Thinning of the Rotary Cuff (inner muscles of the shoulder)

 Hi Guys,

Just wondering if you’ve had any shoulder problems? I was just having a tiny pain in the frontal deltoid, with no weakness whatsoever, but figured I’d get an MRI. So to make a long story short, the mid portion of my supraspinatus tendon/muscle of the rotary cuff is recessed, which I took to mean worn or frayed, or maybe it just means “thinned."

So the doc says no more overhead lifting or even bench presses unless the elbows can remain close to the body. He said and I’ve heard this elsewhere, that weight training with the arms at or above the horizontal plane (bench, lateral raises, flies, pull-ups and more), inevitably causes rotator cuff tears. He did offer me an alternative in isometrics, which is basically infinite load, so may have some potential for muscle mass(?).

Just wondering if you’ve got any information about this kind of thing? Everything on the internet says 20-30 reps does not equal strength. Hell, yoga’d be more effective than 20-30 reps with weights.

Best Wishes,

Dave

Dave, I've had 4 surgeries on my right shoulder - 3 scopes and 1 open. The first was a scope to repair the supraspinatus in 1992.  in 1993, had to have it scoped again  to repair another small tear and remove the bursa sack. Healed up, but tore it loose while doing bench presses  a year later, so once again they scoped it.   In 1995, my shoulder started killin me again, and the pain was not only in the rotator but also in the front area where the bicep tendon ties in. This time they did much more extensive tests, including dye injection. They found that my shoulder had been fractured years before (when I was 16, I hurt it during a high school football game, but never had it checked by a doctor - the team trainer just popped it back in and I continued to play - Hey, it was 1969, what can I say?). Well, the shoulder had healed on it's own, but was not in proper alignment.  This was causing impingement in the movement of the rotator cuff. So, they opened it up, removed 1/2 inch from the end of my clavicle, had to insert pins in the 2 bicep tendons, and another pin in the supraspinatus.  That was a tough surgery to recover from, but the shoulder had been fine until about 2 months ago.   I've started having some pain in the shoulder again, especially when I first wake in the morning after sleeping on it.  The surgeon told me if I require surgery again, it will probably require a  reverse ball-and-socket implant. Man, that will suck if I have to have that done!

Here's a link to a site that may help you some:

http://www.mayoclinic.com/health/rotator-cuff-injury/DS00192 /DSECTION=causes


Anyways, take care of your shoulder and good luck!

Thanks, Bama!

Sounds like you've really had a rough time with that shoulder. I hope you don't have to have surgery again.

I'm wondering what to do here. I have a feeling the cortisone shot and some Cox-2 antiinflams and H2 inhibitors are going to clear up the pain.

I get different opinions. There are some who say keep lifting and then, the docs who say no training whatsoever at or above 90 degrees (above parallel with the floor). Not sure what to do.

Best Wishes,

Dave

My opinion - lay off any resistance training exercise and any motion that aggrivates it or causes pain.  Continue to do carefully range-of-motion exercises that do not cause discomfort or pain and do them very carefully to keep the shoulder muscles flexible. Look up shoulder rehab exercises used by post-op shoulder surgery patients on the net and try using them for a while. If you do experience pain, back off.  After exercising the shoulder, apply ice for 20 minutes.  In my experience, all the cortisone did was cover up the underlying problem. I've seen several guys have shoulder and rotator problems, get the cortisone shots, the pain subsides, their shoulder "feels" fine, and they go back to regular exercises and totally blow em out they ended up with major reconstructive surgery.  Good luck to ya.

Thanks again, Bama!

I've got some additional exercises to do from doc. He freaked out that my deltoids are huge and then what he called in Japanese the "inner muscles" are tiny. Supposedly a combination for trouble, because the outer deltoid and pec muscles allow you to lift, but it's the inner RC muscles/ tendons that hold everything together. 

It's pretty tricky to do the RC exercises correctly. I have been doing several, but when you use say, more than a lb. of weight the deltoids kick in and lift the weight and the RC muscles go unworked. You actually have to know the location of the Supraspinatus and reach around (hoo!) with the othe hand and feel if it's contracting. I think this also double as biofeedback for when you're working out.

I have a lot of dumbell and cable exercises that don't cause pain. I can probably stick with those.

So Bama, do you feel that all of your weight training earlier on was a plus, or has it turned out to be a liaibility? I always get mixed opinons on this. My UK doc friend says heavy weight training does not lead to a musculoskeletal system that ages well. Then I hear others say that weight training improves mobility.

I know one thing for sure, Heaviness does not lead to mobility - at any agre and particularly into old age. I've seen this repeatedly with family members and neighbors as they pass 50.

Best Wishes,

Dave

Thanks again, Bama!

I've got some additional exercises to do from doc. He freaked out that my deltoids are huge and then what he called in Japanese the "inner muscles" are tiny. Supposedly a combination for trouble, because the outer deltoid and pec muscles allow you to lift, but it's the inner RC muscles/ tendons that hold everything together. 

It's pretty tricky to do the RC exercises correctly. I have been doing several, but when you use say, more than a lb. of weight the deltoids kick in and lift the weight and the RC muscles go unworked. You actually have to know the location of the Supraspinatus and reach around (hoo!) with the othe hand and feel if it's contracting. I think this also double as biofeedback for when you're working out.

I have a lot of dumbell and cable exercises that don't cause pain. I can probably stick with those.

So Bama, do you feel that all of your weight training earlier on was a plus, or has it turned out to be a liaibility? I always get mixed opinons on this. My UK doc friend says heavy weight training does not lead to a musculoskeletal system that ages well. Then I hear others say that weight training improves mobility.

I know one thing for sure, Heaviness does not lead to mobility - at any agre and particularly into old age. I've seen this repeatedly with family members and neighbors as they pass 50.

Best Wishes,

Dave

Dave, I actually believe the weight training has been beneficial in more ways than one.  The underlying cause for my shoulder problems is the old high school football injury that was not treated at the time. The way it healed back on its' own created a problem with alignment and mechanics, which created impingement. The ortho specialist told me the added muscle actually helped my shoulder hold up longer than it would have, and aided in my healing faster after shoulder surgery. 

I do share the opinion that the continual lifting of super heavy weights, such as in the case of power lifters, eventually takes a toll on the skeletal system. I know several guys who were hard core power lifters for 10 or more years. They were constantly doing super heavy bench presses, squats and deadlifts to increase their 1 rep max for competitions. Every one of them are now having major problems with their knees, ankles, elbows,  etc.  A couple of them are bacically crippled from it now. 

To give you an idea of the super heavy weights these guys used - they all benched over 550 lbs., deadlifted over 750 lbs., and would squat over 800 lbs. One actually held the record in his weight class (he weighed 242 lbs,) when he squatted 1002 lbs. That record was later broken.  Comparatively, my personal bests were: 405 bench press, 675 deadlift, and 650 squat. Of course, I was 48 at the time, which was at least 10 years older than any of those guys.

Bama,

You were at pro level compared to me. My workout weights (not powerlifting) were pretty heavy, but nowhere near anything like the ones you were doing. Of course, I have always mixed things up. For a couple of years in my 30's I did triathlons and full marathons. I had to learn to swim, so that meant swimming with a bad stroke for 8 or more hours a week, which probably sawed down my rotator cuff some.

The doc says one important thing is working on the muscles that pull the scapula together, so that the tops of the shoulder blades will open up space in the shoulder cavity and not saw on the rotator cuff muscles.Hope it works.

I was doing lots and lots of pushups of various types and no benches and was fine. Then a friend of mine invited me to do some benches and that combined with repeated work on the handstands set it off.

Don't know what to do. I do know that the doc was shocked at the discrepancy in size between my RC muscles and my deltoid and peck muscles so I defintely have to do a much better job of exercising those.

Thanks Again,

Dave

 To limit--and heal--inflammation you should definitely lay off the shoulder exercises I'd say. Whatever hurts, don't do that. Don't try to be superman b/c you're not no matter how many abdominals I can see in that picture. Recessed seems to mean it's no longer in the correct area for optimal use which means it slipped or something I'd think. Of course I'm just going off the top of my head (I've taken anatomy classes for nursing school but am by no means close to an expert lol) but really if you have pain then just stop and/or make sure you're not doing things to over-stress your already stressed areas. I know you're a big super freak about exercise but my thing is not "No pain, no gain" my thing is "No pain, WONDERFUL." 

 No, you're absolutely right. I have a winged scapular on that side and scoliosis at both the top and bottom of my spine, so shoulder alignment is off and the top of the shoulder blade rubs the inner muscles of the shoulder joint and left and right joints are not in the same alignment. This is why the doc has me doing exercises to squeeze my shoulder blades together (in addition to the regular rotator cuff exercises). 

Now the pain is almost gone (Cortisone and NSAIDs) so I'll have to be careful not to injure it, because nothing hurts. 

Thanks,

Dave