Another Shoulder question

Leslie Timms (f)

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I see a definite trend in shoulder injury questions... well here is my story. Ive been injured for 7 months now, I rested for 2 weeks immediately after the first episode in which I couldnt even lift my arm. Then I felt fine and climbed too hard too fast. It came back 10X worse. Then I rested for 4 weeks, ice, stretching and light exercises. I then started to slab climb for 2 months and continued rotator cuff exercises. Then I started to increase the angle and difficulty in my climbing. I have trained my shoulder a lot for 3 months or so and only climbed 1-2 days a week. Now, I've increased my shoulder strength training regime, it is getting stronger, but the pain is still there and I still cannot climb harder and it gets weak again after 3 climbs. The pain is in the front of my shoulder,  radiating to the chest and arm pit. There is also pain in the back of my shoulder, close to the arm pit and some near the shoulder blade. My neck gets sore as well. The pain is like a dull ache, or sometimes like someone lit a small fire in my shoulder. Im not restricted in any movement, but I still cannot do pull ups, especially wide ones. Tricep push ups used to hurt the most, but I am able to do a few now. It is mostly irritated from lifting, or simple things like pushing a grocery cart or putting on a seat belt. It is just so weak. I felt like I was 95% better last week and now it is back again and feeling weak again. I dont get it!  A few questions: 1. Any idea what the injury may be? 2. Is it normal during recovery to feel a lot better one week and then it flares up again the next? 3. What step do I take next? Any advice is appreciated...I miss climbing sooooo much!!

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Noah Kaufman

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Leslie, give me details about how the injury happened. 1. need more data, but sounds like a severe sprain, perhaps rotator cuff or bicepital long head, maybe several sprains. Was it a shoulder "jerk" mechanism to the injury? The dull ache and neck pain may represent fatigue from other muscles stepping in to compensate for a functional deficit. this could signify a complete tear of something or a more significant injury. Read below for healing suggestions, but if that doesn't work, you made need an MRI and Orthopedic consultation. Sorry about that. 2. yes. probably climbing too hard. NO bouldering, no pull-ups. 3. NSAIDS, rest, super, super easy climbing (but use your arms.) stretch. do not test range of motion for pain. Aerobic activity, Ice after climbing, hot tub for stretching. If you can't do anything without pain, rest for 2 months and begin again, even more slowly than before. Good luck, Noah Kaufman, MD

Leslie Timms (f)

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It was an overuse injury, just kinda happened, all of a sudden one day I was in excrutiating pain. I think you may think I am in more pain.than I am right now. Basically, Im at the point in which I can feel 100% one week and the next week it is aggravated again. I can climb 5.12s now with no pain, but it can just take one move to flare it up again. Is it normal during recovery to feel good one week and bad the next? The good weeks keep getting better. The only thing Im concerned with is coming back too hard too fast. As for the pain, it is kind of like a warm sensation , and some days it is in the front and some days in the back of my shoulder. It comes and gos, and just makes my arm feel really weak. Do you think that it is good to start putting my arm under some stress now or no? Is pain during exercises okey sometimes or should I not do anything that causes pain? Thanks so much for your time by the way, I really appreciate it.

Bjoern Alber

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From offered data i would guess that this is a strain off the tendon of the supraspinatus muscle. You would need to cut back on climbing especially overhanging, Stretch the tendonn (you need to have a person with knowledge of this stretch to physically show it to you. A skilled doktor might give you an cortisone injection that would follow the tendon in under the clavicle (collarbone) This in combination with an antiinflammatory dryg would speed up the healing. Remember - most important - I can only make an educated guess - you should get a sports medicine trained MD to examine and diagnose your injury - this will avoid loosing a lot of time trying remedies for something you actually don't have Best of luck Björn

Gianluca Boldetti

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Reply First : did you do any physical therapy? I had problems in both my shoulders, one similar to yours, and I feel that doing some assisted exercise is very helpful, you really have to "learn" some things about your shoulder to exercise and recover by yourself correctly. Is it normal during recovery to feel good one week and bad the next? I don't know if it's "normal" in your case but that's definitely my experience at least for the most serious injury. I had a shoulder subluxation in late january this year, it recovered quite well without surgery but I still have good days and bad days. In the first phase I was very sensitive to weather changes. Now, it's more affected by my excercise ratio and sleeping position. If I skip exercising for one week and I sleep on a softer matress than what I'm used to, it definitely gets unstable, expecially in the morning. I usually sleep facing down and resting the "bad" shoulder on a small portion of my pillow, so that it's gently pushed backwards while I'm sleeping-the correct starting position is usually "rolled back and down", while with unbalanced muscle developement your shoulder wants to move upwards and to the front, leading to overuse inflammation and unstability : you usually need to stretch your pectorals and biceps in some way to keep the correct position, the pillow trick helps this. It's also clearly affected by unlucky episodes, eg holding a jug and feet slip suddenly...

Leslie Timms (f)

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Well I cannot thank you enough for all of your advice! I will be getting the results from a shoulder MRI in a week, so once I know I will let you know and we can go from there I guess. THANKS!

Leslie Timms (f)

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Well MRI results are in and it turns out that I have Type 2 Acromion. Bad ginetics I guess. The curvature in the acromian is causing shoulder impingement. There is also a minor tear in my Labrum. Recovery suggestions?

Bjoern Alber

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Hi Lslie As you allready know type 2 acromion means that it is spoon shaped and inpinges the supraspinatus tendon in the front part of your shoulder. You might consider surgery,, shaving of the protusion of the bone, you might try stretching and roatator cuff muscle training combined with antiinflammatory drugs and see how far it would take you, The labrum tear is a bit worrying since it more directly will involve your power when climbing - you will need alot of patiency to ,by stretching and strenght training , recover this (if at all possible) In other words make your surgeon, to be, thorougly understand what it is your are doing so he will be able to advice you better - must doctors could even phantom the kind of movements and powerdemands we put on our bodies. Good luck Björn

Annemarie Stangaciu

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Hi leslie, I have a question: how comes that you use ice for your injured shoulder? Shoulder injuries are most of the time a tendon injury. Tendons and ligaments are not good irrigated, i.e. the blood flow is very low. To get a higher blood flow and speed up your recovery you need lots of warm and massage. I am not a doctor but read One move to many in order to understand a little bit of the proces. I had a bad injury last year too, trained a little bit soffter for 4 weeks and got a shoulder bandage from my sports doc. If I train hard I try to lift for example weights, specific shoulder colar exercises. I try to strenghten my antagonists and to improve my climbing technique in overhang. It should work, have a good recovery. Oh and by the way..strech strech strech .. Anne:)