From: jim@ljkiraly.lerc.nasa.gov (L J "Jim" Kiraly)
Subject: Re: Shoulder Injury Doctors don't have a clue about
Organization: NASA/LeRC
Date: Sat, 12 Sep 1992 17:11:53 GMT

In article <494@highett.mel.dbce.csiro.au> inpd@mel.dbce.csiro.au (Ian  
Davidson) writes:
>Hi,
>
>I was recently playing a game of volleyball where I was playing as a setter. 
>We were playing Universal setter and the opposition front court were not  
blocking me at all when I was legimately on the front court so I faked to jump  
set and turned and smashed the ball.
>
>When I rotated in the air and smashed the ball I felt my left shoulder (my
>hitting shoulder) go in and then out (it was not dislocated though) and felt
>some immeadiate pain.
>
>
>The Doctors do not know what is wrong but they know this Physio that will
>charge me $100 an hour to fix this problem they do not know about.  :-)
>
>So my questions are:
>
>Has anybody out there had a similar injury.  If so how did you overcome it, 
>how long did it take, and what warm up exercises do you do to prevent it from
>happening again.
>
>Is it worth seeing a physio even though the doctors are not sure what muscle  
is
>strained, torn (they suspected the rotar cuff but the tests showed nothing).
>

I had a similar injury and was even scheduled for a major surgery which would  
have immobilized my arm for 6 weeks, required a year of rehab, and according to  
the orthopaedic surgeon (who I thought was pretty good) could expect no more  
than 80% function afterwards.   Then, after a lot of self-study (and a long  
story which I won't recount here) I found a GOOD orthopaedic surgeon who  
instantly knew what the problem was and fixed it arthoscopically with a full  
recovery in about 6 weeks.

MESSAGE #1 -  See some other doctors and specifically ask about an acromial  
impingement.

MESSAGE #2 - ALWAYS do shoulder warm ups before playing.  Throwing the ball  
back and forth with exaggerated full arm motions helps.

MESSAGE #3 - Find a good physical therapist who knows the exercise regimen  
required to strengthen the head suppression muscles of the rotator cuff group.   
These exercises are designed to keep the surgical head of the humerous (the  
round part of your upper arm bone) held low enough that it won't hit the  
acromium (the boney projection of the scapula which is the fixed bone on top of  
your shoulder joint).

It is fairly common injury Volleyball spiking/blocking and tennis backhand  
motions to rapidly raise the arm and have the humerous impact the acromium- the  
resulting pain isn't funny.  In my case, this punched a hole in the ball of the  
humerous and right through he superspinatus (one of the rotator cuff muscles-  
the one that is involved with lifting your arm laterally).  If you have  
difficulty raising a weight laterally, hear a lot of clicking (bone against  
bone) you may be experiencing this kind of injury.  Try to extend a loaded gym  
bag onto the passenger seat of your car with your injured (presumed right) arm.   

Also, since one of the bicep tendons pass through a groove in the same area of  
the surgical head of the humerous, I frayed the bicep tendon due to the same  
acromial impingement and had great difficulty with any kind of arm curls.  

The big problem with all of this is, that it gets progressively worse.  I  
treated my injury with massive doses of ibuprofen and as time went by had more  
and more difficulty.

The non-invasive fix for all of this is arthroscopic surgery where the surgeon  
grinds off the underside of the acromium, trims various tendon structures and  
and cleans up the socket that the humerous rotates in (this is called the  
glenhoid rim).  I have a 7 mm hole still in the superspinatus which isn't  
causing me any difficulty.  If the hole were bigger it would have to be fixed  
and would cause a potential loss in range of motion due to scar tissue  
formation.  

There are relatively few surgeons who practice arthroscopic shoulder surgery of  
this type.  They will avoid any operation until there are major tears which  
cause you to be seriously disabled- and then will do a full open surgery which  
results in scar tissue formation and permanent loss of function.  I would  
recommend that you call around to find someone versed in acromial impingement  
and arthroscopic shoulder surgery.   I went from a planned 5 day hospital stay  
with the first surgeon to an outpatient surgery with the GOOD surgeon.  I have  
been religious about doing the painful rehab and basically am ready to play  
again after only six weeks....

--
__________________________________________________________________
Jim Kiraly- jim@ljkiraly.lerc.nasa.gov- NASA Lewis Research Center
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