Shoulder Impingement

shoulder impingement

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Impingement is the fact of having mechanical compression and/or tendon wear of the rotator cuff. Rotator cuff is composed of a serie of 4 muscles connected to the shoulder blade at the humeral head (upper part of the shoulder joint). The function of the rotator cuff is to maintain the humeral head within the glenoid (socket) during normal shoulder function and to participate in shoulder strength during activity. Normally, the rotator cuff glides gently between the inferior surface of the acromion, the bone at the point of the shoulder and the humeral head.

Causes

Any process that can interfere with rotator cuff being able to glide normally can cause impingement. The causes are :

  • Weakening

  • Degeneration of the tendon due to aging

  • Formation of the bone spurs

  • Inflammation of tissues on the space above the rotator cuff

  • Injury due to overuse

Overuse activities that can lead to impingement are most commonly seen in tennis players, pitchers and swimmers.

Diagnosis

shoulder impingement

Diagnosis can be made with the patient’s history and physical examination. Patients suffering impingement often complain of pain in the shoulder. This pain worsens with overhead activity and can be so strong that it causes an awakening during the night. Manipulation of the shoulder in a specific way by a doctor will usually reproduce the symptoms and confirm the diagnosis. X-rays are also useful for the evaluation of the presence of bone spurs and/or the narrowing of the subacromial space.

Treatment

The first thing to do is to eliminate identifiable causes or factor that contribute to the pain. This means temporarily avoiding activities like tennis, pitching or swimming. A non steroidal anti-inflammatory medication may also be recommended by your doctor. The treatment is based on exercises aimed at restoring flexibility and normal strength to the shoulder girdle, especially by strengthening the muscles of the rotator cuff and the muscles responsible for the normal movements of the scapula (shoulder blade). This program may be performed by a doctor, a certified athletic trainer or a qualified physiotherapist. Sometimes a cortisone injection may be helpful in the treatment.

Surgery

Surgery isn’t necessary in most case of shoulder impingement. But if the symptoms persist despite non-surgical treatment, surgical intervention may be beneficial. Surgery involves deriding or surgically removing, tissue that is irritating the rotator cuff. This can be done with open or arthroscopic technique. The result is favorable in about 90% of cases.

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-Steph

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Rotator Cuff Tears

rotator cuff tear anatomy shoulder

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Rotator cuff is a group of 4 muscles and their tendons that together form a « cuff » around the head of the humerus (upper end of the arm). The 4 muscle, originate from the scapula (shoulder blade), are upraspinatus, infraspinatus, subscapularis and teres minor. Tendons of each muscle fit on the humerus tuberosity.

Rotator cuff’s functions :

  • Lift the arm

  • Turn the arm

  • Stabilize the humerus in the joint

Causes

rotator cuff tear anatomy

The causes of a rotator cuff tear can be an acute injury such as a fall or because of chronic wear with tendon degeneration. For people over 40 years old, the pinching of the tendon on the underside of the scapula may participate in tearing.

Diagnosis

Diagnosis of rotator cuff tears is based on an examination and/or diagnosis study such as a MRI (magnetic resonance imaging) to confirm the diagnosis. Diagnosis early on in the first symptoms and rotator cuff’s treatment can help to boost the treatment’s results.

Treatment

Goals treatment are to relieve pain and restore strength to the injured shoulder. Several tears in rotator cuff can be treated without surgery. Anti-inflammatory drugs, steroid injections and physical therapy can all be beneficial in treating the symptoms of a tear in the cuff.

Even though a full-thickness tear needs to be cured with surgery, it’s possible to use non-surgical treatments to have a satisfactory function in some cases.

Surgery

rotator cuff tear anatomy surgery

Surgery is recommended if there is persistent pain or shoulder weakness that doesn’t improve with non-surgical treatment. Often patients who have surgery indicate nocturnal pain and difficulty using the arm for lifting and reaching. Many will indicate persistent symptoms despite several months of treatment and limited use of the arm.

Surgery is also recommended for active people who use the arm for overhead work or sports.

Surgical options

The type of repair performed is based on the findings at surgery. A partial tear my necessarily only a trimming or smoothing procedure called a debridment. A full-thickness tear with the tendon torn from its insertion on the humerus is repaired directly on the bone.

3 techniques are used for rotator cuff repair :

  • Open repair (through a traditional incision)

  • Mini-open repair (partially assisted by a camera view, with a smaller incision)

  • Arthroscopic (performed with only a small camera inserted through multiple small puncture wounds)

Recovery and rehabilitation process

Whether for the treatment of non-surgical and surgical rotator cuff tear, rehabilitation has a very important role. Usually recovery is at least 6 months or more depending on the extent of the tear.

When there is a tear, there is frequently a loss of shoulder movement. An exercise or physical therapy program is needed to restore strength and improve shoulder function.

Although surgery repairs the defect of the tendon, the muscles around the arm remain weak and an important effort is necessary in the rehabilitation so that the procedure is a success. After surgery, a complete re-education can last several months.

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-Steph

P.S. If you’re in Miami and you like Caribbean food, go to my cousin’s bistro to eat Haitian food, click here .

Acromioclavicular Joint Injury

acromioclavicular joint injury

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Acromioclavicular joint is a joint between the clavicle and the scapula. Acromion is a continuation of the scapular spine and hooks over anteriorly. It articulate with the clavicle (collar bone ) to form the acromioclavicular joint.

Problems types

The most common problems are arthritis, fracture and separation. Arthritis is characterized by a loss of joint’s cartilage. Arthritis of acromioclavicular joint is common with weight lifter, especially with bench press and a little less with shoulder press. When there is a problem with the rotator cuff, it’s possible that there is also acromioclavicular joint’s arthritis.

Acromioclavicular separation

acromioclavicular joint injury type grade

When there is an acromioclavicular joint separation, it means that the ligament that connects the acromion and clavicle is damaged and that the 2 structures don’t align properly. Separation’s state can be weak or severe, that is why there is a system of « grade » according to which ligament is torn and the severity of the tear.

Grade I Injury – This is the weakest damage and the acromioclavicular joint is still aligned.

Grade II Injury – This is an average damage. Ligaments are only stretched but not fully torn. In case of stress (physical effort), the acromioclavicular joint becomes painful and unstable.

Grade III Inury – This is a serious damage. Ligaments are completely torn and the collar bone is no longer attached to the scapula, which creates a visible deformity.

Treatment of acromioclavicular joint arthritis

If the rest, ice, medications and change of the training program (changing the exercises) don’t work, the next step is a shot of cortisone. A shot of cortisone in the joint may have calmed the pain and may be permanently swollen. As each individual is unique, the effects may vary and it’s possible that it doesn’t swell permanently.

If non-surgical methods fail, it’s possible to perform a surgical operation. The pain is localized at the bones end that make contact with each other and the goal of the operation is to remove some of the end of the clavicle. This ambulatory surgery can be done with a small incision of 1 inch (2.5 cm) long or with the arthroscopy technique with 2-3 incisions. The results and recovery of these 2 surgical techniques are about the same. Most patients have a full movement by 6 weeks and can return to do sport by 12 weeks.

Treatment for acromioclavicular separation

Separation can create very painful injuries, so the first thing to do is to decrease the pain. Hold the arm in a sling, put ice and pack the shoulder for 20-30 minutes every 2 hours as needed. Acetaminophen and non-steroidal anti-inflammatory medications can also help calm the pain.

When the pain begins to subside, it’s important to move the fingers, wrists and elbow (and eventually the shoulders) in order to avoid having stiff or « frozen » shoulder. The length of time needed to regain complete movement and function depends on the severity or injury’s grade.

Recovery from Grade I acromioclavicular separation usually takes 10-14 days while Grade III takes 6-8 weeks.

When surgery

Grade I and II separations require very rarely surgery. With a Grade III injury, after surgery, it’s possible to have full body physical activity with some restrictions.

Statistics

  • More males than females suffer acromioclavicular joint injuries

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-Steph

Variant To Avoid Dumbbell Bench Press Shoulder Pain

shoulder pain

What’s up ? This is THE stephane ANDRE ! I watched an Athlean-x’s video  and I learned some good stuff.

I wrote an article about to avoid pain when you do dumbbell press or overhead shoulder press because I have a pain when I do it. Click here to read the article  . I have the same problem with the dumbbell bench press. I have pain when I do it, so I write this article to continue this exercise without pain.

Bench press is one of the fundamental exercises to build muscles but with this pain, I wondered if I should continue doing this exercise because it hurt.

Problem

The reason for this pain may be a biceps tendonitis, a torn labrum, an inflammation or shoulder impingement (inflammation in rotator cuff). All these problem create instability during this exercise while we know that stability (body’s stability and dumbbell’s stability) is very important to perform the movement properly.

In the case of a torn labrum, labrum is tied to the biceps tendon or rather the biceps tendon is attached to the labrum. During the movement, it’s the tension of the biceps tendon that pulls on the torn labrum.

Solution

The solution is to change the elbows position. To do the classic bench press, the elbows are at between 45° and 90°, dumbbell held horizontally in the hands and you press up. To calm the pain, we’ll change the position. The technique is to tilt the dumbbells so that the dumbbell’s back are facing the ceiling.

Classic dumbbell bench press

dumbbell bench press

dumbbell bench press

dumbbell bench press

Variant dumbbell bench press

variant dumbbell bench press

variant dumbbell bench press

variant dumbbell bench press

Tilting the dumbbell’s back does 2 things :

  • This brings your arms closer to your body because you use a semi pronated grip. With this position your hands and arms make your shoulders have a neutral position. It’s the equivalent of barbell corner press which helps to reduce the pain caused by dumbbell press .

  • You use your triceps more than your biceps during the movement. With the classic position, you use your biceps to stabilize dumbbells than your triceps. With this position, you flex your elbows so you use more triceps to stabilize dumbbells than your biceps.

 

 

dumbbell bench press
Classic dumbbell bench press

 

variant dumbbell bench press
Variant dumbbell bench press

Using more triceps than your biceps will seriously reduce the pain or make it disappear because there is less tension through the biceps and it will less pull on the torn labrum. If you have biceps tendonitis or inflammation, this will seriously decrease the pain. Try this technique and you’ll see that it will be the first time you’ve been doing pain-free bench press for a long time.

When I had this pain during this exercise, I thought of 2 options :

  • Stop doing bench press because you can’t support the pain anymore

  • Use lightweight

Now that I know this technique :

  • I can continue to do bench press

  • I can keep the same weights and increase them

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-Steph

Exercise To Avoid Overhead Shoulder Press Pain

shoulder pain

What’s up ? This is THE stephane ANDRE. I watched an Athlean-X’s video  and I learned some good stuff.

I have a little pain when I do dumbbell press  or overhead shoulder press, maybe you have that pain too ? As I want to avoid having surgery like the majority of professional athletes, I tried to find out if I could find an alternative exercise to work the same muscles without pain.

This shoulder pain during this exercise is a real problem, because it’s a movement that is so advised to do to develop shoulders that the majority of people continue to do despite the pain. The longer a person continues to do this exercise with the pain and the more the person, several years later, will need to do a surgery to the damaged shoulder. It’s sad because people keep doing this exercise because they don’t know (like me at the beginning) that there are alternative exercises.

Pain

For me, I felt the pain at the starting position, it means with a dumbbell in each hand, dumbbells at the level of my ears or a little above my shoulders and my elbow at the outside. It was impossible for me to keep this position for more than 5 seconds and after a few reps, I felt less pain. A few months later, I changed the starting position. I started with my arms outstretched but the pain was still there. The feeling of pain is really bizarre because sometimes, I felt that my shoulders could be dislocated with heavyweight.

Solution

barbell corner press

The idea is to do this exercise with the elbows forward because the pain is due to instability of the rotator cuff. In fact, this pain appears on the weakest shoulder.

This exercise has no official name and has a lot of variation but the best known name is barbell corner press. You need to use a barbell and put it in a corner of the gym. If you do this at home, I advise you to put a blanket in the corner of the wall to not damage the wall. Put a plate of 10kg (22lbs) or 20kg (45lbs) on the opposite side :

  • Lift the barbell with your 2 hands with a squat position to protect your back. Stand up with your torso leaning forward, your back straight, one leg forward and your hands almost on your torso with your elbows forward.

  • Press straight up overhead and exhale

  • Back to the start position and inhale

You can also do this exercise with one hand. Barbell corner press is an alternative exercise to dumbbell press or overhead shoulder press to continue developing your shoulders without pain and without sacrificing your shoulders.

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-Steph

Stretch Of The Rotator Cuff’s Posterior Muscles

stretch of the rotator cuff posterior muscles

I read a Frederic Delavier’s book « Strength Training Anatomy » and there is good stuff.

Standing with a dumbbell in one hand. You bend your bust forward by holding yourself to a machine (or with a incline bench).

Release your arm and let hang the dumbbell for a minute trying to relax your shoulder.

This exercise stretches your infraspinatus, teres minor muscle, and a little bit your supraspinatus. These muscles are on the posterior side of the scapula.

In bodybuilding, these muscles often contractures and spasms. The consequences are that this can put your shoulder in a bad position and can, over time, create pathologies of wear and tear tendon.

Note : Contratures of spasms of the teres minor muscles and infraspinatus creates an external rotation of the humerus. Which causes an excessive friction of the tendon of the long head of the biceps (in intertubercular furrow of humerus) in the forearm. The consequences are inflammation followed by a rutpture of wear of the tendon.

It’s for this reason that as soon as you have a suspicious contracture, do this stretch to try to relax your muscles.

Share this article if you think it can help someone you know. Thank you.

-Steph