Nov 24

Shoulder Study

Incorrect Form: Looking down in the overhead position.

Incorrect Form: Looking down in the overhead position.

35 year old female with left shoulder pain that commenced for no apparent reason.  Pain was rated at 5/10 and worse with any overhead activity-crossfit movements and a moderate interference with daily activities .

MRI Results May 10, 2012: Left Shoulder Partial thickness articular surface tear of the supraspinatus tendon with noted increase subacromial/subdeltoid fluid presents that may reflect an occult full thickness tear versus mild bursitis. Moderate glenohumeral effusion with more irregular and inferior extent of fluid than is typical. Orthopedic suggestion:  Best bet is surgery and that she would definitely not be able to crossfit anymore. Evaluation deficits on June 15, 2012 Weakness 4-/5(moderate) of L shoulder external rotation at waist level, L internal rotation weakness at 90 deg 4-/5 (moderate)  and L triceps 4/5(mild).  Noted biceps/pectoral tightness. Pain with left shoulder flexion and with reaching up behind back. Assessment “Tightness Inhibits Strength”  has proven to be true time and time again. Weakness in triceps, external rotation, and internal rotation at 90 deg is a direct result of tightness in biceps and pectorals. Repeated testing:  Repeated external rotation at 90 flexion decreases pain with reaching overhead is most likely due to stretching of tight pectoral muscles.  Pt was then progressed to extension and later progressed with extension with internal rotation to focus on biceps mobility allowing for improved strength of triceps and external rotators.   Pt was able to progress to overhead lifting in 2-3 weeks allowing for gradual return to crossfit.  Once pain free can start to re-introduce progression back to pulling with balance of mobility and pushing activities.  Retest after 1 month of therapy shows 5/5 no weakness in all shoulder movements.

Correct Form: Looking straight  forward  in the overhead position.

Correct Form: Looking straight forward in the overhead position.

Form correction given: Look forward when lifting weight overhead allowing for improved shoulder mobility.  Programming caution: Balance pulling and pushing workouts.   Pulling workouts would encourage biceps tightness and can lead to a regression. Follow Up:  As of 8-15-14 Pt was pain free and was able to compete in crossfit regional for 2014.  Best of all no surgery needed.