Dear Rider Jen

All is not lost, there are still a variety of conservative treatments that can be tried. Again we can only go by what you say,...

my thoughts (please take them as suggestions alone as I would never undermine another professionals judgement)

We will start with the exercises... you are doing resisted exercises... this is fine, but we only advised when you are totally pain free in active range before considering resisted exercises...these exercises sound like there are aimed at improving scapular adduction and humeral lateral rotation...no issues with that except you still arent painfree without resistance there they shouldnt really be coming up just yet...this is just my opinion nothing more...if you have a tendon issue like this it builds up scar tissue and fills up the already narrow space...concentric exercises (like the ones you describe-this means causing muscle shortening) adds strength, builds fiberes but isnt good for flexibility really...exercises aimed at tendons should be eccentric in design (this means allow lengthening)...this adds strength as well as flexibility...that is what you need to start off with (i feel) when strengthening is to be considered...

WHAT ARE FULL PLANKS? (PARDON MY IGNORANCE)


PInching your shoulder blade is good...this improves the pain and better elevation...I generally will start you off on scapular exercises only... the exercises you have got build up strength but really from you description there might be timing issues affecting scapulohumeral rythmn...this may be due to imbalance or abnormal firing of muscles..you need training on how to organise how the muscles work to give good scapulohumeral rythmn

there are several reasons why poor scapular motion causes an impingement...(im sure you've had this lecture before)
1) a depressed scapular...this means the scapular is low in position, it may rotate well but because its low it still impinges...if this is what you are I would be looking at the length of your trapezius and its timing
2) a downwardly rotated scapular...this means the scapular may be in a good position but its tipping forward so when you raise your arm its not rotating fully so its not creating enough room...in this cause i would be looking for pecs tightness...
3) and abducted scapula/ winging: scapular is so far out and fans out...this suggests serratus weakness, may come with pecs tigtnessand rhomboid weakness...in this case...there would be poor setting of the scapular...so pinching scapular together would make a difference perhaps to how much room you will get..
3) an adducted scapular: sometimes suggestive of subscapular adhesions or tight scapulospinal muscles...so there isnt much room for some level of abduction and rotation...impingment the occurs...

The other issue is with your arm...is the humerus head too far foward within the joint or is it too high up, is it rotating maximally during arm elevation to clear the subacromial space...if it is this can be another reason why impingement happens (anterior displaced humeral head)...the biceps tendon could be involved this may explain the anteror shoulder pain you are getting, may be kinesio taping will help...to give you feedback about where to place the humerus for good and painless motion before you move...

I generally will be teaching you how to set you scapular and practice external rotation (slowly in return from external rotation to give eccentric phase) without resistance until we are able to get a full and painfree movement (some tapes might be needed to show you what your scapular is meant to be doing until you master it)...

you can have a combination of these factors...the question is which/or ehich combinations are happening to you? maybe you need some manual therapy work, to equalize the tissues, maybe you need exercises that are specific to correct the problem...i wouldnt be going strengthening with resistance just yet...

You mentioned you were icing the shoulder...but no effect, the problem is the shoulder is still mobile if the space is narrow and the lesion is very irritable..then repeted use may not make this effective...in this case...injection therapy maybe helpful...although there are sideeffects, pain relief is often dramatic but the steroids delay healing so you may have to stay exercise free for about 1-2wks...acupuncture may be another adjunct therapy that can be used...

I still stand to have the space checked out for bony spurs...this if there is is just likely to grow bigger and physiotherapy may be futile...

Other considerations are what your activity of daily libving is like, is it the dominant hand that is trouble some...(do you forget and lift things up that might be too heavy)...
While the arm is still irritable active assisted movements may be what you need to do to prevent any muscle contraction...it may be good to also take gravity away from the equation for some exercises

Cheers