Terrible shoulder injury pls help

[Jamesy]

Hi guys i really hope someone can help - im nearly 2yrs suffering from this prob that no speciliasts can pin down....

Over 18 months ago my shoulder got really sore after kettlebells lifting and some flys
since then i have tried it all to no help;
osteo
sports physio
accupuncture
Pain killers and anti inflams
athoroscopy
rest
i have had endless scans all come back clear. It has no common symptoms of anything else such as fotator cuff.
It feels like impingement but i have no tingling in hands or fingers.

I had a bone scan and it revealed i have inflammation of ribs 1,4 and 5.
The only thing that sorkd was jn the summer my slecialist gave me the steriod predisalone. I only took it for 4 weeks and kept training thro injury. It totally went away during those 4 weeks it was like a miracle. I could do all weights in gym. But then one night out of nowhere the pain came back (pec minor area) and hasnt gone away since.


. Ive Tried strong diclofenac 75mg twice a day. 2 weeks in and hasnt touched the sides. So im now back to 20mg Predisone for 4 weeks but a week in and no difference. Im gutted and getting very frustrated no one knows whats up or how to help!
(the only other thing i can loosely think is i switched from fags to e-ecigs just before this started but im kind of ruling that out as the pain totaly went away during the predisalone

- - - Updated - - -


When i first got the injury i thought it was either a rotator cuff or pec minor injury. I took off 8 weeks. Didnt get better so went down the osteopath route for around 6months - he tried everything including deep tissue massage, stretching accupunture, rock tape etc.

Tried working around the injury in the gym, tried more time off. Nothing improved it.

Had multiple mri and bone scans. Nothing was injured. But the bone scan revealed inflammation on ribs 1, 4 and 5. The inflammation is on the small bit that connects the rib to the centre of rib cage. It feels like impingement as it takes your breath away but i guess thats the ribs inflammed.

Over 18months on and only 4wks predisone took pain away. After finishing it one night severe pain came back out of nowhere in same place - that was 2months ago. Since then ive tried to train thro the pain

I then got a course of super strong anti inflammatories - diclofenac 150mg a day - again did nothing

So on monday i started another 4wks predisone. Im so fed up and frustrated.

I managed to gain 10lbs bulking over the last 2 months and seen fairly decent growth but working thro the injury just keeps flaring up. Im taking this whole week off while i take the predisone. .

All the specialsts are at a loss and my bupa allowance is maxxed out.

Someone mentioned maybe a long thoracic nerve injury? But wouldnt that have shown on an the mri, ct and/or bone scan ive had done?

It really feels like a nerve or impingement bit i dont have tingling or numb hands.

Hope someome may have some ideas.... Thanks


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[Jamesy]

Just tried a few stability movements with a theraband...


External rotation is Painful/burning
External rotation with arm abduction 90degrees is painful/burning
Internal rotation is fine no pain
Abduction is fine no painp


Does this help diagnose any further?

[Fyzzio]

Hi,
sounds like you're still treating it as if there was a biomechanical problem, although that should have healed a long time ago.
Any pain that is persistent for more than 3 months gets classified as "Chronic Pain". By this stage your pain pathways (in the brain) will have changed. And your treatment should focus on genera functional aspects rather than injury site specific.
Have you tried getting a consultation from a multidisciplinary Pain Clinic/ Service?

Good luck,
Fyzzio

[Jamesy]

Hi,
sounds like you're still treating it as if there was a biomechanical problem, although that should have healed a long time ago.
Any pain that is persistent for more than 3 months gets classified as "Chronic Pain". By this stage your pain pathways (in the brain) will have changed. And your treatment should focus on genera functional aspects rather than injury site specific.
Have you tried getting a consultation from a multidisciplinary Pain Clinic/ Service?

Good luck,
Fyzzio

thanks for taking time to reply

no so far ive seen this year a private healthcare shoulder speciliast, chest speciliast and rhuemastism specialist. Lots of blood tests and xrays and mri's - everything has come back fine!!!

feels really sore and tight again tonight. Sometimes a dull ache but tonight more short sharp stabbing pains :-(

[Fyzzio]

Accept it - your shoulder is no longer the problem - it's fine.
What's messed up is your pain reception/ pain pathways - as it is very common in Chronic Pain.
Look up 'Complex Regional Pain Syndrome' and check whether you have a Clinic close that deals with this. They are usually multidisciplinary, e.g. have a Physio, Occupational Therapist, Medical Pain Specialist and Clinical Psychologist all working as a team.
Good luck,
Fyzzio

[Jamesy]

Accept it - your shoulder is no longer the problem - it's fine.
What's messed up is your pain reception/ pain pathways - as it is very common in Chronic Pain.
Look up 'Complex Regional Pain Syndrome' and check whether you have a Clinic close that deals with this. They are usually multidisciplinary, e.g. have a Physio, Occupational Therapist, Medical Pain Specialist and Clinical Psychologist all working as a team.
Good luck,
Fyzzio

ok thanks again

even all my early scans last yr showed zero signs of any damage. All the mri's etc the docs said its a great looking shoulder. Its the inflammation in chosto ribs i still hope thats causing greif.

Im into 2nd week of predisone and diclofenac so hope that works. Booked to see gp monday and will ask to get refered to pain clinic

[BucksPhys]

Hi

Just a few comments, hopefully helpful, regarding your pain.

Is the pain located over the costo-sternal joints (where ribs join sternum) or do you feel pain in your actual shoulder joint? Or in Pecs?

The bone scan showing inflammation in the costo-sternal joints may well explain the cause of your pain and the fact that it settled well with steroids - would tend to indicate that it is a long-term (chronic) inflammatory problem, as steroids are strong anti-inflammatories. The blood tests will have excluded any "systemic" inflammatory disease and it is reassuring that these are negative and also reassuring that the MRIs etc haven't shown any structural problem.

The underlying cause of the costo-sternal inflammation is likely to be overloading via the pecs which attach onto the ribs. It sounds as if you have been working hard with (?big) weights to bulk up, including when the pain had only just settled and when you were on steroids. As this problem has gone on for so long you need to give it every chance to settle down and keep off the upper limb weights until the problem is well behind you. Use this time as an opportunity to work on other body regions / aerobic fitness. (I liken it to having a blister on your foot and keeping on wearing the shoes that gave it to you, it will always keep coming back and never really heal until you settle the inflammation and stop the aggravating force). As you say, working through just keeps flaring it up.

Oral anti-inflammatories, such as Diclofenac have to be taken consistently for at least 3 weeks to really get on top of the inflammation.

Whilst I agree that long term pain affects the pathways in the brain and often this makes the severity of the pain feel worse than what is really going on in the joints, I don't think you have any signs that would suggest you have CRPS (and I have significant experience in treating that problem in pain clinic patients in the past). Also, you describe what we term "mechanical" pain i.e. comes on with particular movements whereas other movements are fine. (CRPS is not predominantly mechanical and wouldn't respond to steroids).

Even after 18 months it is possible to have an ongoing biomechanical problem, albeit with some chronic pain added in. A pain specialist may be able to inject local anaesthetic and steroid into the costo-sternal joints to settle it down. I would also suggest stretching out pec minor / major (look up corner wall pec stretch) and perhaps finding someone who specialises in myofascial release to help off load the area.

Also need to consider that sometimes scans show something which is not actually the cause of pain. Also fact that you have had arthroscopy on shoulder joint suggests that you have been feeling pain in the shoulder joint area?
Re: your query regarding impingment. There are broadly two types: shoulder impingement where the rotator cuff tendons catch under the bony acromial arch - common in weight lifters but should have been diagnosed by an experienced physio and seen on a scan. Also nerve impingement which can give you tingling and pain in the arm, but not always. Can just give a mechanical pain. It is difficult to comment more about treatment as do not know what hypothesis the previous practitioners were working on and treating.

Different doctors and therapists have different areas of expertise and although your journey has been very frustrating, I am sure you will find a solution to this problem. First priority would be to confirm that it really is those sterno-costal joints causing your pain and an experienced musculo-skeletal physiotherapist should be able to do this and exclude impingement, etc.

Good luck

[Jamesy]

Hi

Just a few comments, hopefully helpful, regarding your pain.

Is the pain located over the costo-sternal joints (where ribs join sternum) or do you feel pain in your actual shoulder joint? Or in Pecs?

The bone scan showing inflammation in the costo-sternal joints may well explain the cause of your pain and the fact that it settled well with steroids - would tend to indicate that it is a long-term (chronic) inflammatory problem, as steroids are strong anti-inflammatories. The blood tests will have excluded any "systemic" inflammatory disease and it is reassuring that these are negative and also reassuring that the MRIs etc haven't shown any structural problem.

The underlying cause of the costo-sternal inflammation is likely to be overloading via the pecs which attach onto the ribs. It sounds as if you have been working hard with (?big) weights to bulk up, including when the pain had only just settled and when you were on steroids. As this problem has gone on for so long you need to give it every chance to settle down and keep off the upper limb weights until the problem is well behind you. Use this time as an opportunity to work on other body regions / aerobic fitness. (I liken it to having a blister on your foot and keeping on wearing the shoes that gave it to you, it will always keep coming back and never really heal until you settle the inflammation and stop the aggravating force). As you say, working through just keeps flaring it up.

Oral anti-inflammatories, such as Diclofenac have to be taken consistently for at least 3 weeks to really get on top of the inflammation.

Whilst I agree that long term pain affects the pathways in the brain and often this makes the severity of the pain feel worse than what is really going on in the joints, I don't think you have any signs that would suggest you have CRPS (and I have significant experience in treating that problem in pain clinic patients in the past). Also, you describe what we term "mechanical" pain i.e. comes on with particular movements whereas other movements are fine. (CRPS is not predominantly mechanical and wouldn't respond to steroids).

Even after 18 months it is possible to have an ongoing biomechanical problem, albeit with some chronic pain added in. A pain specialist may be able to inject local anaesthetic and steroid into the costo-sternal joints to settle it down. I would also suggest stretching out pec minor / major (look up corner wall pec stretch) and perhaps finding someone who specialises in myofascial release to help off load the area.

Also need to consider that sometimes scans show something which is not actually the cause of pain. Also fact that you have had arthroscopy on shoulder joint suggests that you have been feeling pain in the shoulder joint area?
Re: your query regarding impingment. There are broadly two types: shoulder impingement where the rotator cuff tendons catch under the bony acromial arch - common in weight lifters but should have been diagnosed by an experienced physio and seen on a scan. Also nerve impingement which can give you tingling and pain in the arm, but not always. Can just give a mechanical pain. It is difficult to comment more about treatment as do not know what hypothesis the previous practitioners were working on and treating.

Different doctors and therapists have different areas of expertise and although your journey has been very frustrating, I am sure you will find a solution to this problem. First priority would be to confirm that it really is those sterno-costal joints causing your pain and an experienced musculo-skeletal physiotherapist should be able to do this and exclude impingement, etc.

Good luck

Thank u very much for taking the time to reply. I have had 3 cortisone injections into the pain area, one under ultra sound, none gave any rest bite on the pain. I have done a lot of pec minor stretching recently. the strangest thing was the pain completely went while using Predisone 2 months ago, infact I actually trained top half pretty decent weight training all the way through the 4-week course of oral tablets, and I could feel it getting better everyday despite training hard. then it all came back with a vengeance. this time, 8 days into prednisone again and I have noticed zero improvement so far. id say the pain is sometimes connected to breathing and yes in the costo area where it connects, but also some dull ach and burning pain just under the collar bone above the pec minor attachement. im getting desperater for a fix of some kind now to get better! I have been told to take the 4 weeks off the gym while on the predisone course

[Fyzzio]

Hi BucksPhys,
great explanation, thanks.
CRPS does not exclude local inflammatory processes, nor does it mean not to take effective pain relief for local inflammation.
I believe the costal irritation might be caused by the compensatory movements that will have occurred over the last 18 months and that by now you will have to look at the whole body/ alignments/ loading in order to address the problem - not just the shoulder.
Am also wondering about the actual training that you, Jamesy, undergo. Who trains you? Who devised and amended your training programme? What are you training for and why do you want to bulk up?
Fyzzio

[Jamesy]

Hi BucksPhys,
great explanation, thanks.
CRPS does not exclude local inflammatory processes, nor does it mean not to take effective pain relief for local inflammation.
I believe the costal irritation might be caused by the compensatory movements that will have occurred over the last 18 months and that by now you will have to look at the whole body/ alignments/ loading in order to address the problem - not just the shoulder.
Am also wondering about the actual training that you, Jamesy, undergo. Who trains you? Who devised and amended your training programme? What are you training for and why do you want to bulk up?
Fyzzio

Hi thanks again

i dieted for about 12wks to get fairly lean and then went about a bulk phase - this is when the injury first occured. 18 months on i've done bits in gym but never been able to go 'full metal'. I devised the plan myself with some help of a bodybuilder friend. Im nowehere near that, im about 20% BF but was hoping to just get some decent size to then cut down before summer

After the pred worked a couple months ago i have been seriously bulking, 6-8 meals a day and a lot of compound lifting. Was going great, adding 2Lbs a week but its still niggling and i need to fix it once and for all. So im now in 2nd week off the gym and will stay off for the reamaining 3 wks of pred.

The whole shoulder seems to aching, mainly just under collar bone. And also feels quite tight as if im not always getting a full lung of air.

Its really getting me down, i cant seem to shift it. Im now throwing literally everything i can at it in the hope somsthing will take the pain, dull aches and occassional shooting pain away

[Fyzzio]

In that case: apart from being looked at by a Pain service, I suggest that you have a gym programme devised by a Specialist for rehabilitation (Physio, Exercise Physiologist), not a Bodybuilder. Your injury occurred due to a problem with your training plan - so I wouldn't recommend that you continue with the same plan.
Just my 2 cents.

[Jamesy]

In that case: apart from being looked at by a Pain service, I suggest that you have a gym programme devised by a Specialist for rehabilitation (Physio, Exercise Physiologist), not a Bodybuilder. Your injury occurred due to a problem with your training plan - so I wouldn't recommend that you continue with the same plan.
Just my 2 cents.

Thanks mate, I'm on the 10th day of Pred and seen no signs of improvement yet - also over a week off the gym altogether. Just want it to go for once and for all, then work back up to decent weight training after. for now all can think of is how on earth will I ever get rid of this aching and shooting pain.... hope the meds and rest works soon....

[Jamesy]

This isnt working at all

been on loads of anti inflammatories and nothing is working. Constantly feels like something is catching and hurting.

Ive taken total rest from gym and tried some very strong anti inflammatories and still not even 1% improvement.

Surely it cant be inflammation as it would have responded by now.
All my scans show no injury to chest or shoulder so im totally lost what to do

[Fyzzio]

Hi Jamesy,
sorry, just me again.
What I don't understand is: You say that all your scans show no problem, but first said that the bone scan showed inflammation.
Can I also ask you: do you have pain or symptoms anywhere else in your body? And is there a physical aspect to what you do for work?

My hypothesis: You injured your shoulder. Then it got inflamed (please note - the inflammation is a secondary problem). Tried treatment, then got a Prednisone dose that was possibly strong enough to anesthetise the area. So the damage was still there but you couldn't feel it. At which stage you re-started your training (I hate to think what you mean with "pretty decent weight training"), which might/ will have caused further straining to the present injury and will have led to compensatory movements and overuse of other areas. Prednisone does not heal the actual injury! Your body told you something was wrong, e.g. pain, but you kept on training through the pain - and it does not appear as if you were guided by a Heath care Professional for your training. And this all went on for 18 months.


I'd say that one week of Prednisone and rest from training will not cut it.

Anyone else got any comments?

Fyzzio

[Jamesy]

Hi Jamesy,
sorry, just me again.
What I don't understand is: You say that all your scans show no problem, but first said that the bone scan showed inflammation.
Can I also ask you: do you have pain or symptoms anywhere else in your body? And is there a physical aspect to what you do for work?

My hypothesis: You injured your shoulder. Then it got inflamed (please note - the inflammation is a secondary problem). Tried treatment, then got a Prednisone dose that was possibly strong enough to anesthetise the area. So the damage was still there but you couldn't feel it. At which stage you re-started your training (I hate to think what you mean with "pretty decent weight training"), which might/ will have caused further straining to the present injury and will have led to compensatory movements and overuse of other areas. Prednisone does not heal the actual injury! Your body told you something was wrong, e.g. pain, but you kept on training through the pain - and it does not appear as if you were guided by a Heath care Professional for your training. And this all went on for 18 months.


I'd say that one week of Prednisone and rest from training will not cut it.

Anyone else got any comments?

Fyzzio

hi mate thanks again i really appreciate every reply

so i injured it in feb 2014. I had numerous mri's, xrays etc for about a year and all came back clear. Then i had the bone scan around June this yr which showed inflammation. Once i got that result i went on predisone and miraculasy within 2wks of taking it i was pain free for the first time. Then a 3 weeks later one night it came came back out the blue. My prob now is anti inflammatories arent getting rid and im totaly resting it - surely it would have made some difference by now.

My job is office based so not manual labour. And my gym work is just a hobby at lunch from work - im no bodybuilder or anything like that.

Im totally lost as to what to do as im under 3 specialists - chest, shoulder and rhuemitoid and none can pinpot this constantly aching under the colar bone and sharp pains around chest :-(

[Jamesy]

Went to docs again today

hes put me on different NsAid's to take alongside the predisone.

He said the next step is back to specialist and get some immune system tablets to supress the overworking immune system. This should hopefully get to the root of the pain instead of just trying to take down the inflammation

im still not sure if its actually still inflammation - ive taken lots of nsaid's and none are working. Im trying to see if i can get a 2nd bone scan as the pain is worse since it came back after the initial course of predisone in Aug took all the pain away.

Im sitting here tonight in pain, all around my shoulder chest and even back tonight. Getting a mixture of really p!ssed off and so frustrated. Never ending hell

[Jamesy]

I've noticed this week the pain is more constant around the shoulder and under the collar bone. It also hurts a bit behind the shoulder blade.
Plus im now starting to feel tingling and numbness in my right hand, same side as shoulder pain. Im constantly trying to stretch out fingers....