Resources on Shoulder Injuries

I keep an ice pick near the bed. When my shoulder hurts so much it wakes me up, I jab the pick deep into my thigh to get my mind off the shoulder.

Amy,

I have been dealing w/a rotator cuff/labral tear for 6 months plus. I started working w/ Dr. McCarty last fall and he recommended PT over surgery. I went to Mapleton for rehab and faithfully did my exercises, but was still in pain like you describe.

I started going to Chris Wall at the BRC for MAT(muscle activation technique) and Dr. Jane Ray for acupuncture and chiropractic in December. Finally I am starting to see a light at the end of the injury tunnel. Both Chris and Dr. Ray have degrees in kinesiology. Both their work seems to be more finely targeted than that of the PTs I've worked with (with the exception of Laurie Sage). Pain began to subside once I began the more targeted exercises. Also I have not engaged in any activities that induced pain, so no climbing, hard biking, yoga, lifting, etc. I opted not to use cortisone.

Chris just created a gimp workout for me and I am feeling no deep joint pain in the shoulder. I'm still a month or two out from climbing, if all continues to go well. Don't give up on your bodies healing process too quickly.

Best of luck.

Thanks David for the good info. A few more questions for you. Did Dr. McCarty say you weren't a candidate for surgery or just that he wanted you to try PT first? It seems like they make everyone go through the motions of trying PT for an extended period but many still opt for the surgery. I know it makes sense to strengthen the shoulder regardless because you will still need it to be strong to get through surgery.

I have heard of Chris Wall and MAT as a few friends have worked with him. I'm not a member of BRC but maybe I could still get into to see him?I have worked with my PT Sue Nakaoka at Mapleton for years and she is quite good but who knows. I'm going to her for trigger point dry needling which feels great after but doesn't last long enough. I guess after two hip surgeries I still have the feeling that when the joint is dysfunctional its very difficult to change the soft tissue mechanics around the joint without getting to the core of the problem. Maybe the shoulder is different though.

I am still convinced that if I could get the inflammation down in my shoulder than doing the exercises would not be so difficult but right now there is so much fluid and inflammation in there that the theraband exercises just aggravate it more. I wouldn't be opting for cortisone but being pregnant has meant I really need some pain control and I cannot take NSAIDs at all now that I am in my third trimester. I just feel like my shoulder is getting more and more dysfunctional as the days go by -- my scapula is starting to pull awkwardly, I have pain down my biceps and any kind of movement at all seems to bother it. If it were just a matter of resting it completely than I would gladly do that but even when I go 5 days with barely moving it my shoulder still aches randomly and seems to flare up for no apparent reason.

Damn, this couldn't be less convenient with a new baby on the way. I don't know how I managed to pick the most incompatible sports injury for having an infant!! What great luck.

Thanks again for the tips. I will try to get in with Chris Wall for some gimp exercises.

Amy, I could be wrong but if you are having that much pain then you have something else going on. Living a lot of years with a torn labrum, I never really ever had pain. What I was told is that the pain is usually tendonitis or a torn or partially torn ligament, muscle, or tendon.

The same is true with the shoulder as with the hip. The rehad is geared towards strengthening the shoulder so as not to depend on the hurt part of the shoulder. The rehab business loves this approach because you become a patient for life. Granted once you learn the exercises you can do all of them at home.

I always found that if I rested my shoulder after an injury it tended to take longer to get back to felling normal. I tried to start doing range of motion exercises within a few days of the occurrence. If you put yourself in a sling for a few weeks, it will freeze up. Then you have to work through that which can be painful.

I am not sure what to tell you about the inflammation issues. It might have something to do with the pregnancy. Although, that is a red flag to me that there is probably something more serious going on.

I had two MRI and CAT done in the last 6 months and they all missed the seriousness of my bone loss. They went in to do a simple surgery to fix the labrum on Dec 28th and backed out of the surgery when they saw firsthand what the damage looked like inside my shoulder. That is one of the main reason I am now, more than ever, an advocate for finding a good surgeon that will go into the shoulder to take a look if it does not feel right after a certain amount of time, maybe 6 months. Granted being pregnant means you will probably need to wait.

Thanks Josh for your suggestions. I too am baffled by the amount of pain I'm having for a supposed small labral tear. I do also have a partial tear of the supraspinatus tendon but it really doesn't seem to be the source of my pain -- I can't ellicit any real pain from raising my arm and it doesn't seem overly weak. The pain really seems to be coming from the joint -- its the classic dull sometimes throbbing, burning ache. It is quite possible to have a labral tear in your hip or shoulder for years that is not symptomatic and then you injure it and it can hurt like a bitch so who knows. Usually - but not always - muscle/tendon pain doesn't bother you much at rest.

I do agree that immobilizing any major joint only seems to create further problems that require a longer recovery. Case in point: my first hip surgery I was on crutches for 5 weeks and it took me months to recover the loss of strength and function. My second surgery was more extensive but the surgeon had me off crutches in 4 days and by being forced to use my own body weight and get the joint moving again I was dramatically better in only a short period of time. That is why the whole idea of being in a sling for 6 weeks seems counterintuitive.

Oh where to begin. I'm another climber with shoulder injury. I've been treating it for a year now. I started with eStim and ultrasound from my chiropractic along with rest, NSAIDs and icing. I switched my work and home mouses to the uninvolved side. I did 5 weeks of PT on Dr. McCarty's recommendation. I got a little relief of the sharp pain I'd get reaching out or across my torso (I could then actually fasten my seat belt with my right hand). I started the RTC exercises we all know in May, continued religiously through the summer. I plateaued in my healing, still having plenty of pain and loss of range of motion. My PT recommended that I get an MRI to find out what exactly is wrong inside my shoulder. This list is long BUT no tears. Lots of inflammation, definitely impingement, and some miscellaneous other things that may be just be age and wear related.

I stopped climbing when I got the MRI results mid October, got two cortisone shots (ultrasound guided) into the joint and bursa in late November and immediately started 7 more weeks of PT. Still continuing the exercises every day.

I do not think the shots did anything for me. I was told that biomechanically I've come a long way, even if I experience a lot of pain in my daily life. Right now, I feel like I am no better than last October.

I can echo the sentiments about the night pain, the dull/burning ache that goes down the arm ("referred pain"), the random pain etc. etc. I am at the point of considering some experimental treatment and having a surgeon arthoscopically diagnosis my shoulder. I should be better after a year, given everything I've read. I could have recovered from surgery faster and be back to climbing in my opinion!

I wanted to suggest to the OP to look for exercises on the Thera Band website. Zero in on the shoulder and back ones; they are the ones you'd pay a PT to tell you about!

I wanted also to mention the bit of relief I've gotten wrt the referred pain. I was told by the PT that it can be caused by a nerve being pinched in the shoulder (due to impingement/misalignment); the PT and separately, a massage therapist, did adjustments to my neck and shoulder and I got some relief.

I'm going to the ortho doc this Friday for a post PT/shots follow up. I'm going to try to be nice but I've flat out lost patience after doing my best for a year. All I have is a lighter wallet.

Good luck everyone!

usually with these injuries, you kind of want to avoid bench press and overhead press exercises. these muscles tend to be more overdeveloped and pull your shoulders forward. i used to do a lot of pushups, and i think it helped my elbows, but not so much my shoulders.

i'm not sure what i would do different, other than do a lot more of the rotator cuff sorts of exercises and stretch more. but that's probably what everybody would say.

Hi Amy, Dr. McCarty urged me to go the rehab route, and said surgery was an option but that the prognosis was about the same either way. My MRI revealed 2 minor tears in the labrum, bursitis, and impingement due to the inflammation. He indicated that recovery would take about the same amount of time either way.

Chris will work with anyone, just call the BRC to schedule. He does a round of muscle testing to see what is working properly and what isn't. He will "massage" those muscles that aren't and then retest. (massage is used loosely. He will work the length of the muscle and this can be quit painful at times). He will then send you home w/exercises targeting specific muscles. These are not like general PT exercises, each is a very precise isometric action used to activate the muscle.

From what you've said, your injury is very recent. I found that it took a lot of work to get the inflammation under control. I did ice and then ice/heat contrast for weeks. I used topical analgesics both allopathic and homeopathic. The theraband aggravated my shoulder as well, I think due to instability at the sternocalvicular joint from a tear to the ligament there. The PTs were just filing the prescription to strengthen the rotator cuff and not treating all the symptoms.

Chris and Dr. Ray are the practitioners that really helped set me on the road to recovery ( still a ways off). I have worked with some great PTs at Mapleton, but one has gone far beyond simply filling the Dr's orders. Laurie Sage is a PT I worked with who did have a more holistic approach and i really wish I'd gone to her w/Dr. McCarty's oders instead of BCSM.

Best wishes for your recovery and your baby.

JLP wrote:These injuries sound horrible. What would you people w/ injuries do different? How did the injury occur? Before the injury, were you strong in the non-climbing motions - bench and overhead press, dips - and all the other exercises the PT wants you to do?

My impingement occured when my back/shoulder weakness was challenged by harder grades in the gym, in particular climbing on an overhang. I was definitely overreaching and pulling from an extended, weak position with the involved side. No problems up to that point climbing indoors or outdoors. Sitting at a computer all day in addition to lacking a good strength training program was a disaster waiting to happen. Big lesson learned! I never want to be back here again.

David Rivers wrote:I found that it took a lot of work to get the inflammation under control. I did ice and then ice/heat contrast for weeks. I used topical analgesics both allopathic and homeopathic. The theraband aggravated my shoulder as well, I think due to instability at the sternocalvicular joint from a tear to the ligament there. The PTs were just filing the prescription to strengthen the rotator cuff and not treating all the symptoms.

This is worrisome to me. I've done everything you talk about and continue to do exercises with Therabands. Nothing so far has done anything to change the level of inflammation. I'm probably constantly irritating my shoulder simply because the inflammation continues to cause impingement.

Don't laugh but I'm going to spend my weekend reading a PT text book called The Athlete's Shoulder to see what different information I can gather.

I currently also have a torn labrum from a ski wreck (going on 8 weeks now). I won't go to surgery except as a last resort, so here is my current plan, which seems to be working:
1. Do a bunch of superlight shoulder exercises on a daily basis (you should go to a good physical therapist to have these exercises set up for you).
2. Go cross country skiing about 2-3 times a week.
3. Go tele skiing about once a week, but don't crash if you can avoid it! It hurts like hell...

I think the main thing is that you have to keep it moving in order to heal it, but you don't want to overdo it to the point of inflaming everything in the shoulder or retearing stuff. I have quit climbing for the time being, hopefully will get back into it by spring.

The problem is a lack of blood flow into the area of the labrum, so it takes a long time to heal. I am told the non-surgical rehab can take months...good news is that the pain is no longer constant and I am sleeping all through the night now...

Wow, I wish I could still cross-country ski that much...even though that is what got me into this mess in the first place! (slipped when I was skate skiing on some ice and landed on my shoulder). I think the repetitive motion from poling would flare up my shoulder too much. When I went back-country skiing (telemark) a few weeks ago I had my bad arm by my side the entire 2 hour skin uphill and just put my pole in my backpack until I needed it on the way down.

The labrum will never actually heal - it is avascular. It is possible that once the inflammation goes down and the muscles around the joint have a chance to heal that the symptoms may diminish with time.

Lots of great info on here. Thanks for all the tips and recommendations for PTs, therapists in Boulder. I have an appointment with Chris Wall next week so I will hopefully start the MAT techniques as soon as I can. Even resting it as much as I have been doing (I'm essentially only stationary biking and hiking 3 times a week with plenty of rest in between) and icing don't seem to be getting the inflammation down so I have to hope that maybe some targeted muscle work will help to at least get the joint moving again properly which typically aids in reducing inflammation. The worst pain I ever experienced was after my first hip surgeon put me on modified bed rest for a month to see if my hip would improve post-op...all the inflammation just seemed to accumulate and go nowhere so I am never a proponent of total rest for more than 2 weeks or so.

E Johnson, if you have tried to manage/treat your injury conservatively for a year and have seen no real improvement than I would suggest seeing a surgeon as you said - a year is plenty of time to see some level of improvement even for a major injury. It has taken me more than a year to recover from other surgeries but I was seeing improvement at around 5-6 months. I know surgery is a last resort but in truth there are some cases where the mechanics of the joint just aren't going to change enough to allow for consistent activity and for the symptoms to go away. If you can live with the loss of function that is one thing but if it means you can't do what you want to be doing activity-wise than you may as well take the risk. In that instance, surgery is the next step. I am sure that at least you will be stronger going into your surgery from all the PT you have done.

I guess I have my work and my timeline cut out for me regardless of what I would like it to be. I am due in May so I will have to keep doing the PT until then and if I have no marked improvement I guess I will consider surgery sometime in mid-summer. I have no idea how I will manage a sling and being unable to carry my child for an extended period but I will have to come up with something because living in pain is equally debilitating.

Part of the mental part of dealing with a major injury is just accepting that it is an enormous task and that you can't change that it happened and can only change how you approach the situation. It has taken me years to figure out that one.

another thing I just realized I am doing: listening to tons of Nirvana, Pearl Jam, and Soundgarden...

Apparently I am trying to convince myself that I am still in my 20s.

and no, I guess it never really heals - basically you hope to build up some scar tissue to the point that it all holds together in some form or fashion...

E Johnson,
One other question -- who did your ultra-sound guided injections? I am still convinced that I should get one into the joint that is guided b/c even the best surgeons think they get it in the right spot but often don't unless its guided. I have had huge luck with cortisone in the past (one shot lasted me about 3 months and even when it did start to wear off the inflammation was never as bad). Did they do it for you at BCSM?

Thanks.

Amy Stengel wrote:E Johnson, One other question -- who did your ultra-sound guided injections? I am still convinced that I should get one into the joint that is guided b/c even the best surgeons think they get it in the right spot but often don't unless its guided. I have had huge luck with cortisone in the past (one shot lasted me about 3 months and even when it did start to wear off the inflammation was never as bad). Did they do it for you at BCSM? Thanks.

Dr. Jason Glowney at BCSM. I had to specifically request and it cost about double to get it. But I had read studies that showed even in expert hands they often missed their target when giving cortisone shots w/o guidance (ultrasound or one other method which escapes me). Sounds like we've read the same study! I was adverse 3/4s of 2010 to getting the shots but when I did, I'd decided a) it was the next step and b) I should get it done right.

Best of luck!

Thanks. I appreciate the info on Dr. Glowney. I am hoping to get in asap. As much as I don't like/want to rely on cortisone, at this point I can't take NSAIDs or even use topical anti-inflammatories and I really need to do something to help get the swelling down enough to start the exercises. My shoulder joint seems to be getting more and more dysfunctional with each passing day. I tried to jog a little this morning and that was a bad idea.

My shoulder problem is different, but McCarty's advice was not consistent with the surgeon I ended up trusting to surgerize my shoulder who stated it would have been a lot better to do the surgery earlier.

I got the same line from McCarty to stengthen prior to deciding on surgery and in the process he gave me cortisone injections. The shoulder did not get better specifically from the treatment.

It is a jungle out there when it comes to deciding on medical care.

Ben ,
What is the process for getting an appointment with Millet? I read through your other posts and it sounds like he is possibly more progressive than some surgeons in that he doesn't think one should be bound in a sling for 8 weeks post-op. This makes a lot of sense to me as I've only had problems with restricted mobility after surgery. Is it typically a 3 month wait to get in to see him in Vail? I know that for the hip surgeon at Steadman (Marc Phillipon) can be upwards of 3 or 4 months just to have him review your MRI before he even decides if you are a surgical candidate. I'd just like to get up there and see Millet for a second opinion. Anyone heard anything about Dr. Tom Hackett at Steadman? He supposedly also does shoulders.
Thanks.

Amy Stengel wrote:Ben , What is the process for getting an appointment with Millet? I read through your other posts and it sounds like he is possibly more progressive than some surgeons in that he doesn't think one should be bound in a sling for 8 weeks post-op. This makes a lot of sense to me as I've only had problems with restricted mobility after surgery. Is it typically a 3 month wait to get in to see him in Vail? I know that for the hip surgeon at Steadman (Marc Phillipon) can be upwards of 3 or 4 months just to have him review your MRI before he even decides if you are a surgical candidate. I'd just like to get up there and see Millet for a second opinion. Anyone heard anything about Dr. Tom Hackett at Steadman? He supposedly also does shoulders. Thanks.

I initially got in to see Millet quite quickly, but it was a wait for surgery, not because of his schedule, but my work commitments. A phone call to the Vail clinic would get you a quick answer.

Hackett came highly recommended as well by a number of people when I was shopping.

All, thanks for your insight and stories. In 2002 I tore the labrum in my left shoulder and had arthroscopic surgery to repair the tear. The recovery was challenging and post recovery I tore the long head of my biceps tendon in the same arm. Much to my dismay, I was recently diagnosed with a lengthy SLAP tear in my right shoulder (the good one) due to slip in the climbing gym. I am trying to avoid surgery this go round and was wondering if anyone out there has been diagnosed with a torn labrum and avoided surgery through PT. Specifically, have you been able to get back to climbing at your pre-injury levels. Thanks.