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Shoulder Problem - Potential Scapular Winging?


#1

Hey guys, I've been lurking around these forums for a while, but recently I picked up an injury (or two really) and have spent considerable amount of time researching it when in fact I probably should have just made an acct an asked some of you guys on this forum.

Basically, I have been experiencing pain in my left shoulder which through some of my research I feel may be due to scapular winging. I feel the pain mostly when doing overhead pressing exercises, and I've noticed that when I lift my arms overhead, my left elbow seems to tract outward a little bit while my right elbow follows a relatively smooth vertical path. The pictures and video of me doing shoulder dislocation maybe should let you get an idea of what I'm talking about. (Although in the video it seems to me at least like the right shoulder is protruding laterally at the top of the movement, but again my expertise is limited on this subject).

Also, although I think this might be a somewhat unrelated issue, but I have also been experiencing considerable amounts of lower back pain that I've actually seen an ortho about. He says there may be a tiny disc issue and possibly some spondylolysis, but I'm not sure how, if at all, this might relate to the current issue.


#2

My first guess would be a tight pec minor, especially based on your comment of your elbow not tracting properly overhead. If you do a lot of overhead work, and a tight pec (or lat also) will not allow for proper range of motion, this could place your lower back in a stressful position to compensate for lack of mobility.

There is no side picture of you, but I would guess you have a bit of rounded shoulders as well (posture). I've had similar issues, and found that the more I stretch my pecs and lats, the better my shoulders and lower back feel when pressing.

Shoulder dislocates (I prefer a stick with these instead of band, more stretch that way), face pulls are good. Check out different pec and lat stretches on the site. A couple of visits to a good deep tissue therapist /chiropractor helped me a lot also. good luck.


#3

Hey grove thanks for the reply.

I was thinking tight pec minor as well and have really started targeting that area with some agressive stretching so hopefully I'll see some results there. The lat is a little trickier to get, and for that I have been mostly been trying to use the lacrosse ball to get into that area and get rid of any knots.

Another thing that I have noticed that might be related to this scap issue is that during some triceps exercises, my left tri tends to be a bit stiffer and give out first for some reason. I also noticed that if I was to tighten my neck muscles, the ones on the left are a lot tighter as well. I'm not sure how all that relates to each other, but I believe there has got to be a link somewhere.

I think for now I'm going to cut back on the heavy lifting and maybe start the 'Neanderthal No More' routine to sure up my posture a bit. Kind of a 1 step back 2 steps forward approach.


#4

In that picture your right scap wings more than your left, you can see by the inferior angle prominence. (SICK, scapular malposition, inferior angle prominence, coracoid pain, and scap dyskinesis)

Those shoulder dislocates or whatever you call them are a horrendous exercise (no offense). You'll get much more out of basic cuff and scap exercises. You can start adding some lower trapezius exercises. What kind of shoulder pain are you experiencing. The lacrosse ball and soft tissue stuff is ok but its wayyyy way way overused ever since kelly starrett started promoting it for every injury. The ball will provide some active release but will not provide tissue lengthening. You'd be better off doing some contract relax with doorway stretches for pec minor.


#6

Not being able to externally rotate the shoulder has so many different causes its hard for me to just give you a reason. It can be congenitial, it could be R v L hand dominenece, it could be your an x baseball player or tennis, it could be tightness of anyone of the internal rotators, it could be a capsular restriction.

Hump like appearances are sometimes bony in nature, scoliosis or curves in the spin can cause this on forward bending.

The easiest way to approach this would be for you to give me some insight into the nature of the L shoulder problems, history of injury and current movements and motions that could be the causing factor.

Tight pecs can cause subacromial compression causing irritation of the supraspinatus and bursa, but typically this will only originate in someone your age if your doing a ton of overhead work.


#7

Well as far as my symptoms go, like I said they can really be divided up into lower body and upper body based issues. Originally I thought these might be two separate issues, although the fact that they are both based around the left side of my body kind of makes me think that they might be related somehow.

For the shoulder issue, I can't exactly pinpoint the time when I first started noticing the injury (I'm kind of a suck it up and work through the pain type of guy), but I vaguely remember doing a 1-RM max incline bench press about 3-4 years ago and having that shoulder spontaneously give out, forcing me to drop the weight and having the shoulder be really immobile for a couple of days. Still, this was years ago so I'm not sure if it's still relevant now.

As far as the current symptoms go, the #1 thing I notice is instability and pain on top of the left shoulder whenever I do any sort of overhead pressing movements or with things like L-raises and side DB raises. When doing pull-ups, I also noticed that I can't seem to place the shoulder in the socket well and it severely limits the amount of pullups I can do.

Like I said, my left elbow also tracts outward a bit when doing OH pressing movements. I also feel a noticeable amount of tightness under my armpit (lat area) that seems to radiate towards my triceps when doing some exercises. Still what gets me is that in the pic and video, it seems like my right shoulder wings a little bit, which I think is interesting.

For the back, I did get an x-ray and MRI not too long ago because it's something that's been bothering me for a while now. The x-ray did show possible spondylolysis in the L5 vertebrae, but the doc said that it's not actually clear from either image whether there is actually any fracture. There is no scoliosis or any other bony issues (or I'm assuming) since they didn't mention anything and I think that would have showed up on the x-ray.

As far as my symptoms there, the pain is also located mostly to the left side of my lumbar spine and when bending down, there is like a, well hump-like appearance just on that side. I seem to get the pain especially after days when I do squats and deadlifts, and the doc suggested that perhaps my form was off for whatever reason and I led with one side.

There might be some truth to that, however, this whole year I really cracked down and improving and perfecting my form on all the lifts and the pain still is there. Also, during things like side bends, I've noticed that I can't really bend as far to the RIGHT, so maybe there is an issue with something like the psoas or the oblique? I dont know just a thought. Lastly, I've been getting extremely tight hamstrings (both but left seems to be a little worse sometimes) and the ortho said that that's something that's commonly seen with spondylolysis.

Btw, I just want to say thanks for the help! I honestly didn't expect this kind of interest and response and I appreciate it.


#8

The shoulder injury sounds indicative of a SLAP lesion, OHP is probably one of the most dangerous (and in my opinion overrated) lifts. With a labrum pathology, I would avoid any overhead shoulder work (you can attempt/try to continue with the incline pressing). SLAP lesions involve the bicep anchor which is most likely why your having pain during pullups and also complaining of instability. With a SLAP lesion you can typically perform ADL's without trouble or surgery but if you want to perform higher level activities it typically has to be repaired.

Spondy typically hurts with extension exercises, although pain on forward flexion doesn't completely rule it out. I wouldn't read too much into the soreness after squatting and deadlifting, I think the majority of our backs are sore after these lifts. The biggest improvement I've noticed with reducing back pain with heavy squatting and deadlifting is to raise your general physical preparedness as it improves our bodies abilities to adapt to stress.


#9

Hey thanks Bholl sorry I wasn't able to reply earlier, I was just busy studying for finals and the like.

I decided I'm probably going to see a PT some time next week and try to get someone to take a thorough look at all this because I really feel like it's limiting me and at least mentally, it's acting almost like a brake as during the lift I'm starting to doubt my form and stability, which limits the amount of weight I can put up.

I haven't considered that the shoulder issue might be a SLAP tear and I really hope it isn't because I would prefer to fix this without surgeries or any invasive procedures. I still think this whole thing is connected to my back somehow because it seems like the whole left side of my body is screwed up a bit and that's just odd in my opinion. Nevertheless, my knowledge here is very basic so I can't be certain.

Anyways though, thanks for your help and I'll try to post updates on what I learn from the PT.