Disrupted scapulohumeral rhythm (right shoulder pain)

[lickitungg]

Hi everyone,

I have been suffering from right shoulder pain for 8 months now.
Injured it somehow while benchpressing or overhead pressing (no particular acute event that I could remember).
Pain is anterior, dull with not clear spot that you can touch to elicit tenderness and there is some annoying feeling in my shoulder when I raise my arms overhead.
Strength is not compromised at all.
I can bench full strength but a few hours later and the next days there is annoying inflammatory pain that arises in the area.

I rested my shoulder during the pandemic but right after I got back into regular lifting, pain resurfaced and persisted, suggesting a friction process re-igniting inflammation. I saw a shoulder specialist and had an MRI. MRI only shows supraspinatus tendinosis. No tears. No cartilage damage. No obvious labral tear. An x-ray did not show any major acromion abnormalities.

I saw a PT this week and she immediately recognized that I have a problem with my right scapula. She said that my muscles below the scapula are clearly atrophic and she can see that my scapulohumeral rhythm is very disrupted on the right side where I have pain. I found articles suggesting that when you have RC pathology, you get stuck into a circle where disruption of the rhythm gets worse and feeds the impingement process. Instead of having a smooth scapular rotation during overhead movements, the scapula separates rapidly and excessively from the ribcage and causes impingement on the RC muscles.

She gave me a set of exercises to strengthen all the muscles around the scapula (lower traps, rhomboids and serratus). The goal is to bring back that scapula down and pinned onto the ribcage.

She said that building these small muscles will take time and that I need at least 6 weeks to feel any difference. By that time, hopefully the subacromial space will be larger and the supraspinatus tendon better healed. In the meantime, no benching, no overhead pressing, nothing above shoulder height.

I told her that during the months preceding my injury I was obsessed with shoulder and chest exercises. I ignored my back and might have created and anterior-posterior imbalance which led to injury. She agreed and said that my posture and my constant work on keyboard during the day also leads to back muscle weakness.

Has anybody been into such a scenario? How did exercises go? Is there light at the end of the tunnel?
I really would like to go back to benching without pain.

Thanks

 

[Jin]

Wish POB were here. He would know what to do.

Sorry man, way out of my knowledge base.

 

[dk8594]

I can't tell you if I had the exact same things since I never had a clinical diagnosis, but I had something very similar in regards to pain in my right shoulder due to postural issues. In addition to the exercises your PT gave you, I would also suggest stretching the pecs and anterior delts. The door stretch (where you stand in a doorway and stretch your pecs that way) is a staple, but I've also found hanging from a pullup to be a good addition as it hits the pectoral minor. My guess is that you'll feel both stretches more on your right side.

You may also want to talk to your PT about wall slides (https://www.youtube.com/watch?v=AEbcmAYbOkI) If you find them too difficult to do against the wall you can regress them by doing them on the floor and using gravity to assist you in getting your elbows flat.

 

[CJ]

You could also just have a hooked end to your acromion, which doesn't allow enough space in the joint when going overhead, no matter how much scapula rotation you can get.

Has that possibility been looked at? It's pretty common. In fact, the gf had a quick outpatient surgery for it, they basically shaved off the end, creating more room. It fixed her issue.

https://www.academyofclinicalmassag...ked acromion is a,that lie under the acromion.

Insurance companies are assholes though. They'd rather send you to 100 physical therapists, all saying different things, than pay for the proper imaging to find the real issue. They hope that you just give up. It took TWO YEARS of that nonsense before my gf's insurance company would finally approve to perform the surgery, in fact she paid for her own MRI to get it done.

 

[lickitungg]

I can't tell you if I had the exact same things since I never had a clinical diagnosis, but I had something very similar in regards to pain in my right shoulder due to postural issues. In addition to the exercises your PT gave you, I would also suggest stretching the pecs and anterior delts. The door stretch (where you stand in a doorway and stretch your pecs that way) is a staple, but I've also found hanging from a pullup to be a good addition as it hits the pectoral minor. My guess is that you'll feel both stretches more on your right side.

You may also want to talk to your PT about wall slides (youtube.com/watch?v=AEbcmAYbOkI) If you find them too difficult to do against the wall you can regress them
by doing them on the floor and using gravity to assist you in getting your elbows flat.

Thank you.
My PT actually recommended I do door stretches. I have pain in my pec minor area which could be secondary to the whole disrupted biomechanics of my shoulder.
How long did it take you to become pain-free and return to benching?

 

[lickitungg]

You could also just have a hooked end to your acromion, which doesn't allow enough space in the joint when going overhead, no matter how much scapula rotation you can get.

Has that possibility been looked at? It's pretty common. In fact, the gf had a quick outpatient surgery for it, they basically shaved off the end, creating more room. It fixed her issue.

Insurance companies are assholes though. They'd rather send you to 100 physical therapists, all saying different things, than pay for the proper imaging to find the real issue. They hope that you just give up. It took TWO YEARS of that nonsense before my gf's insurance company would finally approve to perform the surgery, in fact she paid for her own MRI to get it done.

My x-ray does not show any acromion abnormalities. My MRI is not impressive. Just some tendinosis. This is why we're leaning towards a functional and positional impingement syndrome that is caused by the disrupted scapulohumeral rhythm and not a fixed anatomical abnormality. I hope that strengthening the periscapular muscles will solve the problem.

 

[dk8594]

Like you, I spend 8+ hours a day at a computer “training “ myself in bad posture so the PT is not something that I will ever be completely done with. I would say after 3-4 months of religious PT and working with a rehab focused massage therapist I could train normally again, but can’t speak specific to benching as it has never been a staple for me.

 

[lickitungg]

Like you, I spend 8+ hours a day at a computer “training “ myself in bad posture so the PT is not something that I will ever be completely done with. I would say after 3-4 months of religious PT and working with a rehab focused massage therapist I could train normally again, but can’t speak specific to benching as it has never been a staple for me.

What were the exercises that used to exacerbate your shoulder pain at the gym? Did you stop them for 6-8 weeks then started back with baby steps?
Thank you

 

[dk8594]

Anything that used my anterior delts. I would do exercises with extremely light weight to keep the mobility and movement patterns , but didn’t start reloading them for 2 months and then it was very slowly. You’ll have to listen to your body, but I would plan to focus on back and legs for awhile.