness in that location, and then progressed into full blown pain during the following weeks. I believe that the cause of the injury was an god awful form during bench pressing (pain was the worst during the concentric phase) + rapidly increasing weight. Grip was way to wide, plus not paying attention to when the pain started and kept training through it without changing my form. At a point every shoulder exercise was torture. Pain is now less than when it started (Acute phase is gone, I believe)


I have been to doctors and PT. Had 2 MRI's (normal one and an arthogram). The only injury that was found was: tendinosis of the supraspinatus. (this showed up in the normal RMI. Supposedly, in the arthogram report, the supraspinatus and the whole rotator cuff is healthy). In both MRIs, the Labrum and the long head of the bicep tendon were in impeccable condition. Healthy Acromion type 1. No tears anywhere. No alterations in the biceps-labral complex. No alterations in the AC joint. No other injury or tissue damage. Even so, during the Arthogram they externally rotated my shoulder for an specific image that helps to diagnose an possible SLAP tear, but none was found.

So, two MRIs, and thankfully there is no major injury. But the pain is still there. PT had me doing the classic rotator cuff strengthening routine for a month or so. Bands and stuff. Pain did not improve, even so, it worsened at some points. Ditched the PT. Doctor just diagnosed me as having a "Proximal biceps tendinopathy" and told me to stay away from lifting, especially anything overhead until the pain resolves with PT. In his opinion, I don't have an impingement. Did a PRP injection. Seemed to help for a while, but pain came back. Also ditched the doctor. As you see, doctors in my area are crap.

The only thing that seems to help is stretching. Pecs, biceps and the shoulder. Reduces the pain but doesn't fix it. Tried to rehab it myself (eccentric bicep preacher curls for the biceps "tendinopathy" + rotator cuff strengthening) but during some exercises the bicep tendon (I believe) gets inflamed and starts to pop out of the groove, causing pain. I have to wait a couple of days for this to calm down and the cycle repeats. This happens with face pulls or anything that resembles a throwing motion or posture.

I'm completely lost at this point. Don't know the reason of the pain and don't know how to proceed. It seems that everything I do, triggers it. Doctors did not help me at all. Resting did not work, just made my shoulder feel weaker and weaker. Stretching helping me, makes me believe that I have some kind of postural o rounded shoulder issues causing impingement, but the doctor discarded that diagnosis. I've already been out of the gym for 4 months.
The only thing left I haven't tried is to push trough the pain and do the Starr protocol with overhead presses (which causes minor pain, but I can do them).

I would appreciate a lot a bit of feedback and direction on this.

Thank you.

[Nick D'Agostino]

Hey FrancoL,

I think your intuition about the rate that you were loading the bench press and how you were doing it are likely contributors to your situation. Some other things are contributing too, but nothing you've written above jumps out as a red flag that would require more medical attention than you've already had. It sounds like your experience is a typical persistent tendinopathy. These types of issues tend to linger, and the rehab process for managing them is full of ups and downs. It is not linear, like a cut or a broken bone.

One important thing to note here is that it is ok to feel pain when you are rehabbing. It sounded like when the pain emerged, you took a push through strategy and had a pretty bad exacerbation, but since then, you have been using more of an avoidance strategy, staying away from things that make it hurt. The ideal strategy for managing something like this is between those extremes, and I call it a nudge strategy.

Another thing going on here is that you seem to think that something must be damaged because you have pain. This is not the case. It is more productive to think of pain as an alarm telling you that something might be in danger. Sometimes our alarms are too sensitive and signal that something is threatening when it is not that big a deal. It's like the house alarm that goes off when a mouse runs through it. The mouse is a problem that needs taking care of, but the purpose of the alarm is to detect burglars; thus, it does not accurately reflect the danger of the situation.

To manage this, I would use a linear periodization approach by starting to press and bench lightly for higher reps (say 12ish) and gradually decrease the reps and increase the weight over the course of 12 weeks. Working up to a top set or two and doing 3-6 total sets after the bar warmups. The goal here is to be 85% better in 12 weeks and feel confident managing your situation in the future. The goal is not the total elimination of anterior shoulder pain forever. I can't help you with the latter goal, but I can with the former. Giving you a specific detailed plan for dealing with this is beyond the scope of this board. If you are interested in a consult or more regular online guidance, check out my website here: Emerge Stronger

I hope this helps!

[FrancoL]

Nick, thanks a lot for the guidance and information.

I'm actually astonished that any of the 2 doctors and 2 pts I visited, did not explained any of this to me. I still don't know my diagnosis after 4 months and my pain it's still the same. Ridiculous

I completed the form on your website and I'll hopefully fix this issue with you. No more wasting time and money with these useless doctors. I wish that the money I gave to those "doctors" went initially to you.

Again, thanks a lot for your knowledge.

[Nick D'Agostino]

Thanks FrancoL! I just responded to the intake. Looking forward to speaking with you soon.

[mbdonner]

I had a similar experience, although without all the MRI's. Got the same diagnosis from an orthopedic surgeon. I started working with Nick. It has taken many months, but quite early on I was able to sleep through the night, and now most of the day I am pain free. I occasionally feel discomfort, and the low bar squat takes more time to ease into then it used to, but a dramatic improvement.

Side bonus: I'm working with a SS Coach and am getting a lot of help with my form so overall, my lifts are improving. Can’t recommend him more.

[Nick D'Agostino]

Thanks for that mbdonner

[Dust Devil]

I'm 24. I've been dealing with constant nagging anterior shoulder pain for 4 months now

I've become a bit cynical about Orthopedists & PTs (sorry Nick) after a similar issue. I had some intense shoulder pain that affected me for almost a year; it hurt while squatting, but eventually made pressing movements impossible. My internet research suggested a problem with the subscapularis, but an Orthopedist diagnosed tendinitis of, I think, the infraspinatus. He prescribed anti-inflammatories and physical therapy. The PTs had me doing 5-lb weights & stretchy band exercises and some wall stretches for a few months, which did nothing to help and cost me a couple of grand.

I discovered a hint of the problem after a lot of Googling: trigger points in my rotator cuff muscles. I bought the book "The Trigger Point Therapy Workbook" and found where my subscapularis could be accessed, which is the back of the armpit. Digging into that area with something pointy provided some immediate partial relief from the pain, and making it a several-times-a-day ritual made the pain go away totally in a few weeks.

So, whenever I experience some pain, I first turn to "The Trigger Point Therapy Workbook", which solves 95% of my issues.