"Snowboarder's Shoulder" or Impingement Syndrome

[Buzzworthy]

And again I am falling apart. The orthro actually called it "Snowboarder's Shoulder". One more pro toward skiing again.

Back to PT. Apparently this has been an ongoing project for years for me. Too many OTB on the board and the MTB.

Now it is catching up and my shoulder is hurting someting fierce. Taking Viox and Tylenol 3 for a better comfort level. PT 1-3 times a week and I think a 30 minute massage per week would not hurt since insurance will pay 50% of the massage.

Here is what I found on the net: Anyone have more to add or experiences? No improvemtent in 3-4 weeks equals cortisteriod shot.


What Are the Structures of the Shoulder and How Does the Shoulder Function?

The shoulder joint is composed of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) (see diagram). Two joints facilitate shoulder movement. The acromioclavicular (AC) joint is located between the acromion (part of the scapula that forms the highest point of the shoulder) and the clavicle. The glenohumeral joint, commonly called the shoulder joint, is a ball-and-socket type joint that helps move the shoulder forward and backward and allows the arm to rotate in a circular fashion or hinge out and up away from the body. (The "ball" is the top, rounded portion of the upper arm bone or humerus; the "socket," or glenoid, is a dish-shaped part of the outer edge of the scapula into which the ball fits.) The capsule is a soft tissue envelope that encircles the glenohumeral joint. It is lined by a thin, smooth synovial membrane.

The bones of the shoulder are held in place by muscles, tendons, and ligaments. Tendons are tough cords of tissue that attach the shoulder muscles to bone and assist the muscles in moving the shoulder. Ligaments attach shoulder bones to each other, providing stability. For example, the front of the joint capsule is anchored by three glenohumeral ligaments.
The rotator cuff is a structure composed of tendons that, with associated muscles, holds the ball at the top of the humerus in the glenoid socket and provides mobility and strength to the shoulder joint.
Two filmy sac-like structures called bursae permit smooth gliding between bone, muscle, and tendon. They cushion and protect the rotator cuff from the bony arch of the acromion.

What Are the Origin and Causes of Shoulder Problems?

The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. It is easily subject to injury because the ball of the upper arm is larger than the shoulder socket that holds it. To remain stable, the shoulder must be anchored by its muscles, tendons, and ligaments. Some shoulder problems arise from the disruption of these soft tissues as a result of injury or from overuse or underuse of the shoulder. Other problems arise from a degenerative process in which tissues break down and no longer function well.
Shoulder pain may be localized or may be referred to areas around the shoulder or down the arm. Disease within the body (such as gallbladder, liver, or heart disease, or disease of the cervical spine of the neck) also may generate pain that travels along nerves to the shoulder.

Tendinitis, Bursitis, and Impingement Syndrome

What Are Tendinitis, Bursitis, and Impingement Syndrome of the Shoulder?

These conditions are closely related and may occur alone or in combination. If the rotator cuff and bursa are irritated, inflamed, and swollen, they may become squeezed between the head of the humerus and the acromion. Repeated motion involving the arms, or the aging process involving shoulder motion over many years, may also irritate and wear down the tendons, muscles, and surrounding structures.
Tendinitis is inflammation (redness, soreness, and swelling) of a tendon. In tendinitis of the shoulder, the rotator cuff and/or biceps tendon become inflamed, usually as a result of being pinched by surrounding structures. The injury may vary from mild inflammation to involvement of most of the rotator cuff. When the rotator cuff tendon becomes inflamed and thickened, it may get trapped under the acromion. Squeezing of the rotator cuff is called impingement syndrome.
Tendinitis and impingement syndrome are often accompanied by inflammation of the bursa sacs that protect the shoulder. An inflamed bursa is called bursitis. Inflammation caused by a disease such as rheumatoid arthritis may cause rotator cuff tendinitis and bursitis. Sports involving overuse of the shoulder and occupations requiring frequent overhead reaching are other potential causes of irritation to the rotator cuff or bursa and may lead to inflammation and impingement.

What Are the Signs of Tendinitis and Bursitis?

Signs of these conditions include the slow onset of discomfort and pain in the upper shoulder or upper third of the arm and/or difficulty sleeping on the shoulder. Tendinitis and bursitis also cause pain when the arm is lifted away from the body or overhead. If tendinitis involves the biceps tendon (the tendon located in front of the shoulder that helps bend the elbow and turn the forearm), pain will occur in the front or side of the shoulder and may travel down to the elbow and forearm. Pain may also occur when the arm is forcefully pushed upward overhead.

How Are These Conditions Diagnosed?

Diagnosis of tendinitis and bursitis begins with a medical history and physical examination. X rays do not show tendons or the bursae but may be helpful in ruling out bony abnormalities or arthritis. The doctor may remove and test fluid from the inflamed area to rule out infection. Impingement syndrome may be confirmed when injection of a small amount of anesthetic (lidocaine hydrochloride) into the space under the acromion relieves pain.

How Are Tendinitis, Bursitis, and Impingement Syndrome Treated?

The first step in treating these conditions is to reduce pain and inflammation with rest, ice, and anti-inflammatory medicines such as aspirin, naproxen (Naprosyn*), ibuprofen (Advil, Motrin, or Nuprin), or cox-2 inhibitors (Celebrex, Vioxx, or Nobic). In some cases the doctor or therapist will use ultrasound (gentle sound-wave vibrations) to warm deep tissues and improve blood flow. Gentle stretching and strengthening exercises are added gradually. These may be preceded or followed by use of an ice pack. If there is no improvement, the doctor may inject a corticosteroid medicine into the space under the acromion. While steroid injections are a common treatment, they must be used with caution because they may lead to tendon rupture. If there is still no improvement after 6 to 12 months, the doctor may perform either arthroscopic or open surgery to repair damage and relieve pressure on the tendons and bursae.

[Pinner]

I've got a chronically painful shoulder that keeps me up at night and separates several times a year. Been putting off surgery as the recovery takes several months.

And this week I discovered I've got ANOTHER FUCKING HERNIA. Nothing quite as uncomfortable as abdominal surgery.

[iceman]

Originally posted by Tap
. What part of snowboarding exactly caused the injury

Uh, I believe that would be the falling part.

[Vinman]

Buzz,

Most of the time impingement can be treated successfully with therapy. Strengthening of the rotaor cuff and muscles around the scapula are very important. If possible avoid the cortizone shot.

Sometimes impingement is only a symptom of a bigger problem such as a torn labrum. Your doc will most likely start you on therapy. if it does not get better, he might try the shot. Relief is usually temporary days to 1-2 weeks. If the pain comes back he might then look a imaging of the shoulder to check for something else like a torn labrum that is casuing the instability instead of weak cuff muscles.

[Buzzworthy]

Originally posted by Tap
Buzz, sorry to hear you're hurtin' bro. What part of snowboarding exactly caused the injury (and skiers lose 10 points if they say "strapping in at the top of the run and making their skier friends wait" .....uh, that is, IF they wait

Not really sure, a culmination of many over the handlebars superman sytle on the board, snagged a tree last year, came down hard at the MINI at Basin and felt a great pain, chopping cords of wood to keep our house warm, Mountain biking with only 3 inches of travel on my old Haro, Great Danes (165 and 105lbs) pulling hard on the leash to get out, thus pulling my shoulder, lifting more with my left side even though Im right handed, .........

Your guess is as good as mine. ANd I have been off it for 3 weeks now to heal, but all of a sudden the pain started after waking up on a bad shoulder a week ago to a ton of pain and numbness. Been to Doc, then ortho now PT, so Im following the white coats at this point.

ANd maybe I am just plain good at hurting myself. Ya never know.

[jdabasin]

I had a skiing fall 3+ years ago that jacked up my shoulder. It bothered me for a few months, particularly when I hit the gym. I went to the doctor and Xrays were negative but they diagnosed the problem as chronic "impingement". Still not sure what that is exactly but it's probably explained in Buzz' first post. The Doc told me to take a month off of lifting and to try taking Glucosamine Sulfate. I used to have some knee issues, running related, and I heard Glucosamine is good for that also. I've been taking GS for 2.5 years now and I swear the shit works. I've had no further shoulder issues and no knee or joint related issues even though I've been stepping up my running in the past two years a lot. I take 500-1000mg a day. Try it out but you got to stick to it for a month or more before you notice any difference....

I give it to my dog too cause the vet said it'll help with her hip issues. She has not gotten any worse over the past year and is probably a little bit better off actually.

[powderhound]

i had a knuckle-dragging buddy catch an edge and dislocate his shoulder last month

[Buzzworthy]

Originally posted by Vinman
Buzz,

Most of the time impingement can be treated successfully with therapy. Strengthening of the rotaor cuff and muscles around the scapula are very important. If possible avoid the cortizone shot.

Sometimes impingement is only a symptom of a bigger problem such as a torn labrum. Your doc will most likely start you on therapy. if it does not get better, he might try the shot. Relief is usually temporary days to 1-2 weeks. If the pain comes back he might then look a imaging of the shoulder to check for something else like a torn labrum that is casuing the instability instead of weak cuff muscles.

Most painfull>>>> Holding left arm out straight out and lifting up to a straight across shoulder, muscles kill and something hurts inside too. Damn near impossible at this point, the muscles just feel stretched, damaged, hurt from my shoulder start bone ( the bump there) staright down 3-4 inches on left arm. Moving forward and back is fine, no pain. Can't lift a gallon of milk right now.

[Buzzworthy]

Originally posted by jdabasin
I Try it out but you got to stick to it for a month or more before you notice any difference....

I give it to my dog too cause the vet said it'll help with her hip issues. She has not gotten any worse over the past year and is probably a little bit better off actually.

Will do for myself and my 9 year old Great Dane. Thanks for the info!!

[Vinman]

Originally posted by Buzzworthy
Most painfull>>>> Holding left arm out straight out and lifting up to a straight across shoulder, muscles kill and something hurts inside too. Damn near impossible at this point, the muscles just feel stretched, damaged, hurt from my shoulder start bone ( the bump there) staright down 3-4 inches on left arm. Moving forward and back is fine, no pain. Can't lift a gallon of milk right now.

HOw did it happen, I understand going over the bars many times but was there ever one that was worse that the others. If so explain how it happened what your shoulder felt like after.

Also and clicking or catching in the shoulder?

[Buzzworthy]

Originally posted by Vinman
HOw did it happen, I understand going over the bars many times but was there ever one that was worse that the others. If so explain how it happened what your shoulder felt like after.

Also and clicking or catching in the shoulder?

Probably the last one at the MINI at Basin. Went of a 5-7 footer, got a little forward on the way down and landed on front edge and then went down hard onto outstretched arms (specifically left arm) into 6"+ pow so it was not hard, but pushed my arm up and I heard and felt a pop. Very faint, sounded like cracking a knuckle. Hurt this time good enough to "tuck my wing" on the rest of the trail down and then called it (3PM anyway).

Sore for 2-3 days and then it has been ok for since, till a week ago. OH, was also pulling my motorcycle out of a tight spot last Wednesday. Heavy bike, but again just sore. Maybe I pulled something doing that. Plus splitting about 3-4 cords of wood this winter Im sure put a little wear and tear on it.

It has been clicking off and on and the ortho said that is just air popping out of the joint or something like that.

Right now it feels like there is not enough room under my shoulder for everything to move properly and so it feels like any movement is rubbing things together too hard in there. Too much friction. The swelling needs to go down and then it should feel better. I hope.

[Vinman]

A fall to the outstrecthed arm is a great way to tear you labrum. Although it is impossible for me to know just by doing this kind of thing I would be suspicious of it based on your description.

The thing is, when the labrum tears, the shoulder be comes unstable and changes the mechanics of the joint. That causes inflammation to the rotator cuff tendons as they pass under the acrominon. Basically they run on the underside of the bone and become swollen and irritated. This inflammation is very easy to detect on exam and may be though of as the root cause of the pain, when infact it is only a symptom of the actual damage to the labrum.

On this image, look at the arch formed by bone at the top of the shoulder with the cuff tendons running under. That is where the impingement is happening


side view In this view the labrum is the two small triangles on either side of the socket. The labrum is actually a ring the surrounds the socket that serves to stabilize the joint.


See this link too http://orthopaedics.hss.edu/services...joint_tear.asp

[Buzzworthy]

The doc specializes in shoulders and does not think I tore anything after all the yanking and pulling on my shoulder and arm and all the "push down hard", "now hold for resistance" test.

I hope he is correct. I have looked into this quite extensively and I am going to go with the PT and see what happens. If it gets worse, I will cetainly speak up to the doc. I have good days and bad days with the pain and today is a bad day (probably cause I woke up on it again.) For some reason I keep ending up lying on my left side (which is normal or on my back), but I can't seem to stay off it in my sleep.

Someone said no on the cortiosteriod shot. Reasoning? I do not know much about the shot part. Sounds temporary to me though. Or would it take the pain away long enough to heal a bit?

The doc has not done an MRI on it, as I thought he might. He seemed real confident that I have just tramatized the area. I see him again in 3-4 weeks, after a bunch of PT.


Bullet, yes please fill me in on how you did and what they did for surgery. The more informed I am, the better. I want to stay away from the knife if at all possible. I hope all goes well for you. The Nerve Block sounds like what I need right now for a few days so I don't involuntarily move my arm quick to catch something for example (beer got knocked over last nite by dog tail, reached for it, missed and yelled in pain, luckily it was only canned beer).


Vinman, thanks for all the help too. The ortho pulled out a similar model and showed me the areas that are "rubbing" in there. The shoulder feels relatively stable. I will ask about the labrum deal to hopefully rule that out.

[teledave]

bump for more info.

buzz, not only would it be snowboarders shoulder but also telemarkers shoulder since all the falls I take would be face first onto outstretched arms.

I'd had a cortisone shot about a week before the mini but the effects had pretty much worn off by then. I've got decent strength and ROM in the (worst) shoulder but reaching my hand towards the other shoulder (especially from behind) hurts like hell and my shoulder pops and cracks loud enough for other people to notice.

Actually this thread makes me hopeful that it will all just go away with time, please.

[Buzzworthy]

Originally posted by teledave
bump for more info.

buzz, not only would it be snowboarders shoulder but also telemarkers shoulder since all the falls I take would be face first onto outstretched arms.

but reaching my hand towards the other shoulder (especially from behind) hurts like hell .......


Actually this thread makes me hopeful that it will all just go away with time, please.

For me, the pain is non-existent reaching the way you do. It is the "reaching for the sky" that hurts like hell.

That sucks Dave, I'm with you, I hope is will go away in time.

PLEASE!!