Pinching/Piercing Pain Under Deltoid When Raising Arm At 90 Degrees

[mhewitt]

I've consistently had this problem for about 3 years in both my right and left arm with varying intensity. It is worse in the left. The right still hurts a bit if i exaggerate the specific movements which trigger the pain, but otherwise it is fine.

Basically if i lift my arm (either to the side or in front of me) while my elbow is bent at a 90 degree angle, i get a pain under my deltoid. I realize the deltoid probably has nothing to do with it, but i don't know the anatomy of the shoulder well enough to get into the nerves, ligaments etc.. If i do it with zero resistance (just the weight of my arm) it's not a bad pain, but i can definitely feel it. If i do use any sort of weight, even 5 pounds, it hurts. Every repetition of the movement will hurt, some much worse than others, which makes me think something is being pinched, but that is a completely uneducated guess.

Furthermore, if im lifting my arm in front of me with my elbow bent to 90 degrees, and i then lower my fist while keeping my elbow where it is (ulna/radius are no longer parallel to the ground) the pain is at its worst. Moving my fist up and down while in that position (arm out in front, elbow bent to 90) with any sort of weight would be excruciating.

I did go to physio for this about 10 months ago for 2-3 months, but it wasn't improving and it was costing me 50 bucks a trip. They mostly had me do exercises where i would keep my elbow at my side, bend my elbow to 90 degrees, and move my fist out away from body while keeping the form i began with. Helped to a degree maybe? Was hard to tell, and to me wasn't worth the 50 bucks every week or two weeks.

Now it does trigger from movements other than these when i'm just doing my daily things, but not in a consistent fashion. These are the only movements that always hurt to some extent.

Lastly, like i mentioned at the start, it has been consistent since it's come on but some weeks/months its not too bad, and others it gets quite painful. I've tried to take some things out of my daily routines that i thought it could be, such as working out, sleeping on my stomach, too much time sitting at my computer, but none seemed to make a difference.

Kind of a long post, but i wanted to be thorough. If anyone has any answers, or any questions to help them come up with an answer, please let me know .

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[mudassarnati]

hy, its mudassar a physiotherapist from pakistan, as u described in ur post, this is the typical condition known as rotator cuff syndrome,,,,in which the supra spinatus muscle is most commonly affected,,,,,,,,as u told that u hv gone through physiotherapy earlier,,,,i think furter physiotherapy sessions will have nothing to do with your problem, except minimizing your pain, ,,,,,so the ultimate option could be a surgery,...so i advice you to go to a city hospital and discuss all this with orthopaedic surgeon, with your medical record,,,,,
regards

[love sareen]

Hi,I am love k sareen,a sports physiotherapist.your condition seems to be a case of rotator cuff tendenitis, in which any movement with shoulder in internal rotation causes increase in pain,pain usually increases during mid night & radiates to front of arm,sleeping over the affected shoulder gives u relief initially with subsequently increase in pain.you must ask your therapist to give T.E.N.S, I.F.T and ultrasonic therapy with depomedrol. usually it will take more than a month to see a significant reduction in pain, once tenderness at shoulder decreases u can start with the rotator cuff and scapular exercises.

[BenMort]

Hello, when you say under your deltoid do you mean at the front, side or back of your arm? And also, do you not get any pain when moving your arm infront of you or to the side when your elbow is straight? Just when bent?

Finally, what kind of working out did you do before you stoppped working out as much?

Hope you get the right answer!

Ben

[mhewitt]

Yes sorry, under the front and outside. It does go down the arm on the outside a little bit if i trigger it badly.

Pain is only when bent, which is why it seems so weird.

As for working out, i've worked out on and off since grade 12, and im now 21, so about 4 years. I've been at about the same intensity for the last year, averaging probably 2-2.5 hours a week, so nothing too serious.

Thanks for all responses.

[alophysio]

Hi,

I am thinking you have either impingement, labral tear or a strain the shoulder (like tendinitis - i just don't like the term tendinitis for something that is a year old!)

What sort of professional advice have you sought?

Some of the movements you described seem to me to be impingement tests...

You are 21...don't let it get bad - get some advice!

[dsheri2]

Hi MHewitt

I am a Neuromuscular Thrapist,From What you describe in your post. I would say you have Trigger points in your Scalenes muscles(located on the side of your neck) which will refer a nervy type pain to your deltoids and many more muscles down the Arm and into the pecs.
Other Muscles with Trigger points that will refer pain into the Deltioid(Infraspinatus, Supraspinatus, Lats, Teres Minor and Major,Pecs).But i would say the Scalenes will be your main problem(Constant chest beathing, ie Not breathing from your Diaphragm will cause the scalenes to be over worked which will create Trigger Points).
Please do not follow the surgery advice as this problem is certainly treatable.
Get yourself to a Manual or Soft Tissue Therapist(i think they are called Licesned Massage Therapists in the USA,likely to be the same in Canada).
Do yourself a favour and get a book called "The Trigger Point Therapy Workbook by Clair Davis" it explains how to self treat trigger points.Best book i have ever bought.
Dont Give Up
Danny

[alophysio]

Thanks dsheri2...my question would be "why are the trigger points there in the first
- maybe the muscles are in a protective spasm for something like a stress fracture or labral tear?
- maybe he has a poor stabilisation strategyand the muscles are being used as stabilisers instead of movers
- maybe he has a motor pattern that overuses these muscles instead of other muscles
- maybe he has a neck problem causing scalenes, upper traps, levator scap, etc to overwork
- maybe the neck problem has a neural component
- maybe he really does have a rotator cuff tear - rare in a 21y.o.

All these questions can be answered with a good assessment mhewiit

Cheers!

[dsheri2]

Some good Points Alophysio..an assesment would be the best way to find out !!
- maybe the muscles are in a protective spasm for something like a stress fracture or labral tear? "On Both Arms?"
- maybe he has a poor stabilisation strategy and the muscles are being used as stabilisers instead of movers"Possible"
- maybe he has a motor pattern that overuses these muscles instead of other muscles 'definately possible"
- maybe he has a neck problem causing scalenes, upper traps, levator scap, etc to overwork 'definately possible"
- maybe the neck problem has a neural component "Trigger Points so close to the neck will definately cause neural problems"
- maybe he really does have a rotator cuff tear - rare in a 21y.o.
Knowing if mhewitt does weights regularly or has done in the past would be usefull.Or any other Exercise regime that could have bad form"

Just my thoughts
Cheers
Dan

[alophysio]

Thanks Dsheri2.

They are good points you raise and i agree...and i have seen protective muscle spasm on one arm worse than the other due to labral tears and poor technique (motor control)...more than a handful of times.

I guess my original intention was to agree that Trigger points are just one possible reason of many that might cause this problem.

The way i think is that problems can come from 6 general sources...these can be linked back to various authors but most prominently Diane Lee and LJ Lee's Clinical Puzzle which builds upon the work of others as well as their own.

1. Their Strategies for Functional Tasks - the way you do something
2. The person's psychosocial influences - what meaning do they place on the pain/problem, their representation of their virtual body, their story, their goals etc etc
3. Their articular system components - ligaments, cartilage, bones, capsule etc
4. Their myofascial system - muscles, tendons, fascia etc
5. Their neural system - motor control, nerves, central influences, etc
6. Their visceral system - the effect of the state of their visceral system on their neuromyofascial system, chemical imbalances etc

To me, trigger points fits into either the myofascial system or the neural system depending on the view you take of them...

...i was merely trying to hurriedly point out the other components in a practical way

Thanks!

[dsheri2]

Very Interesting alophysio...i will look out for those authors.

[mhewitt]

Knowing if mhewitt does weights regularly or has done in the past would be usefull.Or any other Exercise regime that could have bad form"

I do. I probably work out 2-3 hours a week. It's a lot of bodyweight exercise (pushups, pullups, crunches), and the weighted routines i do aren't anything extreme. I mentioned it in a previous post but in case you missed it, i did stop working out for a while (1-2 months) and noticed no difference. I realize that it could maybe take longer than that for something to 'heal', but im not the best with patience .

I also forgot to mention that before i went to physio, i actually did visit two doctors (not sure of their specific field) that tried to assess what it was that i had. The first was all hands on, just asking me to move my arms and upperbody in general in certain ways. Then asking when it hurt, when it didn't, how bad it was etc. They said it could've been a few things but they weren't too sure and i would need to visit someone else. I then visited someone who did an x-ray sort of thing. He said he couldn't see anything, and that's when i went to physio.

I realize i'm probably going to have to go back to my doctor again to figure this thing out, i just didn't really like how it ended up last time. A few people telling me they aren't sure/they can't see anything wrong, and shipping me off to physio where i didn't notice much of a difference.

Thanks again for all the replies

[vam44]

It sounds like to me that you need a much more precise diagnosis and precise exercise programme to address this issue. This problem is something that physio should be able to fix with correct diagnosis.

In my experience should exercises need to be correctly prescribed and performed correctly and very consistently to make the best improvement. Were you shown scapulae stabilizations exercises? Did anyone massage and stretch your shoulder external rotators. Did you always exercise without pain? Did the physio assess comprehensively at your neck. Did anyone analyse your bodyweight routine. If the answer is no to any of these questions then not everything has been done yet.

[alophysio]

hi dsheri2 - Diane Lee and LJ have written a great book - The Pelvic Girdle 4th ed. - as well as The Thorax 2nd ed. Their websites are Discover Physio - Diane Lee and LJ Lee, Diane Lee & Associates - Consultants in Physiotherapy and Linda-Joy Lee Physiotherapist Corporation - Physiotherapy Education and Resource Company - Vancouver, BC.

Amazon.com: The Pelvic Girdle: An integration of clinical expertise and research (9780443069635): Diane G. Lee BSR FCAMPT CGIMS: Books

Amazon.com: The Thorax: An Integrated Approach (9780973236309): Diane Lee: Books

Cheers

[dsheri2]

Hi mhewitt

I realize that it could maybe take longer than that for something to 'heal',......"Trigger Points dont tend to heal, they will diminish put will not disappear until Direct Pressure is applied for 30secs to a few minutes until the pain has ceased.
Once TrPs are deactivated you will need to change/alter your movement patterns so the trigger points dont reoccur.
As an example i have a left side low back pain after running..that is corrected by Tigger point therapy/massage/stretching..but i also need to strengthen certain muscles in my glutes to prevent the problem happening again. Try this website .
Scalene Trigger Point Diagram

Cheers
dan

[AquamanIbiza]

Hi There, this is AquamanIbiza, a new member as of his morning and arrived here trying to find a solution to my problem. For the past 5 years, possibly following a motorbike accident in Goa I have had pain in right arm and shoulder. To be specific there seem to be 2 points in the centre of the right arm Deltoids and trigger point pain in the lower scapula. As described by the originator of this thread, pain on raising, holding my right arm with elbow bent and a general feeling of weak musculature in this region. it is particularly vexing as my work as a Watsu Practitioner requires me to support people in our pool, with my right arm in this raised bent position. I have had many sessions with Physiotherapists, masseurs, Cranio Sacral, et al but never seem to come up with a solution. Currently I am doing joint mobility exercises (Scott Sonnon) but after 3 weeks the pain seems to be getting worse. in all other aspects I am fit and well, not over weight and very active. I wonder whether a CT scan might reveal ome clues as the best way forward. see Watsu Ibiza - Water therapy pool Thanks in advance for any help.