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Help diagnosing shoulder injury

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sillynarbie
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2015/02/19 17:12:15 (permalink)
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Help diagnosing shoulder injury

I used to have a shoulder injury, and you guys on here helped sort it right out - turns out it was an impingement that basically got fixed doing lots of external rotation work.
 
Now, I fell on my forearms, face-first, while snowboarding. Heard a click in the shoulder, went numb, but then regained feeling a minute later. Absolutely killed the next day but felt better by the end of the holiday.
 
However, 1.5 weeks later in the gym it's hurting. If I place my hand flat on my opposite shoulder, and move my elbow above my head, it hurts a lot. External and internal rotation are fine. Doing a side-raise hurts once my arm is parallel with the ground.
 
As far as gym work goes it doesn't hurt during benching or dipping, but I haven't tried shoulder press. However, I have a feeling that somehow benching and dipping is contributing to the pain afterwards.
 
Any ideas on where the problem might lie and what rehab exercises I can do?
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    jack5r
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    Re: Help diagnosing shoulder injury 2015/02/19 17:42:47 (permalink)
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    Sounds like a traumatic impingement. To confirm do a few impingement tests such as Neer sign, Full/empty can, Hawkins and kennedy.

    As it's traumatic you want to rest the tendon so any swelling can go down. A swollen tendon will cause impingement pain. Avoid anything that aggravates it. I would probably avoid dips. Try a session where you only bench press and closely monitor how you feel afterwards.

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    phil3030
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    Re: Help diagnosing shoulder injury 2015/02/20 16:57:19 (permalink)
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    I wrote an article somewhere on shoulder injuries and benching shearing forces. With jack's reply above in mind I'd suggest not taking the bar to your chest, ensure lower traps are engaged, lower the bar until arms around body height/approx elbows at 90 and do that for a bit of time to continue exercise but allow recovery.

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    sillynarbie
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    Re: Help diagnosing shoulder injury 2015/02/21 00:44:34 (permalink)
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    jack5r
    Sounds like a traumatic impingement. To confirm do a few impingement tests such as Neer sign, Full/empty can, Hawkins and kennedy.

    As it's traumatic you want to rest the tendon so any swelling can go down. A swollen tendon will cause impingement pain. Avoid anything that aggravates it. I would probably avoid dips. Try a session where you only bench press and closely monitor how you feel afterwards.



    All of those came up negative. As I say, the only position I've managed to get pain in is if I put my hand on my opposite shoulder and then raise the elbow while keeping my hand on the shoulder. What's the name of that test?
     
    I'm holding out until Monday where I'm having a week off due to working abroad. Laying off the dips seems to have helped actually, even though it doesn't hurt during the dipping.
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    phil3030
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    Re: Help diagnosing shoulder injury 2015/02/21 01:01:53 (permalink)
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    The position you describe forces an impingement.
    The other tests are around 80% sensitive so there's still 20% chance you won't test positive but it'll be false. Did you test yourself or have someone test for you?
     
    They're often more difficult to elicit positives in people with more muscle as recruitment patterns alter, other muscles kick in and stabilise, and the single movement performed for the test is not adequately reconstructing the repetitive environment of training and aggravating factors.

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    sillynarbie
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    Re: Help diagnosing shoulder injury 2015/02/21 10:33:42 (permalink)
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    Did it myself. Sounds like would you describe could be happening. I can feel all sorts of muscles tensing when I do them.
     
    Pain is much reduced today when I dropped dips yesterday. I'll cut down my ROM on bench like you mentioned too.
     
    Injuries are bloody exhausting.
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    Skrewdriver
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    Re: Help diagnosing shoulder injury 2015/02/21 12:14:31 (permalink)
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    sillynarbie
    I used to have a shoulder injury, and you guys on here helped sort it right out - turns out it was an impingement that basically got fixed doing lots of external rotation work.
     
    Now, I fell on my forearms, face-first, while snowboarding. Heard a click in the shoulder, went numb, but then regained feeling a minute later. Absolutely killed the next day but felt better by the end of the holiday.
     
    However, 1.5 weeks later in the gym it's hurting. If I place my hand flat on my opposite shoulder, and move my elbow above my head, it hurts a lot. External and internal rotation are fine. Doing a side-raise hurts once my arm is parallel with the ground.
     
    As far as gym work goes it doesn't hurt during benching or dipping, but I haven't tried shoulder press. However, I have a feeling that somehow benching and dipping is contributing to the pain afterwards.
     
    Any ideas on where the problem might lie and what rehab exercises I can do?




     
     
    I spoke to a surgeon who specialises in shoulder injuries, he told me that "impingement" is a buzz word often banded around which is actually a catch-all for what could be many different specific shoulder issues.  You want to diagnoses over the internet?  You need specialist investigation; physio, weighted and unweighted xrays, MRI scans etc
     
     
     
     
     

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    sillynarbie
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    Re: Help diagnosing shoulder injury 2015/02/21 12:26:50 (permalink)
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    In my experience, doctors are barely more helpful in this regard. I frankly trust somebody like jack and phil more than a GP 2 years out of Uni with no experience with weightlifting or with excerise specific knowledge. "My shoulder hurts when I do weights" - "Stop lifting weights then".
     
    I've had a doctor tell me that a knee injury I had was ITB syndrome. I flat out told him in the surgery he was wrong, because I can feel where my ITB band joins and the pain was an inch below that. "ahh yes, you're right, best get you for an MRI scan then". Turned out to be a meniscus tear.
     
    With a joint as complicated as the shoulder I'd expect about 6 months of to-ing and fro-ing before I got a reasonable diagnosis. By that point, it'll be fixed anyway due to the advice of phil and jack. Of course, if it isn't, then I'll go to the doctor ;-) But as a first port of call their advice has been spot on and completely fixed my shoulder issues last time, so I'm willing to trust it again. Thanks jack + phil!
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    phil3030
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    Re: Help diagnosing shoulder injury 2015/02/21 12:29:09 (permalink)
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    Skrewdriver 
     
    I spoke to a surgeon who specialises in shoulder injuries, he told me that "impingement" is a buzz word often banded around which is actually a catch-all for what could be many different specific shoulder issues.  
     



    He's quite right. Multiple pathologies disguise themselves as "impingement". As a surgeon in general his interest is in finding something to fix. As a physio our interest is in restoring function and return to activity via exercise/non surgical methods. A catch all "impingement" term is far more useful to lay people than describing something in detail - they just want to know how to get better - and a lot of rehabilitation methods will be the same for a number of shoulder injuries with slight tweaks here and there as needed.

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    Skrewdriver
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    Re: Help diagnosing shoulder injury 2015/02/21 15:23:04 (permalink)
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    sillynarbie
    In my experience, doctors are barely more helpful in this regard. I frankly trust somebody like jack and phil more than a GP 2 years out of Uni with no experience with weightlifting or with excerise specific knowledge. "My shoulder hurts when I do weights" - "Stop lifting weights then".
     
    I've had a doctor tell me that a knee injury I had was ITB syndrome. I flat out told him in the surgery he was wrong, because I can feel where my ITB band joins and the pain was an inch below that. "ahh yes, you're right, best get you for an MRI scan then". Turned out to be a meniscus tear.
     
    With a joint as complicated as the shoulder I'd expect about 6 months of to-ing and fro-ing before I got a reasonable diagnosis. By that point, it'll be fixed anyway due to the advice of phil and jack. Of course, if it isn't, then I'll go to the doctor ;-) But as a first port of call their advice has been spot on and completely fixed my shoulder issues last time, so I'm willing to trust it again. Thanks jack + phil!


    I agree, doctors are useless.  I would still seek professional advice from a real life person over a diagnosis over the internet  - no disrespect to Phil & Jack i'm sure they're both brilliant :)
     
    I got to see an NHS physio via GP referral in about 5 weeks, - diagnosis from surgeon in about 9 weeks (following MRI's and x-rays).  Not 6 months.  My shoulder is properly fixed now, - the root of the problem was something quite unique and not something that would ever have been diagnosed the internet.  My NHS Physio in particular was amazing... - very, very impressive.  I saw a private one also (random one, not recommended), who turned out to be not so good...
     
    If you can't wait for an NHS, just go private - get a recommendation.  I think for something as important as your health, it's worth it 
     
     

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    #10
    sillynarbie
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    Re: Help diagnosing shoulder injury 2015/02/21 17:25:03 (permalink)
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    I agree in general, but it isn't exactly a big issue. A bit of pain the day after the gym. I certainly would never contemplate surgery for this issue, even if a surgeon claimed surgery could "fix" it. If you have a hammer, everything looks like a nail, and I've found that to be so true of surgeons. Their automatic reaction to everything is to operate on it.
     
    Instead, I would rather work around the issue by a) relieving pain by resting b) changing exercises/movement to stop aggrevating the issue. It's worked well in the past. If I still have this pain in 6 months I might consider seeing someone, but the first thing a GP or physio will tell you anyway is to try a handful of exercises to "strengthen" your muscles anyway. It's just trial and error, the same as what I'm doing by listening to phil and jack. I'm just cutting out the middleman.
    #11
    JimRat
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    Re: Help diagnosing shoulder injury 2015/02/21 19:09:38 (permalink)
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    Traumatic impingement a possibility but also consider AC joint injury given your mechanism, and the fact that what your describing as a painful movement is essentially a 'modified scarf test'. 
     
    Clicking during an injury is also not suggestive of impingement (or what we now call Subacromial Pain Syndrome). The additional remote possibility is a labral injury, but we can internet guess all we want, I'd book in to see a sports physio for a proper assessment. 
     
    Hope it gets sorted!
    #12
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