Ongoing Issues With Shoulder

Edited , 3 users are following.

Hi There,

I've been having troubles with my right shoulder. I have something called shoulder instability, in addition a minor SLAP labrum tear. The top theory so far is that the laxity of my shoulder joint allows it to rest forward and downward rather than in it's normal place and that this position is pulling on my neck and low back to create symptoms away from the original source.

Now, I've been evaluated by just about every doctor for every respected field over the years. Neurologist from a movement disorder clinic has told me he's seen it before-- "...increased muscular activation of the right shoulder musculature, which though not suggestive of a primary dystonia syndrome could represent chronic muscle contraction and tension in response to injury".

Following that appointment I met with a Physiatrist:

This gentleman has a long history of right shoulder issues that are gradually worsening

over last 2 years. He now has pain in the right neck, upper back, chest and anterior

shoulder with some occasional radiation down the right arm. He also feels laxity or

looseness in the right shoulder and feels this is causing compensation in other areas. His

examination showed restricted right cervical rotation and with the apprehension test he

had guarding which made it difficult to assess and the guarding did not improve with a

relocation maneuver. I suspect there are several areas of myofascial pain in

compensation for underlying shoulder instability. He is already being followed by a sports

medicine doctor in his local area of ------. He's tried extensive conservative treatment

without much in the way of benefit. He has seen four orthopedic surgeons earlier in the

course however not recently and I recommended he follow-up with orthopedic surgery as

he does have a labral tear in imaging and may have some element of shoulder instability

which is not responding to prior conservative treatments.

Every shoulder specialist I see has one of these common answers:

  1. SLAP tear is minor, not worth a surgery to fix.
  2. Physiotherapy is the best solution for shoulder instability.
  3. The issue is neuromuscular in that the muscles are not maintaining the shoulder in a proper anatomically correct position (Solution- Physiotherapy).
  4. I have genetically lax joints, so any sort of stabalization surgery would be rendered ineffective.
  5. The symptoms in the neck and low back are unrelated to the shoulder and I should address those issues seperately with the necessary therapies.

I've now spent years of attending physiotherapy, in addition to other therapies as well and there has been no improvement. I've recently begun Prolotherapy, an injection therapy to try and create tissues to stabalize the joint. Again, no change. Right now the best response is to continue with Prolotherapy or move it up to PRP injections.

Has this happened to anyone else, chronic shoulder instability not being resolved? Does the labrum play that much of a role in stability? Does a damaged labrum really matter?

The symptoms in my neck and low back have become quite debilitating over the years and gradually worsen as time goes on. Any thoughts on where to go or what to do next?

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6 Replies

  • Posted

    Impressive recount of what you've been through...

    Want my opinion?

    If you haven't had an MRI or exploratory surgery have it done...get that labrum fixed. When i had my labrum fixed on both shoulders all that instability resolved. Don't get me wrong, I like most people don't want surgery and would rather just do physical therapy and I loved going to therapy.

    BUT, if you've got a tear, you've got a tear...it can only get worse, enlarge, put stress on surround muscles and tendons, etc.

    I'd get that fixed, then concentrate on pt.

    Just my thoughts from my own experience.

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    • Posted

      Thanks for the opinion.

      I've had many surgeons tell me just about every extreme---that patients with full labrum tears have little to no effects, that's how useless the labrum is, and that others with even smaller SLAP tears have just as bad or worse symptoms. It's hard to know what the right answer is when the professionals have a split view.

      You're right, damage is damage, and it's kind of upsetting when having a report which directly quotes the muscular issue is a response to injury and surgeons blow it off because it's not a giant gaping hole.

      I think surgery may be in order, but first I will try the step up injections (as you said surgery is undesirable and if there's a chance it can be resolved without it, a couple more months of waiting and some cash is a small price to pay).

      I appreciate you taking the time to share your personal experience, and I'm glad you're doing much better now!

      Jp
      
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    • Posted

      Hi,

      Just to be clear I meant that surgery is nervewracking but it is in your case, probably the best next step. If I were you, I'd skip injections especially of steroids as everything I've read indicate it leads to issues: deterioration of muscles, tendons, etc.

      My left shoulder was a case of immediate surgery. I had no option. My right, they tried physical therapy but the surgeon said surgery was the next best option when that didn't help. And he was right.

      BTW, at the orthopedic clinic I went to there was one doctor who had a torn bicep. It was small and repairable but he went the route of getting steroid injections every so often. When i asked him why he just didn't get surgery and have it fixed and done with and he said, "No, I'm scared."

      Also, there's a lot of things to consider...how long is it since you were diagnosed by MRI that it was a torn labrum? It might have progressed since that last finding and no one really knows.

      It would be pointless to have another MRI, as the surgeon can just go in there and he will see what else might be an issue and address it during surgery.

      The way it is now you have a non-functioning arm or an arm that is in so much pain it's useless. Do you really want to go on like that?

      Just my thoughts and I hope you keep us posted on your condition.

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  • Posted

    Hi,

    Sorry to hear about the issues with your neck and shoulder. Good you have the support of medics. Has any professional ever suggested some gentle swimming exercise? Only a thought as it's supposed to be such a good all-round, gentle work-out for the muscles, stretching and strengthening etc.

    I too have a shoulder/neck issue, made worse by using the computer After having serious pain and discomfort for weeks, I had to stop doing lots of things, and I am now undergoing physiotherapy - I have been started with traditional stretching and strengthening exercises, targeted at the rotator cuff muscle group of the shoulder. I am only 9 days in and already it has been encouraging, although I think there is a long way to go yet. Have you had such a programme of rehab designed for you to try ?

    Grimm.

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    • Posted

      Yes, I've had the traditional physiotherapy targetted at the rotator cuff and scapular stabalizing muscles for years now. I've also tried chiropractics, acupuncture, ART therapy, and others to focus on releasing tension around the neck and low back, and to strengthen the shoulder. It's been a long ride, and both the therapists and I agree this is not what I need.

      I actually was doing light swimming, a couple years back. I do try to keep moving every day but the whiplash that I get after moving around too much is becoming very burdensome now. It's definitely become worse without question, it's concerning because I've been doing so much to recover 😦

      Glad to hear you have your pain and symptoms are lessening and that you've found the help you need. I hope I'm next, lol.

      Jp
      
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