primary instability/secondary impingment
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Category: Patient Forum
Forum Name: Shoulder Injuries/Conditions
Forum Description: Patients can post questions and experiences about shoulder injuries/conditions.
URL: http://www.cyberpt.com/ptforum/forum_posts.asp?TID=460
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Topic: primary instability/secondary impingment
Posted By: imkidy
Subject: primary instability/secondary impingment
Date Posted: Aug 17 2009 at 1:03am
hi,
i actually hurt my right shoulder about 2 years ago working out, after doing lat pull one day, i got a sharp pain in the back part of my shoulder, i went to the doctor and he told me i have an inflammed shoulder and that i just needed to lay off of it for a while. after staying off of it for three months, i went back to working out and playing basketball, like i used to, however, my right shoulder started to feel a little looser than the other. and when i started doing bench press and other weight i started to feel a sharp pain in the front of my shoulder, and it started popping. I went back to the doctor and he put me on anti inflammatory medicine and decided for me to get an mri and arthogram. the mri revealed just inflammation in the shoulder, and no tear or anything. i went to physical therapy for about 2 months and had little improvement. i decided to go to another physical therapy place after a while to try to improve the shoulder. After a while, the shoulder just felt looser than my left shoulder (the shoulder that isnt effected). so i decided to go to another doctor, and he said since it had been so long, he gave me a cortizone shot, and then wanted me to work on strengthing my shoulder muscles because they are instable, since he believed that i have a rotator cuff problem. the imflammation went down but it still did not feel 100%. After going to therapy some more, it still hasnt improved, still feels loose, and still pops. the second doctor said i have pain in the ac joint, not the biceps tendon. and classified it as primary instability/ secondary impingment. i still play basketball, and i asked the therapists and the doctors, and they said i dont have to stop playing just stretch before i play. It hasnt imrpvoed much and the doctors said they wanna do an arthoscope on it, and try to tighten up the joint. I was wondering if anyone had any suggestions, i wanted to try to stay away from surgery. do you guys think i should avoid basketball and resistance workouts with the therabands for a while? i got the cortizone shot about 2 months ago. Thanks guys.
Imran
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Replies:
Posted By: PT Guy
Date Posted: Aug 17 2009 at 1:18pm
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Hello Imran,
When you mention they want to tighten up the joint, are you referring to the glenohumeral joint (shoulder)? If the AC joint is hypermobile this may give you some problems as well. Also just curious what kind of exercises were your therapists having you do?
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Posted By: imkidy
Date Posted: Aug 26 2009 at 1:20am
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well when the doctor pressed down on the shoulder to ask me where most of the pain was, i showed him and he said it was the ac joint that was giving me pain. as far as my shoulder, it just feels looser than my other shoulder. however, whenever he did tests to check the strength of it, he said it seemed fine. also after time, my right arm in general has become smaller in mass than the left, and the doctor thinks its just because my shoulder was inflammed before the cortisone shot. as far as exercises that my therapists made me do, were: internal and external rotation (rotator cuff), shoulder raises, rear deltoid exercises, scapular retraction. my doctor wants me to start using weights again, but i just feel that my shoulder is not ready for that becuase it does not feel fully healed. one more thing i wanted to add is when i put my arm straight out, my right shoulder blade feels like it sticks out more. like i said, doctor just said to try to strengthen that who rotator cuff/shoulder area, and it should be back to normal, if not then surgery.
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Posted By: PT Guy
Date Posted: Sep 03 2009 at 7:40am
Hi imkidy,
Loss of muscle mass or atrophy is usually associated with inactivity ie. being in a cast or with some kind of neurological involvement where the neural interaction and stimulation to a muscle is decreased. If your shoulder was inflamed and you performed limited use with your affected shoulder than it would be possible for some of your muscles in your R upper extremity to atrophy. In this case strengthening usually consists of low weight and high repair before progressing to higher weight and lower reps in order to facilitate muscle growth. Winging of the scapula or external rotation is usually the result of a weak rhomboid muscle and scapular stabilizers. Scapular stabilization and strengthening exercises should be performed to help correct for scapular external rotation.
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