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