Originally Posted by
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
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