[Hayley Bamber]

Hi all

I'm new to this site so hope I'm in the right forum! I have a shoulder impingement which I have had for 18 months following an impact fall. My surgeon is hesitant to operate due to my age and wanted to try conservative options. He recommended hydrocortisone injections (one of which I had got from my gp with no benefit but no additional pain). My surgeon carried out the second injection and since then I have been in more pain than when I had the initial fall. To be honest I have had enough of being in pain and not sleeping. I'm on morphine but this does not seem to be touching the pain. To be honest I am exhausted and really stressed and down with it all and was hoping there was any advice from people who have been in my position as I feel no one understands

Thanks in advance
Hayley

[Jomar]

Why is age a concern? too young or to old?

Did you have any PT or possibly chiropractic before the injections?
If you had PT was it the same person or place , did you ask for a more advanced therapist?

Has there been any imaging - MRI or x rays?
What if anything shows on those?
If nothing specific stands out then it could be soft tissue related, trigger points or a nerve is being compromised somewhere.

Perhaps acupuncture might be helpful?
Or low level laser, also called by soft laser or cold laser..

Have you gotten other medical or perhaps even expert chiropractic opinions?

I found a teacher of PT that had his own PT clinic and taught at the local university, he was very good and did a full evaluation for my RSI/TOS issues.

You don't have frozen shoulder syndrome?

[Hayley Bamber]

Hello, thanks for commenting - age is a concern because I'm too young. The surgeon said they could operate and shave some of the tendon to create more space to avoid the impingement but he said because I'm 30 and female there is a chance that the impingement could reoccur in a few years and then he would not be able carry out further surgery without possibly
Compromising my arm function.

I have had physio before the injection however they could not really do much because of my pain (that was why I saw the shoulder physio and was referred to the surgeon).

Had an ultra sound scan which didn't really show much as I was unable to move my arm how tgey wanted to to see the shoulder properly so I had an MRI which the surgeon said shows a clear impingement (there had been concerns about a tear but that was not indicated on the MRI)

Physio have considered acupuncture but have said that they are hesitant to really do much if morphing isn't touching the pain, so all she said she can do is monitor me until I see the surgeon again in 3 weeks.

Not seen a ciropracter and that was not something which has been suggested to me so that is an option!

I don't have frozen shoulder symptoms yet - physio say there is not massive stiffness yet - my shoulder has clearly and visibly dropped and rotated inwards and the muscle across my back has stopped working so they are really struggling to work on the impingement pathway.

Just feels like a brick wall at every turn and it's getting to the point where it feels overwhelming and like there is no solution.

Thanks for you help

Originally Posted by Jo*mar

Why is age a concern? too young or to old?

Did you have any PT or possibly chiropractic before the injections?
If you had PT was it the same person or place , did you ask for a more advanced therapist?

Has there been any imaging - MRI or x rays?
What if anything shows on those?
If nothing specific stands out then it could be soft tissue related, trigger points or a nerve is being compromised somewhere.

Perhaps acupuncture might be helpful?
Or low level laser, also called by soft laser or cold laser..

Have you gotten other medical or perhaps even expert chiropractic opinions?

I found a teacher of PT that had his own PT clinic and taught at the local university, he was very good and did a full evaluation for my RSI/TOS issues.

You don't have frozen shoulder syndrome?

[Tengen]

Has the cause/site of impingement been identified? Like Jomar suggested, don't be afraid to consult more doctors and specialists for additional opinions. It is very important to get a definitive diagnosis both to guide treatment and for your own closure. I've had to consult with over 8 different healthcare providers to figure out my TOS situation. Hang in there!

[kyoun1e]

Hayley,

I recently (Nov '13) had surgery for impingement (subacromial decompression) and really wish I didn't. It created more issues for my TOS symptoms since it tightened the area up a bit and made it easy for TOS to enter the fray once again.

I think the big question is why do you have impingement?

Impingement is usually caused when the humeral head of the shoulder moves forward in the socket thus creating less room for the ligaments to move through. To correct this, you have to a) loosen up the pec minor muscle which pulls that shoulder forward (since it's attached to the ribs) and b) strengthen the posterior muscles of the rhomboids and lats that help pull the shoulder back and down.

But again, the question is why this is taking place?

Is it due to poor posture? That would mean forward rolled posture, tight pec muscles, and weak rhomboids/lats. This is fixable.

Where it gets tricky is when TOS is involved. If your posture is too forward, nerves can get compressed in the thoracic outlet making it impossible to strengthen those muscles since their not getting impulses correctly.

Anyways, I would not move quickly to surgery until you have found a very good physical therapist to explore the above.

KY

[Hayley Bamber]

Hi all thanks got commenting. I would struggle to consult a lot of different doctors as I live in England. My current treatment is on the NHS and I do not have private medical insurance (and if I got it now they wouldn't cover my injury. The cost of seeing the same surgeon I am seeing on the NHS private is £200 per consultation. I know my surgeon is good as I have worked with him in the past so have seen the results he has got with people. The impingement is involving the supraspinatus. We have never really discussed why as all the damage is as a result of trauma.

The initial injury was the impingement and the TOS to be honest I didn't realise I had until I came on this forum an looked it up. I think the TOS is secondary to the impingement. As physio has struggled to do anything due to pain I have noticed that the TOS has become more problematic. And the pain from the impingement has become more difficult to treat.

Thanks
Hayley

[Jomar]

What types of things is PT doing or having you do?

Are they trying any pain reliving modalities - massage, trigger point, ultrasound, soft laser, if stim, body work?
If a nerve is directly impinged these may not help much..

Or is PT based on trying to strengthen while you are in pain?
this will rarely work and may worsen the problem.

You may want to explore our useful sticky threads as there is so much info on therapies and such, much more than we can recall and type out..

plus many videos on youtube - Eric Dalton has some interesting vids, and various others using key words related to your symptoms.

[Hayley Bamber]

PT are not able to try anything really - they have tried massage but they cannot go very deep with it due to pain. Exercise wise they asked me to shrug my shoulders and stretch my neck. They are hesitant to do anything else so not got very far with it to be honest

[Jomar]

I would try to locate a chiropractor or PT place that has a low/soft/cold laser.. Just to see if that can help with pain or not.

My chiro had one and it was wonderful for my painful spots he used it on my elbows,wrist, shoulder low back, and my foot when I got Plantar fasciitis.

When prices come down more I plan to buy one for family use at home.

[Hayley Bamber]

Thanks I will definitely look into that and see what my surgeon says when I see him! I'll report back and hopefully it will help the pain