ok, nice chatting with myself
but since I've had another couple of minutes with this guy yesterday, I thought I'd add to the story, maybe it will be of any use to somebody sometime. maybe not.

anyways, here are the findings so far:

  • AC neg. -
  • Transverse humeral neg.-
  • Empty can +- (mild)
  • Lateral abd. painful over 90deg.+
  • Impingement relief pos. +
  • Impingement (90deg GH fwd flexion, 90deg elbow flex.,forced int rotation) pos.+
  • Resisted ext.rotation painful +

+ reports of pain at night, especially when changing sides etc.
after overhead activities with pain, 1-2 weeks of pain and symptoms consistent with flared up inflammation (pain, heat, loss of function)

therefore, my thoughts so far are:

  • primary injury was poss. to external rotators, poss. including T.Maj.
  • this in turn induced weakness and inability to properly control humerus tracking in glenoid resulting in subacr. impingement.
  • having in mind extensive time frame (11 years), there should be a considerable amount of degeneration present,possibly calcification of cuff tendons, or even a formation of bone spur under acromium.
  • Therefore an MRI would be very useful here

suggestions so far:

  • stop overhand activities (stop weight training for upper body overall? suggestions?) and any other that places rot. cuff at risk at this point. (wide bench press, pull ups etc.)
  • RICE for ~5 days (about the next time I'll see him)
  • NSAIDs?

since he's a regular in the gym, I just said to come and see me every time he comes in, just to see how things are going.

if pain subsides after initial rest period, all the obvious rehab would start with MICE, stretching, cuff strengthening, scapular stabilisation, progressing to more global movements, improving GH translation, mobilisation to GH if necessary to improve distal translation etc.