bhanks back story

[Krankenstein]

Not sure what part of mechanically can’t move it you don’t get. So go ahead mr trainer you tell me what is going on here and how it’s nothing to worry about

You over engage the trap on the right indicating a problem with the rotator of the right.....but thats neither here, nor there.

What was positive in the orthopoedic exam? 

If there is an issue within the first 30deg, that is most likely a problem with the supraspinatus muscle and/or tendon.   Because you can't move it...that would more likely be a partial thickness tear.  Full thickness would have pain subside within 48 - 72 hrs . 

Being that you only did abduction, there is limited info.   Testing should involve internal rotation of the arm, then shoulder flexion to the point of pain, then resistance placed on forearm.

Then passively bring arm into the same position and release the arm allowing the patient to keep in that position.  If they can't that can indicate rotator + labrum issue

arm hanging down with active internal and external rotation also will give a clue into the AC joint.  With superior to inferior pressure on the Ac joint and measuring the patients response will also give in indication if any ligament damage is suspected.

Oh, I forgot....I am just a fucking trainer   

[Hulkotron]

I am hoping it is simply inflammation of the rotator cuff tendon which is not allowing the tendon to slip through the joint

[bhank]

You over engage the trap on the right indicating a problem with the rotator of the right.....but thats neither here, nor there.

What was positive in the orthopoedic exam? 

If there is an issue within the first 30deg, that is most likely a problem with the supraspinatus muscle and/or tendon.   Because you can't move it...that would more likely be a partial thickness tear.  Full thickness would have pain subside within 48 - 72 hrs . 

Being that you only did abduction, there is limited info.   Testing should involve internal rotation of the arm, then shoulder flexion to the point of pain, then resistance placed on forearm.

Then passively bring arm into the same position and release the arm allowing the patient to keep in that position.  If they can't that can indicate rotator + labrum issue

arm hanging down with active internal and external rotation also will give a clue into the AC joint.  With superior to inferior pressure on the Ac joint and measuring the patients response will also give in indication if any ligament damage is suspected.

Oh, I forgot....I am just a fucking trainer   

That is exactly where the pain started so yeah its not passing through the shoulder blade correctly could also be the bursa sack having some issues that is why I figured a cortisone shot would be best to reduce the inflammation. I would say I havent been able to move it for a couple days and it did start with the shrugs. I then used heat the next coupel days instead of ice as had no ice.

But yeah could also be a full tear it has been an issue for months I realized I was havign real issues with overhead presses and even when I take the bar off trhe bench it feels very instable at first. But pec is paid and scheduled so whatver it is it is going to have to wait just need some cortisone hopefully. But left shoulder was already next in line I have known for months it is going to need some kind of surgery

[Krankenstein]

I am hoping it is simply inflammation of the rotator cuff tendon which is not allowing the tendon to slip through the joint and will go down but will see shoulder has been having worsening instability issues the last couple months

The rotator cuff "tendon" does NOT do that.

Think of the rotator cuff complex as a rubber band keeping a golf ball on a tee.  All four muscles are needed for stability.  The supraspinatus is primarily responsible for abduction (Ie the movement you were trying to do).  The subscapularis is used to depress the head of the humerus allowing the joint to move.

Now, if you have a "joint mouse" your shoulder will feel "stuck" and painful.  This could bits of calcification or even a small part of the labrum.  Typically distraction of the joint can help clear up a joint mouse issue by allowing that piece to cease causing restriction.

(can't believe I am typing this).....

Start with pendulum swings, working smaller circles to bigger ones.  arm pressed against body and slowly curl the forearm with palm up, then lower with palm down.  prone on incline bench 90 deg retraction of elbows (like a row) then slowly working towards external rotation.

Beyond that if you haven't been icing the hell out of it....you are not doing things you should.

[bhank]

The rotator cuff "tendon" does NOT do that.

Think of the rotator cuff complex as a rubber band keeping a golf ball on a tee.  All four muscles are needed for stability.  The supraspinatus is primarily responsible for abduction (Ie the movement you were trying to do).  The subscapularis is used to depress the head of the humerus allowing the joint to move.

Now, if you have a "joint mouse" your shoulder will feel "stuck" and painful.  This could bits of calcification or even a small part of the labrum.  Typically distraction of the joint can help clear up a joint mouse issue by allowing that piece to cease causing restriction.

(can't believe I am typing this).....

Start with pendulum swings, working smaller circles to bigger ones.  arm pressed against body and slowly curl the forearm with palm up, then lower with palm down.  prone on incline bench 90 deg retraction of elbows (like a row) then slowly working towards external rotation.

Beyond that if you haven't been icing the hell out of it....you are not doing things you should.

Yeah I could have a loose body causing the issue as well I get it is not the roataotr cuff tendon but it is part of the whole thing the subwhatever is def injured but it is just going to get some rest and coritsone for now because I am getting the right pec operated on first

Cant believe I may actually try this

[Grape Ape]

Krank knows his shit.

[Krankenstein]

That is exactly where the pain started so yeah its not passing through the shoulder blade correctly could also be the bursa sack having some issues that is why I figured a cortisone shot would be best to reduce the inflammation. I would say I havent been able to move it for a couple days and it did start with the shrugs. I then used heat the next coupel days instead of ice as had no ice.

But yeah could also be a full tear it has been an issue for months I realized I was havign real issues with overhead presses and even when I take the bar off trhe bench it feels very instable at first. But pec is paid and scheduled so whatver it is it is going to have to wait just need some cortisone hopefully. But left shoulder was already next in line I have known for months it is going to need some kind of surgery

Once again, the supraspinatus muscle sits above the spine of the scapula....period....it does not move anywhere else.

The subacromial bursa would be the only one that could potentially be the problem.  Subscapular bursa would fee better with abduction as you are clearing the humeral head away from it.  But you would still be able to lift the arm.  Heat is NOT indicated in the first 3 days post injury.  In fact, you are doing yourself a disservice unless this is something that has been present for 3+ months.  You have an acute issue. 

Once again, if it is a full thickness tear...you would be relatively pain free 3 days later.  There's no more tissue to aggravate!  Think of a cut on your knuckle.  If its a large cut and you keep bending it, the cut keeps opening and its painful.  Thats what a partial thickness tear would be like.  What tests did the urgent care doc do?  I am going to guess relatively few if any.  They aren't that knowledgeable in those things.  Probably just touch and tell exam, xrays, and then get you the fuck out of the office.

[Krankenstein]

Yeah I could have a loose body causing the issue as well I get it is not the roataotr cuff tendon but it is part of the whole thing the subwhatever is def injured but it is just going to get some rest and coritsone for now because I am getting the right pec operated on first

Cant believe I may actually try this

You also probably have tendinosis of supraspinatus and most likely infraspinatus.  Your internally rotated shoudlers just scream problems with scapular stabilty.

I don't care to look back and see if the rad report showed a loose body. 

You may actually try it?   Do or don't....not my shoulder.  I have rehabbed more shoulders than I care to count.  I have gone through full thickness repair of my own on the left and partial thickness on the right.  I have four patients on active therapy plans for their shoulders.  Its part of what I do....WEEKLY.

I have tried to help you understand that repeated cortisone is only doing you a disservice.  That should be a last resort if active therapy does not help.  It takes 6 - 9 months to reverse tendinosis.  Slower, eccentric movements allow you to change over the weaker collagen Type III fibers back to healthier collagen type I. 

[Triple-H_2005]

You also probably have tendinosis of supraspinatus and most likely infraspinatus.  Your internally rotated shoudlers just scream problems with scapular stabilty.

I don't care to look back and see if the rad report showed a loose body. 

You may actually try it?   Do or don't....not my shoulder.  I have rehabbed more shoulders than I care to count.  I have gone through full thickness repair of my own on the left and partial thickness on the right.  I have four patients on active therapy plans for their shoulders.  Its part of what I do....WEEKLY.

I have tried to help you understand that repeated cortisone is only doing you a disservice.  That should be a last resort if active therapy does not help.  It takes 6 - 9 months to reverse tendinosis.  Slower, eccentric movements allow you to change over the weaker collagen Type III fibers back to healthier collagen type I.

I was unaware of this, thank you!

[joswift]

You over engage the trap on the right indicating a problem with the rotator of the right.....but thats neither here, nor there.

What was positive in the orthopoedic exam? 

If there is an issue within the first 30deg, that is most likely a problem with the supraspinatus muscle and/or tendon.   Because you can't move it...that would more likely be a partial thickness tear.  Full thickness would have pain subside within 48 - 72 hrs . 

Being that you only did abduction, there is limited info.   Testing should involve internal rotation of the arm, then shoulder flexion to the point of pain, then resistance placed on forearm.

Then passively bring arm into the same position and release the arm allowing the patient to keep in that position.  If they can't that can indicate rotator + labrum issue

arm hanging down with active internal and external rotation also will give a clue into the AC joint.  With superior to inferior pressure on the Ac joint and measuring the patients response will also give in indication if any ligament damage is suspected.

Oh, I forgot....I am just a fucking trainer   

Hopefully thats duff info to make his shoulder worse..

[mops]

You may actually try it?   Do or don't....not my shoulder.  I have rehabbed more shoulders than I care to count.  I have gone through full thickness repair of my own on the left and partial thickness on the right.  I have four patients on active therapy plans for their shoulders.  Its part of what I do....WEEKLY.

Thank you for taking the time to write all those posts (nh)

[Krankenstein]

I was unaware of this, thank you!

Its what causes the tendons to become more brittle and susceptible to inflammation.  So in the case of doing external rotation exercises, one of the way to do them is lay on side, rolled up towel under the arm, elbow bent at 90 deg.  LIGHT WEIGHT...as in 3 - 5lbs....driving the dumbell straight up while pressing arm against side.  slowly lower the weight over 3 - 5 secs. 

Quadriped scapular CARS....get on all fours (nh)...then work through scapular elevation, then protraction, then scapular depression, ending with scapular retraction.   It will look like a square....or a circle...depending on how you move.  Each movement should take 1 - 2 secs.

[Triple-H_2005]

Its what causes the tendons to become more brittle and susceptible to inflammation.  So in the case of doing external rotation exercises, one of the way to do them is lay on side, rolled up towel under the arm, elbow bent at 90 deg.  LIGHT WEIGHT...as in 3 - 5lbs....driving the dumbell straight up while pressing arm against side.  slowly lower the weight over 3 - 5 secs. 

Quadriped scapular CARS....get on all fours (nh)...then work through scapular elevation, then protraction, then scapular depression, ending with scapular retraction.   It will look like a square....or a circle...depending on how you move.  Each movement should take 1 - 2 secs.

If I want to take this advice and utilize it for my knees, specifically pain around the patellar tendon and over the top of the patella, would you use a multi joint movement like a leg press, a banded movement, a single joint movement like a leg extension? Which direction should I go there? Thank you again!

[Krankenstein]

If I want to take this advice and utilize it for my knees, specifically pain around the patellar tendon and over the top of the patella, would you use a multi joint movement like a leg press, a banded movement, a single joint movement like a leg extension? Which direction should I go there? Thank you again!

Patrick step downs with a band behind your knee, then the other end connected to the rig.  Same thing about slow eccentric.

Slow spanish squats with a db or KB in goblet hold

couch stretch :30 / side 2x

nordic curls (start out with a band to reduce tension coming forward)

Also, take 4 weeks or so and do more tempo work with squatting (i.e. 40x1 type of thing)

There could also be an imbalance with hamstrings.  Thats why the nordic curls are helpful. 

[Triple-H_2005]

Patrick step downs with a band behind your knee, then the other end connected to the rig.  Same thing about slow eccentric.

Slow spanish squats with a db or KB in goblet hold

couch stretch :30 / side 2x

nordic curls (start out with a band to reduce tension coming forward)

Also, take 4 weeks or so and do more tempo work with squatting (i.e. 40x1 type of thing)

There could also be an imbalance with hamstrings.  Thats why the nordic curls are helpful.

I’m going to implement this immediately… Thank you for taking the time to give such a detailed response. I appreciate it!

[Lartinos]

If I went? I literally posted my paperwork along the timestamp since you guys thought my vitals were a conspiracy. I also posted the xray comments from mychart.

The original injury was a bad dislocation about 15 years ago. They also missed that dislocation on my original hospital visit I had to go back a 2nd time for them to get it. I have nothing else to compare it to. I have been injured many times nothing like this it is acting and feels like a dislocation. I cannot raise the arm. There is something mechanically wrong.

When are you scheduling the surgery for the Labrum/Rotator Cuff tear?

Shouldn’t that take precedence over a cosmetic surgery?

[bhank]

When are you scheduling the surgery for the Labrum/Rotator Cuff tear?

Shouldn’t that take precedence over a cosmetic surgery?

I have already had a labrum cuff repair. Getting a pec tendon repaired is not a cosmetic surgery it will prevent further injury. It doesn't really matter which I do first. I cant train until I do them both.

[Lartinos]

I have already had a labrum cuff repair. Getting a pec tendon repaired is not a cosmetic surgery it will prevent further injury. It doesn't really matter which I do first. I cant train until I do them both.

More likely rotator cuff because you can’t lift your arm though I think.

[Bevo]

Why the heck are you always injured??!??!! You are worse than football players playing a full contact sport

[bhank]

Why the heck are you always injured??!??!! You are worse than football players playing a full contact sport

I actually raced dirt cars for 5 seasons and had about 5 cases of whiplash a season I am all jacked up but stopped that nonsense

[joswift]

I actually raced dirt cars for 5 seasons and had about 5 cases of whiplash a season I am all jacked up but stopped that nonsense because apart from one other guy no one had the same car , I picked that car after finding out no one else had one, makes winning easier if theres no competition..

fixed

[JustPlaneJane]

You over engage the trap on the right indicating a problem with the rotator of the right.....but thats neither here, nor there.

What was positive in the orthopoedic exam? 

If there is an issue within the first 30deg, that is most likely a problem with the supraspinatus muscle and/or tendon.   Because you can't move it...that would more likely be a partial thickness tear.  Full thickness would have pain subside within 48 - 72 hrs . 

Being that you only did abduction, there is limited info.   Testing should involve internal rotation of the arm, then shoulder flexion to the point of pain, then resistance placed on forearm.

Then passively bring arm into the same position and release the arm allowing the patient to keep in that position.  If they can't that can indicate rotator + labrum issue

arm hanging down with active internal and external rotation also will give a clue into the AC joint.  With superior to inferior pressure on the Ac joint and measuring the patients response will also give in indication if any ligament damage is suspected.

Oh, I forgot....I am just a fucking trainer   

Excellent information.

That will be ignored, misused, and not completely comprehended, then whined, bitched, pissed, and moaned about at a later date.

Kudos to you for trying.

[Krankenstein]

Excellent information.

That will be ignored, misused, and not completely comprehended, then whined, bitched, pissed, and moaned about at a later date.

Kudos to you for trying.

Surprised you could type all of that with the showing of underwear in that video.....granny panties soaked?

[wes]

Krank knows his shit.

X 10,000

[webstar]

Surprised you could type all of that with the showing of underwear in that video.....granny panties soaked?

What’s a good shoulder health /mobility routine people can do just keep the shoulders healthy from years of wear and tear ?