Labram/Rhomboid Tear

[Joshua Davis]

Well, as much as I have been able to "work around it", I am going to go have an MRI. I have had a bum shoulder since an August squat session, and the pain simply refuses to go away.

While having a deep tissue massage session, the therapist dug deep into my right rhomboid, causing instant sharp pain in the top of my shoulder, where the pain has been. Asking questions to those much more knowledgeable than me about kineisology, and learned that the rhomboid inserts/attaches to the labram. During my initial PT session, doing ROM tests, the PT guessed that my symptoms matched up with a labram tear.

So, after I get a new Ortho shoulder specialist, I will not look into PT immediately (as it didn't really help in the first place). Instead, I plan to opt for reattachment if torn, if a partial tear then I'll look for cortisone and time off from all activity, except maybe some PT if the doc prescribes it. Now would be the time, since I am pushing the diet as fast as possible... my strength isn't where I would like it to be.

[Ann Collins]

Your rhomboid doesn't insert into the labrum, the cartilage rim around the glenoid,the socket in your shoulder. Rhomboids attach to the medial border of the scapula. If the pain is at the top and front portion of the shoulder you still may be dealing with impingement/rotator cuff injury. Unless you have traumaticly dislocated your shoulder a labral tear would be unlikely. The MRI should help to somewhat clarify the diagnosis. Get a second opinion from a shoulder specialist, not just a general orthopedic surgeon.

[Joshua Davis]

Thanks for the response Ann.

One question for you... would an impingement last this long (august to present)? I have already had xrays and there is nothing bone-wise that is out of place.

I originally found a shoulder specialist, but he simply slapped the "bursitis" tag on me and moved on... if this is bursitis, then it is lasting a whole lot longer than I would expect. I will look for a new shoulder specialist now, I actually was recommended a new person to look at this injury and will be calling them today.

[Ann Collins]

Impingement can last for 6 months or more if not treated properly. The orthopedic surgeons I work with generally do the following: subacromial steroid injection (cortisone), PT including rotator cuff strengthening, scapulothoracic strengthening and stretching. We have found that this works 85-90% of the time, but it can take 3 to 4 months to get the cuff muscles to hypertrophy. Sometimes a second injection is needed. If this fails then they order an MRI and a decision is then made as to whether or not surgery is indicated. If surgery is indicated it's usually what we call a subacromial decompression where the acromiom is shaved back to give the underlying structures more room. The worst case is that a cuff tear is found and it needs to be repaired, a much longer rehab process.

Good luck!

[Joshua Davis]

Thanks Ann. I did some rotator movements with a shoulder horn and did some band pulls and rotator curls tonight. The pain has been a little worse as of the past few weeks, and the ROM of doing these movements plus some ibuprofen, ice, and dmso has helped cut back the pain a touch in the past, I am hoping to wake up to a less painful shoulder tomorrow.

I also setup an appointment with a new shoulder specialist. My old one had a sports background, but my mom worked with him at another hospital years ago, and had to file a report because he was careless with cleaning procedures... I am not down with that.

[tackle78]

having had major shoulder operations three seperate times, the only thing I could say to add to what Ann has said is if you do get an MRI I would ask for an arthrogram to ensure complete results. They suck and getting a needle into the joint capsule is no fun, but neither is having to have a second operation scheduled before your other one is healed because they say a bunch of stuff torn they didn't have time/preperations to fix the first time. I would also say go to a sports person! They're not too hard to find, you could always contact a local college and see who they use. Working with your average guy is almost worthless. They will give you the same rehab routine as an 80 year old women. Also if you are worried about labral tears do no bicep work. I had partially torn my bicep when I initially tore my larbum(along with other stuff) and didn't know about the bicep. Well I was trying to do some bicep stuff to preserve what strength I had before they cut me and I completly tore my bicep.

Anyway I could write all day about my dumb shoulders....

[Joshua Davis]

My shoulder actually hurts worse now with all the additional attention. I am no longer training until the pain subsides, I just can't risk taking long-term time away from work.

I found a shoulder doc that works on professional baseball teams. I figure that baseball players have more shoulder probs than we meatheads possibly could, so hopefully this is a step in the right direction.

[jordanfoley]

Josh,

You are doing all of the normal "I have a screwed up shoulder" things and they don't seem to be working very well. My left shoulder is a mess and became even worst when I tore my labrum last October playing rugby. It was managable in my training for strongman but always hurt a bit.

Long story short: I increased my strenth in OH pressing a lot despite the problem but it caught up with me toward the end of the strongman season to the point where I couldn't really press at all. Then in Spetember is was so bad that I could hardly move my arm in daily life.

I looked into even more stuff and tried everything. I came up with this:
1) Do exercises for the serratus - some can be found here, along with other good stuff.
http://www.t-nation.com/readTopic.do?id=1053531
http://www.t-nation.com/readTopic.do?id=1055409
http://www.t-nation.com/readTopic.do?id=1153915

2) Have a day devoted to the stabalization of your shoulder and triceps exercise that do not agravate it at all.
3) Band traction for the shoulder helped me so much. Do it, no questions asked (unless you need instruction, then I can help point you in the right direction).
4)http://www.westside-barbell.com/articles.htm

Go to that link and go to the article called "Using kettlebells." I do this on my 'stabalization day' and I think it made a huge difference. Like bigtime man. Also, I actually do this on incline bench cause flat kills my shoulders and incline does not.

The above things really saved me, I was about a day away from deciding on surgery but now I continue to progress. Obviously do the the other things like go slowly with progression and avoid what hurts, but the serratus stuff will save you man. It did for me.

If you need more info on how I have implemented it you can check my training at:
http://www.titannutrition.ca/phpbb/phpBB2/viewtopic.php?t=7

Good luck and let me know if you have other questions.

Jordan

[Chris Mathison]

Josh,

You are doing all of the normal "I have a screwed up shoulder" things and they don't seem to be working very well. My left shoulder is a mess and became even worst when I tore my labrum last October playing rugby. It was managable in my training for strongman but always hurt a bit.

Long story short: I increased my strenth in OH pressing a lot despite the problem but it caught up with me toward the end of the strongman season to the point where I couldn't really press at all. Then in Spetember is was so bad that I could hardly move my arm in daily life.

I looked into even more stuff and tried everything. I came up with this:
1) Do exercises for the serratus - some can be found here, along with other good stuff.
http://www.t-nation.com/readTopic.do?id=1053531
http://www.t-nation.com/readTopic.do?id=1055409
http://www.t-nation.com/readTopic.do?id=1153915


Jordan

fantastic articles. thank you very much.

[Chris Mathison]

so how did the MRI turn out Josh?