Shoulder worry – 6 mths post op

Hi Ryan

Having relatively complex shoulder surgery can be really effective, unfortunately having a frozen shoulder after can mute the positive effects of the surgery – and all the things you mention are possible BUT with the MRI’s you would hope the radiologist would have spotted something amiss.

Instead why not go down a much more simple path of is this a spinal/neural issue giving shoulder pain and symptoms. Your pain description doesn’t immediately make me think “true” shoulder.

Use a confirm or deny process with your treatment – get someone to only treat your neck/thoracic spine (not shoulder) and see how you for the next 48 hours. This will straight away help guide what needs to be done next.

Good Luck

The Guru

Ryan replies…

Thanks for your reply, I appreciate it.

I have been to an oseteopath who is very highly regarded as a guru of the human body. He thought it was a brachial plexus injury so he worked on my neck spine did some adjustments and also gave me some saline injections but still nothing. To me it really doesn’t feel like nerve damage and does feel like something has structurally changed. It’s like there was some sort of connection from the outer edges of the lats the runs up into the triceps and also connects with the posterior deltoid tendon that attaches to the postero lateral corner of the acromion – these were all connected before giving this sensation and now ever since the injury when I felt a tendon or something get pulled over other tendons (what felt like under the acromion) then the feeling was gone and it felt like my shoulder was tangled and twisted forward. Have you ever heard or seen or think this could happen with a subluxation?

The Guru explains in more detail

Hi Ryan

I think the point is there is no anatomical structure that runs this route, hence the neural explanation. However, what you feel is definitely what you feel and it’s for your osteo to be clinically reasonable about why you’ve got your symptoms – remembering that pain doesn’t need dysfunctional/damaged tissue. It can simply be a product of your brain telling you that something feels odd. Frustrating, but very real.

I’d opt for a more confirm or deny route to treatment. What I mean is that for a session or 2 I’d put all my eggs in one basket and only treat 1 part of what may, or may not be part of the problem. So 2 sessions where you do nothing apart from rehab  your rotator cuff OR just treat your thoracic spine OR just treat your neck – and then see what the effect is. They may only be short term buy it should give you a lead as to what needs to be done next….

Ryan:

No worries thanks for getting back to me.
So there is no anatomical structure there?
I am trying to rule out possibilities as I go – and will be getting an EMG nerve test next week.

Is there is a connection between the posterior deltoid tendon (originating from the postero-lateral corner of the acromion) that connects with the triceps? It feels like the deltoid tendon was pulled inwards.

Is there any connective fascia or similar that connects the triceps, lats and posterior delts (and/or teres major etc)

Is it possible that the posterior labral tear caused this lack of feeling through it rendering those muscles unable to connect through contraction?

Thanks
Ryan

In summary, there is no substitute for decent rehab…

I’m sure there are lots of nefarious fascial chains and connections that move around in that area, but nothing really meaty that could mimic/produce symptoms such as yours.

The more you look the more you find, which as a patient with symptoms is deeply disappointing – but pretty common.

I think it’s best to do the simple things well rather than trying to do the complex things poorly.

Shoulders whilst being complex, multidirectional kit generally need more and better control over the structures that contract – the muscles rather than trying to make heads or tails of the boney and structural fixed anatomy.

See what the EMG says but don’t substitute anything for decent rehab.

Ryan responds immediately…

Ok thanks for the feedback, I really appreciate it.
Maybe it was just a fascial connection that was broken – it was like a snug tight feeling at the high part of the back of the triceps which after the injury did feel like it was let out of its casing and turned more into like a blob – does this sound like fascia? And if so does fascia regenerate over time with training?

So your saying rather then worry about structure – just concentrate on building the muscles around the shoulder?

Thankyou

The Guru

I’m pretty sure lots of fascial and more structural stuff was properly broken!!

Most shoulder repair work will only help the large, visible structures. Some fascial can have the appearance (and structure) of cling film and can’t be repaired – or even known they need to be repaired.

It will regrow but you want to determine the right function by making sure that your shoulder moves and behaves how it should – hence rehab all the way.

Ryan:

OK, thankyou for that information.

In your knowledge have you ever heard or conceive that in the same injury that a posterior labral tear occurs (so anterior pulling of the arm across the chest and forwards and upwards and also upwards a little bit) is it possible for the fascia along the outer boarder of the armpit to be relocated by being pulled under the acromion and over the front of the shoulder. It feels as though whatever this was – connective fascia or something else was attached or blended with inner feeling of the triceps up into the deltoid acromion tendon and also blended with the deltoid and was pulled forward, I can’t accept that this has never happened to anyone but me in the history of shoulder injuries?

Thanks

The Guru signs off

Hi Ryan

The really obvious thing here is that you, and your beliefs are desperate for this to be the ultimate cause – lock, stock and barrel.

This puts any potential medical professional in a dilemma (and even worse without you physically being in front of me) as they either go with what you want them to go with or they perhaps give a differing opinion that doesn’t fit with yours so you go seek another and possibly another until their belief fits with yours.

Harsh? Possibly but ultimately it’s how the thread reads.

It’s therefore well worth my (and your) time to say yes to all of the above, you’re probably right.

But I just don’t think like that…

Ryan asks…

Well no offence but I’m pretty aware of my body and what I’m feeling so of course I’m going to be set on what I think is going on and what I think
Isn’t, HOWEVER, I am not a shoulder guru and don’t know the specific goings on in and around the shoulder which is why I’m asking yours and other specialists opinions on the matter.
But I’m sorry if I’m explaining it in a hard way to understand.

I know that it’s not nerve damage that I am feeling because when I hang on a pull up bar my right shoulder (good shoulder) has tension running up the inside of my triceps and down the side of my armpit – on my left side (bad shoulder) that’s gone and it makes my shoulder rotate inwards and makes a clicking noise. Does that by any chance make any more sense for you? It isn’t muscle atrophy either, this happened instantly after my shoulder subluxation injury and has been gone ever since. Another example would be just leaning my weight on that arm – my good shoulder has a tension that I can feel up the inner upper triceps and it’s gone on the bad side.

Does that make any more sense?

The Guru replies:

I’m also not sure it’s a single structure.

Pain is multi dimensional and not just related to pathology or beliefs or tissue sensitivity but it’s best dealt with by exercise.

Frustrating as it is I wouldn’t fixate on the symptoms but focus on fixing why it’s an issue with exercise….

The Guru

Ryan has one more question:

Yeah thanks again for the advice,

One more question do you know much about fascia? Would you think that if it was fascia that was moved since it has already been 7 months since the injury if it would already be adhered in its new position? What do you think my best option would be to do now?

The Guru emails him back –

Rehab

Exercise

Normalise movement

Simple things, done well….

PS normal caveats apply etc etc