Supraspinatus tendonitis/osis HELP

This has to be the most frustrating thing ever!

I injured my shoulder back in April shouldering pressing with bad form and a lot of weight.

I saw a physio a couple of months ago he did the usual diagnostic tests and wasn't really sure what was wrong until he frictioned my supraspinatus tendon and i felt a lot of pain! He came to the conclusion I have Tendonitis from impingement and prescribed me a couple of exercises, stretches and instructed me to friction it myself.

the exercises/stretches he prescribed were pec and lat stretches and supine/prone positioned rotator cuff exericses...

(supine exercise like this...) http://thebodymechanic.ca/wp-content...and-supine.jpg

Anyway I have gained a lot of range back and it no longer hurts to friction the tendon BUT the pain/instability is still there (although improved), I also still feel a lot of clicking and it's annoying that I can't yet work out properly!!

I visited an osteo twice and he did a lot of soft tissue work but still I'm stuck :(

Any advice guys?

Hi Kadafee. thanks for your post.

The first thing I would say is that an acute injury (a fresh one) does not really need frictioning to much as that is usually applied to more chronic injuries that have stopped the natural healing process. The second would be that often a tear to the supraspinatus tendon that becomes symptomatic is the result of a gradual degenerative process in the tendon, perhaps due to long standing poor mechanics and overuse.

Shoulders are notorious for being slow to rehabilitate and you can understand why when you consider the length of time it takes for them to become painful. I suppose i am suggesting many people have a supraspinatus issue without pain before that eventually (though not always) sets in.

Now this can take 8-12 months for pain to resolve especially if the tear is significant. The best way to get a quick understanding of the damage to the tendon is to have a diagnostic ultrasound performed by a skilled professional. Once you have that you can plan the next step. Your physio could also look at the mobility of your AC Joint during the arms movement to see if that can be optimized. That may reduce the clicking as would thoracic mobility work, especially into extension to allow the scapula to find a stable position during elevation.

The exercise you attached shows more a stretch for the internal rotations and pec minor etc which is fine however it is not the main part in restoring rotation cuff instability. You need your therapist to work on the external rotators, especially eccentrically and while mainting the scapula in the correct position though various degrees of arm elevation.

So see if you can get some investigations. Take it SLOW as it will take time and you can't speed that up by doing more. You could look to some pain relieving modality perhaps as as adjuct to the treatment specifically to address pain.


Lastly let us know how you get one. Best of luck.

Hi thanks for the quick reply!

I've had the problem for a while now and 3 years ago had the exact same problem on my left arm. With my left arm I had the problem for a long time (around a year and a half before getting it diagnosed) NHS physios and ortho couldn't diagnose it, MRI showed nothing so went in for arthroscopic surgery which again showed nothing but afterwards a physio whom I met at a boxing event quickly evaluated me and told me I had shoulder impingement. I didn't do anything with that shoulder and it took 3 years to finally heal. I'm just worried I don't have to go through the same thing with the right one!

Unfortunately I can't afford to seek private help anymore so will have to go back to the NHS. Is there anything/anyone i should specifically ask for and in the mean time what should I be doing? Currently I do the supine and prone rotations along with roations on a shoulder horn, pec and lat stretches and scap push ups.

EDIT: Also I feel clicking when I squeeze my shoulder blades together my phyiso explained it's nothing.

Thanks for the additional information. In a way you are answering some of the questions around shoulder impingement type issues. They take a long time to heal. And you have this experience already. You need to look at what you are doing to cause this issue as perhaps it was what lead to the first issue and hasn't been corrected so lead to the current one. I should think opening the chest / rib cage area by doing things like dumbbell fly's on a foam roller (keep the low back flat and low ribs down) would be a good way to work on postural mobility to later allow a better position for overhead tasks. Deep tissue massage (DTM) to the pec minor, subscapularis is usually beneficial to assist this release of the shoulder area and perhaps some neck mobilization would assist as well.

You might also consider supplementation with things that provide food to the healing tissue e.g. Glucosamine Sulphate. and for pain could even try some acupuncture to the specific sore spots.

The clicking, if coming from under the scapula, when you retract them is usually just the scapula moving over the rib cage with perhaps some muscle knot etc in between. The rib cage mobilization and DTM will assist with that. Strengthening the rhomboids and low traps may also assist with that in the longer term. Overall I think you need to know that your issue is extremely common and is a normal part of life really. I did my left which took 18-24 months to return to full range and even now it occasionally complains for a month or two. So patience is a virtue.

Of course commenting on a forum can only go so far as we cannot see you, feel the tissue structures themselves or assess your movement patterns. Hopefully your next NHS physio will be able to assist further but for now try to be calm and accept time is going to be the biggest factor right now. The other work you do is more prevention for next time and it sounds like that is going well. :-)

Quote:

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Originally Posted by physiobob

Thanks for the additional information. In a way you are answering some of the questions around shoulder impingement type issues. They take a long time to heal. And you have this experience already. You need to look at what you are doing to cause this issue as perhaps it was what lead to the first issue and hasn't been corrected so lead to the current one. I should think opening the chest / rib cage area by doing things like dumbbell fly's on a foam roller (keep the low back flat and low ribs down) would be a good way to work on postural mobility to later allow a better position for overhead tasks. Deep tissue massage (DTM) to the pec minor, subscapularis is usually beneficial to assist this release of the shoulder area and perhaps some neck mobilization would assist as well.


You might also consider supplementation with things that provide food to the healing tissue e.g. Glucosamine Sulphate. and for pain could even try some acupuncture to the specific sore spots.

The clicking, if coming from under the scapula, when you retract them is usually just the scapula moving over the rib cage with perhaps some muscle knot etc in between. The rib cage mobilization and DTM will assist with that. Strengthening the rhomboids and low traps may also assist with that in the longer term. Overall I think you need to know that your issue is extremely common and is a normal part of life really. I did my left which took 18-24 months to return to full range and even now it occasionally complains for a month or two. So patience is a virtue.

Of course commenting on a forum can only go so far as we cannot see you, feel the tissue structures themselves or assess your movement patterns. Hopefully your next NHS physio will be able to assist further but for now try to be calm and accept time is going to be the biggest factor right now. The other work you do is more prevention for next time and it sounds like that is going well. :-)

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Thanks again mate!

It's just frustrating being young and inactive and losing all the gains I've made! I used to be an amateur boxer and quit after my first shoulder injury and now another one has come back to haunt me!

Anyway I might save up a bit to seek private Help once again if the NHS doesn't go to well. Is there anyone you can recommend me in east London?

I can recommend you someone if is allowed here. I am not sure if it is. If the moderator is fine with that, I can write it for you.

Quote:

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Originally Posted by anka_nikoleta

I can recommend you someone if is allowed here. I am not sure if it is. If the moderator is fine with that, I can write it for you.

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Maybe you can pm me?

I've looked in the directory can't find any near me.

I hear the guys at Crystal Palace Physio are great. I am not opposed to others making suggestions however you should always do your own checking on suggestions and not take them as gospel.

Quote:

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Originally Posted by physiobob

I hear the guys at Crystal Palace Physio are great. I am not opposed to others making suggestions however you should always do your own checking on suggestions and not take them as gospel.

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Of course not mate but having seen a few physios i know it's hard to find a good one. Not that the ones I've seen were particularly bad but I think some are just not as knowledgeable as others. For example the 2 physios and the osteo I've seen for my shoulder I asked them to explain what it means when i feel/hear a click when i pull my shoulder blades back and all of them just said it's nothing probably tendons going over each other yet you were able to tell me it could be that the scap is going over the rib cage without even diagnosing me! Since then I've been doing rib cage stretches and the clicking has reduced a lot!

So I really value recommendations!

Hi Kadafee.

Just to add my 2 cents in if its worth it. Physiobob is correct and shoulders are notorious particularly if its been hanging around for awhile. Besides stretching it may be an idea to also work on your posture. Do you mind tell me what you do for work? If it is anything desk related and requires sitting for long periods of time trying to avoid a forward lean posture will also reduce a potential factor that may be aggravating your symptoms.

So what is an ideal posture? A posture where you lift your chest up like on the left pic not the right. If you really accentuate the posture you should feel muscles between your shoulder blades working and these are the rhomboids and postural muscle physiobob mentioned before. You should also feel a bit of an abdominal stretch/ tightening as if you want to suck in your stomach. Posture will help in the long term as it coincides with the stretching you are trying to do.

http://alteringperception.files.word...ure-charts.gif

Hard to find a good health professional in any industry like dr, nurse, physio so feel free to shop around. A good physio will do some serious hands on work to release your shoulder muscles (upper traps) and front chest muscle (pects) as these are holding your shoulder up and forward causing your muscle to get caught under the bony arch/ pointy bit of your shoulder. (oops long sentence) So there are a few biomechanical issues to address.

Hope that helps and you get better.

Hello guys been a while...

Well I haven't visited a physio since I posted this but I have been continuously stretching and doing external rotations, my shoulder has become slightly better, definitely nowhere near fully healed.

Anyway I started looking up Kelly Starrett's mobility exercises and I tried a few of them, one of them is called the rotator cuff smash where you place a hard ball behind your armpit area and rotate your arms internally and externally. like this...

http://www.precisionnutrition.com/me...-%20before.jpg


Now when i tried this i was in excruciating pain, the area is extremely tender, forget rotating my arms just placing myself on the ball i felt a lot of pain, I tried the same on my good arm and I feel nothing but on the injured arm I couldn't lean on the ball properly without having my eyeballs pop out.

So this is quite a revelation to me, isn't it the infraspinatus/teres minor area? does this mean i possibly have an infraspinatus injury?

share your thoughts please physios!