Shoulder Clunking - what's the cause?

[friendlypain]

Shoulder clunking on pull ups.... tough one unless I know how the exercise is being done. A clunking is usually a muscle's tendon strumming against a boney projection much like a guitar pick on a guitar string. Needless to say it is not a good situation for the tendon.

My guess would be a supraspinatus tendon due to an improperly set GH joint. My area of interest is the position of the humeral head and if it is more anterior (by => 2 inches) at rest. If it is I would suspect an anterior humeral glide due to a very tight infraspinatus and a shortened bicep setting the head of the humerous outside the "normal" position, leaving the supraspinatus tendon vulnerable to strumming.

If it isn't then I would look to the boney structures of the shoulder with special interest given to the active movements and positioning of the scapula. Since I can write a small book on this, and is nothing but a review of your education, I will save my keyboard from my index finger assault.

Treatment would be based on the history of trauma of the shoulder, the speed to return to activity, and the discipline of the person to do their self care.

[Physio33]

Thanks a million “friendlypain” and “alophysio” for your valued insight into the shoulder clunking problem……The ideas on shoulder instability, boney structures of the shoulder and positioning of the scapula have left me with plenty to work on. I have had limited clinical experience with shoulder injuries and so wasn’t sure where best to start with the examination of the individual.

I could write a book on this individual so will keep it brief (But please ask if you require more information):
Client with the clunking shoulder does a lot of weight lifting and has excellent muscle development globally. So, I was a bit daunted as to where to start my physical examination. Now, have been well guided by your suggestions. Pt has ANTERIOR SHOULDER INSTABILITY. THANKS!

A further question:
Can an athlete of this calibre still have a weakness of the Rotator Cuff muscles, yes? And if so,is this due to them developing their SECONDARY MOVER muscles of the Rotator Cuff (Ant and Post Deltoid) to a much larger degree than the PRIME MOVERS (Supraspinatus, Infraspinatus, Teres Minor and Subscapularis)?
Weight lifters are prone to falling into the “trap” of developing and exercising the LARGE MUSCLE groups as they achieve visual results of muscle development quicker. Can this then have a knock on effect of making them more prone to developing joint problems as they are neglecting to strength the stabilising muscle groups?

Finally, What level of exercise rehab would be suitable for this individual? (LEVEL meaning, this athlete has a very good baseline shoulder strength level) Does one start with:
• Scapular setting
• Isometrics (of Internal and External Rotators of the Shoulder Jt.)?
• Resisted Int/Ext Rotators with T-Band progressed onto weights

Since doing pulls ups is the aggravating activity, late stage rehab should involve exercises done in outer ranges of shoulder ROM?

Thanking you in advance of any feedback.