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View Full Version : Tricky rear shoulder/rotator cuff problem



Francine
21-01-2007, 04:55 PM
Hi Guys
Some of you may recognise my name from the osteitis pubis thread... unfortunately during the whole time i've had OP, i've also been stuggling with a very stubborn left shoulder.
For about the last 2 years, I have had an annoying muscle type pain in the back of my left shoulder - pretty much just under the rear deltoids, in the rotator cuff area. It is very pin-pointed in that area, just above the underarm - although sometimes I feel it move futher inwards (to on top of the scapula).
It was swimming induced and seemed to be an overuse thing because I dont ever remember as certatin "time" that it happened.. It was a gradual progression.
I have tried rest, massage, physio etc... (sometimes excessive rest due to my OP)... however it has NEVER gotton any better.
Now that I am starting to train for triathlons again, I am realising that it is quite a problem. I had an ultrasound on it, but it showed up absolutely nothing! Which I found quite odd. (X-rays also showed nothing).
It is quite painful to "prod" and hurts the most in the pull through phase of swimming, and also when i bring my arm out of the water.
Does anyone have any suggestions or had the same problem?

The guy who has successfully treated my OP is also treating my shoulder, however it is being much more stubborn :(
I was thinking a cortisone injection might be beneficial? Especially since there seemed to be no tear showing up on the ultrasound...

Look forward to some advice!
Francine

kjwilkin
21-01-2007, 08:47 PM
Hi Francine,

An ultrasound won't show much. You are better off having other types of scans.

Are you currently seeing a sports physician ? They can accurate diagnose your problem and order the appropriate scans. They can also refer you on as necessary. I know of some good sports medicine clinics and physicians in Melbourne, Canberra and London, UK. Let me know if you want the details.

I suffere from multi-directional instability in both shoulders and am currently waiting to see Greg Hoy for a second opinion on my shoulder. I've been doing conservative treatment for a couple of years now, but not getting very far. Although, I've been doing pilates and found that has really helped. I do it twice a week with physios and have my own program.

Let us know how you get on.

kjwilkin
21-01-2007, 08:48 PM
Hi Francine,

A ultrasound won't show much. You are better off having other types of scans.

Are you currently seeing a sports physician ? They can accurate diagnose your problem and order the appropriate scans. They can also refer you on as necessary. I know of some good sports medicine clinics and physicians in Melbourne, Canberra and London, UK. Let me know if you want the details.

I suffer from multi-directional instability in both shoulders and am currently waiting to see Greg Hoy for a second opinion on my shoulder. I've been doing conservative treatment for a couple of years now, but not getting very far. Although, I've been doing pilates and found that has really helped. I do it twice a week with physios and have my own program.

Let us know how you get on.

angieliu
21-01-2007, 08:52 PM
Hi Francine,

I agree with KJ, an ultrasound may not show too much and agree that you should see a sports physician. I waited two long after suffering two shoulder injuries and I should have in the first instance gone to get it properly checked out.

Take care of the shoulder and let us know how it all goes.

Francine
22-01-2007, 11:01 AM
Hey Guys
Thanks for the feedback. I did see a physician awhile back but obviously didn't help a whole lot!
I live in Melbourne so any names on people who specialise in shoulder problems would be great :)
Cheers
Francine

Nicholas
22-01-2007, 01:17 PM
Hi Francine,

An ultrasound won't show much. You are better off having other types of scans.

Are you currently seeing a sports physician ? They can accurate diagnose your problem and order the appropriate scans. They can also refer you on as necessary. I know of some good sports medicine clinics and physicians in Melbourne, Canberra and London, UK. Let me know if you want the details.

I suffere from multi-directional instability in both shoulders and am currently waiting to see Greg Hoy for a second opinion on my shoulder. I've been doing conservative treatment for a couple of years now, but not getting very far. Although, I've been doing pilates and found that has really helped. I do it twice a week with physios and have my own program.

Let us know how you get on.

Greg Hoy is probably the best out of the Melbourne shoulder surgeons but the problem is that he can be hard to get into!!!!!!!

jellybean
23-01-2007, 06:51 AM
Hey Guys
Thanks for the feedback. I did see a physician awhile back but obviously didn't help a whole lot!
I live in Melbourne so any names on people who specialise in shoulder problems would be great :)
Cheers
Francine

Hi Francine,

I completely agree with the advice given above. If physio is not helping (and it sounds like you've given it a good go), go and see a good sports physician, who's good with shoulders, to get a diagnosis and advice re the best treatment for your shoulder.

KJ always gives Andrew Jowett and Chris Bradshaw (Olympic Park Sports Medicine) good raps (and I've heard good things about them elsewhere). Apparently Andrew Jowett also has or has had shoulder problems. (Finding a good sports physician who has also experienced the same or similar problems is always a bonus).

Good luck. Let us kow how you go.

Cheers,

JB

Francine
23-01-2007, 01:11 PM
Thanks heaps guys, i'll get onto it and reply when I have some news :)
Cheers
Francine

kjwilkin
24-01-2007, 08:18 PM
Thanks heaps guys, i'll get onto it and reply when I have some news :)
Cheers
Francine

Hi Francine,

It's actually Chris Bradshaw that has shoulder problems himself. So, he knows how frustrating it can be.

I'd see a sports physician to start with. Chris Bradshaw, Andrew Jowett and Paul Blackman are great sports physicians at Olympic Park Sports Medicine Centre. The contact number is 9427 0366. Ian Macindoe is a great shoulder physio and is based at Olympic Park as well as Albert Park Sports Medicine Centre at the Melbourne Aquatic Centre.

Greg Hoy is a specialist shoulder surgeon. So is John Salmon. I'm scheduled to have surgery with John Salmon in early March for shoulder instability but am seeing Greg for a second opinion in mid February.

Good luck and let us know how you go !!!

sueyear
05-02-2007, 05:34 AM
After a car accident, I kept having rear shoulder pain. Two years of therapy, 3 chiropractor's, cortisone injections, A dozen or so sport doctor's, I was at last given an MRI. Well, the rotator tear was in back, where they "never" tear. I was in surgery within a week, and what was suppose to be just a few holes, turned into holes, a 4 inch scar, and three screws holding my rotator cuff together. Turned out I had only threads still holding it together, and the surgeon was amazed at the fact I had been using it and my "extreme" mobility. My mobility was the biggest "reason" the doctor's kept telling me there was nothing wrong, and kept sending me to therapy. So, do what you have to do to get an MRI of your shoulder. Even if it means paying for it yourself.

Francine
22-02-2007, 04:45 PM
Hey Guys - just a quick update.....

I went and saw Chris Bradshaw this week (OPSMC). I was right in calling this a "tricky" shoulder problem as there were a few possibilities it could be including suprascapular nerve entrapment and AC joint dysfunction. I have a tight posterior capsule as well..
Anyway, he injected my AC joint with cortisone and it alleviated quite a fair bit of my pain.. I am still sore at the end range of external rotation, however movement on a whole is much more pain free.
So, I am going to see him again next week and will have a few swims etc... to see how it goes. Fingers crossed as the next point of call will be nerve conduction tests which apparently are quite painful??

Will keep you updated,
Francine

kjwilkin
22-02-2007, 07:41 PM
Hey Guys - just a quick update.....

I went and saw Chris Bradshaw this week (OPSMC). I was right in calling this a "tricky" shoulder problem as there were a few possibilities it could be including suprascapular nerve entrapment and AC joint dysfunction. I have a tight posterior capsule as well..
Anyway, he injected my AC joint with cortisone and it alleviated quite a fair bit of my pain.. I am still sore at the end range of external rotation, however movement on a whole is much more pain free.
So, I am going to see him again next week and will have a few swims etc... to see how it goes. Fingers crossed as the next point of call will be nerve conduction tests which apparently are quite painful??

Will keep you updated,
Francine

Hi there,

I'm glad that Chris has been able to help you. He's my sports physician too. Over the last couple of years he's helped me a lot.

I've also got a tight capsule and found that both cortisone and hydrodilation injections really helped. It allowed me to do more of my pilates and shoulder exercises. My pilates instructors commented on what a difference it had made.

Chris referred me to Greg Hoy and am doing some more specific physio at the moment. I go back to see Greg in about 7 weeks. We will then make a decision whether to continue with physio or have surgery.

Let us know how you get on.

Francine
23-02-2007, 06:53 AM
I will for sure :)

I've just had my first post-cortisone swim and wasn't entirely happy.. i was still getting my rear shoulder pain (as well as bruising pain at the front from the injection!!).. It wasn't quite the miracle that I hoped for after the positive signs straight after the cortisone.. Anyway, will see what Chris says next week.

Good luck with the physio - hopefully surgery wont be an option :)

By the way, what exactly is a hydrodilation injection? Chris mentioned it but I didn't clarify it at the time...

kjwilkin
23-02-2007, 07:39 PM
I will for sure :)

I've just had my first post-cortisone swim and wasn't entirely happy.. i was still getting my rear shoulder pain (as well as bruising pain at the front from the injection!!).. It wasn't quite the miracle that I hoped for after the positive signs straight after the cortisone.. Anyway, will see what Chris says next week.

Good luck with the physio - hopefully surgery wont be an option :)

By the way, what exactly is a hydrodilation injection? Chris mentioned it but I didn't clarify it at the time...

Hopefully the next time you go for a swim your shoulder won't be too painful. It can take a couple of days for the cortisone to take full effect.

A hydro injection is under x-ray where they inject local anaesthetic, saline and some cortisone into your joint.

I haven't felt a change as yet in the physio. Still waiting for it to change.

Let us know what Chris says next week.

Mary
26-02-2007, 03:43 PM
Don't rely on Ultrasounds. Before I had my first lot of reconstructions last year, ultrasounds showed nothing - in fact the radiographer told me I had 'perfect shoulders!' I also had normal Xrays. It was only that my OS did thorough testing on me that we did the recons & lucky he did. He went in arthoscopically for both & found that I had a SLAP tear, torn the labrum, supraspinaus etc. Basically in his words "things were hanging that shouldn't". Don't always rely on tests. Sometimes the best test if everything proves 'normal' is to go in arthroscopically & have a real good look around. This is what saved me last week when all my tests that i've been having since June 06 kept coming back normal! No tests showed up the amount of inflammation in my shoulder joint that was caused from the anchors from the previous surgery - it was red raw! My advice go & see a good OS. I got to say I was getting really frustrated with mine - but if you want to travel to Brisbane, Dr Phillip Duke is one of the best I have ever been (& I've seen quite a few). I didnt' think so at first but there is a method behind his madness!

Good luck & let me know how you go

Mary

Francine
28-02-2007, 11:19 AM
Hey Guys

Just got back from seeing Chris Bradshaw again. In a nutshell, the cortisone injected into my AC joint has seemed to alleviate about 90% of my pain! It took awhile to kick in, but my last swim was very close to pain-free!
So basically the tightness in the posterior capsule was referring issues to my AC joint and causing the pain. He has now referred me to a physio for specific work on the problem areas. Fingers crossed the problem will be rectified and my pain will stay away!

Weird how the body works hey?! It seemed like a typical rotator cuff problem, but ended up being referred pain! Wish I had of got onto Chris 3 years ago!

Will keep you all posted on how the physio goes.

Cheers,
Francine

kjwilkin
28-02-2007, 07:37 PM
Hey Guys

Just got back from seeing Chris Bradshaw again. In a nutshell, the cortisone injected into my AC joint has seemed to alleviate about 90% of my pain! It took awhile to kick in, but my last swim was very close to pain-free!
So basically the tightness in the posterior capsule was referring issues to my AC joint and causing the pain. He has now referred me to a physio for specific work on the problem areas. Fingers crossed the problem will be rectified and my pain will stay away!

Weird how the body works hey?! It seemed like a typical rotator cuff problem, but ended up being referred pain! Wish I had of got onto Chris 3 years ago!

Will keep you all posted on how the physio goes.

Cheers,
Francine

Hi Francine,

That's great news !

Has Chris referred you to Ian Macindoe at OPSMC ? He's my physio and is fantastic with shoulders.

KJWILKIN

Francine
01-03-2007, 10:03 PM
Has Chris referred you to Ian Macindoe at OPSMC ? He's my physio and is fantastic with shoulders.

He certainly did :) I'm seeing him on Wednesday.

xonicjan
14-03-2007, 03:52 PM
Fingers crossed as the next point of call will be nerve conduction tests which apparently are quite painful??
Francine

Been there, done that and yes they hurt.

Especially when you have soreness on the tip of your shoulder and they wanna stick the needle in there :(

Good Luck.

Francine
15-03-2007, 09:45 AM
:(

so far i haven't been referred for that... which is a good thing!
basically i'm now doing a lot of scapula stability, upper back flexibility and rotator cuff strengthening... The thing I hate about that sort of rehab is it takes so long and you can't tell straight away if it will work or not! So frustrating....
So I guess if this doesn't help the problem, maybe it is nerve-related...:confused:

Anyway, will keep you all informed

Francine

Francine
15-03-2007, 09:47 AM
Oh - I forgot to mention that the cortisone wore off and it got sore again :(

i just wish they could keep injecting it! haha..... I would be a much happier little vegemite :P

kjwilkin
15-03-2007, 04:23 PM
Oh - I forgot to mention that the cortisone wore off and it got sore again :(

i just wish they could keep injecting it! haha..... I would be a much happier little vegemite :P

Hi Francine,

How are you getting on with Ian ?

Unfortunately my shoulder hasn't progressed that much. Started swimming which my shoulder can tolerate, which is good. Due to see Greg Hoy in 3 weeks. Will be interesting to see what he says.

Francine
15-03-2007, 05:16 PM
Ian was great - really thorough and went thru basically everything.
I'm just a bit disappointed because I had such good success with the cortisone into the AC joint, but once it wore off I was back to square 1. Ian thinks that even if there is AC joint issues, the biggest problem I have is scap stability... Which means all this slow rehab stuff.. I just dont have the time for a long-winded bout of rehab! I've just come back from about 1 year off with Osteitis Pubis (see thread!) so I just can't be bothered with all this!

It just seems really weird that there is such localised pain in in the rear of my shoulder (where I would expect pain from a rotator cuff to be) - which i've had for about 2-3 years now.. and it has never gotten horribly worse, nor has it got better. I just know that whenever I swim, it triggers it off.
And all I know is that the only thing that made it better was cortisone!!

Sorry - just having a "cbf" day :(

I guess you're probably frustrated too if it's not progressing as you would like..
Please keep me posted on what Greg Hoy has to say :) Hopefully he has some answers for you.

kjwilkin
15-03-2007, 08:18 PM
Ian was great - really thorough and went thru basically everything.
I'm just a bit disappointed because I had such good success with the cortisone into the AC joint, but once it wore off I was back to square 1. Ian thinks that even if there is AC joint issues, the biggest problem I have is scap stability... Which means all this slow rehab stuff.. I just dont have the time for a long-winded bout of rehab! I've just come back from about 1 year off with Osteitis Pubis (see thread!) so I just can't be bothered with all this!

It just seems really weird that there is such localised pain in in the rear of my shoulder (where I would expect pain from a rotator cuff to be) - which i've had for about 2-3 years now.. and it has never gotten horribly worse, nor has it got better. I just know that whenever I swim, it triggers it off.
And all I know is that the only thing that made it better was cortisone!!

Sorry - just having a "cbf" day :(

I guess you're probably frustrated too if it's not progressing as you would like..
Please keep me posted on what Greg Hoy has to say :) Hopefully he has some answers for you.

Hi Francine,

I know exactly how you feel at the moment. Are you still seeing Ian ? I'm seeing him about 2 times a week at the moment as my upper back gets really tight and it has to be released. Also see Chris a couple of times a week. He's been doing some work on my psoas which helps quite a bit with my shoulder too. Maybe you could ask Chris about that and the hydro injections. I've had a couple of them and made a real difference. The only problem is that they don't last at all.

It's count down until I see Greg Hoy now.

Have you tried swimming with hand paddles and flippers ? I can't swim without the hand paddles as it really flares up my shoulder.

Let us know how you are progressing.

KJWILKIN

angieliu
15-03-2007, 11:01 PM
Ian was great - really thorough and went thru basically everything.
I'm just a bit disappointed because I had such good success with the cortisone into the AC joint, but once it wore off I was back to square 1. Ian thinks that even if there is AC joint issues, the biggest problem I have is scap stability... Which means all this slow rehab stuff.. I just dont have the time for a long-winded bout of rehab! I've just come back from about 1 year off with Osteitis Pubis (see thread!) so I just can't be bothered with all this!

It just seems really weird that there is such localised pain in in the rear of my shoulder (where I would expect pain from a rotator cuff to be) - which i've had for about 2-3 years now.. and it has never gotten horribly worse, nor has it got better. I just know that whenever I swim, it triggers it off.
And all I know is that the only thing that made it better was cortisone!!

Sorry - just having a "cbf" day :(

I guess you're probably frustrated too if it's not progressing as you would like..
Please keep me posted on what Greg Hoy has to say :) Hopefully he has some answers for you.


Hi francine,

I'm sorry to hear that the cortisone treatments did not have a longer effect I guess that's the problem with them. They are only short term solutions. With my shoulder I have referred pain in my neck and it is very tense along with the muscles around the shoulder blade and rotator cuff.

To try to deal with this as it cause great pain I went to see a chinese traditional medicine acupuncturist and the treatment has been really good so far. What it does is increase the blood flow and also trues to dispell some of the blood which has been blocked. I also had cupping done, rather scary thought but it has worked. What it does is essentially help with the blood flow and if you have poor blood flow in one part of your shoulder you can see it as you bruise there.

Take care

Angie

Francine
03-04-2007, 10:57 AM
Hey guys,

Just had an MRI done and the results were as follows:
low grade tendinopathy of the supraspinatus and infraspinatus, and low grade bursitis of the subacromial subdeltoid bursa..

not 100% sure where i go from here as I haven't seen my doctor as yet - but will keep you all posted :)

it's sorta nice just to have a name for my pain!!

francine