Superior Migration of Humeral Head

[John Lowe]

Hello,

As the title says my humerus has migrated superiorly in the shoulder socket. I have been trying to find out what exercises and stretches etc. can be done but can't find much online, so I decided to join up and ask here, I would greatly appreciate any help if anyone would be kind enough to offer it.

I have been to the physio and am still going but this isn't getting better, I'm doing endless rotator cuff exercises and also stretching the posterior capsule with the cross body stretch, but it's not getting better and the physio won't refer me for an MRI even though I've asked multiple times.

Thank you
John

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[John Lowe]

Does anybody have any advice?...

Thanks
John

[kcho]

What do u mean by "humerus has migrated superiorly"? Did u mean you have shoulder impingement syndrome? how do u know?
Can u describe your symptoms? what movements aggravate it? what eases it? what your physio have done so far? what he has said to you about it?

[John Lowe]

What do u mean by "humerus has migrated superiorly"? Did u mean you have shoulder impingement syndrome? how do u know?
Can u describe your symptoms? what movements aggravate it? what eases it? what your physio have done so far? what he has said to you about it?

Yes, impingement due to the humerus riding upwards, this is what the physio told me, said the humerus isn't sitting right and is too high.

Symptoms are pain at the front of the shoulder during most movements, especially overhead movements, no pain when at rest. Also feels really tight at the front and fatigues very quickly making the pain worse.

So far physio has given me exercises for the rotator cuff, external rotations, band raises and also some push up pluses and chest stretches... been doing these for months on end and they helped a little to begin with but aren't making any difference now.

I am absolutely fed up with this, and the physio hasn't done any investigations, no scans, no referral to a doctor... to be honest I'm pretty annoyed.

Thanks a lot for your reply.

- - - Updated - - -

Also, I have bought a shoulder horn for £90 two weeks ago and think this is helping a little bit, using this I've cut the weight down by almost half from what I was doing before for external rotations so I think I may have been using too much rear delt before?

I'm considering paying for an MRI privately too as I think this will elucidate what exactly is going on. I think I should have had one when I first saw the physio as the pain was excruciating and I was getting numbness and tingling in down my arm and in to my hand.

[John Lowe]

Is it normal to be going to a physio for almost a year and not having any investigations done? No scans etc?

[KiwiPike]

Hey John,

Sorry you are having a crap time. I am a physio in the States but am actually a Kiwi. Honestly MRI's xrays etc are pretty much useless in most cases. in fact I almost never look at them at all. There is so much research out there showing that if they show anything most times it has no relevance. Meaning the same "abnormalities" appear in a person who does not have pain. If you take 100 fellas over 40 WITHOUT any pain, 50% of them will have a rotator cuff tear. I have had people diagnosed with full tears walk out the same day with almost full pain free range and no strength loss.

OK I just re read your post. very high probability it is your neck. Do you have neck or upper trap pain, neck sitffness, shoulder blade pain? It is an easy fix. There are a couple of other things that cause numbness and tingling, but they are not very common.

[John Lowe]

Hey John,

Sorry you are having a crap time. I am a physio in the States but am actually a Kiwi. Honestly MRI's xrays etc are pretty much useless in most cases. in fact I almost never look at them at all. There is so much research out there showing that if they show anything most times it has no relevance. Meaning the same "abnormalities" appear in a person who does not have pain. If you take 100 fellas over 40 WITHOUT any pain, 50% of them will have a rotator cuff tear. I have had people diagnosed with full tears walk out the same day with almost full pain free range and no strength loss.

OK I just re read your post. very high probability it is your neck. Do you have neck or upper trap pain, neck sitffness, shoulder blade pain? It is an easy fix. There are a couple of other things that cause numbness and tingling, but they are not very common.

Thanks for the reply, KiwiPike!

That makes sense about the MRI's then, no point having one if it wouldn't be of use.

The physio did say I have a stiff neck but then never mentioned it again or treated that area, and it does feel stiff on the right side where the shoulder pain is, with a very slight 'crick' in it too, but I wouldn't say it was painful, most of the pain is in the front of the shoulder, with some elbow and wrist pain too, I was getting numbness and tingling in my hand early on but that has improved a lot. Looking at a picture on google of the neck I would say the 'crick' is around the C4 or C5 area if that helps.

I have no upper trap pain, but again the physio has said the upper trap is tight and hypertrophied (as is the chest), I have been doing chest stretches but I wasn't given any sort of stretch for the upper trap, apart from just being told to try and relax it if possible.

No shoulder blade pain either, but it does feel very tight along the medial border near the bottom of the scapula, with some pain there when I try to stretch it.

What would the 'easy fix' be? I'm very grateful for your reply and willing to try pretty much anything at this point haha

[KiwiPike]

Thanks for the reply, KiwiPike!

That makes sense about the MRI's then, no point having one if it wouldn't be of use.

The physio did say I have a stiff neck but then never mentioned it again or treated that area, and it does feel stiff on the right side where the shoulder pain is, with a very slight 'crick' in it too, but I wouldn't say it was painful, most of the pain is in the front of the shoulder, with some elbow and wrist pain too, I was getting numbness and tingling in my hand early on but that has improved a lot. Looking at a picture on google of the neck I would say the 'crick' is around the C4 or C5 area if that helps.

I have no upper trap pain, but again the physio has said the upper trap is tight and hypertrophied (as is the chest), I have been doing chest stretches but I wasn't given any sort of stretch for the upper trap, apart from just being told to try and relax it if possible.

No shoulder blade pain either, but it does feel very tight along the medial border near the bottom of the scapula, with some pain there when I try to stretch it.

What would the 'easy fix' be? I'm very grateful for your reply and willing to try pretty much anything at this point haha

Hey John,
I would be comfortable stating that this is definitely your neck. Everything you have said screams cervical radiculopathy. Basically a bulge of a disc pushing on a nerve as it exits your spine. With sxs in your hand it will be a lower cervical nerve. WIthout knowing specifically which fingers it will be nerve root C 6, 7 or 8. Palpation, or your physio "feeling" your muscles and saying "oh its tight or got a spasm, is pretty bogus too. Palpation is lower inter and intra-rater reliability than anything. Meaning you could have 10 physios feel the same spot and all have different assessments. Its really subjective, thus crap!

Discs usually bulge posterior laterally, some have more lateral component some have more posterior. Hard to tell without seeing you move your head.
A good starting point to assess would be doing a cervical retraction and seeing what happens. I am most concerned with the furthest pain from you hand. Google cervical retraction exercise. Your best bet without forking obver money to me or a physio is to buy a book called treat your own neck by robin Mckenzie. It covers a lot of good things in general.

[John Lowe]

Had neck checked and everything was fine according to my physio.

This problem is still no better after over a year of seeing the physio, and just thinking about it makes my blood boil now.

Should I go back to the GP and ask to see a proper Dr. as I can't see my physio referring me to anyone specialist or ordering any scans in the foreseeable future?

[KiwiPike]

Was the physio a Cert. MDT? They must have this certification. I was a general physio for many years and learning McKenzie assessment of the body is completely different. I would not have been able to clearly identify cervical component without learning MDT.
I still put money on your neck John. Again hard to definitively say without seeing you in person. So if you happen to be in Philadelphia let me know.
If they were and found nothing with your neck then it starts to run into other possibilities such as neural tension, thoracic outlet syndrome, etc.

[John Lowe]

I don't know to be honest, they are just an NHS physio.

I think I will go back to my Doctor and ask to see someone else.

I would see you but Philadelphia happens to be over 4000 miles away haha

[KiwiPike]

Hey John,
They really do need to be an MDT.
Here is a site to find one in the UK
Find A Clinician | The McKenzie Institute International®

[John Lowe]

Finally having an ultrasound scan, went back to my GP and he requested it and he was baffled as to why no investigations have been done already after 15 months of seeing the physiotherapist.

What is an ultrascan likely to show?

Also, the GP said to carry on going to the physiotherapist, but my last session she actually did nothing, and I mean nothing, just a chat and she said she would book another appointment for two weeks time - which she never did, I had to ring up six weeks later! Can I tell her I want to see another physio? Because quite frankly she is a disgrace and terrible at her job, and a liar to boot!

I'm usually a very calm guy but I'm tempted to give her a piece of mind at my next appointment.

[anka_nikoleta]

Dear John,

Have you got the results from the ultrasound?
Did it show anything?

Nicoleta

[John Lowe]

Dear John,

Have you got the results from the ultrasound?
Did it show anything?

Nicoleta

Hi Nicoleta,

The ultrasound didn't show anything, nor did an X-ray, but I had an MRI scan last month and they found I had a torn labrum which needs surgery. To be honest I'm relieved, I've had over 18 months of physio and was constantly told they were sure 'nothing was structurally wrong' and that it didn't need scanning and was just an imbalance, even though I told them repeatedly I thought it was more than just muscular and felt investigations would show something, I've been injured in the past and have always healed, but I knew this time was different, just felt like something was snapped or torn, it's a shame it took so long to get to the bottom of it and I'm disappointed in the physio's inability to act or listen - it took going back to the GP to actually get anything done.

Thanks