Humerus is bumping into the AC joint...

[hjohnstone]

I think that is my problem and the reason i get a clicky noise in my shoulder without pain every so often. Some advice on how to get the humerus to move back to its normal position would be much appreciated e.g. exercises and/or stretches. Thank you!

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[alophysio]

hi

you have given very limited information.

i think physiobob has a guide somewhere on what to include in your posts.

It should include a history of your symptoms, what treatment you have sought, what aggravates your pain, what eases your pain, how long have you had it, any scans or examinations you have had, any opinions from doctors etc etc etc

Otherwise you will get the only advice we can give (and why hardly anyone replies)...which is "go see a physio in your local area for an opinion".

Cheers

[hjohnstone]

hi

you have given very limited information.

i think physiobob has a guide somewhere on what to include in your posts.

It should include a history of your symptoms, what treatment you have sought, what aggravates your pain, what eases your pain, how long have you had it, any scans or examinations you have had, any opinions from doctors etc etc etc

Otherwise you will get the only advice we can give (and why hardly anyone replies)...which is "go see a physio in your local area for an opinion".

Cheers

History of the symptoms: The clicking in the shoulder started around 2 months ago after a heavy bicep workout, after-which my upper arm ached for a little afterwards and my biceps were very sore. No scans have of yet been carried out, but an Osteopath was seen a while ago to merely examine the shoulder, and his opinion was that the humerus was rubbing against the AC joint causing the cracking. If i fold my right arm into an L shape and then externally rotate it in a circle i feel something catching (sliding over in the shoulder - no actual audible click), could that be the AC also? There is no pain, but the clicking does seem worse if i do a bicep workout i.e. i can make it click easier and it may click in everyday movements like if i move out my arm straight suddenly in a punching motion. My shoulder do no appear very rounded, but perhaps they are slightly with the way i slouch over a desk during school hours ( i now try to keep my shoulder back). If it is the AC joint bumping in to the humeral head, then could this cause any issues as long as it remains painless, and IF it was, what could i do to prevent/lessen this bumping. I honestly don't know what more i can say...i just want some advice. Would some RC exercises help possibly along with working the posterior deltoids to balance out the shoulder as my anteriors are a lot stronger.

[alophysio]

My friend, i understand your plight but please understand our situation...we might give you advice that might make things worse which is NOT what we want...

To me it doesn't sound like the AC joint.

You sound like you have the bicep tendon popping out of it's groove.

It could be due to many different possible imbalances in the shoulder.

As a rule, strengthening your rotator cuff as well as keeping the range of motion even in all directions is a good rule of thumb. Bit of a cop out i know but it really is tough to give advice like this.

It is like asking your mechanic on the phone what is wrong with the car.

Or asking your doctor on the phone what to do about the rash that has just come up/started.

I would much rather NOT give you specific advice and ask you to see someone who knows how to deal with these things...

...but my money is on a tight posterior capsule, possibly some glenohumeral interal rotation deficiency due to excessive tightness of the inferior glenohumeral ligament complex.

Your belief that anterior delts are causing the problem might be correct or it might not be. It depends on whether the joint is sitting correctly in the joint or not.

Or maybe you have a glenoid labrum tear...

Or maybe it really is your AC joint (but i don't think so).

I am sorry. Maybe ask someone about the above points?

[hjohnstone]

Thanks, that was in fact rather reassuring, except for the 'labrum tear', which one would expect pain from? I have no pain at all, so presumably that means a tear is very unlikely? I am seeing a physio next Thursday, but until then i just was some possibilities. Thanks so far for your input.

[alophysio]

ok,

let's assume that it is a biceps tendon because it is quite common, there would need to be a biomechanical reason for it (usually).

i am hesitant to point you in the direction of articles for fear that someone (you or someone else) might try to self-diagnose...please remember that a good physio assessment will always beat an article hands down...

...but i have attached a quality article that will assist...perhaps you can print off a copy for a physio to review and go over with you? It can be found on this thread...http://www.physiobob.com/forum/gener...endonitis.html - there are another 2 parts to the series of articles but this is a good start. The 2nd article is on SLAP lesions and the 3rd is on rotator cuff exercises...can't find them right now...sorry

If you have a physio that dismisses your concerns saying "it's nothing", i would simply reply "it is important to me therefore shouldn't it be important to you?" - pretty provocative actually...maybe tone it down from that!

In other words, you are the client...the physio will either know how to fix the problem or won't know. It is unlikely you will find someone who will admit to not knowing so if they dismiss it, it is either:

1. They know what is wrong and don't think it is a problem
2. The know what is wrong but don't know how to fix it
3. They don't know what is wrong and so don't know how to fix it.
4. Believe it is nothing because other people who don't know tell them that!

You will find similar stories from patients about clunking *everything* - knees, hips, elbows etc.

It might not be painful (yet). It might be "normal". But they still haven't explained why it happens...which is all people want right? Why is it happening and what do i do to stop it?

So read the articles, Google the words you don't know (it is what i do!!) and try to find someone who cares enough to admit they are willing to learn with you how to fix it.

And in case someone wonders why i am writing so much on something like this, it is simply because i think we as a profession don't seek to learn enough and admit our limitations. I got challenged early in my career by a patient and it made me realise that i need to keep learning for life. Simple "pat" answers are not enough...

See what happens when you get me sleep deprived and tired?? You get me waxing on like a lush!!! Sorry

[hjohnstone]

I'm hoping it's nothing serious however. A tear could ruin my sporting career. Would pain be a likely, if not certain symptom? here is no awkwardness throwing, merely a click now and then.

[hjohnstone]

Sorry, i know you can't do it without hands on exmaination, but would the fact that if i clasp my hand over the deltoid region and it not click indicate nothing pathalogical?

[alophysio]

like i have mentioned before, it is unlikely to be a tear but you can't be certain without an exam.

The clunking is probably a bicep tendon flicking.

An realtime ultrasound (U/S) can see this happen.

Don't stress about the complicated stuff. Get assess properly, it is likely something common like a muscle imbalance. You will likley have to do the GIRD stretches and some rotator cuff strengthening or something working into the range that you have the clicking happening.

You'll be fine. Otherwise, book a flight and come see me (there are STACKS fo physios in the UK who should be able to help you by the way!).

[hjohnstone]

Thanks so much for your help, as i say the clicking is a really bugger! The left shoulder practically never does it, but the fact that it can every so often is also an indicator not of a tear, but of a bicep imbalance i would imagine? Thank you so much!

[hjohnstone]

like i have mentioned before, it is unlikely to be a tear but you can't be certain without an exam.

The clunking is probably a bicep tendon flicking.

An realtime ultrasound (U/S) can see this happen.

Don't stress about the complicated stuff. Get assess properly, it is likely something common like a muscle imbalance. You will likley have to do the GIRD stretches and some rotator cuff strengthening or something working into the range that you have the clicking happening.

You'll be fine. Otherwise, book a flight and come see me (there are STACKS fo physios in the UK who should be able to help you by the way!).

Hypothetically, if it was to carry on clicking without pain would it be more likely to dislocate, snap, tear etc? Or would there be no long-term concerns if that was what it is? Also, is it okay to do RC strenghtening exercises on a light weight e.g. 2/3 kg twice/three times a week?

[alophysio]

Hi,

I don't think it si a bicep imbalance...rather the bicep is working because it is forced to turn on to try keep the head of the humerus in the glenoid fossa.

Rather, i think it is other muscles (including rotator cuff) which are probably imbalanced and the other soft tissues (capsule/ligaments/etc).

Also, rotator cuff exercises are usually pretty benign is done properly...again AT YOUR OWN RISK...i still think a good assessment is the way to go - i know you are probably sick of hearing it but it is the truth...

BTW, repeated clicking etc *may* lead to tendinosis or tendinitis or even tears and ruptures. IMHO, the reason clicking occurs is usually mecahnical so find the mechanical reason for it and change the situation to decrease the mecahnical loading on the structure.

Good luck.

[hjohnstone]

Thanks for your your help mate. The clicking is not all the time anyway - only certain positions. I would say maybe 10 clicks a day really. Of course, the bicep tendons should be pretty strong with what i lift (although i am lowering it for more reps now) and the RC should be stronger soon. If i do my RC exercises twice a week, how long does it gernally take for the ligaments/tendons to strengthen? Once again, thanks. I've booked an appointment with a physio for thursday afternoon.

[Canuck Physio]

Hi will have a ready,