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Tendinitis....... Shoulder or Bicep?
I'm hoping this is what I have and not a tear or something. But how can I determine if I have tendinitis in the upper bicep or shoulder/rotator cuff? Thanks
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This is a very complicated joint due to the many motions its responsible for. It could even stem from a problem from the neck and shoulder blade region which eventually goes through the shoulder and down toward the bicep. Great question and hopefully an expect can answer this............
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My opinion it is always due to the shoulder muscles.
http://www.mypressureproducts.com/pa...ence_chart.htm Get a hard rubber ball (lacrosse ball) and start rubbing the shoulder and neck trigger points against a wall. The will be sore to the touch but within a week will loosen up along with the shoulder. |
Curtis76
The long head of biceps runs beneath the rotaor cuff then down the front of the shoulder where it joins the biceps belly Biciptial tendinitis is felt in the front of the shoulder. If yoy roll your fingers across the front of the shoulder you can feel the tendon. Put your elbow at your side and your forearm out in front. Now flex and extend your elbow. Try turning your forearm on its axis (pronation/supination). Pian felyt anteriorly with these actions is often bicipital in nature. Rotator cuff tendinitis is felt over the outer shoulder and upper arm. Typically it is hard to sleep on the side at night. Place your arm straight by your side and raise it sideways in an arc above your head. If you have pain as the arm goes through horizontal this is typical of rotator cuff pathology. Weakness can mean a cuff tear. Exercise can help both these conditions (but cannot repair a tear) and Im sure Vickii will have some advice re these. Remember if in doubt or you are getting worse see a doctor. If it is your right arm beware that cardiac pain can refer to the right shoulder so if you have a cardiac history, any chest tightness or jaw pain call an ambulance! |
I assume it's tendenitis since it went away and then came back. I would think a tear would be constant.:???:
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Besides rest and ice, anything else I can do?
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Curtisj76,
Rest and ice are fine and probably a little Advil/Aleve may help with the pain. The gentleman posting as Julian is an orthopedic surgeon in New Zealand (you've been "outed" Julian!). He has given you the proper advice. One thing I might reiterate is the pain felt at night while sleeping is classic for rotator cuff problems. I see this a lot in my practice (I'm a family practice doc) and my wife has had both of her rotator cuffs repaired. The thing she complained about both times was minor problems during the day but couldn't sleep at night--and as a result I didn't sleep well either! Did you do the tests Dr Julian suggested??? What were your results?? I'm sure when Vickie and/or Physioguy find this thread they can help you with some exercises/rehab. Hope you get this solved soon---the warm weather is on its way! Dr Dave |
This is a great Thread. I too have this problem. But it stemmed from an accident 20 years ago. I was riding a motrocycle about 20 miles an hour and this lady comes out from between two cars. I brace and lock my arms straight holding the handle bars as her legs hit my engine and then her body side swipes my right shoulder. I didn't fall but she spent a week in the hospital:( . That same day I started to feel a tired shoulder when I washed my hair. Never got it checked out. But years later went to a chiropractor. He said that the pain in my neck through my shoulder and into my bicep stemmed from the shoulder blade. Sometime my shoulder feels fine but at times I can't bench press or do chest flys. Cab someone help???....thanks r[-o<
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Yea, shoulders are a tricky subject since there can be so many potential and complimentary problems. Julian is right as Dr. Dave encouraged you to try his tests. It will atleast give you a direction. I have found a common cause of shoulder pain whether it winds up being rotator cuff or bicipial in nature. It is a weakness in the lower trapezius muscle that allows for faulty shoulder position. When your scapula rides up (you will see with rounded shoulders) it also tilts anteriorly allowing the Pectoralis minor to shorten and perpetuate the problem. I recommend doing a strength training program with more emphasis on the full range of motion in proper position than on the quantity of weight. This is often tricky since I usually see people doing a butterfly exercise by opening their arms but not the chest. Take your mind to the muscle you are working and you will feel the chest opening and expanding and the arms just serve the process. Likewise a cable lat pull down is often pulled with the biceps minimizing the power you bring to the large lat muscle. Any time you do an exercise or a stretch, take a minute and engage (tense) the muscle you are focused on and then let your extremities follow the pathway.
I would refer you back to an earlier thread with Martee where a number of exercises are listed in detail. He had great results and you can too. Just bring you mind to your muscles and enjoy freedom from pain. Remember, consistency is the secret. Vickie |
Thanks Vicki,my Chiro just gave me ultra sound on my shoulder.As he was applying the sound, he hit a nerve so to apeak and I felt a pain from my neck through my shoulder to my forearm.That whole area became weak............
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Ultra sound can be very effective and very illuminating. Now you have a sense of the nerve pathway that being impacted. It sounds like you have a good doctor. Hope you heal fast. Vik
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Some great replies in this thread. Hopefully you have received a diagnosis.
I will piggy back on Vickie's comments. I have an interest in shoulders (having dislocated my own a few years back), and what I commonly see is that the shoulder blade gets "out of synch" with the arm. The shoulder blade relies heavily on the musculature around it, as its only connection to the skeleton is at the sternum, through the collar bone. What I tend to see is significant tightness around the shoulders, typically involving the pecs, lats, and one of the rotator cuff muscles (subscapularis), and often weakness of the muscles between the shoulder blades. To make matters worse, there is commonly poor posture, associated with a head-forward carriage, and rounded forward shoulder girdles. This is more common than you may think. What then happens is that the shoulder blade doesn't rotate in synch with the upper arm, particularly with overhead and elevation movements. When this happens, you can often get a pinching (impingement) of the shoulder rotator cuff muscles. I shouldn't neglect to mention that a fully functioning shoulder requires decent mobility of the upper thoracic spinal (upper back) segments, and this is another area that gets quite stiff. Like most injuries, once it has settled down, proper rehabilitation should include stabilization exercises. Stabilization is simply the ability to control whatever mobility you have. From what I mentioned above, the first thing I usually work on is mobility of the shoulder girdle muscles. As the mobility comes, you strengthen/stabilize it with appropriate exercise. |
curtisj76, Why don't you describe your symptoms a little more thoroughly. Describe when you have the pain and try to pin point the area. Describe the pain. How long did it last? You know, just expound on it a little and maybe we can all help refine the process. If you're so inclined. Vik
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Hi Vickie, the pain is in the front of my shoulder. Normally occurs when I lift my arm up. I haven't lifted or anything in almost 2 weeks and I still notice this. It does seem to show up here and there - not constant. I haven't been icing or anything, I was hoping it would just go away with rest. Any help would be appreciated. Thanks a lot!!
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Curtis, I hate to be so picky but is the pain close to the bony ridge of your shoulder or lower on your arm? How far down does the pain radiate? How's your posture? Do other positions with your arm (out to the side, elbow pulled back around behind you) create discomfort? Does the pain increase if you have something weighted in your hand? Did you get those exercises. I know you said you'd been letting it rest, and that's appropriate but it's time to start working on this problem. Like you didn't already know that. Vickie
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Hi Vickie, I apologize for not responding sooner. I've switched jobs and have a newborn. It's been about a month since I stopped exercising and the pain is going away. I've noticed the decrease for the last 7 days or so. It still feels a little different put there's not much pain. I want to get this corrected and make sure this NEVER happens again. I'm 29 and live an active lifestyle. I've worked out/golfed/sports etc. off and on my entire life. This is the first time that an injury has sidelined me from being active. I just went out and bought 3 workout bands to strengthen my shoulder area. I also have everything you could imagine in my basement as far as working out(Eliptical, free weights, power rack, lat pulldown, cables, etc.). So I should be able to do whatever you want me to do at home. The posture question really has me intrigued. I do have somewhat rounded shoulders and a forward leaning neck. I'm ready to get this corrected and follow your instructions. I LOVE working out and look forward to your response.
PS I also enjoy yoga, which I haven't done in a long time either, should I hold off on this until I get my shoulder area correcte? Thanks again. |
Update from yesterday. I did some band work the past few days and it feels a little sore today. I'll hold off on it until I hear from you. Thanks again
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Curtis76
Pleased to here your getting better. 29 would be young to have a cuff tear. Tendintis is more likely. The other diagnosis to consider in a younger person i.e you is a biceps anchor lesion or anterior labral lesion. Diagnosed either with MRI or athroscopy Cheers Julian |
How bad is tendinitis? If I can live with the pain can I still be active? Or will it turn into something worse? I'm ready to do what it takes to get better. Hopefully Vickie will check in and give me some tips.
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Tendinitis varies in its seriousness. It normally gets better with rest. Vickie may be able to advise you on exercises that depress the humeral head relative to the acromion (subscapularis, teres minor, lat dorsi) and also scapular stabilising exercise. These should help.
Cheers Julian |
Any suggestions Vickie?
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Vickie On Vacation
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**update***
Well it's been over 2 months with this shoulder problem. However, last Saturday I was asked to throw a baseball around with some family members. I was hesitant at first but then decided what the heck, I'll try it. Since then, I have almost NO pain. The most consecutive days pain free in over 2 months. Can anyone explain this? Should I now start those excercises that Vickie gave to marty? Thanks again!
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Well I started those exercises and made up my own. Thinking that playing baseball helped my shoulder, I've been throwing a tennis ball at the wall. Not hard but I nice little toss. So far so good, I've also been taking 4 ibuprofen a day. 2 in the morning and 2 at night. Another thing I've been doing is that I'm not sleeping on my right side. Not sure what is helping what but it seems to be getting better. Definitely not normal but hopefully on it's way. Any suggestions are welcomed. Thanks
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Yea! Good news is always welcome. It is true that the body is a self regenerating system, be it sometimes for better or worse, and you experienced the best case scenario. You were right to use your intuition to expand the work. I have some other exercises that work on depression of the humerus (arm bone) But want you to be in your workout protocol for atleast 10-14 days before you start changing the information flow. I must admit I cringed a little when you said you were throwing the ball even lightly; it's just so easy to start increasing the intensity without realizing. The next phase, in my recommendation will be to add some modified golf action in with the new exercises to come. I am also a little concerned about the anti-inflammatory. I have had some good fortune in beginning to reduce the morning dosage first; assuming that the day can still create inflammatory conditions that might cause reoccurent night time discomfort.
Keep refining your stretches and exercises to great precision to get into the deep tissue of your motions. Keep the motions slow and please still allow yourself plenty of rest. You've waited this long so re-enter with the same patience. Sounds good. I will collect these exercises and be prepared to supply them to you within a few days. Which exercises are you doing, what did you add, and are any of them difficult or confusing. I'm a big believer in full recovery and see it so often I am pretty committed to reevaluating frequently; even well after all the symptoms have given you the impression you're healed. It is at this time that you can really begin your rehab and insure no further problems by finding the origin and attacking it with maticulous consideration. Sorry to have been gone so long. Thank goodness this site has so many qualified participants that care about everyone's success. Look forward to hearing from you. Vickie |
Glad you are back!!
Ok...let's get down to business. I'm doing exactly what you gave Marty and then just the ball toss which I will stop ASAP if you want me to. I guess the only thing I'm not doing is the Standing Abduction Band Stretch, having a hard time visualizing it. I'm also trying to correct my posture, would the posture setup cause my traps to be sore if I'm not used to that position? The other day they killed!!! I'll be honest, I haven't done the exercises every day but I try not to skip any. One question, do I only do 1 set for each?
Looking forward to working with you and getting this corrected. Hope Lynn is compensating you for all your hard work:smile: Thanks |
Not Happy!
Ok now I'm bummed. Woke up this morning and my shoulder hurts again. Pretty bad too. The thing is, I haven't done anything in like 2 days. Not sure if I slept on it wrong or because I haven't taken any ibuprofen in a couple of days or what. This is also the first time that I can remember that the pain was on the outside of my shoulder. Other times it was very hard to pinpoint, my guess was the front of my shoulder. Outside = rotator cuff right? Was :) now :???: !
**Edit** Maybe it's not on the outside, it's so hard to tell. I rub my fingers over my shoulder and I can feel something. Not sure, gonna go down some ibuprofen. |
Hi Curtis, Thanks for staying in the process. You may have read on some of the other posts that I consider myself more a fitness tutor than a personal trainer. This means, for myself and my clients, that I teach exercise protocols specific to the individual with a great deal of focus on detailed mechanics of individual physical attributes. Unlike most 'trainers' who will take a client through a full workout the very first day, it's not uncommon for my private clients to only learn 3-4 resistence movements the first workout along with 2-3 flexibility movements and then a little real life movement therapy (occupation therapy like proper way to stand when walking or getting out of a chair or sitting at and placement of their computer). It often takes the full first month before they have a full workout program. The reason for this is that my 'people' are all adults with misalignments inherent in living a life that tends to over emphasize postures that encourage rounded shoulders. Look at our favorite positions, golf, reading, sitting at a computer (I sit straight, BTW), driving, even giving a hug. Most of us spend little if any time coming back into a fully prone position. No even in sleep most of us wind up laying on a shoulder or curling up.
The good news is that it takes only a little time everyday to counteract the daily postures with training, in all it's various forms, as long as the execution is correct. All of this to say that posture is the secret. So if your posture is off and your cervical vertebrae (your neck) have adapted to a position forward of it's appropriate alignment with the trunk vertebrae over a slow number of years, then the rapid correction of training will create a new, though preferable, stress that will require more work in the neck muscles (and the traps are primary) and they may show signs of soreness and/or fatigue as they take on the newly acquired work load. A silly example is how new Mother's can carry a baby around on their hip all day with seeming ease. Then one of us try to carry the baby for an hour and can't believe how tired our arms and shoulders get.The new Mom was tired also, at first, but continued the new work load out of necessity and eventually adapted both muscularly and structurally. Many of the women I have trained have addressed hip issues and the origin can chart back to raising the babies. Told you it was silly. Anyway . . . Your difficulty with the abduction exercise is understandable. The advantage I have one on one is that I can tweek the degree of movement to the specific action of an individuals shoulder alignment to get maximal incorporation and thereby increase 'access' to the focal muscle. The movement can still be beneficial but with less satisfaction if you don't know how to make the body alignment compatible with the joint action. So I will try to tweek this one exercise here for you. First of all you have to establish standard form to do this, and all, exercise. You should feel very "soldieresque" in this position and you should feel your neck really pulled back and your shoulders back and dropped. Make sure your low back is not over arched but feel like you are slightly sitting in your heels, just slightly - not a squat. I'm changing the words and even positioning for you, as I know a little about your condition, so don't be surprised.If you can face a mirror, all the better. Tie a knot in each end of your band, use a therapy band (like a wide strip of ballon type texture) not surgical tubing. Start with a really light resistence. Once you get the form and the joint position improves you can start to strengthen. Why strengthen an unproductive apparatus? Standing Abduction Band Stretch Standard Form facing a mirror. Stand with your left foot on one end of the band or secure the band at floor level. Hold your band in your right hand with your arm straight by your side your band taunt but not stretched. You may have to roll it around your hand a little to get the right tension. Hold the band with your palm facing forward and your thumb pointed outward. Using the upper arm (rotator cuff muscles), rotate your fist gently to about 45 degrees - not 90. Your hand will not touch your leg. (This position changes as you improve joint flexibility and position. Keep your torso stationary and your arm straight throughout the movement. Stretch your band up to shoulder height in a side lift. Make the movement is created completely from the deltoids (your shoulder capsule) and not by leaning or lifting your shoulder toward your ear. Make sure your wrist is straight and is perpendicular to the middle of your shoulder joint. This is usually slightly more toward your back than feels normal. Your thumb will point directly toward the ceiling. You can look over to your arm to check once you are in position but keep your head straight when you arm moving through each motion. Resist as you bring the arm back down without rolling your shoulders forward or allowing your arm to roll forward (keep the heel of the hand coming into position), or leaning forward. Do 3-8 of these building toward 15 in perfect form each time - be methodical in the execution. It's not about the number of repetitions but the quality of each one. Repeat on the other arm. Now you know why I train one on one. I really believe, through experience, that the work has to be methodical and specific to each joint (and don't be surprised that your right and left sides will work and feel differently). I also will reiterate that the number of repetitions is less important than the quality of each repetition. If you are moving slowly to insure total isolation of the joint action it just means you were in the muscles longer and fatigue can set in sooner but you still stayed in the muscle and profited the benefit. It's not worth loosing an ounce of form to get to some magical number of reps. You ultimately want to feeeeellllll each movement and all the other body tensions that come into play to create that perfect repetition. Just as in the golf swing: Lessons teach the form and the positioning and the technique but ultimately a really good golf swing comes down to finally feeling when you are "on" and then . . . you hit the sweet spot. That's what I have to say today. At this point I have forgotten your other questions. I'll probably readdress those in a little while. It would take less time to teach you this than for you to read it all. Sorry, it's the nature of the beast. Vickie |
Just to clarify, I need to work through the soreness correct? I'm trying to understand, it's just hard to get in my head. When I'm sore, my brain tells me to stop, but it sounds like I need to keep going. How do I know when too much is too much, you know what I mean?
Thanks again. |
The thousand dollar question. Part of the reason I like slow, methodical movement is that your brain can receive the signals that you call pain which are indeed valid. The trick is to first interpret if the feeling is pain or discomfort. The second trick is to translate if the sensation is caused by of inappropriate movement or because you are entering the productive zone. Truly if you feel sharp or dibiltating sensations by all means stop. If you have just become aware of the 'tender' area and you can create a deliberate movement without loosing form or grimmicing then you are transmitting information to the area that you have a higher expectation of performance. This is a tricky area. Basically, if the discomfort makes you grimmice or loose form you are done.
I don't believe in pain but discomfort is the impetus for growth. Great question. You already read that email. And did the clarification, adnaseum, help? Vik |
I haven't tried the new one yet, didn't get a chance to print this off from work. I did however do the other exercises last night and this morning. The pain isn't sharp, it feels like someone, someone big, slugged me in the shoulder and I have a deep bruise. Hope that helps. It's been 2 days straight which is really upsetting since I thought I was almost done with this "beast". Thanks again.
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Curtis, I recommend laying off a couple of days, stay away from the ball throwing and then resume the work isometrically with no band. Get the motions down pat and learn to feel the appropriate. Then add the band and do the exercises once, repeating a second time during the day isometrically for a couple of days. Then do them twice a day with the band. From there we can talk again. There might be a couple of the movements that you would do a third time. This is very consistent with the rehab model. Let me know how it goes. Vickie
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I have laid off for a few days. Seems like I'm back to the way I was a week ago. Not much pain. NO BALL THROWING - promise! Will start out light.
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Curtis, Thanks for typing in. I just wanted to say that I admire your ability to stay in the process. I teach my 'people' to ask questions when their body feels unusually bad or unusually good. The silly statement of choice is "Isn't that interesting?". This keeps your mind asking for answers from your body instead of going into decision mode. The mental body can accomplish things we can't always understand with our 'inquiring minds'. So stay in discovery through this period.
I have a client (age appx. 60) that just came back from six day golf trip with his buds. He played 36 holes a day and had enough energy for scotch at night, slept great and was eager for the next day. When we first met he could barely finish 18 holes with any small amount of joy and by day three had to micro-manage his physiological symptoms, often not playing the last day or two. Now don't let me fool you, that was a couple of years ago that we started. But he would tell you that he only does 'the work' [that I recommend] at about 40%. So if you do it more diligently would the positive results come faster??? He was so excited during this trip that he called his wife to have me send his stretch protocol via email. That happens rarely for this fitness tutor. (His wife was so excited, BTY, caz she loves for him to be happy and pain free.) Keep up the good work. Much of your benefit happens during the rest so don't be discouraged. You will be able to throw a ball again, I promise. A man and his toys. Sheesh. Vik |
Still haven't done anything. Right now I'm not in a hurry. I don't want it to come back. What do you think, should I wait a week and then start the exercises?
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Yea Curtis, A week out of pain and then begin isometically adding the bands in slowly. I know it seems like overkill but I find that slower is better and pain free is best.Are you doing any other torso stretching? For example I love the torso twist and you could begin that right now. Don't be surprised that you feel the stretch more at your arms than even in the hips. The large lat muscle (the one that makes the wing span on gymnists) attaches to the hips and also to your arms. It is a principle player in pulling your shoulder down to allow for clear arm movement. You could also continue to stretch your hamstrings and do your abdominal work. If you are already doing these exercises it help to just plug into your rhythm. Let me know if you don't have these exercises. They have been listed in many of the posts but I can certainly post them again. Repetition, ahhhh a woman favorite. Vik
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What's REALLY frustrating is that I just had 3 days of almost 0 pain and then starting last night it's slowly creeping back in. Nothing extreme but there's slight pain. I just do not get it. I haven't done anything. No pain for 3 days and then it starts to come back?:BangHead: :BangHead: :BangHead: :BangHead:
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Ok Curtis, It's time to start the rehab again. Healing is tricky and it's not uncommon for people to have this sensation. Take it easy and start with the isometric application for a couple of days and then add the bands. The lat work is critical to keep your joint freely allowing for movement. Give me a little detail on the way the pain came back in and is it the same sensation and is it in exactly the same location. I'll try to check in tomorrow around noon. Vickie
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I know I'm going to sound crazy but the pain is gone again. Not sure if it's just in my head or what, but it seems like when I don't take ibuprofen it acts up a bit. Is is ok to wait a few more days or should I do the exercises with no bands. I'm just worried I'm going to make it worse again.
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