Tennis player, shoulder problems. Please help!

[Nadal]

Hello to everyone at the forum

My name is Matija. I am a 19 year old tennis player that is (was!) trying to break through the ATP circuit this year. However, I experienced this problem with my shoulder and it has been 6 months since I could play properly.

The problem is with my left shoulder (I am left handed) and particulary, I feel a bit sharp pain (almost like 2 nerves touch) when I serve the ball. Playing anything below my shoulder ex: forehand, backhand is pain free (although I do feel rather sore after that session anyway)

I first felt this pain during training one day, I went to serve my first ball and felt this extremely sharp pain and could not play anymore. I immediately went to a physiotherapist and I was told that it is supraspinatus.

They put me on treatment such as electrical current, magnets, laser and massage.

4-5 weeks later, I tried to play again, but stretching out my arm fully above my shoulder was impossible, and I was only managing to serve with a sort of bent arm (if you can picture the motion)

After that, I went to another doctor who told me it was Shoulder Impingement Syndrome. He suggested I try cortizone injection and that it should heal in 1 month, So I took the shot and the pain went away for a while yes, but came back agian.

I continued with the physiotherapy and they just kept doing the same thing over and over again. Current, Laser, Magnets, MAssage (extreme pressure)

I visited another physiotherapist, who told me it was sub-deltoid bursitis, and then another doctor who told me it was rotator cuff injury and finally I began being treated for LEFT BICEP TENDINITIS.
The pain from the first day, to this day today is ALWAYS the same.. and it is not improving I think.

I was yesterday told by a new physiotherapist that it could be sub-acromial shoulder problems.

Please, if there is anyone out there who could try and help me, I am desperate. Its been six months since I have played a match, and things are not looking bright. I am losing out on training and matches and things are looking really rough.

Also, I've done an MRI of my left shoulder and they sent me back results saying that there is nothing! In fact this is what was said :

Exam performed: MR Shoulder Left of 15-JUL-2008:

No evidence of a rotator cuff tear or impingement There is a tiny amount of fluids in the region of the insertion of the left supraspinatus suggestive of a small amount of tendonitis/strain injury. No definite tear isapparent.No fluid is present in the subacromial bursa.Normal appearance of the infraspinatus and subscapularis muscles and tendons.Normal situ of the humeral head with a normal appearance ofthe articular surfaces and no evidence of a joint effusion. There is a suggestion of some high signal in the anterioraspect of the inferior glenoid labrum. This could represent labral injury but one cannot adaquately assess for labraltears without adequate joint distension. Similarly it is not possible to assess the gleno-humeral ligaments.


Please somebody help me return back to my dream of playing the ATP tour.

Sorry for the long story, but I thought I would explain everything as much as I could..


"worried" Matija

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[linbin]

hi friend
i want to put up my hypothesis based on your description
there can be a motor control deficit in your shoulder.what i mean is rotator cuff muscle helps to stabilize the shoulder joint bcos of its close presence to joint.
there should be a balance between the rotator cuff muscles and other muscles like deltoid ,pectoralis
during the routine traing and strengthening we give more emphasis in strengthening deltoi,pectorals etc and less imp to rotator group.
rotator group are responsible for dynamic stability
the sports activities you are involved requires frequent overhead movements and lack of rotator control will cause other muscles pulling the humeral head excessively front and causing strain in the capsule
so i feel you should go to a physiotherapist who is skilled in movement impairment approach.there needs a detailed assessment of your posture,muscle length of shoulder muscles,functional movement deviations etc
please keep on informing us
cheers

[toad]

i would agree with the above post, the diagnosis you have been given previously can all fit your symptoms but none of your treatment addresses any underlying cause for your pain.
As was already said muscle length, strength, muscle co-ordination and timing all need to be considered and assessed and a treatment program needs to adress these issues. The treatment you've had seems to be more addressed to your symptom's(pain) rather than dealing with the cause or source of the pain.
A specialist physio dealing with athletes should be able to design a rehab program for you.

[Hunter_PT]

yea...impingement, rotator cuff injury, bursitis, blah blah blah....they all mean the same thing. First you should definitely see a PT that specializes in athletes (overhead especially) and orthopaedic problems.

From what you described and in my experience as a Sports Medicine/Manual PT you most likely have weakness in your scapular/Rotator cuff musculature and MOST LIKELY tightness also (i.e., lattisimus dorsi, serratus anterior?, pectoralis major/minor). Thoracic mobility may be a problem also (do you have pain on the back of your shoulder blade). Also could be addressed is a median nerve immobility (do you ever have shooting pains down your arm?)

There are a lot of things that can be treatments for your shoulder but ultrasound, laser, massage, voodoo, magic wands are not any of them. (all of those modalities are crap and are worthless in treating your condition)


ALSO: since it does hurt during your service which is basically an abduction and external rotation motion it could also be a labral pathology. either/or....still treated just about the same.

p.s. - SIT UP STRAIGHT!

[Canuck Physio]

While hands off therapies are, I admit, an important part of acute and sub-acute therapy, there is no chance of return to top form without appropriate rehabilitation that primarily focusses around normal movement, and training (be it resistance, movement, fascilitated etc.). Your problems will only be solved when the muscles return to a normal pattern of movement, and then training occurs to return you to high level sports.

[msk101]

Hi there,

I'd agree with the advice that recommends you see a physio who can devise an exercise based rehab program for you. The manual therapies you've had may be ok to reduce some acute inflammation but it would seem that the cause of your problem would be a muscle imbalance. Also get your thoracic spine checked out (and perhaps mobilised if need be - as overhead shoulder action does require a certain amount of thoracic mobility).

A generic type rehab program would incorporate strengthening the rotator cuff in neutral and other degrees of shoulder abduction (levels of arm raise), and making sure that you hold your shoulder blades in the right position whilst doing this (i liken it to trying to squeeze a marshmallow in the middle of your back while doing the arm exercises). once you get the muscle coordination right you should be able to gradually increase the pain free range of movement you have with your shoulder. as a bonus, correctly stabilising the shoulder blades and strengthened rotator cuff (of which supraspinatus is one of the muscles) should mean that in the long run your serve and overhead strokes are more powerful and directional control will be better. Also you will be able to generate better power through ground strokes. ... essentially this is making the fulcrum more stable so you can move the lever arm with more control and power.

good luck. but find a sports physiotherapist who can address the muscle imbalance and teach you the correct re-training techniques.

Msk101

[Pedro_2008]

anybody based in the UK (preferably south) able to help my Son with a similar injury ?
pm please if you can help or know of anyone suitably qualified

Thanks in advance

[rose]

hi matija sorry for whate happened to you..i have almost the same problem..each one is giving me different diagnosis and my MRI showes partial tear in supraspinatus
and massive edema reaching bone marrow and another dr said MRI report is not accurate ..?? i take cortisone injection in subacromian bursa still i have the pain on off i cant do my work and my ADL affected i started physiotherapy doing streaching for supraspinatus and biceps and pecs major with strengthening exercises for rotator cuff and median nerve strech..i felt better than befor..and i am working on my posture too which is helping too..

[fredericdamours]

Did you fix your shoulder problem.... I need answers as well because mine is bad as well with sharp pain only when I serve and smash ( I can't hardly do it ) and the pain seems to trigger some electric current along the bicep.
Additional Comment I forgot:
Hello Nadal..... tell me if you are better.
Fred