T Nation

Shoulder Impingement or Ulnar Nerve from Elbow?


#1

@Aragorn and @Powerpuff

I don’t really know my issue, but just so everyone knows I’m doing the workout plan/exercises from this thread that ARagorn helped me come up with. Confused and Need Help, Everything Contradicts Itself

Lately, besides the knee issues. . . I now have another issue.
Besides trying yoga (which bothered my wrists), something is up in my form with barbell press, and when I return the bar to the standing rack after doing bent over rows. When I return the bar, I feel a pinch in my shoulder blade area. And when I try and turn my neck to the right (same side as pinch), I feel pain, tight, less mobility.

Latlely too, after workouts, my ring finger is numb for a while, and I did take a week off everything because of the wrist problem from yoga. I’m trying to stop using the smith machine, but I also read that you can mess up your shoulder from lifting off for yourself on a bench press (that is not smith machine), so now I don’t know what to do. BUt from all I’ve read, it seems I should lessen push exercises, work on rotator cuffs, and stretch chest more.

My question is 1) could the numbness in ring finger be related to shoulder pinch? I thought it might be ulnar nerve compression, but I have no pain in the elbow. I did have and still have slight wrist pain and some fingers are just sore, like weak/tired.

  1. All these lifts seem so complex and hard to get form right, that I"m ready to give up. Being a woman and not very strong, could I benefit my health just doing machines and light weight just to maintain what I have, because I am afraid I"m gonna get really injured on of these days.
    I used to just think you pick up a weight and lift it, but it seems I have terrible understanding of everything and it’s becoming frustrating that everything I do to progress, gives me problems. Maybe weight lifting isn’t for me. Any comments, help. … I’m so ready to throw in the towel and I just became member of a more expensive gym and maybe I shouldn’t have.

#2

Hi there. Sorry to hear about all the trouble.

Short answer, I’ve never had exactly those symptoms, particularly the numbness in my fingers, so I’m not sure.

I wish I could train with you and just help you with form. I had a female friend who did that for me when I started and it was just super helpful.

Numbness in the middle finger sounds like a pinched nerve to me, but it could be lower down in the wrist/ carpel tunnel area as well. If you’ve had problems with wrist pain, problems with your wrists doing yoga, and numbness in fingers if might be related. Hard to say if it’s up in the shoulder or elbow. I don’t know.

Pain when you turn your head can be a pulled or tight muscle. Do you get any relief from massage, foam rolling it? Warm baths? Tight traps are super common. Also, it’s easy to turn your head or hold your head in the wrong position when you’re rowing a BB, and pull a small muscle - Feeling some pain and tightness going up through your neck and back of the head.

When you mention the shoulder blade area, I’m wondering if you’ve pulled your subscapularis. Just a guess. You can find self-massage videos for some of these areas on line. Sometimes you can access these small muscles by reaching and massaging under your armpit.

There’s a massage therapist here who is also a PLer and coach. I sometimes train with him and his wife. He’s fantastic. You may want to look for someone in your area who can sort you out. A good massage therapist would be able to take you through some range of motion exercises and locate your source of pain, and they can often tell what’s going on.


#3

Thanks so much for replying. "Im just so frustrated, it’s like all my forms must be off, and I don’t even want to pay personal trainers,because I’ve done it in the past, and they don’t know or focus on perfect form. I will try some more self- massage, but I know it’s my form. My biomechanics are not that great to begin with. Do you think I should stop all weight lifting for a certain time?? And focus on stretching??


#4

Oh, I understand about the personal trainers comment.

I’d say back away from things that hurt, but you don’t need to completely stop lifting. If a particular exercise or range of motion hurts, stop.

Stretching and range of motion exercises can help, but you have to be a bit careful because you can cause yourself pain if you’re too aggressive with stretching, particularly if your stretching something that’s injured. Be slow and gentle.


#5

Hard to say for sure but most likely ulnar nerve compression. It is very common with ulnar nerve (or any nerve) for the discomfort, tingling, or numbness to be “downstream” of the nerve entrapment. Since the ulnar nerve runs under the shoulder (and through the armpit) down to the ring and pinky fingers, it’s very likely in my mind that it plays a part in this. Ulnar nerve compression is treatable though.

As far as the “pinch” you feel, that could have a number of causes. The ones that come to mind are problems with your scapular stabilizers and/or shoulder blade lacking proper movement. Those are again fixable (I deal with a lot of them in person) but not easily diagnosed over the internet. Rotator cuff, stretch chest and lessen push exercises are all good starting points for sleuthing out the way to fix this. There are other considerations as well though. I would highly suggest the “Neanderthal No More” series on T-Nation by Eric Cressey. It talks about related items. Eric Cressey’s website is also very useful (be prepared for in depth stuff). He works with shoulders primarily.

The shoulder has a relationship with the upper back, the arm, and the chest/collarbone/neck. So the “pinch” could involve any of those areas, not just the rotator cuff. Most common is upper back.

Taking a wild ass guess here, it sounds like your upper traps are over-active and that the balancing muscle fibers of the serratus anterior as well as the low and mid traps (they behave differently than the upper traps even though they’re technically all 1 muscle) are not active and doing their job.

I saw powerpuff reference me in your other thread, and I am very happy to know you’re still working out!! I am sorry for the frustrations you’re experiencing right now for sure. It’s never a smooth and straight line for any of us even though that’s what we all want. It’s the most aggravating part about fitness. You are more than free to modify and change things in your workout! It is never about only doing 1 thing forever and ever, but about having a good starting point and learning as you go…keep trying and applying and learning. Pretty much like any other skill in life including parenting (nobody’s ever ready for that no matter how much they read!)

Regarding your fear of getting injured–yes you could benefit from machines. I’m not against them even though I favor other weights due to being able to use and train the smaller postural muscles. “Light weights” is a relative term. You don’t need to train super heavy at 3-5 reps, at all! But you need to challenge yourself and light weights at 20-30 reps really won’t do much if that’s all you do. A middle ground is needed I believe.

Best advice I can give you is to keep at it. And keep reading. Watching exercise demonstration videos. There is conflicting information everywhere, but if you can avoid “analysis paralysis” you will eventually be able to track down the right stuff. I went through this exact phase years ago. I just got stubborn and said “to hell with it! I’m going to figure out what’s wrong or die trying” and refused to stop…I didn’t have a bunch of people to turn to, just the internet at the time. It was crude but I eventually did get everything sorted. Hope that helps.


#6

Agree that trainers often suck. That’s one reason I started coaching people to begin with…I was sick of them sucking and screwing people up. That said there are some really good ones out there.

You can always post videos of your form and get free help with that here. I’m not sure what area you live in, but depending on where you’re at there are some great training centers. I think the biggest thing when looking for personal training is to try to find a center that is not part of a big commercial gym–look for athletic training centers even though you’re not an athlete and look at their staff members–physical therapists, etc. Typically a center like that is better equipped to handle concerns like this and makes its money on keeping people healthy and/or getting them back. After all an athlete can’t compete or earn money if they can’t play. More expensive, but usually (on average) the best bet.

I think you should avoid things that aggravate areas, but don’t think you should avoid resistance training entirely, most especially things that don’t hurt. But it doesn’t have to be barbells…could be cables or dumbbells etc.


#7

So good to hear from you Aragorn. . . .you are so smart. I try to read and watch videos, but I do really get confused, because I’m not well versed in the anatomy, and like you said, once it gets too deep, I get overwhelmed. What I"m thinking is to drop back to three main compound exercises, barbell press, pull up and bent over rows. But how do I get those smaller trap muscles activated, that is the question. Trusting your experience and intelligence, I bet you are right
In fact, I wonder if the pain in my shoulder blade, the pinch and soreness I have in that trigger point, and a pain in my neck on that same side, could possibly be causing the numbness in my fingers, since it all connects. And I also wonder if the wrist pain is the same or connected as well. My wrists are very tight but they did feel better when I rolled my forearm.
Also, how do I find out how to treat ulnar nerve (although I did ulnar nerve tests from youtube, and I don’t have those symptoms,but sleeping my elbow causes those fingers to go numb. . . so I"m still thinking it could be part of it. ) And how do I treat the scapular stabilizer issue?? Not saying I"m expecting answers from you, but just saying. … .where do I even start?

I will read that article, and see if I can get it but I doubt it. When you say rotator cuff, you mean stretch them or strengthen them?? I will stretch chest and drop down on quantity of exercises. Do you think I need to take time off??

You don’t do skype training do you?? Thanks so much. Oh and one more thing. With barbell press, I"m scared of lifting it off the bar myself, haven’t learned how to do that and I’ve read that people tear shoulder stuff by doing that, so now I"m not sure I want to do barbell press.

Such a relief to hear from you… . you give me great calm, still have so many questions though!! And my knees, still have pain, but I"m working hard on squats and deadlifts and rolling the heck out of my calves. BUt any funky movement, brings the patellar pain right back. IT’s such a hard journey, thanks for your compassion.


#8

@aragorn @Powerpuff
Just maybe onto something. I tried “Rehab” exercises for rotator cuff.
On Abduction Shoulder Dumbbell curls, where you arm is an a L and you lift up. On the left shoulder I heard, I click every time I lift/lower like something is caught,going over something. ANd on the right side, my rotator cuff started to hurt Could this perhaps be the problem area then?? Should I work it or no?


#9

Nonsense–I started out just like you. I just have a LOT of years and a lot of mistakes under my belt that I learned from. I’ve been at this for almost 20 years so I have had time to screw up just about everything you could possibly screw up! And suffer for it… The rest of it was tons of reading and figuring out how to learn stuff I was unfamiliar with. Exactly like you. I am glad to try to help as my time allows.

Also second what powerpuff said about massage therapists. Chiropractors can be good as well–usually you want to make sure they are a bit more “modern” minded than the old school guys. The shift in chiropractic has been towards a more holistic approach (i.e. not just “popping” your back and “adjusting” your spine, but taking care of some muscular or nerve issues). There are still plenty of old school guys around though, so mileage may vary. A good one is worth their weight in gold, but bad ones are less than helpful.

I would probably drop the pull up (unless your gym has one of those assisted pull up machines where you can adjust it to help just the right amount). The reason is that it can aggravate your symptoms–the lats run from your shoulders down the sides of your back, they’re the muscles that look like wings when pro bodybuilders flex, and they pull the shoulder down. This pulling down can compress the ulnar nerve. Now, done properly pull ups are fine. But many people struggle to do them properly and that’s when the trouble with the lats starts.

If your new gym has a machine that looks something like this: https://media1.popsugar-assets.com/files/thumbor/-ZrOIAPmtIKp0BmxBxe2PGwtbXk/fit-in/1024x1024/filters:format_auto-!!-:strip_icc-!!-/2011/11/45/1/192/1922729/fb37a0f02815fd5b_assistedpullup.jpg

…and helps you do the chin up, you can probably still do them because you can adjust the difficulty until you can focus on form. Otherwise I would focus more on rows.

Yes, very good instinct. Of course I can’t say for sure that this is the case with YOU, but I have seen this happen and it is fairly common so I would rank it as likely.[quote=“mamaherrera, post:7, topic:230027”]
And I also wonder if the wrist pain is the same or connected as well. My wrists are very tight but they did feel better when I rolled my forearm.
[/quote]

Maybe or maybe not. Wrists were aggravated by yoga and not any of your lifts originally if I read you right so they may be something else. However, rolling the forearms is a good instinct and relieves some stress so that’s a good sign it is muscularly based rather than nerve based.

Typically tests for impingement focus very narrowly on a couple things and also focus only on clinical syndromes. What I mean is this–for example, you visit the doctor and he takes blood work from you. They run it through the lab and the results come back, and there are standard “normal” ranges on each of those results (good and bad cholesterol, triglycerides, calcium, testosterone, estrogen, etc). A doctor usually only looks to see if anything is out of the “normal” standard value range. If your cholesterol is up but it is still “within healthy range” the doctor will come back and say your cholesterol is normal. Of course, that doesn’t actually mean it’s normal it just means it’s not super duper remarkably bad. Same thing with some of these mechanical tests for nerves and such on youtube. You could have that problem it just isn’t AS BAD as the test is designed to look for.

TLDR, I think the ulnar nerve is still a good candidate.

If the ulnar nerve is simply compressed in the armpit/shoulder from not having enough room to move around like normal–due to muscles or the shoulder blade being out of position and pressing on it–then fixing the muscles around will help move the shoulder into the right spot and sort out a large part of the issue. So focus on scapular stabilizer muscles.

The scapular stabilizer muscles most often affected by weakness are: the serratus anterior and the low and mid traps. Strengthen them and it will help in 9/10 times. Perfect form is needed, since they’re small and weak any fast movements will recruit the other muscles around them. Sort of like how people always use their dominant hand for tasks because it’s more comfortable and coordinated and strong than their other hand…Form can be monitored by simply going slow instead of fast and focusing mentally on the areas you want. This IS one area where reps in the 12-15 range are better than lower reps starting out.

Serratus anterior and low/mid traps are subjects in the Neanderthal No More article series I mentioned, and big subjects that Cressey talks about in his blog (www.ericcressey. com). There is a wealth of in depth information, but there is also a lot of practical exercise examples in his archives for free. No need to sign up for anything or pay for any products.

So I would start by finding out ways to strengthen the serratus and the low/mid traps.

When I said rotator cuff I was referring to what you said about exercises. Not knowing anything about your specific situation in terms of what your shoulders actually DO when they move in these ways, hard to say exactly what to do but I would generally err on the side of strengthening the rotator cuff rather than stretching it. I would also not do any exercises that hurt it even if they are supposed to be “healthy rehab” exercises.[quote=“mamaherrera, post:7, topic:230027”]
Do you think I need to take time off??
[/quote]

No, not really. I think you might just need to use a few different exercises and avoid the “hurting” ones. Time off may help the inflammation and pain go down but won’t fix the underlying issue and then when you start it will flare up again. So avoid doing things that hurt, but don’t take time off of working out completely.[quote=“mamaherrera, post:7, topic:230027”]
You don’t do skype training do you?? Thanks so much. Oh and one more thing. With barbell press, I"m scared of lifting it off the bar myself, haven’t learned how to do that and I’ve read that people tear shoulder stuff by doing that, so now I"m not sure I want to do barbell press.
[/quote]

No, I don’t do skype training, just email and phone. I am confused by what you mean when you say “barbell press”. It can mean either overhead press or bench press…which are you talking about? The easiest solution is to switch to dumbbells instead of barbells here.

I am happy to help you. It can be confusing and frustrating. But as with anything…if it was easy everybody would do it :). It’s the “hard” that makes it great when you stick it out. As for squats and deadlifts, perhaps switching to lunges may be an option for you. Squats can aggravate patellar pain, but deadlifts should not.

Rolling the calves is a good idea. After you roll the calves (angle your calves so the roller hits the inside and outside parts of it) I suggest rolling both the IT band and your adductors. The adductors are an awkward one but it can be done. See if that helps before you squat, you can look up the rolling online.


#10

Definitely onto something. Not sure what you mean by “abduction shoulder dumbbell curls” though. Do you mean lateral raises with arms bent, or do you mean something else…can you link an example?

I would not work it if it hurts, but yes it is almost certainly related to your issue.


#11

Thanks so much.

  1. Yes i have an assisted pull up machine, so I will try and see if it doesn’t aggravate it. I did find a scapular stabilizer exercise, which I hope is good and sufficient. https://www.youtube.com/watch?v=s1qamtyW6wg&index=28&list=PLfBeMVZ3knAhhItBOSFmvD-JrPIKNaI9N

I did it with light weight.
I mean bench press, which I did today with a twenty pound bar. I guess I will switch to dumbbells when I decide to go heavier.

And yes, abduction shoulder dumbbell curls were what you said, lat raises with arms bent. My right rotator didn’t like that and I heard a catching sound on my left.
We’ll see how my fingers respond today after those three exercises I did, pull ups, bench press (very light) and bent over rows. ANd I foam rolled and stretched. Kind of hard to get at those shoulder areas with a foam roller though. Thanks so much for sharing!! You’re an inspiration to keep going. God bless!


#12

Yes it’s good. I use a variation of that exercise very often. It is actually most commonly called a “face pull” and there are a few different ways of doing it. I would change the angle on the exercise, but it may just be the equipment he has to work with at that gym. Ideally I would start with an adjustable cable–one where you can lower or raise the pulley to different heights. I would set it about shoulder height, then do the exercise as illustrated. The focus would NOT be on the arms moving the weight but on the shoulder blades pinching together without shrugging up. The arms moving would be the “finishing” part of the exercise. While that is the easiest thing to see in a video, the real set-up work is done in the pinch at the very start of the move.

That’s actually true of all rows, bent barbell, dumbbell, cable and all.

You should feel it right between your shoulder blades. You can also feel it in the back part of your shoulder (the rear deltoid referenced in the video below).

Here is an excellent video that goes over how I would generally use the face pull (except reps can vary more than he says). https://www.youtube.com/watch?v=l24pXqUrnUk

I do think that he doesn’t put enough emphasis on the contraction of the mid back between the shoulder blades in his verbal explanation, but it is extremely thorough overall.

NOTE: I want to point out a couple very important things in this video–the first being, look at where his arms finish at. His elbows are NOT behind his shoulders!! They are directly to the sides, but not behind. You can actually pull the rope too far back in this move, so stop when your elbows are even with your shoulders out to the sides, or even a half inch in front of your shoulders. Don’t pull your elbows behind you. 2nd, notice his posture–he is not arching his back at all. He has a straight line from his hips to his head, and even though you can’t see it his abs are turned on and squeezed, as if he was doing a plank as hard as he could. This is excellent posture. The only thing that really happens is his body is leaned back a little to balance itself against the rope, which is perfectly fine.

Ok, Lat raises. I would not do the lat raises. It’s not a rotator cuff exercise as much as a shoulder exercise. It’s useful and I use it quite often, but if someone is already dealing with an injury or a problem like yours it can keep things from improving. Once someone is healthy again it is quite a good exercise to put in.

I would switch to dumbbells now. And I would change to a neutral grip (also called a hammer grip). If you’re unfamiliar with that it basically means having your palms facing each other and your elbows tucked close to your sides instead of out wide.

Having elbows out very wide in a bench press–barbell or dumbbell–is in fact one of the things that can easily lead to shoulder issues like you are experiencing. It doesn’t do it in everybody, but in people who are predisposed or at-risk, that is a big aggravating factor.

To understand why I said these things, lets go back to the lateral raise where you feel clicking and pain. Now do one of those lateral raises (without weights please) and hold the top position of the exercise. Holding your arms like that, go lie down on your back–what does that position remind you of? The middle of a barbell bench press exercise. You see how similar those positions are?

RE: foam rolling–use a softball or baseball for the shoulder areas! Foam rollers are easier to reach the legs. You can lean against a wall and lean on the baseball. Make sure you stay on muscles not bones, but otherwise good. Don’t put the ball under your shoulder blades though, keep it between them or on the muscles on top of them, or on the back/side shoulder muscles, even under the shoulder near the armpit. A bit awkward to control the ball and it will bounce away from you, but once you get the hang of using it the ball is great.

Lacrosse balls are a good choice–get them from a sports store or online, they’re the most common tool to “foam roll” the upper back, shoulder, and arms/forearms. The rubber sticks well to most surfaces and doesn’t slide away, and the ball is hard enough to get good pressure on, not so squishy like a tennis ball.

I would do the following:

Wall slides
face pulls
Low trap raises (“10-2 raises”, also called “Y raises”)

as a warm up before your lifting 2-3 times a week, about 3 sets of 10-15 reps each. Reps aren’t as important as control and posture.

Wall slides here from Eric Cressey:

NOTE: when Eric says “Round” in the 1st video he doesn’t mean “slouch”! Stay mostly straight haha
NOTE 2: Wall slides do not need to be done with a roller. Roller can help you feel the posture a bit because you need a little pressure on it to keep it from falling down, BUT a wall slide can just be your arms right on the wall sliding up.

Low trap raise explained well here—but poorly executed because the guy is pretty inflexible and has to bend his elbows. The idea is correct but you need your elbows straight instead of bent…the reason for not bending the elbows comes in the 2nd video which explains a very similar movement.

good explanation bad execution https://www.youtube.com/watch?v=37Z6aO8KsuI

Cressey again explaining a related exercise: https://www.youtube.com/watch?v=YbqcB5dBBD0

Note that Eric is explaining an identical exercise to the 1st video, just using a different form of resistance than dumbbells. It’s harder as well. So start with the dumbbell version, but with just your arms and no weight, then graduate to weight very slowly. Forget the TRX because it is harder–but pay attention to his explanation because it is true for both exercises. Posture is everything here. Eric’s posture cues work extremely well for both dumbbell and suspension trainer versions.

You may have heard the term “shoulder depression” or “depressed at the shoulder girdle” in one of these videos. That is something that can play into ulnar nerve compression. If the shoulders sit down really far (and/or are downwardly rotated, meaning rounded shoulders) they can be sitting so low or rotated so much that they pinch your ulnar nerve.


#13

Wonderful. . . thanks so much. I will study all you gave me, you explained very well, but I will study over the videos before I hit upper body on Tuesday. Good news today, no numb fingers, or shoulder pain so we are on the right track. I hope somehow I can always find you, so that in a few months, I want to make progress, increase work or change up, you will be not impossible to find! Thanks and feel satisfaction that you are helping poor injury-yprone people like me all over the world!


#14

I am so very glad to help. I hope it works well for you!

EDIT–should also add that when you get to the point you are pain free all the time and you have stopped doing the rehab warm up stuff, it’s an easy thing to just add 1 exercise (like the face pulls) into your routine as sort of “active rest” between sets of bench or overhead press. Never to failure when used this way and you should take time to rest before going back to the bench or whatever you were doing first, but it’s a nice way to balance out your training without taking a whole detour and doing tons of rehab or a 30 minute warm-up before lifting. Just keeps you healthy, maintenance style.

Any of those 3 rehab exercises I listed could easily be used as a standalone ‘active rest’ move during normal training, just to keep things on track.


#15

@Aragorn and or @ Powerpuff
One more thing to mention. Last night, I work up again with my last two fingers numb, I mean my poor pinky finger, was completely lifeless. It worries me that I will cause permanent nerve damage, but I hope not. What can I do for that aspect??? Also, I woke up with a sore neck. I have tried every pillow in the world and I like this one, but maybe it’s how I slept. Any tips, thanks
Andrea


#16

No, no likely nerve damage. Remember it’s not lacking bloodflow so nutrients are still getting there.

Sore neck likely related to this shoulder/nerve issue as well as being tight from turning it when you felt pain in the shoulder. Muscular, using baseball to roll will help, focus upper traps/side of the neck area.

happy memorial weekend


#17

thanks so much! Have been working on all this. found I get super big knots in my forearms


#18

@aragorn
Hey I’ve been working on all you have given me. Still have some pain in the upper shoulder blade, going around. ANd yesterday I went swimming, I did breaststroke, side stroke, and backstroke. And I felt more soreness in my shoulder. Could the swimming be at fault??
Do you have any ideas of HIIT I could do with all my issues: knees, shoulder< etc?


#19

The big question is, is the pain better now than it was a few weeks ago?

If so, at least partially on the right track. Of not, then I am not sure an “internet diagnosis” will be adequate lol.

Swimming could be part of the soreness yes. Swimming uses the shoulders a lot. The question is whether the soreness is normal/muscular or whether it feels like joint/tendon/nagging injury soreness.

As far as HIIT, my gut reaction would be to take care of your knees first. I’m not up on your history there any more so not sure.


#20

Ok. I appreciate your help. It is definitely like a nerve pai , burning around the whole top of shoulder blade. It kind of hides symptoms unless i do certain movements but definitely got worse from repetitive movement. Any suggestions, advice thank you. If you dont feel comfy on that, i understand