Scapula clunking (advice please)

[physiofi]

Hi all,

Will try and make this as detailed as possible as I know being vague will get me nowhere. Some basic background: I'm a newly qualified physio (graduated in July). (R handed btw) My problem first started...umm, about 2-3 years ago now I guess. Towards the end of my first year at uni. I noticed a bit of an ache and a gradual pain in my left shoulder anteriorly. Put it down to doing quite a lot of work with learning manual techniques etc and thought nothing of it. It progressed within a few months to being a more aggravating pain (I'd say it was 5/10 at worse) but still nothing so major that I felt like I needed to get it checked out. It would just ache after using my arm holding the hairdryer or carrying a lot of books/bags etc to the library.

Anyway, in September of 2009 (so roughly a year since I first noticed it - although it wasn't constant at the time and nowhere near as painful as it got in the months before sept 09) I went to see a chiropractor. Had about 10 sessions with him where he told me that basically my posture had caused it and adjusted my spine and shoulder for the 10 sessions then gave me lots of scap setting exercises to do and pec minor stretch. For a couple of months afterwards (stopped seeing him because I couldn't afford to go any more) I was fine and totally painfree but the pain gradually came back.

I admit my posture isn't great but have been making a huge effort since then (esp since being aware that not practising what I preach is extremely irritating!) and the pain has decreased from what it went back up to since it got worse after I stopped seeing the chiropractor. The worse it got was probably on my stroke placement when I was handling stroke patients and doing quite a lot of manual stuff. I'd say it went up to a 5/10 most days then.

Now, I'm not getting any pain in my shoulder at all but my left shoulder still doesn't feel right. I'd say it's definitely weaker than my R shoulder but I don't think it's significantly weaker. I don't struggle to hold things in that arm anymore or while carrying bags, unless they're particularly heavy. I feel like I can set both scapulae well now, but when I retract and depress my L scapula, it makes quite a loud clunk. I know it's not normal, but I'm not getting any pain on the back of my shoulder anymore or the pain at the front (which I'm pretty sure was caused by tight pec minor due to my crap posture). my upper fibres trapezius on the left side are quite tight now and despite stretching for weeks now do not seem to be easing...my neck does clunk quite a lot as well and sometimes when I stretch on that side I get quite a large 'click' or snap in my neck. The chiropractor told me this was down to lax ligaments and having a hypermobile neck? but I'm not really sure how much I believe him there, mainly because I haven't been assessed by a physio on this (no offence to any chiropractors).

I have been stretching UFT on that side more than 3 times a day on that side for days now and started doing regular scap setting exercises in prone but not sure either of these are helping.

Any advice / thoughts would be much appreciated (sorry for the long post!).

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[Vanc_WA_PT]

what about trying strain/counterstrain to upper trap?; scap 'clunk' could be from running over ribs and maybe forming a small pseudobursa which the scap now pops over (just a guess); rule out neurogenic weakness in left arm too

[specialisedsofttissue]

Sounds like a chronic sub-acromial bursitis, clunking though....thats anyones guess. The symptoms decreased with chiropractic care, and returned after ceasing chiropractic care, seems pretty logical to me, whatever the Chiro was doing (only you know this) was obviously helping... so repeat.

[physiofi]

Thanks for your replies - I can't afford to go back to the chiro at the moment. I'm not having the same symptoms I was. In fact, I'm hardly having any symptoms at all. I thought if I still had a chronic sub-acromial bursitis then I'd have some kind of impingement? But I have full active range in all directions in my left shoulder and no pain on any of the movements. How do I strain/counterstrain upper trap?

Thanks, Fi.

[Vanc_WA_PT]

I'm a strain/counterstrain 'hack' so I won't disrespect the technique by giving poor information; I'll let a more experienced person explain.

[Larry43230]

I had same problem with right shoulder (dislocated and blew out rotator cuff back in college). Everything was fine when I was teaching yoga, but had to stop due to lack of time. Desk job leaning on elbows using mouse and keyboard all day ended up giving me tight pecs. Shoulder started to naturally dislocate itself forward, would pop back in place after rotating shoulders back. Due to neglect, I ended up with hypermobile upper back and frozen shoulder.

Now working my way back to recovery. Currently pain relief is coming from pills (with food), heat/cold, and lying on a rolled up towel in the center of my back. (It stretches by pecs and pulls the scapulas together.) Also alternating shoulder shrugs, pec stretches, rowing and bent over shrugs to pull scapulas in place to develop stability for longer term relief.

Good luck. I feel your pain. Hope that helps.