Shoulder Bursitis-Tendonitis

[509iron]

I was in prison for 3 years where I lifted the whole time. In prison there are alot of people that can lift heavy weight. 98% of them have horrible form and I was one of them. It took its toll on me. When I got out I was flat benching only 225 trying to sqeeze out alot of reps , I had no spotter, I tried to push out# 15 and my left arm wasnt having it . My right arm made it up and I kind of rolled my left arm/shoulder up just to get the bar racked. Upon doing so I felt a super sharp pain in my left shoulder. At first I thought I might have just stressed my rotator pretty bad. The next day the pain was crazy bad. So I just waited , no lifting , just hoping it would heal on its own. It didnt. You say you cant bring your arm up above your head? I couldnt bring my left arm across my body . I would point my arm straight out in front of me and try to move it from left to right. Once it broke the plane of my torso I had the sharpest pain in my shoulder. So I went to the doc, he gave me the run around at first saying I had just sprained it. I knew I fucked it up good. So made me do 6 weeks of Physical Therapy... none of which helped. I went back to him and he wanted me to do six more weeks! He said if no improvement then he would do an MRI. I was on my 2nd week of PT and the Physical therapist said he would talk to the doc and tell him that the treatment was going nowhere. He did and at the next dr appointment we did the MRI. What that showed was where my arm hooked into my shoulder there is a small amount of spacing which I had completley worn down to the point where the bones were just rubbing together causing bones spurs. The looking like icecicles growing out my shoulder on the MRI. That was what was causing the severe pain. So he scheduled surgery to remove the spurs and part of my collar bone to prevent this from happening in the future. The surgery went like this.... they offered me a nerve block which is where they put a needle in your neck right before you fully sedated. It basically blocks the nerve for 24 hrs, I guess the pain is pretty severe in the first 24 hrs. So I did the nerve block ... they put me under .... the surgery lasted 4hrs. 3 small incisions in my shoulder. I was laid up for 3 weeks before I started PT. I did Pt for only 4 weeks instead of the recommended 6 weeks. I needed to go back to work. I didnt lift any type of weight for 6months. And when I finally got back into it I pretty much started over. I am just now getting back up to what I could do with chest and shoulders... but with no bar. Only dumb bells. I feel for ya ...injuries are fucking lame. I wish you the best. When you are told that you cant or should not lift weights.... its the worst thing to hear. Just take it easy and tell him you are not getting better and that you want to take the next course of action....MRI????

 

[mcs5309]

My point exactly!

These are the A.R.T. exercises my doc has me doing. My question though is - what do these movements do to directly help heal the shoulder tendonitis-bursitis?
Foam Rolling: Latissimus Dorsi: [ame=http://youtu.be/y1HHGKn6gws]Foam Rolling with Dr. Leach: Lats - YouTube[/ame]
Reverse Push- Ups: [ame=http://youtu.be/ajf8xkq_A14]Exercise Tips with Dr. Leach: Reverse Push- Ups - YouTube[/ame]
Front Facing Wall Angels: Shoulder Pain with Dr. Leach: Wall Angels - YouTube
Shoulder Stabilization part 1: [ame=http://youtu.be/7rw69kDgC0Q]Shoulder Pain with Dr. Leach: Lying Bridge Part 1 - YouTube[/ame]
Shoulder Stabilization part 2: [ame=http://youtu.be/Pq6RTzXeMps]Shoulder Pain with Dr. Leach: Lying Bridge Part 2 - YouTube[/ame]
Thoracic Spine Extension & Mobilization: [ame=http://youtu.be/haROgPg19IU]Foam Rolling with Dr. Leach: Thoracic Extension - YouTube[/ame]
Glute Activation Bridge: [ame=http://youtu.be/7v9MLzPqBw8]Rehab Exercises with Dr. Leach: Single Leg Bridge - YouTube[/ame]

 

[mcs5309]

I was in prison for 3 years where I lifted the whole time. In prison there are alot of people that can lift heavy weight. 98% of them have horrible form and I was one of them. It took its toll on me. When I got out I was flat benching only 225 trying to sqeeze out alot of reps , I had no spotter, I tried to push out# 15 and my left arm wasnt having it . My right arm made it up and I kind of rolled my left arm/shoulder up just to get the bar racked. Upon doing so I felt a super sharp pain in my left shoulder. At first I thought I might have just stressed my rotator pretty bad. The next day the pain was crazy bad. So I just waited , no lifting , just hoping it would heal on its own. It didnt. You say you cant bring your arm up above your head? I couldnt bring my left arm across my body . I would point my arm straight out in front of me and try to move it from left to right. Once it broke the plane of my torso I had the sharpest pain in my shoulder. So I went to the doc, he gave me the run around at first saying I had just sprained it. I knew I fucked it up good. So made me do 6 weeks of Physical Therapy... none of which helped. I went back to him and he wanted me to do six more weeks! He said if no improvement then he would do an MRI. I was on my 2nd week of PT and the Physical therapist said he would talk to the doc and tell him that the treatment was going nowhere. He did and at the next dr appointment we did the MRI. What that showed was where my arm hooked into my shoulder there is a small amount of spacing which I had completley worn down to the point where the bones were just rubbing together causing bones spurs. The looking like icecicles growing out my shoulder on the MRI. That was what was causing the severe pain. So he scheduled surgery to remove the spurs and part of my collar bone to prevent this from happening in the future. The surgery went like this.... they offered me a nerve block which is where they put a needle in your neck right before you fully sedated. It basically blocks the nerve for 24 hrs, I guess the pain is pretty severe in the first 24 hrs. So I did the nerve block ... they put me under .... the surgery lasted 4hrs. 3 small incisions in my shoulder. I was laid up for 3 weeks before I started PT. I did Pt for only 4 weeks instead of the recommended 6 weeks. I needed to go back to work. I didnt lift any type of weight for 6months. And when I finally got back into it I pretty much started over. I am just now getting back up to what I could do with chest and shoulders... but with no bar. Only dumb bells. I feel for ya ...injuries are fucking lame. I wish you the best. When you are told that you cant or should not lift weights.... its the worst thing to hear. Just take it easy and tell him you are not getting better and that you want to take the next course of action....MRI????

Yeah, already had an MRI which showed only bursitis and tendonitis, so I question whether surgery is an option since I don't have spurs. Need to look into this more. Thanks for the in-depth. I need all the data I can get. You can see the youtube ART exercises in the post above.

 

[Dr JIM]

Yea yea yea, I've heard this all before! The IDEA is to depress the humerus away from the AC joint, no more and perhaps some "some strengthening". These are exercises are clearly developed for PEN PUSHER PATIENTS, IMO! (Because there success is miserable in BB/Lifters, IME)
.
This sounds even more like impingement to me. Have you been evaluated by a SPORTS MEDICINE TRAINED ORTHOPEDIC SURGEON?

I promise those "exercises" are used for no longer than 6 weeks in professional athletes, thereafter surgery is undertaken IF Iimpingement remains the most likely etiology for the tendonous inflammation.

It seems MORE likely than NOT you have reached that juncture, IMO!

Sometime I do wish I could personally evaluate some of those on Meso, and you are one of them. However the conflict is undeniable and forbids such an encounter.

But fella locate a SM trained surgeon, and obtain a second opinion.

JIM

 

[mcs5309]

Yea yea yea, I've heard this all before! The IDEA is to depress the humerus away from the AC joint, no more and perhaps some "some strengthening". These are exercises are clearly developed for PEN PUSHER PATIENTS, IMO! (Because there success is miserable in BB/Lifters, IME)
.
This sounds even more like impingement to me. Have you been evaluated by a SPORTS MEDICINE TRAINED ORTHOPEDIC SURGEON?

I promise those "exercises" are used for no longer than 6 weeks in professional athletes, thereafter surgery is undertaken IF Iimpingement remains the most likely etiology for the tendonous inflammation.

It seems MORE likely than NOT you have reached that juncture, IMO!

Sometime I do wish I could personally evaluate some of those on Meso, and you are one of them. However the conflict is undeniable and forbids such an encounter.

But fella locate a SM trained surgeon, and obtain a second opinion.

JIM

I'm making another appt. with the ortho doc right now. If he tosses me off back to PT/ART which he did last time, I will get another opinion for sure. This cannot go on

 

[Dr JIM]

Find out if he is SPORTS MEDICINE FELLOWSHIP TRAINED, If your not sure PM his name to me and I'll be happy to find out fer ya mate.

Your wasting time if he is NOT, because the training is a HUGE component towards making this correct diagnosis AND treating it appropriately

 

[mcs5309]

Find out if he is SPORTS MEDICINE FELLOWSHIP TRAINED, If your not sure PM his name to me and I'll be happy to find out fer ya mate.

Your wasting time if he is NOT, because the training is a HUGE component towards making this correct diagnosis AND treating it appropriately

His card reads:

Arthroscopy & Sports Medicine
Orthopaedic Surgery
website: doclv.com

 

[509iron]

I hope everything works out for you. Being injured is lame , be smart about it though.... if something is feeling a little off..... I would suggest to stop that movement all together ..... or lighten the weight. Make sure to let them know that the PT isnt going anywhere.

 

[mcs5309]

Find out if he is SPORTS MEDICINE FELLOWSHIP TRAINED, If your not sure PM his name to me and I'll be happy to find out fer ya mate.

Your wasting time if he is NOT, because the training is a HUGE component towards making this correct diagnosis AND treating it appropriately

From my doc's site: http://doclv.com/shoulder2/treat.asp
A non-operative treatment plan is often all that is necessary for most patients with impingement syndrome. However, the small percentage of patients whose symptoms have not improved after 6 months of dedicated physical therapy may be candidates for surgery. The shoulder should be reevaluated to make sure no other problems exist.
This has been plaguing me for 4 mos. and I have not been doing dedicated PT 100% during that time.
So, wouldn't it seem pre-mature to be a candidate for surgery at this juncture???

 

[mcs5309]

Find out if he is SPORTS MEDICINE FELLOWSHIP TRAINED, If your not sure PM his name to me and I'll be happy to find out fer ya mate.

Your wasting time if he is NOT, because the training is a HUGE component towards making this correct diagnosis AND treating it appropriately

Doc agreed about the impingement, but that the latest is that the docs are now trying to prevent surgery unless absolutely necessary and only failing all forms of PT first. He administered another Kenalog injection (last one was in Oct.) use cold compress, go more easy on lifting and check back in 8 weeks. We did discuss arthroscopic surgery in which he would remove part of the bone that compresses the bursa and that it would be an in-patient procedure and I'd be out of the clinic same day, and that PT would start right away, but not my lifting. Postponing the inevitable perhaps? You will probably thinks so. Perhaps getting a 2nd opinion would be in order.

 

[Dr JIM]

Oftentimes it's insurance companies which infer or mandate a trial of physical therapy is warranted, not surgeons.

What an oxymoron non-operative surgical intervention. I mean really surgeons operate.

Just being a little sarcastic, mate.

The difference between pen pushers and lifters is truly remarkable bio-mechanically. This is particularly true when it comes to impingement!

Why? Because essentially the only time sedentary folk significantly "load" their shoulders, allowing AC-Humeral narrowing, is when the arm is lifted ABOVE the horizontal plane .

However BB and lifters are constantly stressing their shoulders allowing ACH narrowing to occur.

Consequently, in the latter group IF the impingement is due the MECHANICAL NARROWING it won't matter how many of them damn exercises you perform the distance will remain relatively fixed and the only benefit achieved from the exercises is rest, reducing the inflammation, IME.

However once that shoulder rejoins your other "active gym mates" with AROM weight bearing the impingement will resurface (at least that's been my experience treating lifters, IN PARTICULAR, with this condition).

So yea for lifters, the delay and applying the "contemporary" non-operative crusade speak to all comers is a non-sequitur, IMO.

Kinda like treating all patients with high BP the same, NOT!

However it is possible nonoperative management will be effective in your case, so give it a go mate and do EXACTLY as directed by the physical therapist, they are a bright bunch collectively.

Best
JIM

 

[mcs5309]

Oftentimes it's insurance companies which infer or mandate a trial of physical therapy is warranted, not surgeons.

What an oxymoron non-operative surgical intervention. I mean really surgeons operate.

Just being a little sarcastic, mate.

The difference between pen pushers and lifters is truly remarkable bio-mechanically. This is particularly true when it comes to impingement!

Why? Because essentially the only time sedentary folk significantly "load" their shoulders, allowing AC-Humeral narrowing, is when the arm is lifted ABOVE the horizontal plane .

However BB and lifters are constantly stressing their shoulders allowing ACH narrowing to occur.

Consequently, in the latter group IF the impingement is due the MECHANICAL NARROWING it won't matter how many of them damn exercises you perform the distance will remain relatively fixed and the only benefit achieved from the exercises is rest, reducing the inflammation, IME.

However once that shoulder rejoins your other "active gym mates" with AROM weight bearing the impingement will resurface (at least that's been my experience treating lifters, IN PARTICULAR, with this condition).

So yea for lifters, the delay and applying the "contemporary" non-operative crusade speak to all comers is a non-sequitur, IMO.

Kinda like treating all patients with high BP the same, NOT!

However it is possible nonoperative management will be effective in your case, so give it a go mate and do EXACTLY as directed by the physical therapist, they are a bright bunch collectively.

Best
JIM

Thanks, makes sense what you're saying. It's almost like us lifters have to eventually be structurally "modified" in order to continue working our delts with presses, raises, and the like, as all movements to build up the delts are not really functional exercises for the norm in everyday life and mainly are for cosmetic purposes. It's the price we pay as lifters to achieve a certain look beyond "normal". In fact, the ART doc even joked about BBers, saying that "you guys are DMA's" (Display Model Only). His entire philosophy is to get me off of BBing exercises and into CrossFit type movements like headstand presses and using kettle bells.

My gut is that you're right; I will heal for a short time only to re-inflame the area when I'm back to working delts again. A viscous cycle.

 

[Dr JIM]

Give the exercises a go mate, you could be that uncommon outlier whom responds. I suspect it's worth a try regardless.

JIM

 

[mcs5309]

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.

Off topic, but I wanted to bring up the fact that there seems to be much debate over the relevance of free T vs. total T. One doc believes only in total. The other looks at both. Just curious - what are you basing your opinion on? Also, my levels fluctuate widely - from the mid 400s to usually mid 500s. This one's an anomaly. My first line of fire is to reduce SHBG as much as I can naturally and go from there.

 

[Dr JIM]

A 100ng/dl "fluctuation" is NOT at all unusual, primarily because of the MANY variables which contribute to the absolute AA level.

There really is no controversy mate since TT, fT SHBG BAT (bioavailable testosterone) are all relevant really.
Perhaps, some clarification would be helpful, though!

The point to remember is that ONLY FREE (AKA "UNKNOWN") HORMONES can participate in physiologic functioning and this instance, since the hormone is testosterone, that process is androgenic/anabolic activity.

The varied AA tests available are no more than a means to and ends, elucidating the metabolic contribution of a substance, (and correlating those "results" with a patients signs and symptoms), utilizing our limited methodology.

However in this particular instance the results are not so "cut and dry" or "black and white" and MUST be used as an adjunct to a individuals signs and symptoms. Nonetheless, since only fT is available for metabolic processes those factors which impact fT levels would influence said AA activity.

Consequently THREE factors determine fT values and include; TT, Albumin and SHBG. Ergo from a practical perspective it would seem, assays of any or all of these substance MAY BE useful, (on a case by case basis).

However for the majority of folks the fT level is determined by TWO primary factors; the TT level AND total testosterone bound to albumin!

Albumin is important because it attaches to testosterone quite loosely and is the PRIMARY METHOD by which fT levels are maintained on a SECOND to SECOND basis. Subsequently this association (Albumin-Test) is the means by which STEADY STATE FREE TESTOSTERONE LEVELS is maintained at roughly two percent.

Without albumin the testosterone peaks and valleys would be remarkable at the cellular-capillary junction. That is, while those muscle cells at the inception of a capillary path would have plenty of hormone for AA processes, those at the end could/would be denied the same advantage, the earlier cells having already "consumed" a considerable percentage of available androgen!

To separate fT from TT is simply illogical, because the correlation is direct and undeniable with fT being a PERCENTAGE of TT. Thus, as TT declines so does fT and as TT increases so does fT! Lastly, understand the corollary is not true, that is, fT has NO DIRECT or INDIRECT impact ON TT LEVELS, as some have suggested elsewhere.

However, from a physiologic perspective the most important determinant of
AA activity is the combined effects of FREE TESTOSTERONE and ALBUMIN-TESTOSTERONE which is called "BIOLOGICALLY ACTIVE" testosterone, rather than the more limited testing of fT, TT, SHBG, individually OR collectively.

Many people seem to overlook what a MINOR PLAYER SHBG is in those biologic events under the guise of AAS. That's because SHBG binds testosterone quite TIGHTLY and requires considerably higher (via "ligand interference") or very low (increased "equilibrium gradient") TT levels to forfeit (or not even bind) testosterone.

Consequently SHBG testing is more useful when TT approaches lower quartile values, (roughly 250ng/dl, + or - 100ng/dl) since a "high" level of SHBG will lower BAT even further. Moreover at mid and upper quartile TT levels SHBG testing adds LITTLE if anything, (and often confounds the patient's evaluation, IME) to the evaluation of "low T", since near SHBG saturation has often already occurred.

Hope this helps,
Time to watch "THE GAME" mate!

JIM

 

[Dr JIM]

Dagnabit! FOURTH line should read as;
.......ONLY FREE AKA ("UNBOUND" not "unknown") HORMONES.....

 

[mcs5309]

Give the exercises a go mate, you could be that uncommon outlier whom responds. I suspect it's worth a try regardless.

JIM

Update:
I do have shoulder impingement syndrome. Since starting this thread, I had 2 Kenalog injections which only helped to reduce the inflammation briefly. Since then, the pain just got progressively worse after workouts even though I tried to go lighter on press movements. I also have minor disc bulge and degeneration in one disc in my lower spine. You can view my MRI here: https://thinksteroids.com/community/threads/134340200
I feel tendonitis/bursitis in my elbow joint as well.
Since I had not tried an entire course of PT before, I decided to give it a shot for 6 weeks before resorting to the possibility of surgery. I just finished my first week of PT. I actually feel worse now, especially when waking. Ortho doc has suggested getting cortisone shots to the lower back to help reduce the inflammation during PT. I may need it and for the shoulder again.

I know you already made it clear about the surgery before, but I needed to give it one last shot. If after my 6 weeks of PT and no improvement, am I doomed if I don't have surgery?

On a side note, my doc has rx'd TRT and nandrolone (not for this, but because of my low free T), but haven't yet started. I also am looking into rhGH. I have seen many posts about it helping rebuilding collagen and for joint issues and have asked the ortho docs about HRT and they agree it will definitely help.

 

[GrumpyOldMan]

I was diagnosed with something similar recently, xray/ultra sound showed calcification, thickening of the capsule, bursitis and tendinitis. This snuck up on me slowly, starting with pain in the deltoid doing shoulder flys and then muscle soreness, weakness and severe loss of ROM. I had serious myalgia in both deltoids for a while just sitting on my ass. I don't have any arthritis in the shoulders, which is a miracle, since my back is full of it. I have it in both shoulders, but only the right showed any results on the xray. I've been to the 'sports doc' a few times and she prescribed physio. I also saw a rheumatologist for other reasons and he put me on voltaren, which hasn't seemed to do much. My ROM has improved, and the myalgia (muscle aches) has subsided, but it still hurts like a bitch to raise my arm above my shoulder, especially towards the outside of my body. Lifting any weight away from my body is painful, even putting the kettle on the stove causes pain in the deltoid. I was able to do some lifting when living on Ibuprofen, but that came to an end after a few days. So I haven't worked out much for months, even cardio bothers it due to the arm motion.

I know a doc who will give me a shot, but this sounds like a quick fix from what I read above. I'm supposed to see a physiatrist (osteo doc) but I'm not sure how much that will help.

I can relate to the frustration above, it's real piss off not being able to work out. I've probably lost 20 lbs since this started.

Any advice appreciated, especially on the causality.

Thanks.

 

[maizie]

A tendon is a band of fibrous tissue that connects muscle to bone and is responsible for transmitting forces (i.e. movement) and can sometimes act like springs. Tendonitis is when the tendon becomes inflamed and irritated. Commonly this is caused by repetitive motion and continuous overuse of a specific area and can occur at any joint (i.e. Wrist, elbow, knee, shoulder, ankle etc.). The aging process can also cause the tendon to lose its elasticity. If time and rest are not given, and overuse continues, tendinosis will develop. Tendinosis is when chronic cellular degeneration sets in and inflammation is gone. Some refer to it as 'chronic tendonitis'.

This is my treatment suggestion:

Treatment: First – Rest as much as possible to avoid re-injury. If caused by overuse, a change in habits may be necessary. Second - Cold therapy. Cold will reduce swelling and inflammation, and will relieve the associated pain. Third - Promote blood flow. Make sure the pain and swelling are gone before using the BFST®. Since Tendonitis causes your tendon to become inflamed, blood flow to the area is impaired. The BFST®, once the inflammation is brought down, will stimulate nutrient-rich blood to circulate to the area while you're at rest. This will not only help you heal at an accelerated rate, but will help you avoid re-injury or further injury.
http://www.kingbrand.com/Tendonitis-Treatment.php?REF=46PV10
http://www.kingbrand.com/Bursitis.php?REF=46PV34

 

[kjetil1234]

Strengthen all four rotator cuff muscles, and work on scapular stabilization (strengthen serratus anterior and low traps). Usually fixes it.

Could also be tightness in triceps, biceps, lats, pecs, coracobrachialis or teres major, pulling the humerus out of centration during movement.

Good luck mate.