bad shoulder impingement:can surgery be avoided with exercises to increase the space?

[jon gaper]

I originally injured my shoulder abducting it in a bike accident years ago I couldnt use the arm for 2 months,even to raise a beercan. Then it was totally fine for a few years. Injured it again in the gym with exercise,much less magnitude of injury,but 7 months before I could use it. Now it is 2 months after very little injury at all, and really cant use the arm.
Pain is max with anterior elevation.Cant sleep. Can barely even drive.Tried Aleve for a month with little effect. I have insurance,but really dont want surgery,but need to do something now.
I have tried some minor shoulder exercises just to try to keep it from freezing up, but even creeping my fingers up a wall to elevate the arm is very painful.
Just read here about using a chinup bar to hang and increase the space under the acromion. I can barely reach the bar ,but I would really make a major effort if anyone has had success with this.

[Tye 1on]

My PT was not overhead, but straight lateral using elastic bands- working the shoulders back and down, but my injury was super-minor compared to what you're up against. Good luck----

[creaky fossil]

not an MD here, and everyone's different, but --

around 1999 I had my right shoulder Dx'd as impingement, resulting from an awkward shoulder-hurting fall during college (circa 1982) that I never had examined.

I had a similar 2 mos+ period of shoulder uselessness back when originally hurt. the original injury was never Dx'd, I never did PT for it, I just avoided using it until ROM got to about 60-70% of pre-injury.

it got re-irritated when I was learning eskimo rolls in 1999. orthopod put me on PT regimen. wall crawls were part of routine. they were tough at first, painful and a feeling of impossibility even if pain weren't there.

today I can use the rt shoulder for anything but a pure overhead throw, I have to side-arm my throws. it just took time to get ROM back.

I did a lot of theraband work, some light weight training, the usual heat/cold therapy. ROM was slow to return.

[mfa81]

go see a doctor! the short answer is it depends!

I had some minir impingement from playing tennis few years ago that went away with PT, MRI showed partial tear

couple years ago crashed hard skiing and pain was back, did some PT but pain is still there if I push it too hard

I was that way for a couple months with pain, grab so stuff on a high cabinet, car backseat, stuff like that

did a lot of exercise with those rubber bands, but didn't fix 100%

doctor said it was my choice but did not recommended if I could live without doing some stuff like play tennis, rock climb

can mtb, can ski, so I'm good!

think you really need to spend some money and get mri if the pain is at that level, a complete tear would most likely need surgery!

[jma233]

I agree about seeing the doctor and the adage, 'it depends'.

There's also an adage about getting out of PT what you put into it.

The lateral exercises with a band were probably rotator cuff exercises. Difficult to do them correctly without professional instruction and necessary whether you have surgery or not. Your rotator cuff muscles become inhibited after most types of shoulder injury and will usually not fully recover without targeted training.

The wall-crawling range of motion exercises are targeting your other muscles which have a tendency to get very tight. They also address any scar tissue or adhesions that might develop. I think a lot of the pain associated with shoulder injuries has to do with the tight muscles you develop around the joint. After a significant injury your nervous system puts everything on 'lock-down' to protect the joint. It's an efficient strategy because very few of us manage to turn a partial thickness tear into a full thickness tear during this 'lock down' phase. If we manage to make the injury worse its almost always after we've gained back the range of motion (but not addressed the things that caused the partial tear or impingement/tendinitis to initially develop).

I say to always give PT a shot before surgery. After all, you'll be looking at 3-12 months of therapy if you elect to have surgery and going into surgery as strong as possible is never a bad thing. The exercises will be essentially the same whether pre or post surgery. However, the post surgery routine can progress very slowly.

As far as restoring space for an impingement, it is possible to do this with therapy. The keys are good shoulder mechanics, good posture, and a strong rotator cuff. The rotator cuff pulls the head of the humerous strongly into the socket during overhead activities....exactly what you want to prevent any additional damage. Its possible to have a strong cuff that is uncoordinated (ie: doesn't fire when it should). That's where working on mechanics is useful. Poor posture will physically constrict the subacromial space AND inhibit your rotator cuff due to affecting its length-tension relationship. It also has a profound affect on your shoulder mechanics. Poor posture is probably the number one root cause of these types of shoulder injuries and by far the hardest to fix (most are not able to).

[GoldMember]

Ditto on the PT first. I've had impingements for several years, both shoulders, with certain events aggravating them and disrupting my own routines. Most recent aggravation was a Type 2 AC joint separation one week after an avuncular fracture of the thumb on my other hand. The result was me not lifting weights for the past two years, up until about a month ago. I started again since my impingements were starting to cause me pain again.

Initial PT involved lateral resistance bands, ultrasonic and heat treatments for about a month. After that, it was just straight weights to keep the muscle toned around the joint. That has worked for me for 20 years, until I quit lifting as mentioned above. The orthopod who worked with me feels that keeping the strength up around the joint will cure most ills. I will never be a MLB pitcher or NFL qb but, for the stuff I do, I'm good to go without surgery.

[splat]

If you can't reach the overhead bar, find a round metal railing, grab it, then bend your back and knees and let your weight pull and stretch the a/c.

[jon gaper]

Thank you for all your good advice.You are all right.
Splat- one of the threads that interested me was yours: http://www.tetongravity.com/forums/s...ht=impingement
I started yesterday.
There was another from which I cant find right now from a guy who wrote a book on the pullup bar thing.
I just wondered if anyone had success with either of these.

And Splat:what about prolo? I would not do steroid in this location

[bl2000]

I would check into a TENS unit. Helped me a lot. YRMV

[TBS]

IANADr, but I've had major shoulder repair.

Advice -
1. Get a diagnosis from a real Dr. before doing rehab exercises. Every one of the exercises target a specific muscle in the cuff. You can create a muscle imbalance and worsen the impingement by aggravating existing scar tissue.

2. You may be able to get away with a cortisone shot regimen & some targeted PT, rather than surgery. My doc said surgery needed if >50% of muscle/tendon is torn or if labrum has a full-thickness tear.

3. Do not perform a triple-tomahawk-to-lawndart maneuver shortly after a cortisone injection.

4. The sooner you get a Dx, the sooner you will be healed.

[gonzo_lives]

Maybe this will help
http://www.kirschshoulder.com/Kirsch...r_Imaging.html

[jon gaper]

I originally injured my shoulder abducting it in a bike accident years ago I couldnt use the arm for 2 months,even to raise a beercan. Then it was totally fine for a few years. Injured it again in the gym with exercise,much less magnitude of injury,but 7 months before I could use it. Now it is 2 months after very little injury at all, and really cant use the arm.
Pain is max with anterior elevation.Cant sleep. Can barely even drive.Tried Aleve for a month with little effect. I have insurance,but really dont want surgery,but need to do something now.
I have tried some minor shoulder exercises just to try to keep it from freezing up, but even creeping my fingers up a wall to elevate the arm is very painful.
Just read here about using a chinup bar to hang and increase the space under the acromion. I can barely reach the bar ,but I would really make a major effort if anyone has had success with this.

2 months later...........Vastly improved but far from "normal". Almost normal range of motion,but last bit of forward elevation still somewhat painful and very weak.Could not do the hanging from the bar idea due to pain. Read a lot of books on diagnosis and treatment and youtube PT videos. Probably tore the supraspinatus to some degree. Will get an MRI if strength doesnt further improve over the next month.
No problem with skiing

[splat]

Sounds like most of my shoulder injuries because, when I have described the worst of them, I always remember I couldn't pick up a glass of water to drink for a year or more. But they have healed themselves. I feel like the bicep tendon tears and rotator cuff the doc said looked like hamburger in the mri have come back 87-93% or so in five years without surgery. My worst shoulder injury took 17 years to heal fully to where I didn't feel limited motion or pain.
I exacerbated that injury greatly by trying too hard to work it back into shape when it just needed to heal.

Have you looked for Strider's posts on shoulder injuries and self-healing elsewhere on the board? (I don't think there was a gimp forum then)
He was an ortho who wrote a book on shoulders and said hanging was the best self-treatment. I've been doing it for the last year and love it.