15 year shoulder problem no one can solve

[gcoe]

Hi johnmerrick

It is a bit hard to give advice for something like this over the internet. You have made a good attempt at describing it but there is nothing like actually seeing the posture of the shoulder and see what happens when you move in certain directions.

However from what you described - slightly raised, abducted scapular - with a bit of winging. The key muscle to strengthen and get to work in a more shortened position is the lower trapezius muscle. With a long standing problem like this I would expect strengthening the weakened muscle(s) is going to be more effective than trying to stretch out tightened muscles. Building up the strength of the lower trapezius should make it easier to conteract and provide passive resistance to the tightened muscles at the front of the shoulder.

It is rare to get spasm in the serratus anterior. Usually the reason that the scapula is out to the side, around the rib cage and there is some some winging is a tight and/or over developed pectoralis major. If there is a bit of winging of the lower part of the shoulder blade of the pectoralis minor is often tight. Tightness or spasm of the serratus anterior would cause the scapula to abduct but there would be no winging

Does your therapist use a movement impairment syndrome approach (author is Shirley Sahrmann)? That approach often can offer help with this sort of thing.

One other possible reason is if there is some adverse tension of the brachial plexus (nerve complex that runs between the cervical spine and the arm). A key symptom might be pins and needles or numbness down the arm. However this really has to be checked out by a skilled therapist.

[johnmerrick]

thanks for replying.

i actually sent [a physio] a video of my shoulder doing various movements. [their] response :--


As we discussed on the telephone, your shoulders are what are termed dropped, which means the ends of your shoulders are too low. The end of your shoulder should be higher than where your collar bone attaches in front of your neck. Your scapula are too adducted which means that the border of your scapula is too close to your spine. The border of the shoulder blade should be 3 inches away from your vertebral spine. That means your upper trapezius and serratus anterior are both too LONG. You need to, as much as possible, keep your shoulders held up and do not do anything that pulls your shoulder blades down or back. When sitting have your arms supported under your elbow to keep your shoulders up in the direction of your ears. Also imagine you have a band wrapped around your shoulders and you want to expand that rubber band and make your shoulders broad. When standing put your hands on your hips so that your shoulders are not dropped. The upper trapezius will feel tired and may even get uncomfortable because you are putting the muscle in a shortened position which can contribute to a cramp. Only stretch it as much as necessary to get rid of the discomfort. The only way these muscles will get short as they need to be is by trying to keep them in a shortened position. It will take a while, but that is definitely what you need to do.
[a physio]

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that didn't help.

you talked about the lower trapezius well i've done those exercises with the rehab guy i just saw. end result left shoulder moves over some more(too left)

I mean that guy released everything pec minor major ,lats... posterior capsule stretch...everything. And left shoulder still moving over to the left . No matter what you do the left shoulder moves over to the left and doesn't come back.

that's why i say serratus anterior first two ribs. normally it's not tight but that's the only thing that explains why it continues to move over and stays there.

Someone has to tell me why it's stuck there. yes strengthen lower trap, also loosen ALL tight musles and make sure capsule not tight you would be fine but if something is STILL tight and you don't have the full range of motion then you can like i have exercise lower trap all you want and you wouldn't make any progress.

It actually makes things worse. [One of the physios] never like so many other people addressed why the shoulder continues to move to the left and stays there.

I do thank her and all the others that i've seen over the years for taking time to solve this problem though.

thank you too

JohnM

[yesland]

I'm not sure but I had something similar. I had one shoulder forward and left shoulder higher and back, leading to bend in spine and all kinds of unsymmetrical difficulty. The only succes I had was to work both sides of my trapezius and rear shoulder gently at first with bands held in both hands, rowing movements daily, in various small to larger extrended movements, and then yoga back exercises to correct the spine. It took a very long time, to bring the body back to finding its normal balance, and then a long time convincing me that normal was normal.

Muscle spasm, or unused muscle takes a long time to convince to remain switched on, and using very light resistance initially is the best way for me, so I did alot of taichi. What I found was that if unopposed by the right side my left traps would pull the shoulder all the way back. Its only the balance of both sides that keeps the shoulders equal. So I had to be extremelyt particular at working muscles in a symmetrical way. Not using one side alone for a time. The same applied to working the chest shoulders and traps.

pLEASE TELL US MORE.....