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Lateral/Mid Deltoid Tendinosis?


Hi,

First Id like to say that Ive been lurking around these forums for well over a year now, but just now made an account, so bear with me if Im trespassing any rules or anything.

So, back to topic. Ive been having these issues with my shoulders ever since doing some stupid lateral raise holds half a year ago. I then had this anoying pain in both my shoulders that lasted well over a week. It finally subsided but keep returning whenever I do any lateral raise variation. I basically avoided lateral raises for half a year, and not once did i feel the pain.

The pain is not located in the shoulder itself, but rather quite low on the humerus, where the lateral delt attaches. After doing some lateral raises in the scapular plane earlier this week I now have this nagging “warm feeling pain” on my left humerus once more. I have marked the area on the pictures below. (The area is not actually red, it just got red from me pressing around trying to locate the exact spot).

I’ve been searching through the forums like a madman, but have not been able to find any posts that describe the exact same problem I’m having.

As to my shoulder health I have a slight lack of overhead reach on the left side, which is also the one getting the most affected by this issue. I’m currently consentrating on overcoming this issue by foam rolling the lats and strengthening the serratus anterior and mid and lower traps. (Basically the article ‘Pushups, facepulls and shrugs’ seems to fit my situation perfectly).

Im starting to believe i have a tendinopathy issue. I’ve seen a lot of posts regarding the rotator cuff, and having tendonitis in the tendons of the cuff, but it seems to me that such pain would be located further up on the humerus. If it was a rotator cuff issue I would’ve thought heavy bench pressing, heavy incline presses, and pullups would agrevate it, but I can do those without any problem at all. The reason I suspect tendinopathy is that lateral eccentrics from a low pulley seems to not cause this pain, and I remember reading an article once about this being a good cure.

So what do you guys think is the culprit? Do I suffer from the dreaded tendinopathy/tendinosis? Is there any tests i could do to figure out the culprit? Any exercises you can recommend?

Any help would be greatly apreciated

I googled this…it might help you:

http://www.aussiebodies.com.au/news/build-lean-muscle/376-the-pain-of-shoulder-injuries-part-1

This is better, look under the subacromial pain heading:

http://www.google.com/url?sa=t&rct=j&q=deltoid%20insertion%20pain&source=web&cd=2&ved=0CDQQFjAB&url=http%3A%2F%2Fwww.medicalhub.com.au%2Fview-editions%2Fdoc_download%2F223-gen-assessment-of-shoulder-pain&ei=obgJUe7dOuqL0QGyv4GoBg&usg=AFQjCNE8Uun4Tj3PixvMarxctz5H_N24ug&cad=rja

Sorry but i am busy moving. If you are still searching in a few days just repost here and i will share my experience. Wish you well.

Oh, wow! Thanks a lot! I don’t understand how i haven’t managed to come across this earlier.

I will have to look into this a bit further. Any suggestion on tests I can do to find out what exactly is the problem? Im thinking, is it tendinosis, impingement, tear, or something else?

I’ll also get in contact with a doctor to have him take a look at it. Its just nice to have an idea what might be wrong before i go visit him, as he tends to subscripe mountain hikes for every illness there is.

I googled this document, it is very good, more like a cheat sheat for physical therapists.

http://www.stlukeselksrehab.org/docs/Protocol_ShoulderImpingement.pdf

As far as diagnosis, there are different combinations of special tests you can do that give you different likelihoods of having a particular diagnosis. You definitely have impingement so you are trying to figure out if you just have inflammation (stage 1), a partial tear (stage 2), or a full thickness tear (stage 3). It seems like you are only at stage 1 since you describe a warm feeling and no significant weakness, only pain.

If you want to be official, the clinical prediction rule is that impingement is 95% certain if the following 3 tests are positive and 90% certain if only two are positive: Hawkins Kennedy, painful arc, infraspinatus muscle strength test (look up how to do the tests, ask if you need more help).

The clinical prediction rule for a full thickness tear is if all of the following tests are positive: painful arc, infraspinatus muscle strength test, drop arm sign.

[quote]smallmike wrote:
I googled this document, it is very good, more like a cheat sheat for physical therapists.

http://www.stlukeselksrehab.org/docs/Protocol_ShoulderImpingement.pdf

As far as diagnosis, there are different combinations of special tests you can do that give you different likelihoods of having a particular diagnosis. You definitely have impingement so you are trying to figure out if you just have inflammation (stage 1), a partial tear (stage 2), or a full thickness tear (stage 3). It seems like you are only at stage 1 since you describe a warm feeling and no significant weakness, only pain.

If you want to be official, the clinical prediction rule is that impingement is 95% certain if the following 3 tests are positive and 90% certain if only two are positive: Hawkins Kennedy, painful arc, infraspinatus muscle strength test (look up how to do the tests, ask if you need more help).

The clinical prediction rule for a full thickness tear is if all of the following tests are positive: painful arc, infraspinatus muscle strength test, drop arm sign.[/quote]

Okay, so I’ve just come back from the doc. Not much she could tell me really. She performed the painful arc test, abduction against resistance, external and internal rotation against resistance, the Hawkins Kennedy test, and the one where you reach your upper arm across the chest towards the other shoulder. I’ve also performed the “empty can test” with a little held from my mom. No pain at all.

I asked if it could be impingement, which she immediately stated that it wasn’t. I then showed her my lack of overhead reach and asked if weak traps and serratus anterior could be a contributing factor. She replied that it wouldn’t hurt to train those muscles, but that it was not the cause of the symptoms.

She then advised me to stay with very light weights when performing side raises and instead increase the frequency. Then I could slowly start using heavier weights.

Allthough she is a doctor and should know her stuff, I’m not confident that her diagnosis is to be trusted, and I will continue working on increasing my trap and serratus strength to increase overhead reach.

Does anyone else have some doubt towards my doc’s diagnose and advise? I’m sorta back to where I was initially, which is suspecting a lateral deltoid tendinosis.

If you had no pain with any of the special tests and your range of motion is not limited by pain, but by something else, then I agree with your doctor and keep working on your trap and serratus strength.

[quote]smallmike wrote:
If you had no pain with any of the special tests and your range of motion is not limited by pain, but by something else, then I agree with your doctor and keep working on your trap and serratus strength.[/quote]

Okay, I’ll follow your advise and listen to my doc. I’ll stay away from overhead pressing until the overhead ROM has increased I think. I haven’t done much overhead pressing yet, so staying away from it for some more time until i get my traps and serratus worked out won’t make much difference.

As to the range of motion, it is not limited by pain, but rather it feels like it just stops against something on the top of the shoulder. I suspect this to be caused by the scapula not moving correctly due to weak serratus and mid/lower traps, and therefore there’s limited room for the humerus to move correctly. This seems logical, as the right side has better overhead reach, and this side is where I have the best mind-muscle-connection with my trap. This is also where I have the most developed serratus(by this I mean that I don’t get DOMS here as on the left side, which I take as a clue that the right side is stronger).

Do you have any recommendation as to what could be done for training the mid delts? I could offcourse start off with light lateral raises and slowly work my way up as the doc suggested. I have tried this before though, and it didn’t really help much. Do a lateral raise with 10 lbs, and the symptoms appear. I don’t have a specific need to develop large mid delts as I mainly focus on strength, but there comes a time where lack off mid delt size looks stupid.

Thanks for your help, its greatly appreciated.

hey mate, i read through your post, and personally I’ve never had a problem with lateral raises.

I have, however, had pain in exactly the spot you circled… throbbing, angry, hot pain. This was caused by deadlifting, specifically mixed grip deadlifting which I learnt through trial and error and searching forums etc.

After I eliminated mixed grip deadlifting from my routine and just settled with double overhand deadlifts the pain went away.

Maybe this will help, maybe not.

It’s now been a while, and I thought I may as well update on this issue, if anyone happens to come by this thread with a similar issue as mine.

First, impingement and the lack of overhead reach/mobility. I sure didn’t have any signs of impingement at the time of my initial post, but that was probably due to not doing any overhead work. I did a couple of strict heavy sets a while after, and the proceeding day my rotator cuffs where all hot and painful. So that was a bad idea. Interestingly, the lack of overhead pressing may have been what was causing this issue in the first place, since I’ve had an imbalance between scapular downward and scapular upward rotation in my training.

This pain was not remotely the same as the pain I was experiencing earlier on, so the pain I was originally experiencing in this thread was in fact some type of tendinopathy to the lateral delts insertion on the humerus. This also makes sense, since I could trace the muscle down my arm and feel the exact position of insertion on the humerus, which was also the location of the pain. Loads of light weigth superstrict lateral raises and eccentric only cable laterals have been added to address this issue, and it seems like it’s working.

I started a daily routine of scapular pushups and standing with my forearms against a wall, pushing them up one at a time(I think I saw this in a Cressey article ages ago). Especially with the face-to-the-wall forearm slides I felt an imense strech in the rhomboids. This helped with serratus activation and upward rotation. I also did incline shoulder raises with dumbells at times when at the gym, to get a second angle of serratus work. These really fried my serratus.

I also incorporated a lot of different shrugging variations, and it’s still a work in progress. To begin with, the overhead shrug was close to imposible. I could only manage a couple of reps with the bar. I just had no mind muscle connection at all. This has improved, and I believe it’s helping me overcome the issues. Having done 300+ in the big three lifts and not being able to shrug 66 pound dumbbels for 5 reps screams imbalance, but I’m getting there.

I still had some issue ongoing with the overhead reach though, and by accident I came over a mobility wod video that delt with pec minor tightness. Attacking my pec minor with a tennis ball gave an immediate effect, and the slight internal rotation of my shoulders that I used to have was now almost gone. I was now close to being able to do overhead movements! A more thorough search on this site gave me directions to another really helpfull article, that had a couple diagnostic test that I hadn’t been able to find earlier on. This proved very valuable, as I found some major shortness in my pecs, amongst others. It can be found here: http://www.T-Nation.com/free_online_article/sports_body_training_performance/in_defense_of_overhead_lifting

So to close things up, what I’m currently doing to improve the situation is: High incline close grip bench press and landmine press to train the upward rotation, shrug-variations, incline shoulder raises and scapular pushups, forearm wallslides. I’m also doign turkish getups and TRX pushups for scapular stability. I attack the pecs and rhomboids with the tennis ball before every training session, and I’m also planning on incorporating the “wall angel” along with other excercises that promote upward rotation and scapular stability.

I hope this little summary is helpfull. Feel free to ask questions if there’s something thats not clear.

[Edit: Corrected some mid-night-tiredness-typoes]

Wow, great write-up of your experience! This could be very helpful to many people!

Hi there. I have had a very similar issue for about 10 years. Every article I read talks about impingement and pinching in the front of the shoulder.

My pain is in the same place you show on your picture on both arms.

I get pain lifting my arms, they ache throughout the day, I wake up in the night when it aches so much it hurts. There is clicking and popping when I lift my arms.

I get pain benching, overhead pressing, pushdowns.

I have to keep my arms by my side and just move from the elbow, I look like a robot.

Everything seems to aggravate it. Nothing seems to ease it, so I dunno what to do.

Good to hear yours is getting better.

Wow! Mother of necrobumps! That aside, though.

Your issue definitely sound much worse than mine ever did. Popping and cracking also sounds really bad, and you should really seek professional help (which i guess you have, but one may never know).

I’m pretty sure i just had some tendinosis in the tendon, as described. Eventually I solved it as described, with heavy eccentrics and super light high volume lateral raises. I then basically stopped doing lateral raises for a while, and it stopped being an issue. I have since found that for shoulders time under tension is more important than load. But it should also be noted that i never really progressed much further in strength or musclemass, instead shifting the focus to fatloss, combating stress, and just keeping in decent shape.

I can now do heavy overhead work, or heavy lateral raises, as long as I don’t push the range of motion too far, without any issues. I know I’m not of much help to you, but it’s been so long without any issues that I have a hard time remembering how things went on after the last reply here.