Shoulder pain

[CremaKing]

I've had pain during bench pressing in the right shoulder for the last 10 weeks. The injury probably happened during an impromptu pull-up competition. I had not trained pull-ups previously and did not warm up. When I bench pressed 180x5x3 two days later, there was clear and strong discomfort in the shoulder which I just worked through. After that I decided to lay off the bench press. There is no pain when I am inactive but I feel soreness during certain moves of the shoulder, e.g. depressing the shoulder and moving back and forth and by stretching by reaching up the back with the right hand.

I tried for 2-3 weeks to take a total rest of the shoulders and use NSAIDs. This did not fix the problem. Then I resumed the OHP at normal weights and the bench press at the weight that did not cause pain, 95lbs. Pain still remains over the ~6 weeks I've been doing this. When I bench press, I feel a slight soreness in the shoulder after. When I press at my max weight, I feel slight strings of pain toward the top of the movement. Nothing too bothersome but concerning because it indicates chronic inflammation.

I've had two MRIs, one in 2014 and one recently. Both show a SLAP tear. The Dr. tells me there is not a significant change since 2014 in the SLAP tear. The latest MRI shows a SLAP tear, paralabral cyst and supraspinatus tendonosis. I've put the MRI report at the bottom of this message. The Dr. recommends taking an NSAID Diclofenac sodium 75mg 2x/day and rest from any activity that causes discomfort, which for me would be bench press and OHP. He also prescribed PT for SLAP tear, cuff strengthening.

I'm very curious to hear your opinions on the best way forward. I want to avoid surgery and would like to follow a plan that reduces the inflammation in the shoulder over the next few weeks and hopefully resume the full training program without pain in the same way as I was doing before. I'm aware of the general opinion of PT on this forum.

Can you give any advice for my case? What can I do to help kill this inflammation? Should I just do what the doctor ordered:
- take the NSAIDs
- stop bench and OHP
- do PT
- wait 6 weeks and see
or is there something else I could do ?

Thank you.

Pain timeline
2014: initial diagnosis of SLAP tear. Treated with PT which eventually alleviated elbow pain and improved posture
2016
May: start Barbell strength training
12/31: Pull-up competition, no pain
2017
1/2: Pain during bench, finished 180x5x3
1/3 - 1/20: total rest from bench press, OHP and chin ups, only squat and deadlift
1/16 - 1/20: Naproxen 2-3x/day
1/21: Still painful to bench above 100lbs
1/23 - 3/10: On bench days, only do 95x5x3 with minimal pain. Progress on OHP with some slight pain.

Current age 39, weight 215lbs, male. I did a SS style progression from May of 2016. Shifted to advanced novice a few months back and most recently I do HLM style training.
Beginning lifts:
squat 115
deadlift 80
bench 95
press 45

Recent lift maxes for reps:
squat 345x5x1, 310x5x2
deadlift 335x5
bench 95x5x3 (previously was 180x5x3)
press 120x5x3
power clean 150x3x5
chin-ups 5x3

Current program (just did deload on squat)
Monday:
squat 275x5x5
press 120x5x3
deadlift 335x5

Wednesday:
squat 245x5x3
bench 95x5x3
power clean 150x3x5

Friday:
squat 275x5x3
press 95x5x3
chin ups 5x3

MRI report:
--------------
Reason for exam: Shoulder pain

History: The patient injured his shoulder doing pull-ups approximately 2 months ago. At some point in the past she has had an MRI study with diagnosis of a SLAP tear. He has not had shoulder surgery.

Compare: None

Technique: Multiplanar images of the (right) shoulder were obtained with T1 weighted and water sensitive images.

Contrast: Dilute gadolinium (1:125 dilution) from a preceding arthrogram.

Findings:

Osseous - The humeral head is normal in shape and configuration and is in normal relation to the glenoid. A cluster of cysts are present in the posterior lateral humeral head on series 3 image 13.

AC Joint - the acromioclavicular joint is normal.

Labrum - there is a SLAP tear that extends from 2:00 anteriorly to 10:00 posteriorly seen on series 5 image 12 and series 4 image 9. The posterior part of the tear extends into a para labral cyst on series 4 image 9.

Articular cartilage - no focal or generalized cartilage destruction is identified.

Bone marrow - no evidence of osteonecrosis is identified. Bone marrow edema is identified in the distal clavicle on series 5 image 12.

Muscle edema/atrophy - there is no evidence of muscle edema or muscle atrophy.

Biceps tendon/sheath/anchor - the biceps tendon is in normal position within the bicipital groove and is of normal dimension and contour. There is increased signal in the intracapsular intrasubstance portion of the biceps tendon seen on series 13
image 14 and series 12 image 15.

Rotator cuff/subacromial space - no evidence of a cuff tear is identified. There is increased signal in the insertional portion of the supraspinatus tendon seen on series 5 image 12. No findings to suggest subacromial subdeltoid bursitis are
seen.

Synovium - no evidence of synovitis or loose bodies is identified.

IMPRESSION:

There is a superior labral anterior posterior tear with the posterior portion of the tear extending into a para labral cyst.

Supraspinatus tendinosis.

Intrasubstance degeneration in the intracapsular portion of the biceps tendon.

There is bone marrow edema in the distal clavicle
------------------

[Mark Rippetoe]

You have a SLAP tear. It will not heal. Waiting 6 weeks is pointless. Get it fixed so you can train.

[CremaKing]

You have a SLAP tear. It will not heal. Waiting 6 weeks is pointless. Get it fixed so you can train.

I'm not waiting for the SLAP tear to heal, but rather the associated inflammation. I've been training for the better part of a year with the SLAP tear without issues and I think I can continue to do so once the inflammation is under control.

My main concern regarding SLAP tear surgery is that the literature suggests that for a 39 year old, there is significant risk of failure, see A prospective analysis of 179 type 2 superior labrum anterior and posterior repairs: outcomes and factors associated with success and failure. - PubMed - NCBI.

You think I'm making the wrong call ?

[Mark Rippetoe]

Why do you think it is inflamed?

[CremaKing]

Why do you think it is inflamed?

Good question Mark. I'm not an MD. I know that inflammation can cause pain and my discussion with the doctor has not led me to any other potential cause. Remember that there is no significant change in the SLAP tear for the last several years. Even when diagnosed, I suspect the tear had been there for years. My doctor used the word aggravated, not inflamed. He did prescribe an anti-inflammatroy, so I think he thinks there is inflammation causing the pain.

The MRI shows supraspinatus tendonosis. I suppose that could mean that there is physical damage causing the pain that is not inflammation.

[Mark Rippetoe]

Since the superior labrum is torn, it displays abnormal morphology, and therefore abnormal mechanical function. This is causing an inflammatory response, and the presence of the tear will continue to do so. This has apparently been a problem for your training, since you have only benched 180. Therefore, it seems logical that you should have the thing fixed, especially since you are not 75 years old.

[Will Morris]

Get a coach to look at your bench press. I'm damn near certain your bench technique sucks. I have people with SLAP lesions bench pain free all the time. In fact, bench press is one of my preferred techniques for conservatively managing a SLAP lesion.

[Dag]

I have people with SLAP lesions bench pain free all the time. In fact, bench press is one of my preferred techniques for conservatively managing a SLAP lesion.

Now this is getting interesting. When you are managing this injury, how do you progress the weights/sets/reps in the initial stages and with this type of thing, does your experience see people regaining full strength and the ability to bench for 1-3 reps maxes in time?

Anything else on the topic of conservatively managing a SLAP tear and benching would not go unappreciated.

[CremaKing]

Get a coach to look at your bench press. I'm damn near certain your bench technique sucks. I have people with SLAP lesions bench pain free all the time. In fact, bench press is one of my preferred techniques for conservatively managing a SLAP lesion.

Thank you for chiming in Will. That's consistent with my experience so far, I felt I was making fine progress on the bench press prior to Jan 2nd. I think my form is OK. I take somewhat regular sessions with David Abdemoulaie. He fixed my form at first but has not been critical of it lately.

Since the superior labrum is torn, it displays abnormal morphology, and therefore abnormal mechanical function. This is causing an inflammatory response, and the presence of the tear will continue to do so. This has apparently been a problem for your training, since you have only benched 180. Therefore, it seems logical that you should have the thing fixed, especially since you are not 75 years old.

Do you think that proper form SS exercises would cause an inflammatory response in my case ? I did not really experience that until the injury 10 weeks ago, but it may have been occurring at a mild level below my perception. Regarding my 180 bench press, the improvement over 6.5 months was 180-95 = 85 lbs, quite close to the theoretical expected linear progress 28 * 3/2 * 5 = 93 1/3. The difference is at least partly due to missed workouts due to deleterious influences of life on training. I was planning to move to 2.5lbs increments when the injury occurred.

I appreciate the advice and discussion.

[Mark Rippetoe]

Proper form will be a problem as the weight gets heavier, since your labrum is torn. The structure has a function -- i.e. it participates at some level in the force transmission function of the joint -- and at some point the function of the structure will be stressed by the load. And not everything you do with your shoulder is of the controlled nature of barbell training.