Shoulder Pain

[fahim2006]

I am a 25 year male, Athlete with ripped structure, Around two months ago, I was doing inclined bench press in the gym,as soon as I finished the set and sat straight I felt a jolt of pain going through the left shoulder, I have had several injuries over the period of 8 years of exercise and I recovered with in 2 to 3 weeks, But this time Its not the case, first the pain was in front deltoid and tricep but after a month of rest it was gone, No movement issue of the shoulder up and down but when I use the infraspinastus or supraspinatus muscle, I feel pain at the end of the posterior deltoid then whole supraspinatus starts aching for 5 min if I dont sit stationary. I cant seem to locate where the injury is as half of the back and the deltoids start aching once i try to use infraspinatus or supraspinatus.

it has been like two months and I have not done any exercise, loosing some hard gained muscles, What should I do? Should I see a doctor or the pain will go with some more rest?

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[iliastolos]

Hi fahim2006!
What exactly do you mean by using infraspinatus or supraspinatus?

[iliastolos]

Random1982,
Supra- and infraspinatus are muscles but they do not contract on their own during movements. That is you can't isolate their contraction easily. I wanted to know the movements fahim did with these muscles, as almost all shoulder movements cause supra- and infra- activation.

[fahim2006]

By use I mean when I try to do any shoulder exercise. the pain starts from Posterior deltoid and then everything hurts that is connected to it. Tricep, trap, lat.

[Rabail]

HI
Ur not clearly describing ur problem fahim, u said b4 ur having problem in rotator cuff and now ur saying while doing shoulder exercise u feel pain in shoulder muscles including neck muscles..........
u should give complete history to localize ur pain?and in exactly which shoulder exercise u feel pain the most?r u having any history of cervical problem?otherwise as far as ur problem is concerned it seems quiet confusing to make any diagnosis without knowing these things .....

[fahim2006]

ok I feel serious pain in posterior deltoid when i try to do standing lateral raises like this.



or front lateral raises.



then this pain spreads to tricep, trap and lat near the left shoulder, keeps hurting for like 1 week, when there is no pain left, then when I try to do lateral raises again, same happens.

I dont feel any pain while doing dumbell shrugs so trap muslce cannot be the problem



also No pain when I do Tricep exercises. A little pain when I do lat bar pull downs I think thats because of the involvement of posterior deltoid.

I went to a doctor last month, he asked me to do several movements and said that I dont need surgery or any scans and it will heal itself, One month after I still feel the same.

[gcoe]

Hi Fahim
This doesn’t sound to me a straight forward muscle tear. It is a bit hard to really know is going on in an internet conversation. However I suspect you may have done something to cause abnormal nerve tension in one of the components of the brachial plexus. This is based on:

*The symptoms came on immediately after the injurious activity and not during it. Usually if you tear a muscle or tendon you feel something during the activity.

*The symptoms seem very irritable – stirred up for a whole week is a long time of aggravation. Neural tissue is often much more irritable like this.

*The more diffuse nature of the symptoms could be explained by adverse neural tension

*The two exercises you describe that stir up the pain both would put the brachial plexus or components of it on stretch and this would explain why you are so saw after it. If this is true most likely the lateral raises are particularly aggravating.

Do you have any tingling or loss of feeling anywhere in the limb? If you do this adds weight to this diagnosis although even if you don’t it could still be due to adverse neural tension.

As you are interested in continuing your weights program I think it would be a good idea to get some advice from a specialist musculoskeletal physio who can work with you. If you do have neural problem this can take quite a long time to settle down and you may really need some help with your rehab. Nothing will be achieved by "working through" the pain. You will just make your self really sore and could potentially make matters worse.

In the mean time avoid anything that stirs up the pain. Exercises that involve elevating or abducting the arms should be avoided , particularly with an extended elbow.

Things like preacher curls, dips may be ok and backward rows may be ok as long as you don’t start in too much shoulder flexion or with elbows completely extended. However the rule is anything that stirs up the pain should be avoided. The raises you describe, bench press, Pec deck would definitely be out.

[pudding_bowl]

Hi Fahim,
It does sound like you could have hurt your rotator cuff - but then the pain really extends to numerous areas. A theory could be that because your core shoulder muscles aren't working the exercises your attempting are not co-ordinated and they put excessive strain on other areas of the body causing pain.
You would need to retrain the co-ordination of the scapula-humeral rhythm - I suggest a physio's input and continuing exercise but dropping the weights heavily - again with the advice of a physio.
Gcoe could be quite right that you have a neurological aspect - another reason to get a physio referral or see one if you know any.

[fahim2006]

Ok i went to see a Physio, He did all the basic movements and suggested no scans are nessary as the arm movement is fine. He has suggested a week of physiotherapy. Used some heater and a red light bulb after that on my should and collar. Before I go on with the session I need to know whether how much physiotherapy would I need? I feel no good after the first session.. Still hurts like hell if I try to use the posterior deltoid with any heavy object.

[gcoe]

Hi Fahim

You have been having some problem now for quite some time. Sticking a heat lamp on is not going to do anything.

You clearly re having problems with your shoulder movement - otherwise you wouldn't be getting trouble on using certain shoulder muscles.

The physio needs to be working with improving your shoulder function.

[fahim2006]

What is a censored physio?

I still have the same pain. Can anyone suggest some corrective exercises for the bracial plexus strain? I dont think I have any muscle pain but a deep internal pain.

[Josephine]

I suggest you see an ortho surgeon who specialises in upper limb issues. You could possibly have injured ligaments at the acromo-clavicular and coraco-clavicular joints which here are marked in red. The pain from these can radiate all over the shoulder area.



In the meantime, you should go easy on it until you get his opinion.

[f1progeny]

Hi Fahim,
Exercises to improve neural mobility can be highly irritating if done wrong and it sounds like your sensitive enough. You'd need close supervision by an experienced physio to progress these, not to mention to check your neck for additional stress on the nerves. I think you need to do a bit of research into a physio/sports physician to get an accurate diagnosis first before embarking on any new exercises. good luck

[vam44]

Even after 30 years of experience as a physio shoulders are still the hardest to diagnose and treat. There are two key issues the problem is either structural( ie torn ligaments, joint subluxations, damaged tendons or tendon attachments or swollen bursa to name a few) or neuromuscular where the muscle action during movement dont keep the head of the humerus perfectly centred in its very shallo socket.


The former need correct diagnosis with the help of ultrasound or MRI and the result will guide correct advice.

The latter respond to a carefully prescribed programme of exercises that correct the neuromuscular instability. the exercise that you illustrated on the 16th Nov 09 is likely jamming the humeral head upwards within the socket causing swelling in the ligament and or the bursa and rotator cuff there this is a poor exercise

Another comment I will make is that where shoulders are concerned its better to describe the movement than using the muscle to describe your exercises and/or your symptoms

Are you getting any better??

[fahim2006]

@ vamm, thanks for the reply, No i am not getting any better. i have been to an ortho and after that the musculo skeletal rehab doctor but both apparently failed to diagnose..

Do you think I should get an ultrasound done?

[conficltzon]

Sounds like you might have tendinitis, I get that from time to time. A cortisone shot is all that will stop mine. But it goes away in a few days even without the shot.

[vam44]

Hi Fahim,

You still need to find someone who can correctly diagnose your shoulder problem! An ultrasound will be helpful to evaluate the rotator cuff muscle You could have a tear or you could have some extra fluid above the joint, you could have an impingement syndrome THere are very specific tests that a physio or shoulder specialist should be able to do.

The correct exercises will depend on the exact nature of the problem.

Have you stopped doing any aggravating exercises? That is an important part of getting better even if you are not diagnosed yet.

[Petero]

I find those contour pillows made from memory foam can help shoulder pain. I tried one and found it to be helpful. You can get different ones in various different designs likes contoured or made from memory foam.
I would recommend them.

[pt8am]

Farim

i understand your probably very frustrated as you sound very much into your training and personal development and this is having a major impact on your recreational activities. It doesnt sound like anybody you have seen has found anything to help you so far. You need a structured and in depth physical examination by an experienced and dynamic physio. I think the one you saw origionally who did the heat lamp thing did not have a clue (im basing this on your ecollection of the assessment and treatment - basic movements...followed by some heat and red light bulb)

I agree with gcoe on it sounding like a neural issue but this far down the line i think you may have several overlapping problems.

You say you felt the pain after you incline bench press. Did you work to failure with the exercise and how did you offload the dumbells/barbell? A lot of traumatic shoulder injuries occur during the movement of offloading the dumbells nt necessarily during the exercise. The mechanism of injury is an important clue although with the time thats passed this maybe less so.

A proper examination should be able to pick up any medium to major tears in your shoulder muscles and also assess you scupulohumeral rythym repetitively and under loading to dig for information. I would also expect them to look at you performing your painfull exercises. You definaley need an assessment of you neurodynamics and thoracic and cerivcal spines. The structure of the examination needs to be very carefully planned so as not to get what we call false positives(ie its hard to totally isolate any single tissue or structure with any certain test. A test that strongly stresses the injured tissue will aggrevate it and a test that targets a different tissue but also, albeit to a lesser degree, the inured tissue will also be positive becuse its been irritated before hand!!). I would suggest testing one area at a time with a couple of days in between to see what the reaction is before moving on. An MRI or ultrasound may be helpfull but dont be surprised if they dont show anything or maybe even just incidental findings that me or your neighbour or his dog might have (also a false positive). If this is the case and corrective surgery is used then the origional problem will still be the same (This is not a rare thing) and you will have gained nothing.

I think your management very much needs to be based on a diagnosis (preferably with the luxury of imaging to confirm) formed by carefull and tailored examination.

Keep us posted as this is an intersting one.

[tyciol]

The infraspinatus and teres minor work with the posterior deltoid, they all work to externally rotate as well as transverse extend the joint.

Supraspinatus kinda helps the medial delt with abduction, its tendon can get impinged if the other rotor cuff muscles are too weak to properly depress the head of the humerus. Strong delts are awesome but it'd be bad if they overpower the rotor cuff muscles too much. Luckily I think they activate during most shoulder moves so hopefully they keep up unless they're injured.

[cliffkelly]

Special exercises can also help. The first step of rehabilitation therapy is simple exercises range of motion. By bending over and moving your shoulder in large circles, you will help prevent the serious complication of rotator cuff injury, called a frozen shoulder.

Cacao