Shoulder Bursitis-Tendonitis

[mcs5309]

At 53 now, I guess I should expect to see some wear and tear issues, especially being all natural.

I had an MRI and was diagnosed with bursitis-tendontis in my left shoulder a few months back. I also have it in my left elbow joint but was not diagnosed. I went to an ART (Active Release Techniques: A.R.T.) doc who has been pushing me to do specific stability-enhancing exercises to prevent further inflammation and damage. In the meantime, he sent me to a sports MD who administered an IM injection of Kenalog which after a couple days reduced the inflammation to almost zero. I was told to eliminate lateral raises and machine presses. I have been a big fan of lateral raises for many years, but now it is way too painful to do even 1 rep. So I abstained from them and the presses.

After a week or two of doing everything else, the inflammation came back even worse! I cannot raise my shoulder now without sharp pain, weight or no weight. Now a couple months into this, I returned for a follow-up visit to the sports MD. He refused to give another K. shot and suggested PT or to continue doing the ART exercises. He also suggested to do no resistance movement pushing or pulling away from the torso (that would include all presses, lat pulldowns, raises, flyes, pushups). Not what I wanted to hear.

Since this is my first chronic injury that isn't going away, I am at a loss as to what my best option is. I really don't want to start popping ibuprofen either. The ART docs says that if all I want is to get shots to relieve the pain, then that's a lazy man's way out and don't waste time doing any of the ART exercises - but how are the ART exercises going to help relieve the shoulder pain which is what I need to do NOW? I cannot stand not being able to do my workouts and am totally lost at this point.

The ART doc further mentioned it might not be a bad idea to look into TRT (he's on it himself) and peptides or rHGH to help speed recovery. I am supplementing with many OTC joint formulas also. On a side not, my free T is very low, but my total T was 623. SHBG was 60+ too high. E2 too low @10.

Any suggestions?

 

[Thickneck]

Sorry to hear all that.Do the things u can do. I gave up on dips and behind the neck stuff years ago and have not benched in over ten years. Benching really screws with my shoulders worst then anything . I do all presses on the smith machine now and have for 10 years now I bet. Easier on the joints. Im 46 now and somedays really feel it. Just recently got a cortisone shot in my left shoulder and was lifting hard two days later. I do my laterals seated now and very strict so I don't use as much weight. Look into trt and something more for your joints.

 

[Bridger]

At 53 now, I guess I should expect to see some wear and tear issues, especially being all natural.

I had an MRI and was diagnosed with bursitis-tendontis in my left shoulder a few months back. I also have it in my left elbow joint but was not diagnosed. I went to an ART (Active Release Techniques: A.R.T.) doc who has been pushing me to do specific stability-enhancing exercises to prevent further inflammation and damage. In the meantime, he sent me to a sports MD who administered an IM injection of Kenalog which after a couple days reduced the inflammation to almost zero. I was told to eliminate lateral raises and machine presses. I have been a big fan of lateral raises for many years, but now it is way too painful to do even 1 rep. So I abstained from them and the presses.

After a week or two of doing everything else, the inflammation came back even worse! I cannot raise my shoulder now without sharp pain, weight or no weight. Now a couple months into this, I returned for a follow-up visit to the sports MD. He refused to give another K. shot and suggested PT or to continue doing the ART exercises. He also suggested to do no resistance movement pushing or pulling away from the torso (that would include all presses, lat pulldowns, raises, flyes, pushups). Not what I wanted to hear.

Since this is my first chronic injury that isn't going away, I am at a loss as to what my best option is. I really don't want to start popping ibuprofen either. The ART docs says that if all I want is to get shots to relieve the pain, then that's a lazy man's way out and don't waste time doing any of the ART exercises - but how are the ART exercises going to help relieve the shoulder pain which is what I need to do NOW? I cannot stand not being able to do my workouts and am totally lost at this point.

The ART doc further mentioned it might not be a bad idea to look into TRT (he's on it himself) and peptides or rHGH to help speed recovery. I am supplementing with many OTC joint formulas also. On a side not, my free T is very low, but my total T was 623. SHBG was 60+ too high. E2 too low @10.

Any suggestions?

The SHBG is too high, that is probably why your free T is low. You don't need TRT with Total at 623. It won't help your joints anyway.

I have dealt with tendonitis for a few years. It comes and goes, but mostly sticks around. My best advice, since this is your first chronic issue lay off any exercise that might irritate the tendon and stick with the PT or ART thing. Better to give your body what it needs to heal now, in the beginning, than to try and lift through the pain/discomfort thinking its fine. Rest, ice, and ibuprofen if needed. but not to get through a workout.

 

[Dr JIM]

Goodness, since bicepital tendonitis is almost always due to impingement at the bicepital grove (unless you are quite "older" with a collagen vascular or severe degenerative disease process, robably NOT) at it's juncture with the supraspinatus muscle and AC joint, I shall recommend the only curative option .......surgery!

Have you been evaluated by a SPORTS MEDICINE trained orthopedic surgeon?
If not, acquire a couple of opinions regarding surgical decompression, if applicable. The recovery is TWO weeks if your a qualified patient.

PS, I AM NOT A SURGEON by profession, yet have become increasingly cognizant of "medical therapy" as a failure for this condition ESPECIALLY in LIFTERS!

 

[mcs5309]

Goodness, since bicepital tendonitis is almost always due to impingement at the bicepital grove (unless you are quite "older" with a collagen vascular or severe degenerative disease process, robably NOT) at it's juncture with the supraspinatus muscle and AC joint, I shall recommend the only curative option .......surgery!

Have you been evaluated by a SPORTS MEDICINE trained orthopedic surgeon?
If not, acquire a couple of opinions regarding surgical decompression, if applicable. The recovery is TWO weeks if your a qualified patient.

PS, I AM NOT A SURGEON by profession, yet have become increasingly cognizant of "medical therapy" as a failure for this condition ESPECIALLY in LIFTERS!

Yes, have been to a sports MD. Was intially given IM Kenalog which helped, but with training, got inflammed again, this time worse and not healing. Surgery was an option he brought up, but didn't state it was the only "cure". Exactly what does the surgery do?

 

[Dr JIM]

Google
Shoulder impingement syndrome!

 

[Dr JIM]

Actually I posted some articles on this topic a while back, try a Meso search for the same thing.

 

[Dr JIM]

Incidentally the advice Bridger and TN gave is on spot at least until you determine whether your a good candidate for surgical intervention.

 

[mcs5309]

The description for SIS described rotator tears. Don't know if I fall into that. Here's the finding from the MRI:
http://i57.photobucket.com/albums/g207/CS2006/Untitled-2_zps158bc3b0.jpg

 

[Dr JIM]

Yea I know but the tendon runs between the acromium and the humeral head in the bicipital grove beneath the supraspinatus muscle!

If that space is narrow the tendon MAY also be COMPRESSED as a part of shoulder impingement, mate!

The fact that your "injection", especially if performed laterally about the subacromial bursa, improved your symptoms are strongly suggestive a compressive process is the basis of your "inflammation", which is almost always the case in young and otherwise healthy patients.

In young folks "tendonitis" is either due to overuse (which inevitably improves) or a mechanical predisposition.

It's like dragging a rope over concrete compared to a pulley, the "rope" will fray as will a tendon!
Once that happens inflammatory SWELLING ensues (which is why corticosteroids help) causing further compression in an already narrow space.
Jim

 

[mcs5309]

Yea I know but the tendon runs between the acromium and the humeral head in the bicipital grove beneath the supraspinatus muscle!

If that space is narrow the tendon MAY also be COMPRESSED as a part of shoulder impingement, mate!

The fact that your "injection", especially if performed laterally about the subacromial bursa, improved your symptoms are strongly suggestive a compressive process is the basis of your "inflammation", which is almost always the case in young and otherwise healthy patients.

In young folks "tendonitis" is either due to overuse (which inevitably improves) or a mechanical predisposition.

It's like dragging a rope over concrete compared to a pulley, the "rope" will fray as will a tendon!
Once that happens inflammatory SWELLING ensues (which is why corticosteroids help) causing further compression in an already narrow space.
Jim

Thanks! Will mention that to the ortho.

 

[Dr JIM]

My point is, what's the CAUSATION of your tendonitis? I am doubtful your old enough for "age related degenerative arthritis" where the peak incidence for arthritic BCT approximates 76!

Admittedly, I am evaluating patients with the degenerative type of condition at a younger age recently (mid 50's, yet almost all have participated in contact sports, especially those involving high end kinetic energies such as; football, rugby, hockey etc.

Consequently, unless you have shoulder "arthritis" especially that which extends to involve the BCG, a potentially correctable surgical lesion is highly suspect, IMO

Unfortunately injecting the "impingement" space, (that area just below the acromion) does NOT differentiate between classic impingement with "rotator cuff" involvement (almost always the supraspinatus muscle) and bicipital tendonitis.

Some will argue tendon sheath injection is diagnostic and I would agree, but it can be very difficult to ascertain if the correct needle position and "feel" which accompanies this procedure are appropriate. Otherwise the impingement space or the tendon itself may be pinned, the latter of which may be complicated by delayed tendon rupture!

An MRI is of limited benefit also. Fact is the signs and symptoms are so similar the conditions often mimic each other.

Dad gum, I guess someone will have to examine you, lol!
There's about 3-4 physical examination "tests" which are utilized, but as a "single test" I prefer the Yergason maneuver since it most reliably distinguishes between the two conditions.

I believe it's on you tube. Give it a look see and let me know what ya think (the test is more reliable if you use an assistant rather than doing it on yourself) since I believe you'll "pass" the test.
GYM

 

[mcs5309]

My point is, what's the CAUSATION of your tendonitis? I am doubtful your old enough for "age related degenerative arthritis" where the peak incidence for arthritic BCT approximates 76!

Admittedly, I am evaluating patients with the degenerative type of condition at a younger age recently (mid 50's, yet almost all have participated in contact sports, especially those involving high end kinetic energies such as; football, rugby, hockey etc.

Consequently, unless you have shoulder "arthritis" especially that which extends to involve the BCG, a potentially correctable surgical lesion is highly suspect, IMO

Unfortunately injecting the "impingement" space, (that area just below the acromion) does NOT differentiate between classic impingement with "rotator cuff" involvement (almost always the supraspinatus muscle) and bicipital tendonitis.

Some will argue tendon sheath injection is diagnostic and I would agree, but it can be very difficult to ascertain if the correct needle position and "feel" which accompanies this procedure are appropriate. Otherwise the impingement space or the tendon itself may be pinned, the latter of which may be complicated by delayed tendon rupture!

An MRI is of limited benefit also. Fact is the signs and symptoms are so similar the conditions often mimic each other.

Dad gum, I guess someone will have to examine you, lol!
There's about 3-4 physical examination "tests" which are utilized, but as a "single test" I prefer the Yergason maneuver since it most reliably distinguishes between the two conditions.

I believe it's on you tube. Give it a look see and let me know what ya think (the test is more reliable if you use an assistant rather than doing it on yourself) since I believe you'll "pass" the test.
GYM

As I've been told by the ART doc, the cause is from overtraining one or more shoulder exercises (i.e. lateral raises). I looked at the maneuver and I definitely would need help from another person.

 

[Dr JIM]

Pewie!
Performing lateral exercises will not cause problems like this to persist especially AFTER an injection, UNLESS the tendon is being chronically compressed, IMO and IME.

GTG
JIM

 

[mcs5309]

Pewie!
Performing lateral exercises will not cause problems like this to persist especially AFTER an injection, UNLESS the tendon is being chronically compressed, IMO and IME.

GTG
JIM

So far, neither any topicals, NSAIDs, supplements or cessation from training has reduced the inflammation/pain.

 

[Dr JIM]

My point exactly!

 

[509iron]

I had shoulder surgery 18 months ago to remove several bone spurs in my left shoulder caused from poor bench press habits. I havent benched with a bar since. Now all I use for any shoulder or chest routine is dumbells...and have finally worked back up to 100lb dumbells on the flat. If something even feels a little funny in my shoulder I stop that excercise immediatley for at least a week and drop in weight just to be safe. I feel for ya ... having an injury and being told that you cant or shouldnt lift by a medical professional is a devastating blow... I hope all works out for you. Follow the advice they give though to prevent further injury.

 

[Dr JIM]

Excellent point of emphasis
509!

 

[mcs5309]

I had shoulder surgery 18 months ago to remove several bone spurs in my left shoulder caused from poor bench press habits. I havent benched with a bar since. Now all I use for any shoulder or chest routine is dumbells...and have finally worked back up to 100lb dumbells on the flat. If something even feels a little funny in my shoulder I stop that excercise immediatley for at least a week and drop in weight just to be safe. I feel for ya ... having an injury and being told that you cant or shouldnt lift by a medical professional is a devastating blow... I hope all works out for you. Follow the advice they give though to prevent further injury.

I can't even lift my arm laterally without sharp pain now. How was it you and your doc determined that surgery was the best option for you? Had you tried PT, NSAIDs, etc? MRI or ultrasound to see the spurs? Did they use local or general anesthetic, how did the procedure take, and what was the downtime from training? My MRI showed only tendinopathy and bursisits, no deposits or spurs.

 

[mcs5309]

Pewie!
Performing lateral exercises will not cause problems like this to persist especially AFTER an injection, UNLESS the tendon is being chronically compressed, IMO and IME.

GTG
JIM

Besides my symptoms, what diagnostics are available to confirm the tendon is chronically compressed? Ultrasound, another MRI, something else? Exactly how would surgery correct this?