Protecting the shoulder from injury

[salsaqueen99]

Hi there,

I'm wondering if anyone can suggest what I can try in order to prevent any further injury to my shoulder. I have hurt my right shoulder twice in the last two years, the first a rotator cuff tear and the second a possible tear in the capsule (awaiting confirmation).

the pain always seems to be localised at the top of the shoulder or right where the two biceps tendons insert into the capsule. Can anyone suggest how I can protect it whilst doing activities? I have a shoulder brace which is great but I need to know how to protect it when I don't have the brace on.

I've also been doing physio for the last 7 months to strengthen the shoulder girdle.

Comments and advice most appreciated

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[arthyyy]

well in ur case i think its good tom start ur schedule of exercise from begining... first to start up with go with exercise inside water this will reduce ur pain and also will help in strenthening ur shoulder..... for eg u can do... pull back exercise in shoulder... push the water.... work on it for 2 weeks this will surely help u... then its fine to work out with theraband first start with gravity assited execise later on try with against gravity and u can progress with weights.... later on.... go ahead with weights... i have jus given roughly... hope this will help u... tell me how is it after trying it....


be fit...stay fit...
bye

[jwilso]

what activities do you do?did you have a rotator cuff repair? how old are you? what is your job?how old are you?

[salsaqueen99]

Thanks everyone.

Regarding the question about having a repair done for the rotator cuff, it was about a year after I got the MRI done and it showed that it was in tact. The MRI did not show a tear in the capsule as they were looking for a SLAP but there are many false positives and false negatives with SLAPs and it hasn't been ruled out for me even though the MRI did not know anything.

I have been working on a graded rehab program with my sports phsyio with now a new focus on also strengthening the core muscles and stabilisation exercises inclusing external, internal rotation, dynamic protraction and retraction. I have considered doing some hydrotherapy and I think that this is probably a good option to start thinking about.

I guess the real issue is whilst I am dancing and learning how to strengthen my shoulder with the movements which can hurt me whilst I am dancing and also learning to turn on my shoulder muscles. That itself is the hard bit for me.

As for the activities I do, I'm a dancer, I also run and workout at the gym but have not been able to move up to weights because of an unstable shoulder. I'm 26 and my day job is being a public servant which doesn't not help with my posture or my shoulder and my other job is teaching and dancing.

[alophysio]

Hi!

1. What country are you in? From the sounds of it, probably western, i am going to go out on a limb and guess Melbourne Australia! Maybe Sydney.

2. It seems that your programme sounds like a good one. However the results are not there. If you have been doing it for 7 months and have been diligent, i would say it is time to change the treatment strategy. That is not to say that the physio is not doing the right thing, it is just that your shoulder doesn't sound like it is responding to the treatment (otherwise it will feel better).

3. When you say the pain is in where the biceps tendons meet the capsule, do you mean that the pain is in the front of the shoulder?

4. I am confused. Do you or don't you have a tear in the rotator cuff - if you have one, it should show on an MRI. Perhaps you understood a strain as a tear.

5. Has anyone looked at you neck or rib cage? Quite often dysfunction in that area can cause the shoulder to overwork and lead to shoulder symptoms.

Anyway, let us know about the above questions and we will put our collective brains to work (i can only contribute a small amount there i am afraid!)

alophysio

[salsaqueen99]

hi there,

I'm in austalia and from Canberra. I have only started to see a sports doc in sydney who is known to be specialised in shoulders but my physio works at the AIS and is fantastic. The initial tests were also done in Canberra and the MRI came back with nothing.

The program is working well to a certain extend. I think that I have a number of things going including very weak rotator cuff muscles, slight scapula dumping of the right shoulder and have first and second rib dysfunction, and a tight neck, so I have been working with my physio to address this. I read the shoulder instability exercises which said that it was important to also look at core stability, and posture with unstable shoulders and this is only something that I am starting to work on (like in the past 2 weeks).

I have to say that my shoulder does feel better than 7 months ago and I have gained some strength back in the deltoids which were very weak to start with. I think I am getting better but it's very slow. I was told that I should at least try conservative treatment at minimum for 12 months and my sports doc is not convinced that surgery for a possible SLAP will be of any much benefit for me. It is something however which I will consider as a last resort.

The pain is in the front of the shoulder and it seems to flare when my shoulder has been pulled or is aggrevated. Sometimes it also feels like my shoulder clicks in and out, almost like it is subluxing.

As for the rotator cuff tear, it was only suspected and that was a dance related injury which I sustained in 2005.

I am thinking that hydro may also be of some help to help push me to the next level. What are your thoughts on this?

I'm also going to get an ultrasound done next week to see if there is fluid in the biceps tendon because that is where I am getting the pain. the thing is after a couple of weeks of acupuncture treatment my shoulder feels so much better and I just think that it's too good to even think about getting a cortisone injection unless there is clinical evidence to support it.

thanks for you response too.

[alophysio]

Hi,

I thought your treatment sounded Australian! I don't know your physio but i know of a David Berg down there and his wife who i can vouch for. If you are hapy with your physio, then keep going there!

Ok, How is your internal rotation (IR) range-of-motion (ROM)?? Tightness in the posterior inferior glenohumeral ligament can cause translation of the humeral head leading to excessive strain on the anterior shoulder - in other words, a tight shoulder capsule can be causing your pain. Testing the IR ROM is done in supine (on your back), shoulder is 90degABD, elbow 90deg, then into IR. There is a good article by Burkhart et al in Arthorscopy Journal 2003 - get your physio to look it up if they haven't already. It has a lot of information over three articles on biomechanics of the shoulder, SLAP lesions and exercises for the shoulder.

The acupuncture might be addressing the muscles and capsule issues.

Hydro is not bad but my gut feeling is that it will not be the saviour you might hope it to be. I think you have been quite diligent in your exerises - if you have been using theraband, the resistance can be as mild as water resistance.

The scapula dumping is probably overactive levator scapula. You will probably need to work on upper traps and lower traps to get the shoulder rotating upward to help clear the acromion.

The first and second rib problems are likely to be scalenes overworking to try get your shoulder in position to work efficiently.

An interesting exercise would be to assess the stability of your cervical spinal column - you will need your physio to assess this if you don't know what i mean...

1. Lie down. Hold your articular pillar (the bony bit of your neck laterally) using your left hand on the right side of the neck.
2. Lift your right arm straight to the ceiling and then straight out to the side.
3. A stable C/S will not have any lateral shift in the neck during arm movement, especially as your arm gets closer to bed level.

How did the injury start in the first place?

[salsaqueen99]

Hi there,

I am happy with my physio and so it has been going well. I recently went back to see my sports doctor - Seamus Dalton- and had an ultrasound to try to figure out what is causing the pain.

The main pain I have is at the front of the shoulder nearest to the long head of the biceps tendon. The interesting thing is that the ultrasound did not show any inflammation there and I have it may be because the acupuncture has been helping with this. The ultrasound did show thickness of the subscapularis tendon and also the short biceps head.

I think that my internal rotation is ok but external is very tight. I have over worked pec muscles as a result of the compensation so I've been told to work on releasing the pecs by stretching them. I think the problem is because my shoulders do slouch forward, I feel it more in the shoulder cap rather than the pecs. From my understanding this means that my pecs are over working and my lats are not doing enough, is that right?

I'll have a look in the national library in I can track down the burkhart article and see what it has. I found the three part serious shoulder instability articles very interesting too especially how you need to also address core stability and stability of the larger group of muscles on the shoulder.

I think that you are right about first and second rib, and the scalenes are overworking, the question is though how do you get them to work less? Strengthen the traps and lats?

As for the cervical spine, I can tell you that I have a very stiff thoracic spine, it's not very mobile at all probably as a result of over compensation and from sitting in front of a desk all day long. I just started working with somone who specialises in injury prevention and rehabilitation (ex olympian) and he noticed that the lats just aren't very strong so his suggestion is to first get the lats activated and then start strengthening. It does make sense though because with my posture the lats do not support me at all.

As for my injury, I hurt it whilst I was dancing salsa with a partner and I now classify it as a contact sport. A lot of girls dancers have hip and back problems and I'm one of the few who has shoulder injuries but I think shoulder injuries in salsa dancers are on the rise.

In reality sometimes I think someone could write an article on my shoulder, it's caused so many people to scratch their heads and figure out what is going on. It's quite funny, I've had so many different diagnoses from SLAP lesions to impingements to biceps tendonitis, all of which turn up negative on scans. Oh well, it is getting better and since it's been two years since my first injury, it'd be almost like chasing your own tail if I want to find a diagnosis.

Thanks for your help though. I'll get onto finding the article and give it to my physio.

Angie

[salsaqueen99]

Would you mind giving me the full of the Burkhart article? I can't seem to track it down in the journal Arthroscopy.

[salsaqueen99]

I forgot to add that I am weaker with external rotation than internal rotation. I get pain at the biceps with external rotation. The other thing is that I have a very tight thoracic spine and the muscles around the thoracic.

Any ideas on how to stretch the thoracic out without hurting my shouler?

[alophysio]

Hi,

Seamus Dalton is a good doctor. I am glad you are happy with your physio.

You have all 3 articles by Burkhart.

Can't really do much for the Thoracic spine without seeing you. If you trust your physio and Seamus is happy with them, then go with what they say.

I have always told my patients, if we don't get results, i will refer them on. Your case sounds interesting and complicated though...

Which area of Sydney are you from?? North shore, city etc?

[salsaqueen99]

Hi there,

Seamus is great, I like him because he thinks outside the box and always opts for conservative treatment rather than invasive unless it is necessary.

I'm actually in Canberra, have a canberra based physio and my sports doc (seamus) in Sydney. Strange I know but worth the trip to go and see Seamus when I have too.

Shoulder is interesting as no one can tell me what I have done. I've had so many diagnoses it's unbelieve from a possible SLAP to shoulder impingement to rotator cuff syndrome to biceps tendonitis, all of which are not correct from what the scans show. I've even been told to have cortisone injections by a couple of people but the ultrasounds have not indicated the need for it because the pain is so non specific. I think someone could write an article on my shoulder condition. lol.

Oh well it will get better eventually.

Angie



I have always told my patients, if we don't get results, i will refer them on. Your case sounds interesting and complicated though...

Which area of Sydney are you from?? North shore, city etc?

[alophysio]

Hi Angie,

Good luck. I was just in canberra recently. Cold.

I am sure you are in good hands.

If you are ever in sydney...