- I started having nagging shoulder pain in Jan of 2009; at this time, I was working on my clean + jerk a fair amount, and also working on my handstand pushups, and muscleups.
- From memory, there's no specific acute incident that I can recall that triggered anything; I roughly remember bailing on a few muscleups, but that's it.
- I had been doing Crossfit since Nov 2007, pain free.
- A potential subluxation/dislocation to my left shoulder happened around Sept of 2007 during Tae Kwon Do, resulting in pain overhead for about two weeks.
- Since Jan, I have had: Chiropractic adjustments, physio, massage, and ART with no relief. I adhere to an anti-inflammtory diet, threw copious amounts of NSAIDs at it around April/May, take fish oil religiously, and putting ice directly on my skin no longer bothers me.
- I have had an ultrasound, multiple xrays, and a contrast MRI.
- Anything overhead, where the angle of my acromion and clavicle (AC joint) is "closed" (arm straight up) causes pain. Pushing movements away from me cause pain in the anterior delt region. Pain during a WOD is tolerable, next day pain blows chucks, and is cumulative.
Official Diagnosis (80% official, but I'll get to that in a sec): Bursitis secondary to glenohumeral ligament laxity causing shoulder instability.
English: The ligaments holding my shoulder in place are loose, and the "bursa", or fluid filled sac that cushions the joint, is irritated. Pissed. Steaming mad at Mike for letting it get all inflamed and shit.
80%???
So, everything as far as diagnostic imaging has been clear, with the exception of my xrays. They showed osteolysis of my distal clavical---damage to the end of my collarbone where it had been bashing into my acromion during overhead movements. Ultrasound of my rotator cuffs was fine, MRI was "clear"---but Kwan stated that even a contrast MRI is only 80% accurate, and I could still have a labral tear or bicep tendon issue. Bah, wtf.
The Plan
So, the plan is this: He wants me diligently working on strengthening my rotator cuffs with various mobility drills using light weight. Like, 5 lbs weight. Everyday, for the next 30 days. Supposedly, this will "tighten" up the joint and stabilize it. I didn't bother explaining that I have a mile long list of rotator cuff exercises that Cory gave me, mobility and thera-band drills that Brian gave me, and specific stretches, both static and dynamic, that Chad gave me, and that I do this at home, while reading, while at work, during warmup, during cooldown, etc etc etc. Nor did I explain I can still do over 40 kiping pullups, bust out 3 strict chins with 90#, and put 185# over my head. I'm pretty fucking sure my rotator cuffs are fine. Nor did I point out the ultrasound was clear on those, also. I just asked "ok, and after that?"
After 30 days, if there's still pain, he wants to inject cortisone, an anti-inflammatory drug, into the bursa. My displeasure must have been obvious, because he explained that this would be more diagnostic than anything. I'm not worried about the procedure, but it's a band-aid solution versus treating the cause, even if it is diagnostic. All it'll do is remove the inflammation, I'll feel better, I'll start hitting WODs, and shit will get inflamed again. Not to mention the increasing the risks of actual tendon rupture with cortisone. But he's the surgeon. Not me.
AFTER that, he would do an arthroscope to take a look inside the actual joint itself. At this point, if I could do that myself, I would. In the year I've had to dwell on my ongoing injury, I've had a fair amount of time to investigate various cases of acute and non-acute shoulder injuries; needless to say, I think the 80% rate of MRI success is bullshit, and going by how "smoothly" my contrast went, I'd say there's more going on than what the picture shows.
I understand why he's being methodical, and I understand I still have a very high degree of function compared to other injured folks, but christ, I just want this damn shoulder fixed. A resection of the ligaments is a major, MAJOR deal, and I honestly DON'T know if I want to go there. But a scope would be SO damn definitive for imaging, even if it is invasive---but it could find a spur, a tendon tear, a torn labrum instantly. Before a ligament resection, though, there's other fixes---like clavicular resection, where they make more space for the bursa and tendons to move so they don't get pinched. But he's the surgeon. Not me.
For now, I'll comply with the Doc's orders, 100%. I start physio again, based on the tentative diagnosis, and aim treatments around that. I'll throw the fucking kitchen sink at it, and I'll keep doing what I'm doing.
Logging you in...
Posts
Jacob · 799 weeks ago
See you tomorrow at CF
Jimmy Mac · 799 weeks ago
Gerry Kesthely · 799 weeks ago
Cory Gillespie · 799 weeks ago
Deirdre Coburn · 799 weeks ago
Hang in there, do as you are told and hopefully things will work out for you. Perhaps informing the Doc about all the "good" you've been doing will help speed things up for you.
Sean'O · 799 weeks ago
Sean'O
Mike 58p · 798 weeks ago
I'm usually a "the cup is half full" kinda guy, but the length of this injury has been mentally hard to deal with. I'm planning on booking the cortisone sooner rather than later, and after that, if he does not scope it, I will find an ortho that will.
Drew · 798 weeks ago
Best of Luck. BTW...stumbled upon this looking for DCO related injuries with CrossFit
Mike 58p · 798 weeks ago
From looking over the CF boards over the past months, it seems like a very common problem (for Crossfitters). Alwyn Cosgrove wrote about the potential overuse injuries that Crossfitters are liable to run into---and I'd have to agree. I don't have an issue with overhead movements, but I think the amount of instability and lack of flexibility present in the general population just isn't conducive to a LARGE amount of volume at moderate-to-heavy loads.
Keep me posted on your progress!
Ash · 758 weeks ago
Finally stop going to gym and riding all together. Go to primary care physician. He gives the 2 weeks prescription naproxen, and Xray. The hospitals staff radiologist says it's in spec.
Go to sports doc. He refers to PT. Assessment shows strength imbalance in internal and external rotators and poor posture. Impingement like symptoms, feel of tendon catching during certain arm positions. 6 weeks of PT, some strength gains, some other improvements. But still continual pain in AC, and sharp pain at certain positions.
Go see orthopedic specialist (who I should have gone to on day one). He looks at that previous xray and points out AC osteolysis that the original radiologist missed. I want a contrast MRI to also look for SLAP labrum type tear. Going on Monday. He also suggests the cortizone right into the AC as a diagnostic tool more so than for long term relief. If you get immediate relief than it points to AC osteolysis.
Two choices were live with it, take NSAID or a new patch for pain relief, and distal clavicle resection to shave off part of bone to help get it to remineralize.
I loved Crossfit. I really did. The camraderie, the coached workouts, just go listen workout and go home. Loved it all. But won't be going back. The emphasis on high reps combined with so much shoulder work, dips, kipping pullups, handstands did me in.
Mike 58p · 758 weeks ago
I'm sorry to hear about your shoulder issue; please keep me updated on your progress after Monday. Your case sounds so similar to mine, I can only hope it turns out the same way.
There were days I was positive I'd be throwing away Crossfit for good---and days I was nearly in tears when it hurt just to open a rolling side door on the rescue truck at work. Crossfit I could have lived without, but not being able to do my job as a career firefighter? That scared the hell outa me. It took a diligent YEAR of barely doing anything upper body related, let alone overhead, to quell the inflammation. I was 100% positive that I had a SLAP tear. There was no way in hell that much pain could have been from mere inflammation. But it was.
In hindsight, I'd have to say it was a combo of de-loading, high dose fish oil (which, if you check the CF forums, there's a few threads on this exact topic), and actually stopping PT, which I think was exacerbating the inflammation. Initially "doing my own thing" at the gym completely sucked; the camaraderie and community are some of the best aspects of a CF gym. Right now, I'm pretty much pain free from day-to-day; certain movements, like bench press/OHP do cause some significant muscular tightness in the traps/scalenes, and for whatever reason riding *DOES* beat the shit outa my shoulder. But, so far so good. I'll have to deal with a sketchy shoulder the rest of my life, but that I can work around.
I don't know where you train or what your trainers are like, but (and don't get me wrong, I'm not pimping out CF) don't give up on Crossfit just yet if it means that much; get your results after Monday, be it negative or positive for a tear, and then make a gameplan and implement it. Surround yourself with knowledgeable, supportive people---I like to think of these folks as my "network"---trainers, friends, massage therapists, chiropracters, physicians. An opinion, support, and knowledge from every angle.
Ash · 628 weeks ago
So long story short, no need for surgery yet as day to day is liveable. My goal is to stay away from the knife until absolutely necessary. I still workout the shoulder but try to be careful. Some tips someone gave me include:
1.Try overhead pressing with arms more anterior to the shoulder, such as how the bar is positioned in a front squat or a push press. I find this to be a more powerful and functional position than the classic military press when the arms are oriented laterally to the shoulder. Similarly, with your push up make sure your shoulders start retracted and elbows are back closer to your body. However if pushups cause too much pain obviously do not do them yet.
2. Try decline bench, this will hit the sternal pecs better.
3. Try reverse grip bench, position your hands so they're toward your head instead of your feet, this will put your shoulder in more favorable position.
4. Instead of lateral raises try "scapation" this is lifting a DB at a 30 degree angle from the shoulder with thumbs pointed up vs down like in a traditional raise. The angle at which the scapula is oriented is 30 degrees and so by performing a raise at a 30 degree angle anterior from the shoulder allows the scapula to move and get stronger within a healthy ROM. Start out slow 2 sets of 12-15 at a light weight and progress. But remember keep it moderate with the assisting exercises.
I am using a Lifeline Jungle Xt (similar to TRX) and ultimate sandbag for a lot of exercise now. the TRX can place some serious load on the AC when doing chest work like pushups. dips, so I really limit my range of motion on that. I like the sandbag and do things like Turkish get up with the bag on my shoulder as opposed to using a kettle bell with my arm elbow locked. that place a lot of strain on the ac. similarly, if I do kettlebell swings I don't go too high.
The success of the Mumford procedure (cutting off the edge of the clavicle) is high from the research I read, but surgery is surgery and I'm going to try an avoid it.