Quote Originally Posted by 331stang:
thanks for the insight crash, can u help me with a shoulder injury, top of shoulder aggrivated from lifting weights, hurts like hell when i wake up in morning, u dont have to answer if u dont want to , lol
well, this is a big order w/o an exam but I will tell you most shoulder injuries from weight lifting are from impingement and bursitis. You need to work your back and scapulae more and your chest and shoulder less, most times.
Treatment
In patients with stage I
impingement, conservative treatment is often sufficient. Conservative
treatment involves resting and stopping the offending activity. It may
also involve prolonged physical therapy. Sport and job modifications may
be beneficial. Nonsteroidal anti-inflammatory drugs (NSAIDS) and ice
treatments can relieve pain. Ice packs applied for 20 minutes three
times a day may help. A sling is never used, because adhesive capsulitis
can result from immobilization.
Once the acute pain
resolves, a specific strengthening program for the rotator cuff is
recommended for prevention of future injuries. The motions of the
rotator cuff that are emphasized for strengthening are internal
rotation, external rotation and abduction. It is important to remember
that the function of the rotator cuff, in addition to generating torque,
is to stabilize the glenohumeral joint; thus, stronger rotator cuff
muscles result in better glenohumeral joint stabilization and less
impingement. A typical initial exercise program involves the use of 4 to
8 oz weights, with 10 to 40 repetitions performed three to five times a
week.
Patients with stage II
impingement may require a formal physical therapy program. Isometric
stretches are useful in restoring range of motion. Isotonic
(fixed-weight) exercises are preferable to variable weight exercises.
Thus, the shoulder exercises should be done with a fixed weight rather
than a variable weight such as a rubber band. Repetitions are
emphasized, and a relatively light weight is used. Sometimes,
sports-specific techniques are useful, particularly when strengthening
the throwing motion, the serving motion or swimming motions. In
addition, physical therapy modalities such as electrogalvanic
stimulation, ultrasound treatment and transverse friction massages can
also be helpful.
Therapeutic Injections
Therapeutic injections
(lidocaine plus a corticosteroid) are useful both because they are
therapeutic and also because they can help the physician differentiate
impingement from other problems. Indications for therapeutic injections
include the following:
-
Rotator cuff impingement that does not improve with conservative treatment, including NSAIDs and physical therapy.
-
Older patients with clearly operable lesions, such as subacromial
spurs, who are not good surgical candidates. Frequently, older, poor
surgical candidates can be helped with periodic injections.
-
As a diagnostic technique. If a patient fails to improve following a
subacromial space injection and has normal radiographs with an ambiguous
physical examination, the rotator cuff may not be the problem. Thus,
after the injection, repeat impingement testing will verify the
diagnosis if the pain is ameliorated.12–14
-
For temporary pain relief in a patient with an operable lesion.
Although there are several entry points for shoulder injections, the posterior subacromial approach is perhaps the easiest (Figure 4).
Furthermore, by angling the needle to the underside of the acromion,
the physician can easily verify that the needle is properly positioned
and, since the humeral head lies more anteriorally, there is no danger
of hitting it. It is important not to inject directly into the tendon
and, if resistance to flow is encountered, the needle should be directed
away from the site. Some potential weakening of the tendon can occur
with injection directly into the rotator cuff. We recommend using 8 to 9
mL of lidocaine (Xylocaine), 1 percent, mixed with 20 mg of
triamcinolone (20 mg per mL) or a similar amount of methylprednisolone
(Depo-Medrol), 20 mg per mL, or betamethasone (Celestone), 6 mg per mL.
The large volume floods the rotator cuff surface. A 1.5-in, 22-gauge
needle usually works well.
this is the basic treatment algorhythm, I would also google rotator cuff excercises.