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  1. #1
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    Brief Medical History Overview

    Age: 33, Male, Presenting Problem Since: 6+ years, Symptom Behaviour: Remaining constant, Symptoms Worse (24hr Behaviour): Same any time of the day, Aggravating Factors:: Exercising the area, rehab included, Easing Factors:: Sleeper stretch or massage (temporary), Investigations: MRI + arthrogram. No findings, No Diabetes, No history of High Blood Pressure, No Medications, No Osteoporosis, No Hx of Cancer, No Unexplained Weight Loss, No Bowel/Bladder issues

    Major problem / Symptomatic Areas

    Shoulder - Posterior - Left

    Unhappy Long-term shoulder impingement and pain

    Iím a 33 y/o male with a shoulder problem that has kept me out of the gym for 6 years. It seems to be a chronic problem that doesnít go away with rest time and lack of activity.


    The pain was not originally brought on by anything sudden, it was a slow onset as I was lifting weights previously and has evolved over the years since Iíve stopped.


    I feel a strong pinching sensation in my left shoulder at the back (area pictured with awful selfie angle) when I raise my arm up in the scapula plane. The pain kicks in when my arm is around 50 - 60į raised and continues until around 140į.


    I donít have any loss of range of motion and can still generally perform daily tasks. I can get my arms above my head easily and feel like I have plenty (maybe too much) flexibility through the joint.


    Rotator cuff exercises always make my pain worse ó not whilst doing the exercise ó but after. Because of this, Iíve never stuck to these exercises for more than a couple of weeks at best. Equally, any gym exercises involving the shoulder also aggravate the pain.


    The sleeper stretch does temporarily remove the pain. Also massaging right into the teres minor / insfraspinatus area temporarily removes the pain.


    I do also seem to have some achy pain in my SC joint on the same side. I have no idea if this is related.


    I have had MRIs on both my SC joint and shoulder and neither shown anything to note.


    The pain definitely does feel like impingement. From what I understand, itís more likely to be internal impingement. But every corrective exercise seems to make the pain worse. Should I just push through this?


    Iím frustrated, confused and lost with it.

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  2. #2
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    Re: Long-term shoulder impingement and pain

    Hi adoringhummus and thanks for your post. In general almost all shoulder issues (non traumatic) are impingement issues. And as in your case most take years to develop to the state which causes pain. The interesting thing for your issue is that you mention pain begins rather early in the range. A true subacromial impingement of the supraspinatus tendon, especially in respect of a negative MRI, would not normally be painful that early in the range. It does not mean no other structure could be involved though. With a sleep stretch giving temporary relief I wonder if your issue might be somewhat neural i.e. the brachial plexus (nerves) are implicated here. As a therapist I would take an approach to test you face up on the table before and after some cervical mobilisation to see if that area is involved. Also to take a look at the movement at your SC joint as you abduct the arm as sometimes if that joint is not tracking correctly it can cause symptoms that minic impingement.

    My advice would be to see a good manual therapist with a view to rule out or in the neck and SC joints involvement. Once we get some more information on that let us know and I'd be happy to provide some further comment.

    regards

    PB


    Aussie trained Physiotherapist living and working in London, UK.
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