Athlete with shoulder problem needs help

[Yarok]

hi

looks like slight scoliosis re spine, and anterior -superior syndrome re shoulder
thanks

[caz]

Hi there

I'm not a physio but am a fellow 'patient'! I think Yarok is right about the scoliosis. I have similar problems with my right shoulder - the shoulder is rotated forwards and my right shoulder blade sticks out more than the left. This is caused by the spine being twisted, rather than a problem with the shoulder itself.

Sorry I can't suggest anything to help though...

[WrightDPT]

Another avenue to consider is possible injury to the long thoracic nerve. This nerve innervates the serratus anterior muscle which protracts the scapula, assists upward rotation, and stabilizes scapula against thorax. Some asymmetry in scapular position is certainly observable in pictures. This could also account for difficulty during bench press as the serratus works hard to protract scapula. This nerve can be injured via direct blow, compression against chest wall (backpack injury), or repetitive strain. Any thoughts on this?

[CenteredHealth]

hi

looks like slight scoliosis re spine, and anterior -superior syndrome re shoulder
thanks

I couldn't agree more. There is definite spinal involvement, especially evident during bilateral shoulder elevation. I also have a question regarding the protrusion on the left upper thoracic spine; a cyst perhaps? I truly hope it is not the spinous process of C7.

[jesspt]

Let me repeat my question from a previous post - what is the actual problem here? The original poster stated their only concern is asymmetry. No problems with pain or functional limitation. If the only "problem" is slight asymmetry, I don't think there's really a problem at all.

[CenteredHealth]

Let me repeat my question from a previous post - what is the actual problem here? The original poster stated their only concern is asymmetry. No problems with pain or functional limitation. If the only "problem" is slight asymmetry, I don't think there's really a problem at all.

Hi Jess. I understand your concerns regarding this "problem." It appears as though the original post is concerned only with aesthetics and asymmetry. And I also understand that asymmetry is 'normal'. However, at the risk of being unpopular I will add this; asymmetrical postures of the body are due to an imbalance, typically of the myofascial structures. And if that imbalance goes on for long enough, I believe it would be fair to say that would create unwanted tensions and stresses on bodily structures that would eventually break down. Of course the body will compensate for this imbalance, which we can see it doing through his photographs, however the body can only compensate for so long until it either runs out of compensations or those compensations themselves break down. I think the original poster is on the right track in identifying the asymmetry as a potential problem and seeking appropriate treatment. And although that treatment might not need the skill that you can offer, I believe it is fair to say that an appropriate regime of stretching and strengthening exercises along with some postural re-education would prove beneficial. Thanks, replies welcomed.

[jesspt]

asymmetrical postures of the body are due to an imbalance, typically of the myofascial structures. And if that imbalance goes on for long enough, I believe it would be fair to say that would create unwanted tensions and stresses on bodily structures that would eventually break down. Of course the body will compensate for this imbalance, which we can see it doing through his photographs, however the body can only compensate for so long until it either runs out of compensations or those compensations themselves break down.

Centered -

All of the above is strictly supposition. We've got little to no hard data that supports that imbalances are clinically relevant, that they occur more frequently in the myofascial structures than the osseos ones, or that if they exist that they place unwanted stress on any other structure. I think that a lot of therapists think in this vein because it results in the design of a treatment plan that falls within our area of expertise : stretching and strengthening exercises.

I'll pose a question: do we tell a patient who present like the original poster that he has an actual "problem" because we think he may develop a problem down the road, without any real data or clinical findings to bakc this up, or should we wait until a problem actually develops (which may likely never happen)?

[CenteredHealth]

Centered -
I'll pose a question: do we tell a patient who present like the original poster that he has an actual "problem" because we think he may develop a problem down the road, without any real data or clinical findings to bakc this up, or should we wait until a problem actually develops (which may likely never happen)?

Hi Jess. Enjoying our conversations....

I knew that my post was going to be received as unpopular, which is why I alluded to that fact previously.

I believe in preventative care. Call me old-fashioned, call me whatever, but I definitely believe in the adage "An ounce of prevention is worth a pound of cure."

As I stated in my post, this person may not need skilled care from a PhysioTherapist or another health care provider. However, I hope we can agree that identifying this as a potential problem and treating it appropriately (on his own) will only benefit him in the long run.

Is that too much to say?

[jesspt]

I've no problems with the patient carrying out an exercise regimine on their own, as long as the patient is also instructed that although he has assymetry, there is little to no data that implicates it as potentially problematic. Essentially, I think we need ot tell them that they can perform an exercise program that may or may not help, but won't hurt, either.

[BrianB]

Ocyrus411, u still around? it's been nearly 3 years since u created this thread and i was wondering how things are looking for u now? i've been lifting on and off since i was 18 and have dealt with something very similar (if not the same issue) for all of that time. i finally feel i understand what's going on...although it doesn't appear there's too much that can be done about it.