newbie needs help with shoulder pain!

[jp8484]

Hi guys.. I've got to admit i'm not the most knowledgeable person when it comes to articulating my shoulder problem, and that's why i'm here for your help.

Basically my left shoulder has been banged up for a couple of years. It hurts inside/under the left shoulder blade to the left side of my body, but also on the right side. My shoulder sits forward and up from where it should. No amount of exercises, stretches or anything else has helped.

Over this time - the last few years the pain has been constant, it doesnt get worse or better.. its pretty much been the same right through. It does get worse whenever i do any shoulder exercises, or activation exercises regardless of intensity.

It looks like the problem is the muscle? that is meant to pull the shoulder blade down isn't doing its job properly. I can do this consciously when i focus, but of course feel this pain under the shoulder blade. When i'm not consciously focusing on muscle activation and I try for example to lift anything heavyish.. the shoulder leans forward and drops down if that makes sense! It just doesnt 'sit' in place..

Right shoulder is fine, i've never had any injuries.. this shoulder issue has caused restricted movement and stiffness in my upper spine which is causing secondary forward head posture among other things.

Any comments appreciated. Happy to provide any followup information if required.

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[tonywoodall]

The shoulder can be the most difficult to treat. Multiple diagnoses can be made, depending on the Physios experience.
If there was no direct trauma and assuming no condition like Rheumatoid arthritis, Gout etc, then it is likely that the problem is refered pain from the spine. In general, Anterior shoulder pain is from the upper Cervical spine, lateral pain is from the C6,7, T1 area and posterior pain from the C6 to T3 area.
So, in your case the pain is under the Scapula, left more than right. My interpretation is that you have a problem at the level of T2 - 5. Originally you were probably not aware of the spinal problem because the upper Thoracic spine is quite rigid and doesn't move enough to cause local pain. But eventually the inflamation from the damaged ligaments radiated laterally, causing chronic muscle spasm in the Scapula area and now into the Sub Scapula muscles.

So the Physio may choose to mobilise and or manipulate the spine + or - the other Physio treatment modalities.

[Dr Damien]

Dear Jp8484

I am going to agree with tonywoodall that the restrictions in your cervicothoracic spine seem to be contributing to these pain you feel underneath your scapulae. While I agree with tonywoodall, I have a slightly different explanation of the problem which in many ways are similar to what tonywoodall has explained. First of all, it is difficult to understand what the movements that result in discomfort are i.e what do you mean by when I lift anything heavyish? do you mean like carrying grocery bags? lifting weights in a bench press? lifting things overhead etc? what do you mean by the shoulder moves forward and drops down? it is unclear what shoulder exercises you do that makes it worse...

your description is mainly that your have subscapular pains esepecially when you depress/adduct your scapulae...

having a rigid spine can mean that muscles attaching the spine to the scapulae are off balance...it sounds to me that your scapulae generally are not moving optimally within the plane in which your thorax is shaped...my explanation is that each time you try to get them to work as you feel they should within what is an abnormal plane for them you get pain...
Like tonywoodall has suggested mobilization of the cervicothoracic spine could be of some help if it allows for the attaching muscles to move better... in addition you may need some manual work done on your scapulae...to free a tightness in its superiorly attaching muscles to the cervical spine if there are any...

Moreover it is unclear, whether passive movements give you any pain...the good thing is you have another shoulder that seems to be working reasonably well...an analysis of its movement may give an insight to what is wrong with the other one...

You need a proper check of what your scapulae are doing when your arm is functioning,you also need a better assessment of your posture...the challenge would be to get the right setting of scapulohumeral rythmn for your posture that is painless, then this incooperated into a simple exercise for control...depending on the practitioner the option of taping may be helpful for biofeedback

Sometimes , people get a " stuck scapular" owing to issues with its surrounding attaching muscles that overtime causes adhesions to form underneath the scapular...this makes shoulder movements difficult and painful...

I also believe ...once your cervicothoracic region is mobilized...your scapular mobilized within there fullest range, and even if possible your ribs checked out...then maybe things would function a lot smoother...

we all have different shapes and trying to "set" your scapular in a plane that doesnt befit your posture can cause pain...

[alophysio]

Hi,

I agree with the above.

Get the neck, thoracic spine, scapula, clavicle and glenohumeral joints assessed.

If none of those are dysfunctional (that is, they all do their jobs properly without failing to transfer loads properly - this is done with testing) then you may have to check as far down as the Low back, pelvis and possibly even lower since there are muscles that attach to your shoulder that attach to your pelvis.

A common problem often overlooked is also the dorsal scapula nerve which arises from the nerve roots of C4 and C5 (well, mainly C5 but it depends on who you talk to ). This can give you pain into the area between your shoulder blades.

All the best and let us know how you get on!