Scapular Winging & Shoulder Pain -- Anyone Overcome This?

[kyoun1e]

A little background...

About two months ago I was diagnosed with "scapular diskinesis" -- a situation where the scapula is moving irregularly and it's causing the humeral head of the shoulder to create an impingement. What follows is posterier shoulder pain and a slight tear in my infraspinitas.

The discomfort has never been severe. After an MRI arthogram, two orthos both arrived at the same diagnosis, proclaimed my injury as fairly insignificant, and shoved me out the door for "a few weeks of physical therapy" saying I'd be back lifting in no time.

Six weeks and may theraband external rotations later, I feel like the situation has improved only slightly. I've probably done every RC exercise in the book at this point.

Has anyone ever had this and overcome it? If so, what path got you there?

I'm frustrated as hell. I'm still going to the gym and avoiding lifts "that hurt" and sticking to "closed chain" movements. I've visited with Eric Cressey and stuck with his recommendations. I've probably cut 75% of my routine out at this point.

I will say I probably over did it on the rehab -- I really attacked the exercises. It's possible that I strained my external rotators a bit, but still I'd expect more in terms of results.

I've also just recently done some deep tissue work. Pec minor and major, subscap...everything. I think I've loosened some of the shoulder up but the posterior discomfort persists.

I know nobody is a doctor here, but I'd be curious if anyone's dealt with this before. I feel like I'm missing something, tried everything, and just talking to the wrong people or something.

If this was fairly insignificant, why is it sticking around?

Thanks.

KY

 

[MuscleNYC]

you said you had a slight tear to the infraspinatus....its one of the four rotator cuff muscles.. when any of those tendons tear, it takes awhile to heal. I'd lay off the lifting until its healed or you risk tearing it further to the point where it will need surgical intervention.

 

[Pirate!]

I have worked through similar issues. You need to continue physical therapy and focus at least as much on serratus as external rotators. Eric knows his stuff, but there are some minipulations you simply can't do without a PT.
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[kyoun1e]

I have worked through similar issues. You need to continue physical therapy and focus at least as much on serratus as external rotators. Eric knows his stuff, but there are some minipulations you simply can't do without a PT.
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Pirate,

How long did it take you to lick this?

I've done six weeks of physical therapy. Here is my prescribed work. I don't necessarily do all of this in one day:

* 2-3 sets of theraband rows
* 2-3 sets of theraband or 2 lb dumbell internal rotations
* 2-3 sets same for external rotation
* 2 sets of prone Ys with 2 lb dumbells
* 2 sets of prone Ts with 2 lb dumbells
* Scap pushups
* Stability ball pushups
* Overhead ball bounce on wall
* Stretches: Sleeper stretch, pec minor, corner W's, T-spine mobility stretches.

Like I said before, I may have overdone it on the external rotations. I've been trying to explain to my therapist that I have too much pain in the lat or maybe terres major/minor area...almost as if there's a strain there that's also contributing to the posterior shoulder issue. We both agreed that we need to take a two week rest on anything external rotation. One week in, I still feel the muscles right below the back of the shoulder and in the lat area tight as hell.

As for lifting, I do maybe 2 upper workouts per week and limit it to the following:

* Cable rows (which are prescribed and one of Cressey's favorites)
* Narrow grip lat pulldowns (Have just scrapped this due to lat tightness)
* Stability ball pushups; DB floor press if feeling good; DB press if feeling really good
* DB curls
* Tri pushdowns

Rep range is usually 12-15ish. No benching. No overhead anything. No barbells period.

What's odd is that I could argue (with myself) that when I have discomfort I get it equally post workout or while at rest.

The deep tissue work I started a week ago seems to have alleviated some symptoms, but the tightness and slight burning I feel periodically on the scap remains.

So damn frustrated especially considering that my PT says the scap is measurably moving better and better.

I could just be impatient here. This could also be a case of going to hard too fast. It's just confounding that an "insignificant injury" is still sticking around.

KY

 

[kyoun1e]

Well, this is aggravating...just got back from the ortho.

The story apparently has changed.

He thinks the shoulder is clinically sound based on the MRI arthogram results and various tests. Based on my new feedback about the "burning / irritation on the scap" he now thinks it could possibly be a nerve compression issue. An EMG has been scheduled.

If the above is the case, it could be a simple cortisone injection or possibly some arthroscopy to cut away a little tissue and eliminate the compression.

Of course, my question is, "WHY DIDN'T YOU THINK OF THIS 2 MONTHS AGO!" Especially after I've wasted time and money treating another issue.

In some way, this would be good news...my rotator cuff would appear sound. On the flip side, the bad news is these people don't really know what the culprit is.

Anyways, anyone with experience on the nerves around the shoulder? Anyone deal with this type of thing?

Annoyed.

KY

 

[2tomlinson]

KY, ask your experts about PRP -- Platelet Rich Plasma injections. This, apparently, is a cutting edge approach to expediting the healing of ligaments, muscle tears and other tissue-related injuries. (Tiger Woods used it for knee problems, if that is any recommendation.) Has anyone on the board tried this? I was going to schedule a series of PRP injections into my spinal facets, L4-L5 but delayed pending the clinic getting a fluoroscopy X-ray. A peripheral friend is head of one of the country's premier PRP labs, and he raves about the results they are getting, particularly with the Major League pitchers who train in the area, and have a history of rotator cuff problems. I have RC problems myself, and am thinking about scheduling an appointment next week. Insights?

 

[2tomlinson]

For more info on PRP and connective tissue injuries, take a look at this link: http://www.orthosupersite.com/view.aspx?rid=37598

 

[tucker01]

Sometimes a second opinion is in order.

MRIs even with the inject are not the most reliable with shoulders.

Mine was clear, and I ended up having a labral tear that required two anchors.

 

[kyoun1e]

Ian,

I did have two orthos look at this. One originally indicated scap diskinesis originally and the ortho indicated a small infraspinitas tear.

I hammered the scap disk ortho today with questions on "are you SURE that this isn't RC related? Is it possible that there is a labrum issue?" He pretty much said the shoulder is clinically sound. Also, he once again conducted a battery of tests and explained to me that he would have expected me to cry out in pain for some of these tests if it was RC or labrum related.

It wouldn't surprise me if this is nerve related. I've had numbness in my fingers from the getgo and the discomfort at times seems to "radiate" down my upper arm and sometimes ever so slightly to my wrist. I also wake up often and my arm is just dead asleep.

It's just odd that a nerve compression could cause such a ruckas.

KY

 

[kyoun1e]

The more I read up on shoulder pain and nerve issues the more I keep running into a possible c-spine pinched nerve.

The C-7 specifically, which based on reading appears linked to shoulder pain, radiating pain down the back of the arm, issue with the tricep, and tingling in the middle finger.

And those are pretty much my symptoms.

And I don't recall the ortho even mentioning my neck today. Jeesh.

KY

 

[Pirate!]

I actually ended up having a compressed nerve, as well. Look into cervical traction. I swear by it. Also, get chiropractic adjustments and improve posture. It takes time.
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[kyoun1e]

I actually ended up having a compressed nerve, as well. Look into cervical traction. I swear by it. Also, get chiropractic adjustments and improve posture. It takes time.
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Pirate,

I'm actually heading to the chirpractor today. If it's as simple as a few adjustments I'll laugh my butt off. I doubt it's that easy.

I'm just hoping that this is just nerve compression and not nerve damage. From what I understand, nerve damage can result in atrophy and some kind of invasive procedure would be necessary. It may be better than rotator cuff surgery or labrum surgery (which I initially thought was the path), but it's still somebody going in there and altering tissue.

KY