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View Full Version : Protrusion on Shoulder Plus Pain


Matt Horvath
02-20-2009, 09:18 PM
I've had a nagging shoulder pain that has just taken a turn for the worse. Previously, I had an MRI done, saw an orthopedist who gave me a cortisone shot. I didn't really know what was going on and probably would have tried to get by without it had I known what was going on. This all occurred early last Fall.

Now, there is a visible and touchable bump on my left shoulder that isn't as prominent on the right that I noticed the other day. I'll attach an image and was wondering if anyone could provide any insight into what it might be. I have another appointment w/ the orthopedist Thursday, which I hope will go well, but last time he told me he was a runner and he first two suggestions for treatment were a cortisone shot and surgery to shave off some of my collar bone. He diagnosed it as a small case of bursistis after an MRI and X-Ray.

I feel a great deal of pain when I extend my arm in front of me, internally rotate my hand (thumb to the ground) and try to raise my arm against a resistance. Appley's scratch test w/ adduction and internal rotation is painful (http://www.aafp.org/afp/20000515/3079_f2b.jpg ).

The first pull is painful, w/ my arms internally rotated a bit to get my elbows out, for both cleans and snatches. Racking front squats leads to pain as well. After the weight is OH, everything feels fine.

Anybody have any ideas as to what that bump might be? Anything specific to work on in terms of rehab? Anything other things I might want to consider/look into?

Thanks.

Garrett Smith
02-20-2009, 10:24 PM
Sounds like your A/C joint. (http://emedicine.medscape.com/article/92337-overview)

Matt Horvath
02-21-2009, 08:15 AM
Thanks Garrett,

From looking at the link, it seems like that little bump might be a protrusion of the distal clavicle. If I put my left hand on my right shoulder, and push down on the top of the left shoulder, I feel some pain.

It doesn't wake me up at night and the shoulder still feels pretty stable, but the fact that the bump is so prominent makes me worry a bit.

I hope it just a sprain and I think a couple weeks without training would be manageable, but 6-8 weeks plus would be hard to take.

It is either an old injury I reaggravated or a new one. I'm thinking dumping a heavy front squat forward or catching a clean forward could be the cause.

Thanks again.

Garrett Smith
02-21-2009, 08:25 AM
Lay off whatever hurts the area, as that will only delay resolution.

Sounds like the rack position could be a problem for a while.

Contrast hydrotherapy could be very helpful.

Matt Horvath
02-21-2009, 08:44 AM
Garrett,

What is your opinion on NSAIDs. I'm about 175 lbs and I was thinking maybe 600mg of ibuprofen every 4 hours or so.

I appreciate your input. I'll give the contrast hydrotherapy a shot.

[Edit: I saw a post of your on it in a previous thread on AC joint injury. No need to reply]

Garrett Smith
02-21-2009, 09:36 AM
I've got no issues with NSAIDs short-term. Traumeel (gel and/or tabs) may be more helpful though, since this may be an issue from "trauma".

Steven Low
02-21-2009, 10:29 AM
Might have sprained the AC joint or something...

Massage to the area... try to push blood in there to get it healing faster. + Anti inflams.

Avoid the stuff that hurts like Garrett said...

Matt Horvath
02-22-2009, 05:58 PM
Thanks Steve,

I'd give the massage a shot, but it is pretty much just bone up there. I've been taking ibuprofen and will continue to unless I can get my hands on some of that Traumeel. I'll probably end up ordering some.

Ben Fury
02-25-2009, 02:04 AM
Were it my injury, I'd apply lymph drainage to the area and then work the shoulder through Sagittal, Axial, Coronal ROM VERY gently using AIS two second stretch at the end of each ROM with extremely low strain.

I can't help wondering if a muscle imbalance is a contributing factor. Your trapezius development is phenomenal, yet your anterior and lateral deltoid are quite typical looking. Is this usual in males in your family, or is this specific to the training regimen you've undertaken?

Early in my training career, I became overly fond of clean pulls and caused so much hypertrophy in my traps, that I started getting nerve impingement, leading to tingling in my hands and fingers. Deemphasizing traps for 6 months mostly returned them to normal, but I still have to avoid excess shoulder shrugging to prevent reoccurrences.

Matt Horvath
02-25-2009, 07:36 PM
Ben,

My training history is short. I'm 25 now. In high school I played rugby and did a lot of upper body training. Rock climbed in college.

About a year ago, I started basic strength training, i.e. squat, deadlift, pull ups, press, some db benching, learning power cleans and snatches. No bodybuilding style shoulder or trap work. I did a mass phase and went from about 158 to 183, now I'm down to about 175 again and want to get back to around 170. About six weeks ago, I ordered a set of bumpers and rented a garage and started doing greg's wods on this site.

My dad is a pretty muscular guy, and I take after him in that I can add muscle mass pretty quickly, but we are both pretty short and stocky. I'm 5'7". My left shoulder is smaller than my right and has given me trouble in the past. My pressing strength isn't terrible. I pushed press 195 not too long ago and my last strict press was 155x2 awhile ago. I don't know my max shrug, but my best power clean is 215 and squat clean is 225.

I'll try and decipher your stretching recommendations and give it a shot. I have an appointment w/ the orthopedist tomorrow morning and I'll probably be getting some x-rays. I'll keep you guys updated.

Thanks for the help.

Matt Horvath
02-26-2009, 06:54 PM
I saw the orthopedist today. Pretty worthless, he told me it was pretty much just inflammation leading to impingement at the AC joint and had nothing else to add. He offered more cortisone and suggested surgery if things don't improve. I declined both.

I'm going to deload and ibuprofen for 10 days, about half of that doing nothing, then start squatting again, do some shoulder rehab, and maybe some longer c2 rows, while avoid anything that aggravates it in the slightest. I'll get some hands on some traumeel and do the contrast hydrotherapy.

Ben you mentioned my traps, and it got me thinking that my upper traps might overpower my lower ones, and I will do some rehab work in that regard as well.

Thats all i got. I appreciate everybody's input.

Ben Fury
03-01-2009, 11:50 PM
I'll try and decipher your stretching recommendations and give it a shot.
Thanks for the help.

You're most welcome. Thanks for all the background. That helps.

If you want to invest $35 in a copy of Aaron Mattes' Active Isolated Stretching, that would make walking you through the AIS ROM work a lot simpler.

Glad you passed on the cortisone injection. Breaking down scar tissue so new even more random scar tissue can form is two steps forward, ten steps back.

Hang in there and keep me informed of how your shoulder work progresses. How were you thinking about adjusting your upper vs lower trap imbalance?

Matt Horvath
03-02-2009, 06:27 PM
Last time I hurt my shoulder I did a half assed diesel crew shoulder rehab protocol. Its on youtube, http://www.youtube.com/watch?v=A0ONHZmsFec. I'll probably do what I can of that w/ the equipment I have or try to come up w/ substitutes.

Some of the other elements I've been thinking of are:

Y,T,W,L's. I already do a bunch of scap wall slides at work throughout the day w/ some neck and trap stretching. Paying closer attention to my posture is going to be important because I sit at a desk all day.

Higher rep OH squat workouts which I did today. More metcon-ish/endurance work than strength training, but it got some blood moving through my upper back and shoulders. It made things feel a little better w/o aggravating anything.

KB snatches I haven't done for awhile, but I usually pop the kb up at the top to get it back down into my fingers, which might help a little too and I can get some endurance work in.

Pushups plus and maybe some scap pull ups. I have noticed my shoulder pain is less when I try to depress my scapulae when doing OH anything and in the rack position.

Any input would be good, because I haven't really though too much of this out, nor do I really know what I am doing. I think the biggest part is going to be rest and ice.