Shoulder pain and winging scapula

[funkodrunko]

Hi guys.

Just looking for a bit of advice.

For the last 18-24 months I've had shoulder impingement. It began on my right side and about 10 months ago it also started on my left.

Long story short, I had pain when moving my arms in certain positions and had a few flare ups where my arms have been more or less unusable. I've had 3 cortisone injections in my right shoulder. 2 in the side of the shoulder and one more recently at the rear. x-Rays came back fine. I'm now on my third physio as well.

The first (nhs) physio thought I had weak external rotators and had me doing lots of external rotations and told me to keep doing them and it'd get better. It didn't

The second (private) physio thought there was an ac joint issue as well as weak external rotators. I went there for months and it cost me a fortune and made no difference

The third (nhs) physio that Im still seeing thinks that I have winging scapula.
Since I've started seeing him, the impingment has improved but the pain has moved to the rear of my shoulder where it is often throbbing. The shoulders also click like mad whenever I move my arma. It feels like the tendons are catching on something.

I've uploaded a couple of videos showing my winging scapula with me moving my arms out to the side and also in front. The pain doesn't really kick in until my arms are 90degrees to my body and is worse on the way back down.

Out to the side - Shoulder Pain - Lifting arms out to side - YouTube

Arms in front - Shoulder Pain - Lifting arms out front - YouTube


Does this look like your standard winging scapula? and should I feel the pain at the rear of the shoulder?

Thanks in advance

FD

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[Dr Damien]

dear funkodrunko

you definitely have a winged scapular but that doesnt seem to be the only problem with your scapular motion...both scapulae appear to be sitting low, with the right worse than the left...while they seem to rotating adequately, they are doing it in the wrong plane in relation to your thorax, this would cause impingement even with a seemingly full range of motion...

your physios need to look at your overall posture.... working on external rotator strength is not enough...your scapulae need to be repositioned properly to stop the impingment happening...

all that throbbing you getting is muscles overworking to compensate for faulty scapula motion...

your serratus anterior may be weak, your trapezius looks long on both sides at the shoulder level, your rhomboids might be long too...
your scapula depressors might be short too...your pecs minor maybe long

having bad scapula motion affects rotator cuff stability...

address this and you should see some improvement

best of luck

[Dr Damien]

they also seem adducted...can you upload side view videos of yourself ? one stationary and the other doing the movements youve already uploaded

[theshoulderguy]

Hi funkodrunko, man oh man!

Great videos by the way and very helpful from an overall perspective.

I hope you don't mind but I am going to be frank here.


Your impingement problem is multifactorial.

Firstly, pain inhibits muscle activation and thus will change the way you move and the complex nature of your normal shoulder function.

So pain that is chronic, not well controlled or exacerbated by loading, overuse or poor muscle length and tension relationships (due to poor scapular positioning for example) will only make matters worse.

Get your pain under control asap by avoiding those things that aggravate it. It has to be no more than 3/10 at any one time, so keep on top of it.


Secondly, your scapulae and the muscles stabilising them are dysfunctional and so your scapulae move in an abnormal pattern as Dr Damien pointed out.

You look generally deconditioned and so your muscular and tendinous tissue will not cope well with loading and will tend to fatigue quickly (as seen in the videos and evidenced by pain exacerbation following cuff loading).

Your rehab ideally has to be focused on the basics of ideal posture, normal shoulder function and conscious muscle activation.


Ideally, your hand (which is the most important thing here in terms of upper limb use) should work off an arm that is connected to a stable, upwardly rotated and posteriorly tilted shoulder blade (especially when reaching overhead) which is connected to a strong and stable pelvic and core musculature (deep abdominals and gluts).

So if you are having trouble stabilising your lower half then you are going struggle stabilising the top half...get my drift?


Due to your level of de-conditioning and muscular dysfunction...the key to your success will lie in your ability to gain "conscious control" of your body, scapula and rotator cuff muscles, so that you are able to "feel" what it feels like to activate the right muscles in the right sequence.

Gentle loading and feedback are so important here to help you get that feeling.

This is going to take you some time but once you get "the feeling" then you'll be rockin'

I wish you all the best.

[funkodrunko]

Thanks for getting back to me guys.

Dr Damien - I'll mention what you said about the low lying scapula and the short/long tendons/muscles to my physio. Got an appointment on Thursday.

I've been doing a great deal of rows with therabands and trying to keep my shoulder blades back and down but the physio keeps focusing on the external rotation so more work on the scapula seems to be the way forward.


TheShoulderguy - Thanks for your info too. I do try to keep my arms within their limits i.e. not more them in a way that causes me pain but sometimes you just have to. I have a 10 month old baby you see.
In terms of me being de-conditioned, a lot of that just comes down to being unable to do anything because of the shoulder pain, right now I've got the muscle mass of a five year old girl. I dont know if the winging scapula was there when my problems initially started or if it has just developed as I've been dealing with the impingement. Its definately getting worse.

Do you mean I need to focus on each muscle being used when I'm lifting my arm for example? Focussing on keeping my shoulder blades retracted and letting the rc muscles lift the arm rather than swinging it up?

Thanks again.

PS I know I should be asking these questions to my physio but are blackburn's any good for strengthening the scapular region? Blackburns - YouTube. I have done a couple of the exercises but we always end up focussing on rc exercises.