Shoulder clicking

[dunlphysio]

Madiyaan,

Sounds as though you may have shoulder blade instability, that would explain the neck problems aswell as the fact that clicking occurs when your thumb turns down. A Physio could confirm this at a glance and give you some exercises to work on stabilizing the scapula. This would improve your overall strength and possibly stop the clicking.

[Galen Oli]

It could be a rotator cuff issue.
Firstly I'd cut back on the work until you know for sure, since the last thing you want to do is make any injury worse.
It doesn't sound like a severe injury, so if you can do some physical therapy you may be able to nip it in the bud.
Wound Dressings

[madiyaan]

Okay, so the first diagnosis was correct. I believe it started with the ac joint.

I think I suffered a separation due to repetitive movements under load (can shoulder separation happen because of repetitive stress or does it always happen due to macrotrauma?). Perhaps I also sprained some ligaments in the back area (upper traps I think) while military pressing (I did have a crick in the neck after one session I remember).

I went to not one but 3-4 orthopedic surgeons. I had an MRI/MRA done. MRI/MRA both indicated no tear in labrum but thickening of posterior supraspinatus tendon. I educated myself on the shoulder anatomy during these two years since I noticed the clicking. Interestingly, both MRI and MRA reports said that I had a normal AC joint.

However, I recently (in March 2010) had an xray taken. Attached is the xray image. I think It clearly shows separated shoulder (does it?). The ortho I showed it to just shrugged it off without even looking at it properly. He said I would be fine by strengthening the RC.

Here is my own take on the whole thing:

I have looked at quite a few xrays during my own research and I think the clavicle's distal end should be flat, not pointed. The pointed end (osteophyte) shows bone growth there which perhaps happened as a result of microtrauma? (I don't remember ac joint pain anytime in the past year). Or perhaps the growth happened with the clicking/rubbing after the separation.

In either case, I think first the separation happened, then because the scapula lowered down, the subacromial space decreased. And due to my overhead activities I developed tendonosis of the supraspinatus. I think the tendonosis of the supraspinatus is a symptom, not the main issue. The main issue is the drooping of the scapula. Note that there is an external step deformity that none of the orthos I went to bothered to examine (since I didn't report any AC pain).

How to cure it? I don't know. I need to somehow raise the scapula back in line with the clavicle. In doing so, I think the subacromial space will increase and impingment will not happen anymore. I really want to return to going back to the gym and doing heavy upperbody work which I have not done since 8 months into the clicking.

Personally I also think orthos didn't guide me properly and didn't even bother to notice this separation until 2 months after the clicking. Perhaps a screw would have prevented this situation.

That's my own theory (ortho still thinks I need to keep doing PT on the rotator cuff that I have been doing for the past 2 years). Does someone have differing opinions?

I am pretty sick of the shoulder being the way it is (pain when doing overhead activities deep within the shoulder, lots of instability, clicking, popping, etc. ) and want a normal shoulder now!