T Nation

Shoulder - Orthopaedic Consulation


#1

Quick history: three months ago suffered a suspected tendon pinch in the right shoulder following work on the heavy bag. This was building up through over-use (a lot of extra martial arts training, as well as conventional hypertrophy work, e.g. dips, presses, etc; not to mention poor posture as a result of being a desk jockey). I'd had similar issues before, especially in the left shoulder but it had healed quickly.

Despite conventional physio (ultrasound, etc) and ART, the nagging pinch has never quite dissipated, although I have trained around it with few issues but a return to martial arts is a pipe dream at the moment.

I saw an orthopaedic shoulder specialist yesterday. He prescribed a flowchart type of treatment progression, which goes something like:

typical rotator cuff strengthening work with bands, in addition;
get an x-ray - if nothing detected and no further improvement;
steroid injection
if no further improvement and/or suspected bone issue or calcium build up then it's MRI scan
depending what that shows it's surgery.

The good news is my symptoms are typical of a pinch and not a tear. The bad news is, as I've read recently from a respected sports club doctor, such injuries even when fixed are 30% more likely to recur.

My takeway is this: prevention is better than cure. If I could turn back the clock I would have eased off stuff like dips and pull-ups (even though they were on more shoulder-friendly rings), while doing more pre-hab rotator cuff stuff as the push ratio, especially with all the bag work, etc, takes its toll.

Will update this forum if there is anything further of interest from the recovery journey.


#2

First you should make sure your posture is alright, since a shoulder impingement sometimes is a symptom of something bigger, like for instance an imbalance in the serratus and rhomboids. You can do all the rotator cuff strengthening you want, but if the problem originates somewhere else it won’t solve the problem.

Good luck!


#3

After some delays (the joys of the NHS), I am now awaiting my NHS referral to the same specialist. This followed an x-ray, which ruled out any calcific tendonitis. As mentioned, the specialist has advised a steroid injection will most likely follow. The more I read about this procedure, the more it sounds like a waste of time as the success rate sounds grim. I’m going to ask him about Platelet Rich Plasma injections or extracorporeal shockwave treatment, which sounds much more effective. Sadly, and I’m sounding very cynical, there is often a palpable delay in the time it takes ‘conventional’ public medicine to embrace these procedures, which are easily accessible through private medical care (which is out of my budget at the moment). Anyway, fingers crossed going forward.


#4

Dips can surely be a problem but ring pull ups are pretty shoulder friendly. Me thinks the bag work is what got you. I don’t hit the bag hard anymore.


#5

Don’t disagree. The punch work has triggered this for sure.


#6

Following a further consultation, the orthodpaedic consultant decided against a steroid injection (just for the sake of it) and instead referred me for a guided MRI scan. I had this yesterday. The dye injection did make my shoulder feel aggravated but thankfully this subsided quickly. The consultant will give me the results and possible treatment options when I see him again next Wednesday.

In between times, I visited another ART practitioner, who I had first seen back in 2010 with some success for another injury. I wish I had seen her sooner (rather than the other practitioner I opted for ((who is considerably cheaper)). She promptly gave me increased ROM following some movements and it has been stronger ever since. Interestingly, she told me to avoid at all cost the remedial exercise recommended by the consultant, i.e. rotator cuff external rotations with the band. She claimed the band is lethal and has encountered several cases of shoulder problems from people doing this type of band work. Instead, she opts for the more traditional exercise where you lie on your side and use a light DB, or other object, for the RC rotations, as well as some other straightforward stuff. Based on what I’ve said, I would recommend anyone with the same issues do likewise. I await next Wednesday with some anticipation/intrepidation.


#7

Eventually got my guided MRI results back and it was good news: no evidence of a tear or other significant damage. The consultant also said the injury does not warrant a steroid injection at this stage and referred me back for physio for the impingement. While I am pleased, this episode demonstrates how a relatively minor injury can wreak havoc on your training plans for months on end.

Thankfully, it has also allowed me to find an alternative training programme, and general personal challenge, which, in conjunction with diet and Indigo, has allowed me to get into the shape of my life. This challenge has helped compensate for an end to my martial arts adventure. I am, of course, plugging away with as much shoulder-friendly stuff as I can manage but I am aware of the strength I have lost in my push movements. Ultimately I hope to pick up martial arts again in the near future.