Summary: I’ve had infrequent shoulder pain the last couple of years. If an exercise starts hurting I stop, but certain movements don’t always hurt. Example. Dips have hurt more often then not. Pushups used to never hurt, but bench press did. Now pushups hurt as well as bench. I have no traumatic incident that I know of that started the pain.
I have inside out, and magnificent mobility and have spend a decent amount of time reading about corrective exercise. However, lately (the last couple of months) the pain has been bad, and nothing has seemed to help.
I had an MRI and this was the impression:
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mild acromioclavicular joint osteoarthrosis with the acromion slightly low lying.
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small partial articular surface tear anterior supraspinatus tendon near insertion.
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increased signal present with fluid in the posterior labrum both superiorly and inferiorly. There is also some intermediate signal in the base of the superior labrum. These findings are consistent with labral tear. No other abnormalities are identified.
My doctor is a Navy doctor, and doesn’t have much experience with these issues, so I have a referral to see a surgeon. Once my referral is approved by the insurance company I can make an appointment and get the surgeon’s opinion.[
Here are my questions:
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What questions should I be asking the surgeon?
I don’t want to have an unnecessary surgery, or a surgery conducted by an improper person. I just want my shoulder to be healthy.
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Is my current workout program ok?
I’m doing 5/3/1 except I’m not doing any horizontal pressing. I don’t do any movements that cause pain.
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The Navy has also set me up with some PT appointments. They start before I have my consult with the surgeon. What questions should I be asking them, and what can I expect out of the treatment?
Thanks in advance.
Bump! Anybody got anything for me?
Hey man, I am an undergrad in exercise science - pre-professional PT and Strength and conditioning. I also used to work in a PT clinic. Really, it all depends. To be honest, most labrum tears do not heal on their own(usually) and (in my opinion) should be dealt with as soon as possible. The more pressing you do with that shoulder, the more likely you are to just injure it farther. The issue is that there is that the tissue that the labrum is made of simply does not heal well, not like a muscle or many other tissues. In addition, this tear may just continue to worsen if you do not change what you are doing (IE: stop pushing movement…) I don’t think you want to do this for the rest of your life…
So, what does the surgery look like? Well, that depends on what kind of tear you have. Labrum tears have 2 major categories: 1) bucket handle tear (where the labrum is a torn like a flap that can “catch” as your Humerous moves around in your glenoid fossa) and 2) a fraying sort of thing where the labrum looks almost like grass that is pointing upwards and loosely moving around as your humerous rolls over your glenoid fossa. The grade of the tear depends upon which “type” you have (or the combination of) and how sever/large the tear is. If you have a bucket handle tear, they will “sew” the labrum back together (simply put, I know) and if you have a fraying labrum, they will use a funky little tool with a ball and a blade to almost “mow the lawn” so to speak. Again, I am stating this VERY simply. It is usually an arthroscopic procedure (a couple of little holes in your capsule, not an outright open cut).
numbers 1 & 2 sounds like you have decreased subacromial space (due to the arthritis and AC joint issues) which is most likely the cause of your Supraspinatus tear. Be careful with your overhead pressing… This is a hard one to treat, and I’m not sure what they want to do about it. They will most likely not do much, other than treat your supraspinatus and (hopefully) restore it’s full function. They might try a "subacromial decompression (IE: shave the bottom of your acromion process)
A couple of things: 1) do not do upright rows… ever. 2) be careful with your overhead pressing 3) try not to do any lifts that aggravate your shoulder 4)check you posture and do everything you can to improve scapulo-thoracic rhythm. 5) Discuss all of your options with your surgeon 6) get a second opinion(always!)
Oh, and PT is good. The more you can improve your shoulder strength/health before surgery (if you have it - you might not need it, I don’t really know and am not qualified to tell you) the faster your recovery will be post PT.
I hope that helps!
-John
If you go to a surgeon, he’s gonna want to cut… especially in this economy.
The fact that you don’t seem to be able to pinpoint this down to 1 single event makes me think that you just move really poorly and over time that has led to a degeneration of the tissues.
I agree with fedaykin for the most part. AC joint arthritis/osteolysis of the tip of the collar bone is most often the usual suspect of shoulder pain with resistance training. It often involves the bench and almost always is aggravated by dips. When you dip the shoulders round forward and compresses the shit out of your AC joint = pain.
I’ve seen many radiology reports with the same findings as yours, small partial tears of the supraspinatus near the insertion and signal changes in the labrum. The supraspinatus tear is usually just tendonosis. Actual tears in a person under 40 years old is very very uncommon. If you were to give MRIs to 100 people, a quarter of them would have the same findings with pain free shoulders. MRIs typically do not give reliable info on the labrum without contrast (MR arthrogram). The contrast dye separates the tissues, making them easier to evaluate and may leak through torn cuffs/labrum. Significant tears, such as bucket handles, as challer1 said, usually come from a traumatic event. Doesn’t have to be, but almost always.
Any good surgeon will make his decisions based on his physical exam and not your study. Ask the PT about how much passive internal rotation (IR) your shoulder has. A lack of IR almost always leads to some problem. Also ask about the muscles that stabilize the shoulder blade. Weak shoulder blade stabilizers are another usual suspect in shoulder problems. These problems come with and exacerbate poor lifting form.
Definitely ask the surgeon about his experience with throwing and lifting shoulders. Is there a chance you can see a surgeon affiliated with a university athletic program? Almost always worth it.
Good luck with the appointments.
I agree with fedaykin for the most part. AC joint arthritis/osteolysis of the tip of the collar bone is most often the usual suspect of shoulder pain with resistance training. It often involves the bench and almost always is aggravated by dips. When you dip the shoulders round forward and compresses the shit out of your AC joint = pain.
I’ve seen many radiology reports with the same findings as yours, small partial tears of the supraspinatus near the insertion and signal changes in the labrum. The supraspinatus tear is usually just tendonosis. Actual tears in a person under 40 years old is very very uncommon. If you were to give MRIs to 100 people, a quarter of them would have the same findings with pain free shoulders. MRIs typically do not give reliable info on the labrum without contrast (MR arthrogram). The contrast dye separates the tissues, making them easier to evaluate and may leak through torn cuffs/labrum. Significant tears, such as bucket handles, as challer1 said, usually come from a traumatic event. Doesn’t have to be, but almost always.
Any good surgeon will make his decisions based on his physical exam and not your study. Ask the PT about how much passive internal rotation (IR) your shoulder has. A lack of IR almost always leads to some problem. Also ask about the muscles that stabilize the shoulder blade. Weak shoulder blade stabilizers are another usual suspect in shoulder problems. These problems come with and exacerbate poor lifting form.
Definitely ask the surgeon about his experience with throwing and lifting shoulders. Is there a chance you can see a surgeon affiliated with a university athletic program? Almost always worth it.
Good luck with the appointments.
[quote]danjo228 wrote:
I agree with fedaykin for the most part. AC joint arthritis/osteolysis of the tip of the collar bone is most often the usual suspect of shoulder pain with resistance training. It often involves the bench and almost always is aggravated by dips. When you dip the shoulders round forward and compresses the shit out of your AC joint = pain.
I’ve seen many radiology reports with the same findings as yours, small partial tears of the supraspinatus near the insertion and signal changes in the labrum. The supraspinatus tear is usually just tendonosis. Actual tears in a person under 40 years old is very very uncommon. If you were to give MRIs to 100 people, a quarter of them would have the same findings with pain free shoulders. MRIs typically do not give reliable info on the labrum without contrast (MR arthrogram). The contrast dye separates the tissues, making them easier to evaluate and may leak through torn cuffs/labrum. Significant tears, such as bucket handles, as challer1 said, usually come from a traumatic event. Doesn’t have to be, but almost always.
Any good surgeon will make his decisions based on his physical exam and not your study. Ask the PT about how much passive internal rotation (IR) your shoulder has. A lack of IR almost always leads to some problem. Also ask about the muscles that stabilize the shoulder blade. Weak shoulder blade stabilizers are another usual suspect in shoulder problems. These problems come with and exacerbate poor lifting form.
Definitely ask the surgeon about his experience with throwing and lifting shoulders. Is there a chance you can see a surgeon affiliated with a university athletic program? Almost always worth it.
Good luck with the appointments.[/quote]
good call. I just took his word for it that he had a torn labrum. I thought it was weird that he didnt have pain overhead pressing.
[quote]fedaykin wrote:
good call. I just took his word for it that he had a torn labrum. I thought it was weird that he didnt have pain overhead pressing.[/quote]
He very well could have a labral tear. Good luck with PT school. With your background in powerlifting you will really be something us old timers need.
Thanks for all the advice! I’m still waiting on the appointment with the surgeon, but I am getting more knowledgeable with every day that passes.
I know I used to move pretty poorly. I was the classic case of flat back while benching, not enough back work. I probably did a lot more back work than the average lifter, but still probably not enough.
I have a couple video’s in my profile. I know the form isn’t perfect (it was a max test day), but I’ll take some critique’s. Advice is always good. I think my bench form in the video’s is pretty descent. The video’s were filmed about a year ago. I had a small amount of pain throughout before I started the 12 week program. But during the program, I didn’t have any pain. Shortly after I finished that strength cycle, I did a lot of flying. I think my posture is pretty bad when I fly. That is probably what really started to aggravate the problem.
[quote]danjo228 wrote:
[quote]fedaykin wrote:
good call. I just took his word for it that he had a torn labrum. I thought it was weird that he didnt have pain overhead pressing.[/quote]
He very well could have a labral tear. Good luck with PT school. With your background in powerlifting you will really be something us old timers need.[/quote]
I have actually decided to not go to PT school. Like i said before, I worked in a PT clinic a few summers ago, but unfortunately did not enjoy it most of the time. Lots of unmotivated, disgustingly fat and deconditioned people who just did not want to be there (what did I expect?)… Most of them were extremly nice people, but just not the type of clientele that i am looking for. Right now I am changing directions and searching for a strength and conditioning GA. Somewhere, anywhere, just give me someone I can really make work hard… please.
[quote]sestvold wrote:
Thanks for all the advice! I’m still waiting on the appointment with the surgeon, but I am getting more knowledgeable with every day that passes.
I know I used to move pretty poorly. I was the classic case of flat back while benching, not enough back work. I probably did a lot more back work than the average lifter, but still probably not enough.
I have a couple video’s in my profile. I know the form isn’t perfect (it was a max test day), but I’ll take some critique’s. Advice is always good. I think my bench form in the video’s is pretty descent. The video’s were filmed about a year ago. I had a small amount of pain throughout before I started the 12 week program. But during the program, I didn’t have any pain. Shortly after I finished that strength cycle, I did a lot of flying. I think my posture is pretty bad when I fly. That is probably what really started to aggravate the problem.
[/quote]
good luck man! I wish you the best.
[quote]fedaykin wrote:
[quote]danjo228 wrote:
[quote]fedaykin wrote:
good call. I just took his word for it that he had a torn labrum. I thought it was weird that he didnt have pain overhead pressing.[/quote]
He very well could have a labral tear. Good luck with PT school. With your background in powerlifting you will really be something us old timers need.[/quote]
I have actually decided to not go to PT school. Like i said before, I worked in a PT clinic a few summers ago, but unfortunately did not enjoy it most of the time. Lots of unmotivated, disgustingly fat and deconditioned people who just did not want to be there (what did I expect?)… Most of them were extremly nice people, but just not the type of clientele that i am looking for. Right now I am changing directions and searching for a strength and conditioning GA. Somewhere, anywhere, just give me someone I can really make work hard… please.[/quote]
I received my masters at Ohio University in athletic training, and I had a GAship in a rural high school. When I was there they had S&C GA positions available.
I hear you about the unmotivated. I worked in a PT clinic one year and did outreach AT. The clinic sucked.
I had surgery to correct a labral tear about five years ago. Your symptoms sound a little different than mine, but my recovery from the surgery was successful. I was advised to stay away from overhead pressing movements, but I do them anyway. I avoid dips, however.
Good luck with this.