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Old 12-28-2010, 05:07 AM   #1
Joe Birch
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Default Shoulder(s) mess

Hi I thought I would post here to try and get some opinions after no luck with rehabing a shoulder injury past 4 months.

Around 4 months ago I started getting pain coming from my left sternoclavicular joint which radiates out toward my shoulder until eventually I felt like I couldnt use my left arm much at all, there was no acute injury rather it built up and got progressively worse, now the pain is fairly low level but constant and isn't alleviated with rest (been doing physio for about 5 weeks, then stopped and rested it for the last 4 weeks because pain was if anything worsening with physio exercises). Physio exercises prior to this prolonged lay off included stretching pecs and lats, soft tissue work with tennis balls on chest and lats, light external rotations and some scapula position exercises with and without resistance.

However the pain has persisted and my left shoulder now has pain in the joint as well and there seems to be something fully wrong there. The most worrying thing is that pain has now started to creep into my right shoulder in the exact same place (right under the proximal end of the clavicle) and this is despite doing no real exercise other than stretching and soft tissue work. The only way I can alleviate the pain is to really internally rotate and hunch my shoulders forward almost like i was wearing a bench shirt or something. If I get my scapula in what should in theory be its natural position, nice a flat to my rib cage and shoulders not hunched forward, the pain under my clavicle is noticeably worse.

I really don't know what do to be honest, light physio has seemed to worsen the pain, while stretching seems to have no effect, altho when I stretch my lats overhead it does feel incredibly tight in my left shoulder.

Any thoughts would be much appreciated! Thanks, Joe.
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Old 12-28-2010, 07:34 PM   #2
Mark Fenner
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So, it sounds like you've covered the simple bases. My first recommendation is to find a VERY competent sports doc/PT/chiro who works with athletes. If you had physio exercises that you had to quit (i.e., were doing more harm than good) and that weren't adjusted in response, I'm sceptical about the caregiver you were working with (if you were working with one). If it was you, I understand: I've done more harm than good to myself sometimes before (finally) moving forward.

I can only give the most general advice, b/c I haven't had personal experience with pain in that part of the clavicle (excepting when I broke mine ... then the whole damn thing hurt).

1. RICE. If you are really pained under the clavicle, icing may be difficult but try. Elevation is so easy with appendages. Not so easy with stuff in the abdomen and thorax.
2. Ibuprofen bomb if you are content with the cost-benefit tradeoff.
3. Look upstream and downstream as Guru Starrett has taught us. At the SC joint, this would involve lots of stuff: down towards the pecs, back towards the traps, out towards the shoulder (deltoid), up towards the neck. If you are looking to manage this yourself, try to get these systems to give slack around the point of pain. Note that your focus (to this point) has been on only a few of these.
4. Posture (sitting if you are desk jockey/driver and sleeping). In particular, head/neck/thoracic.

The tone of your post indicates that you are frustrated and in pain. You may well have enough going wrong that indirectly related systems are reacting to the trauma and shutting down also (e.g., the lats overhead excessive tightness).

Good luck,
Mark
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Old 12-31-2010, 04:58 PM   #3
Steven Low
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The guy above me pretty much outlined what I would do
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Old 01-05-2011, 09:32 AM   #4
Joe Birch
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Thanks for the advice, I will continue to work on the soft tissue work on stretching of the surrounding musculature as well a bit of RICE treatment. Altho have been struggling to really stretch out my traps/neck but have been working them with a hockey balls to try and loosen them off.
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Old 01-26-2011, 07:36 AM   #5
Joe Birch
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Thanks again for your previous messages, I am seeing a physio in feb (earliest one i could get without paying unfortunately) but I have uploaded a video of me doing some should flexion and abduction to hopefully have a rough look at what is going on with my scapular if is related to that (if you watch in popout window in smaller screen its easier to see whats going on).

http://www.youtube.com/watch?v=eDV8N6LjUes

Fist 5 reps of each exercise are me in my relaxed normal posture, the 2nd 5 reps are me making a conscious effort to correctly place my shoulders/scapular.

Symptoms still the same, pain still originates from inner clavicle and spreads along it, getting worse towards the end of the clavicle as my arms goes overhead. If anyone could comment on my scapular movement or suggest whether it maybe related to my injury i would really appreciate it. Can upload videos of different movements/angles if that would help.

Thanks, Joe
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Old 01-26-2011, 09:37 AM   #6
Nicholas Wyss
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Just to clarify, you're saying the pain is coming the sternoclavicular joint - from the top of your sternum, all the way out to your shoulder? How far does it radiate out? Towards the outside of your shoulder, like where the deltoid inserts? Or is it more of a radiation towards the inside, like towards the AC joint or the corocoid process?
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Old 01-27-2011, 03:40 AM   #7
Joe Birch
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The pain originated from the SC joint area (not necessarily the joint itself) and has spread out along the length of the clavicle, if i were to lift my arm, the pain goes out as far as where the upper trap ends and deltoid begins, no pain in the outside of my shoulder or as far as the acomion.

I guess this has led me to believe it's either upper trap problem or my supraspinatus getting crushed in the space between my scap and clavicle. I haven't had any luck with rehabbing it myself using normal shoulder impingement physio exer's, but admittedly that rehab has lacked direction and focus because i haven't had it professionally looked at.

The pain originally came on from a period of doing a lot of benching and close grip chins because of a lowerback/knee problem which meant taking out military press and bent over rows which were usually part of my training (which was previously focussed around squat\bench\deads and assistance exercises).
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Old 01-27-2011, 11:23 AM   #8
Nicholas Wyss
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Seems like it would be your subclavius, it pretty much runs right along the area you are describing your pain to be in. You may have pulled it doing all that close grip work, it does work to pull the clavicle down and forward. If you pulled it, it might just be semi-healed now, but in a shortened state with a bunch of adhesions that make it painful to try to stretch the muscle. Which would explain why being hunched over and internally rotated relieves your pain. I would try soft tissue work specifically right under the clavicle. I doubt a ball will work since it's right underneath the clavicle, probably need to use fingers. See if it feels tight/painful to the touch. After a few sessions trying to loosen it up you might feel more comfortable trying to stretch the muscle without pain. After that you can start to add in some rehab exercises which can start to strengthen it.

Soft tissue work on the surrounding muscles isn't bad, but I think if you get right on the source of the pain it tends to work a lot better. I've had a few injuries where the pain just lingers for months until I get right on whichever muscle is the source of it and massage it, then my symptoms resolve rapidly.
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Old 01-27-2011, 05:17 PM   #9
Steven Low
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It could also be a first rib issue as well or the SC joint is stuck.

Try the subclavius massage and such first and see how it goes.

Also, hit up pec minor too.
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Old 01-28-2011, 09:41 AM   #10
Joe Birch
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okay thanks for the help guys i will work on that soft tissue work with fingers or anything i can use to get right under my clavicle and let you know. thanks!
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