2 Chronic Pains, all attempted solutions have failed.

[Peejulz]

Hi everyone,

As a disclaimer, I'd like to let you know that my story's not a short one and I don't believe the fix for my injuries to be a simple one either. I've seen 11 professionals in the field of medicine about these injuries, 4 of which were physical therapists who worked with me, 1 of which was a surgeon, and 1 of which was a sports medicine doctor. The others were general practice doctors, my family doctor, and an acupuncturist.

If you'd like to hear me out, here's my story.

I'm currently a 19 year old student at the University of Washington who's been suffering from two chronic injuries since the summer of 2010. During that time, I was a very frequent weightlifter. I'd gone from 135 pounds to about 160 pounds in a matter of about 5 months by attending my local LA Fitness every day using a 4 day rotation to hit each muscle group with adequate rest. I was 17 when I started around the beginning of Spring 2010, 18 when I got injured at the end of Summer 2010. Since then, I've been battling my injuries and have forestalled any and all weightlifting as well as anything over moderate usage of my injured areas.

I suppose now would be a good time to tell you what's wrong with me. Well, that's really the issue. I could tell you my problem areas (my right wrist and left shoulder), but I couldn't tell you much more than that. Neither could two X-rays and an MRI. Both came up inconclusive even with a surgeon having looked them over. There are no detectable physical lesions in my problem areas but yet I still experience chronic pain from them. So, in order to fill you all in, I'll start here and tell you what I can so you can make your own conclusions about them. I've seen the only sports medicine doctor in Seattle, the only hand-wrist physical therapist in Tacoma (there aren't any in Seattle), two MORE physical therapists in Tacoma and one in Seattle. My last resort is to turn to the internet where I truly believe some of the most brilliant, unrecognized minds, tend to flock.

So here it is. Around March or April of 2010, after having suffered a collarbone fracture on my leftside the past winter (December 2009) and after overuse of my right wrist from obsessive video gaming (I told you I was 135 pounds when I started working out, right? 5'9, by the way. =P), I began weightlifting at the gym. I mention these two things because I'm not sure of their relevance, but that's for you to decide. For over 5 months, everything was hunky dory. My wrist never bothered me, my shoulder never ached, and so I never thought to be too careful. I was a reckless teen, after all. I usually did a warm-up set and minor stretches before each workout, but never after.

After having gained almost 25 pounds of pure muscle (my metabolism is a racehorse), around August of 2010, two things happened. For my shoulder, I was bench-pressing (repping about 185 at the time) when I felt an excruciating burn in my left shoulder and I had to have my spotter take it for me. Had I known this would be me almost two years later, I'd have quit working out and nursed my wound, but I was a reckless teen (As I said) and so I continued to workout. Most exercises involving my shoulder were impossible from them on (this means chest and shoulder exercises) but I kept on working my other muscle groups which meant having to load 45 pound plates and often using my shoulder as a stabilizer or as a secondary muscle group (think biceps, traps, rear delts, etc.). My shoulder never healed. As for my wrist, the crucial moment occurred while I was doing curls with an easy-curl bar (forgot the weight but it was substantial) when I felt an almost electric tingling and burning run from my hands shooting up through my forearm, stopping at my elbows. I finished the rep but then dropped the bar and stopped my bicep workouts for the rest of the day. Once again, had I known the severity of this problem, I'd have stopped working out and nursed my wounds. But I didn't. And even worse than my shoulder, with this one, I often times simply worked through the pain. A lot of times it would only hurt for the first few reps and then something (whether it be adrenaline or stupidity) would make the pain stop and I could keep going. After a bit of time, the wrist pain got worse and worse to the point that I was forced to stop and let it heal. For both these injuries, I was so against the idea of ceasing my workouts just because of some pain. Nothing I can't work through, right? I wasn't completely brainless, however, as I would try to give the muscle groups that were injured a break, but only for about one rotation each time (4 days). That, as it turns out, wasn't enough.

So that was the origin of my injuries, next, I should try to describe the symptoms and locations, right?

For my right wrist injury, the pain comes from the area inbetween the ulna and the hand-bones (I'm no professional). I get a searing pain when I place my hand flat on a surface and then try to bring my arm down through the surface while keeping my wrist and hand unflexed (picture a person using a mouse, then remove the mouse, and apply the pressure upwards bottom left area of my palm). I realize this is somewhat ambiguous so if you want further details, please inform me. It also becomes very irritated when I have to grip anything full fisted with a good amount of force, or with a good amount of control. For instance, anything obviously weighty as well as something as simple as handling (with a firm grip for optimal control) a video game controller. Also, when it's irritating me, if I flex my hand inward toward my body while it's pronated so as to stretch the fibers or tissues in the pain area, it tends to cause a good amount of pain. As does reversing the direction of the flex. Imagine a pronated fist that's wiggling left to right, these are the two flexes.

As for my shoulder, there are lots of things that irritate it. Sleeping on it, having pillows behind it, having to stabilize anything that I'm holding with that arm (I.E. heavy grocery bags), lifting the arm straight forward, pushing on anything, etc. Wearing a backpack, I put all the weight on my right side as my left side would become irritated. The shoulder's a harder one to explain as it's less distinct and the pain is less local. I can say that the pain is most obvious from the front of the shoulder, closer to the top of it where the bone is.

I can provide pictures of all this if necessary.

I'll stop there.

I've gone from 160 pounds, an incredibly active lifestyle, and healthy self-confidence to about 140 pounds, a completely inactive lifestyle, a terrible diet, a steadily diminishing hope of recovery, and my physical self-confidence diminishing right along-side it. I've been told by every one of the professionals I've seen that I'm far too young to be having these problems. Frankly, I completely agree. I realize my stubbornness and ignorance has caused me to do this to myself, but perhaps with persistence and wisdom, you guys can help me UNdo this to myself.

Thank you so much for reading,
Paul

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[nmarman]

Ok, first I had your wrist pain before from lifting weights and it is seen a lot in weight lifters. It is a compression injury to the intercarpal bones - rest and manipulation (a chiropractor specialising in extremities will sort this in about 6-10 visits). – job done. wear a support while recovering and if you go back to weights to stop re aggravation during recovery.

The shoulder sounds like impingement with concomitant bursitis (these two together would account for all your shoulder aggravations).

It will normally start with a single injury in shoulder and spread to involve more areas and tissues as you compensate to stay pain free. This Makes it hard to pin point the pain much later on. Remember the joint is just a pestle and mortar lashed together with tons of ligaments and muscles. This means we get loads of movement from it but also makes it prone to injury and poor recovery.

The shoulder is the biggest pain in terms of treatment - I would do 6-10 sessions (2xweek) of ultrasound therapy at 1mhz (10mins) and 3 mhz (10mins). Combine this with rest and start controlled rehab with a thera band once pain has reduced by 60-70% but be careful not to re-aggravating. If you do stop, rest and ice; for best results immobilization during treatment works well (normally only done in severe chronic cases). lastly if that doesn't work try shock wave therapy, the studies show very good results for quick recovery at our clinic (3 visits) however big studies haven't been done yet on this area, except in calcific tendonitis.

To refine this diagnosis can you please list the imaging you have had on the shoulder and the things found – if any.

Niall Marshall-Manifold D.C
London Shock Wave & Sports Injury Clinic
http://shock-wave-therapy-london.co.uk

[Peejulz]

First and foremost, thanks you for taking the time.

With your wrist diagnoses, it sounds like an attractive one. It makes me wonder how critical the ultrasound therapy would be though, as I've tried using a wrist brace for about 3 months and the problem persisted. Albeit, I was using a lightweight band for physical therapy (only wrist curls and stretches) so that may have stunted any progress with irritation. That's moreso a shot in the dark as to why the rest may not have worked. I'll have to look into ultrasound therapy, I hadn't even heard of it until now.

I've had two x-rays and an MRI and neither a surgeon nor a radiologist were able to find physical deformities. They said I looked just fine physically which lead my sports medicine doctor into suggesting acupuncture for 'misfiring pain receptors'. This fact makes me think that the bursitis may not be the case. But I could very easily be wrong.

It should be noted that for both injuries, I've rested them for months with no progress. Seems my body wants action. I've also had a cortisone shot in my left shoulder, and that did little to nothing.

I'll look into what you've suggested, feel free to ask any more questions in the meantime.

Thanks again,
Paul

[nmarman]

MRI and X-ray results are good it
Evans there are no signs of instability - that leaves only one cause for the wrist - compaction. To release this you need manipulation you should feel the difference within 3-4 visits.

The shoulder bursitis also won't be viewable on x ray. However tendinitis when it's acute is visible on MRI.

To some up manipulation for carpal bones

Ultrasound for shoulder due to chronic state here there is bound to be involvement of other rotator cuff muscles and tendons. If you get the acromial humeral x-ray measurement you might even see it on the low end of scale. This should objectively indicate impingement. Although isn't indicative on its own. It should be used in conjunction with orthopaedic test (dr will move you or prod you then ask you if it's painful) have you had this.

[Peejulz]

So it looks like compaction in the wrist is what seems most likely.

I have indeed had orthopedic tests from several doctors/physical therapists. Nobody's suggested bursitis or impingement by the name, but they've all agreed that it looks like there's a rotator cuff issue and that strengthening of the muscles around the injury without actual irritation of the injury itself would be the best route to take. That and some stretching. I've certainly never been suggested any ultrasound therapy. I've only tried physical therapy, acupuncture, and the cortisone shot I mentioned earlier. Since there was no detectable inflammation in my shoulder, the cortisone was really a shot in the dark. As I've said, most of the folks around here are pretty perplexed.

Regardless, it seems like ultrasound therapy is my next option to look at for compaction in the intercarpal bones and shoulder impingement and bursitis.

Any other possibilities I should look at? I'm still happy to answer any more questions while I scout about for a chiropractor.

--Paul

[nmarman]

Assuming the x rays and MRI were read correctly then it is unlikerly that much else could be wrong except for tendonitis and bursitis.
The hard bit comes in finding exactly which area/tendon is the primary pain generator.

The most common is the supraspinatus tendon. This would give pain if you press deep at the side of shoulder, just under the bony roof. This will hurt most when rising a straight arm out to the side against resistance from about 15-45 degrees. After which pain might decease before starting again when arm archs closer to ear.

After a while this with produce trigger points in the muscle belly (top of shoulder blade). These trigger points can produce pain in the belly and even radiate to the elbow.

Pain at the front of the shoulder will be secondary impingement & bursitis as the deltoid lifts the ball of the upper arm high into the socket making the roof space very narrow (impingement) this impinges the bursa causing it to swell. This area will hurt more if elbows are behind body (back pack while holding straps)

Note: people with impingement often find it hard to remove A wallet frOm back pocket.

Try seeing how your symptoms fit into that

[Peejulz]

Using a 3 pound weight, I found that raising my arm up straight to the side actually did pretty much all that you said it should. Pain from the very bottom of the arc, then a bit of release throughout the middle and then pain again at the top. The difference is that my pain was highest at the top when my shoulder was most contracted. Though this could also be because the weight requires more shoulder action up top (due to gravity and less stability and the like). However, since I'm not usually ever required to lift my arm out like that I find that most of my shoulder pains come from having to stabilize a heavy grocery bag (similar to walking around with a 10 pound weight with your arm preventing its swinging) or from letting my shoulders be rolled forward too long (for instance, if seated, resting both elbows on the knee area and then pressing down on the knees with my elbows to keep my head higher and my back straighter). It also tends to get quite irritated when I hold something up in a curl position. For instance, if I'm walking about with my open laptop held by one open palm on the bottom.

Reaching into my back pocket produces hardly any irritation but trying to itch my middle-back will definitely cause pain both during and after. I also do sometimes catch myself with my elbow holding the backpack straps but I've been unable to isolate whether it was that position in particular that caused the irritation afterwards or just the fact that I was wearing a backpack. In other words, no pain during, just pain after.

As a sidenote, my physical therapists have told me that my shoulders tend to roll forward a bit (naturally) and it seems to help the situation (pain-wise) when I consciously keep them pulled back with good posture. Does that indicate anything?

[nmarman]

When you have had a. COndition for a long time the body try's to work around it. There can be so many muscles involved that have change in both ability and function in chronic cases.

at this point you need to reduce some symptoms down specially pain. Only then will the you see the extent of what compensation has done.

To sum up reduce pain (ultrasound treatment with movement but no excercise) re evaluate then ultrasound with rehab.

[physiofi]

Can't comment on your wrist pain as I confess I am no expert on wrists and nmarman's advice seems good.

With regards to your shoulder, the more I read, the more inclined I am to think impingement syndrome. If your shoulder is looking fine on XR and MRI then it's definitely a likely possibility. I've treated numerous cases of shoulder impingement and all improved considerably (asymptomatic or 90%+ improved painwise). Bear in mind that it will take hard work and perseverance and because of the longstanding nature of your symptoms, there is no "quick fix."

Doing some scapula setting exercises and working on your posture will help to re-educate your muscles into the position they should be in. Drawing your shoulders back and down does this (although if you want some in-depth info I can email you an exercise sheet). Be very conscious of your posture and DO NOT SLOUCH or let your shoulders roll forwards. Relative rest - so don't do anything that aggravates it at the moment, lifting with shoulders in a poor slouched position or lifting anything heavy. What does a typical day consist of for you now? Do you spend long periods sitting or at a laptop or computer? If so, is it in a poor position? Sitting with a rolled up towel as a lumbar support in your lower back will automatically make you set your shoulders better and improve your posture.

Impingement syndrome is incredibly common but very treatable. Perhaps your pattern of symptoms confused the healthcare professionals you saw as mechanisms of injury etc can lead to different diagnoses with the information given. Sometimes I find the best way of testing a theory is to just start a bit of treatment and see if it helps! You sound very keen and proactive so I'd say work on scap setting and your posture and see how that changes your symptoms. Feel free to msg me if you want any more info.