weakness in shoulder after Levator Scapulae muscle injury

Hi Guys! I am Kushal, 29 years of age. I have been doing gym workouts regularly for more than six years now. My workouts have always been moderate, not heavy (lift a maximum of 45 Kilograms on bench press and my workout lasts not more than 1 hour). I was working out regularly and stopped eight weeks back, after an injury happened. (I would add here that I had not made any sudden or abrupt change in my workouts just before the problem occurred.)

On June 9 2010, I had a suspected muscle injury in the left shoulder muscle which caused pain in left shoulder and nerve compression that resulted in referred pain in left arm and slight numbness in one finger. The pain didn’t start suddenly during my workout in the gym, rather it started in the middle of night while I was deep asleep.

The orthopaedic physician and physiotherapist to whom I went initially both diagnosed “cervical spondylosis” and prescribed me physiotherapy (a combination of diathermy (heat), cervical traction, IFT for initial few days only, TENS, Ultra Sound and some Isometric exercises at home). Another physiotherapist whom I consulted to get a second opinion said that “prolapsed disc” was causing pain and nerve compression.

After taking 17 continuous days of physiotherapy I realized that the pain and numbness had reduced considerably but was not going away entirely. So I consulted another physio. This guy listened to my case history and pain symptoms and diagnosed muscle injury (of Levator Scapulae muscle or some other shoulder muscle) as the cause of pain which was also resulting in the nerve pinch, which in turn, caused referred pain in left arm.

So as it turned out, the earlier diagnoses were all wrong. It was neither cervical spondylosis nor prolapsed disc, but was a muscle injury.

At present, I am doing the following stretching exercises 3 times a day, as advised by my latest physio (holding the position static for 10 seconds in the terminal positions of each movement and repeating each set ten times):

1. bending the head up and down (so that the chin touches the neck in down position),
2. bending the head sideways (laterally),
3. rolling the head clockwise and anticlockwise,
4. shrugging the shoulders,
5. stretching the chest keeping both arms folded at elbows (to exert pressure towards the spine in the back),
6. rolling the shoulders round and round in circles (both forward and backwards)

I have been doing the above exercises regularly for past 6 days and have experienced a lot of relief. The pain in shoulder (in levator scapulae muscle), referred pain in the left arm and numbness of the index finger have all disappeared completely. But there is something that still bothers me:

I tried doing a simple push-up (dip) yesterday and felt that I have lost strength in my left side- My left arm and shoulder together are not able to support and lift my body weight for long.

Should I be patient and continue with the exercises advised by the Physio at home and hope that complete recovery and restoration of strength would happen by itself? In how much time would that happen (at least an approximate estimate)?

I am worried about how long (how many weeks or months) would it still take me to resume my gym workouts, even if it is from light weights? Please give at least an approximate time period.

Rotator Cuff Injury
The rotator cuff is a group of muscles which work together to provide the Glenohumeral (shoulder) joint with dynamic stability, helping to control thejoint during rotation (hence the name). The rotator cuff muscles include:
• Supraspinatus
• Infraspinatus
• Teres Minor
• Subscapularis
Due to the function of these muscles, sports which involve a lot of shoulder rotation – for example, bowling in cricket, pitching in baseball, swimming, javelin throw,basketball,volleyball – often put the rotator cuff muscles under a lot of stress.
Problems with the rotator cuff muscles can be classed into two categories – Tears of the tendons/muscles, and inflammation of structures in the joint.
Acute Tear
Shoulder will be helped by:
Rest the shoulder
Ice can be used at least 3 times a day and is useful for the first couple of days following an injury
Apply ice for no more than 15-20 minutes ensuring you use an appropriate ice bag, or wrap the ice in a towel to prevent ice burn
Warmth may be useful after the first few days to help with the pain
Medication may be helpful to help control the pain – speak to your doctor if you think you require stronger than what you might usually take
Treatment for an Acute Rotator Cuff Tear
Apply ice to reduce swelling as above
Control the pain with appropriate medications
Rest the arm – a sling can sometimes be quite useful if you still need to go to work/school, which can be removed at night
You may require imaging studies (x-ray, MRI, CT Scan) to identify what the problem is and rule out any fractures
Consider consulting a shoulder specialist who can advise you with rehabilitating the injury
If the injury is quite severe and you are young and active, you might require an operation to fix the tear. This needs to be done within 3-6 weeks. Indications include:
Under 60 years old
Complete tears of the tendon/muscle
Failure of other treatments after 6 weeks
Professional/keen sports people
If your job requires constant shoulder use
Treatment for a Chronic Rotator Cuff Tear
Control pain
Apply ice as above, heat may also be beneficial
Sometimes you might be referred for an injection of steroid medication directly into the site of the problem to help reduce any inflammation and allow you to proceed with rehabilitation
Shoulder exercises which can be provided by a physiotherapist at A+ clinics.
You may require surgery, the indications as above
Treatment for Rotator Cuff Inflammation
Apply ice initially as above
Rest the arm for short periods, but it is important to keep the shoulder moving to prevent stiffness and further reduced movement.
You may benefit from a course of anti-inflammatory medications
You may need to have an injection of steroid medications directly to the site of the inflammation, as explained above.
Heat and massage may help once things start to improve a bit
Small pendular movements when leaning forwards may provide some relief and help to improve the shoulder movement. Consult with a physiotherapist at A+ clinics for a personalised exercise plan.
Walking your fingers up a wall or door can help to improve shoulder movement. Also, holding a stick with both hands and using the better shoulder to move in a circular fashion can help, as this moves the painful shoulder with minimal stress on the rotator cuff muscles
How long will it take to get better?
Depending on several factors, conservative treatment has a 40-90% success rate at fixing the problem.
Surgery often has good results, with some studies citing a 94% satisfaction rate with the surgery, resulting in lasting pain relief and improved function. Very extensive tears often have a poor surgical outcome, however this injury is thankfully quite rare.
If you are older, it will take you longer to heal due to differences in your physiology.
Subacromial Bursitis

The supraspinatus muscle runs along the top of the shoulder blade and inserts via the tendon at the top of the arm (humerus bone). This muscle is used to lift the arm up sideways and is also important in throwing sports as it is the muscle that holds the arm in the shoulder when you release what you are throwing. There are massive forces involved in slowing the arm down after you have thrown something but few people bother to train these muscles. A heavy fall onto the shoulder can also result in injuring this muscle.

Over the tendon is a bursa (small sack of fluid used to help lubricate the moving tendon). This bursa can become trapped in the shoulder causing pain and inflammation.
The athlete is more prone to this injury if they overuse the shoulder particularly if the arm is at or above shoulder level. Or if the athlete has had a rupture of the supraspinatus tendon.
Symptoms include:
Pain and weakness when the arm is lifted up sideways through a 60 degree arc.
Pain when you press in at the inside front of the upper arm.
If it is the tendon that is injured rather than the bursa there is likely to be more pain when the arm is lifted up sideways against resistance.
What can the athlete do?
Rest until there is no pain.
They must however continue pain free mobility exercises to keep the full range of movement in the shoulder.
Apply heat and use a heat retainer.
See a sports injury specialist or doctor who can advise on rehabilitation.
What can a sports injury specialist or doctor do?
Prescribe anti-inflammatory medication such as ibuprofen
Prescribe a full rehabilitation programme.
Operate with persistent problems.
If it is bursitis the doctor can aspirate (stick a needle into the bursa and suck out the extra fluid).


For more details please contact:
Dr. Prateek Gupta (Senior Surgeon)
Arthroscopy Surgery Clinic
C2/5 Safdarjung Development Area (SDA),
Aurobindo Marg, New Delhi - 110016
INDIA
Telephones: +91 9810852876, +91 11 26517776
24 x 7 Helpline & Appointment: +91 9810633876
Email: [email protected],
[email protected]
Website: Shoulder Arthroscopy::Arthroscopy::Dr Prateek Gupta,Dr.P.K.Gupta