Anyone ever deal with a winging scapula and or shoulder impingement?

It started with front shoulder pain on my right side. I can't hold onto things for an extended period of time with my right arm, imagine bringing groceries in from the car.

My shoulder tends to burn up and sting/tingle and get numb. As well, anytime I put my arm higher than shoulder height, anywhere above my heads, it starts to feel this way.

So any shoulder workouts I'm practically unable to do and I feel a disconnection from my back exercises too even. My left side is fine, right side feels iffy.

As well, with this shoulder pain I have a hard time bench pressing since it burns. It doesn't matter the weight, I'm doing far less than I did when I was in highschool.

I've had this problem for about four years now is my guess but I finally got it looked at by my doctor last summer.

I did physical therapy and have been doing so since. I was told to ice my shoulder, take inflammatory meds, and strengthen my back muscles like my trap and rhomboids and serratus anterior.

My back is a lot stronger on my right side than it was previously before pt but still not as solid as my left. Benching is a little better but still doesn't feel right.

I've done a lot of research but still can't find an answer. I have an appointment with the orthopedic department in the upcoming weeks.

I'm worried they're not going to know the issue as I've read several accounts of people with this problem going to massage therapists, chiropractors, physical therapists, acupuncturists, etc. and still having this persist.

Thoughts?

Amputate it. Only option. Godspeed.

Try scapula retraction and protraction exercises . And work on your posture.

Paging @ Kobe Bryant

MOU5PaD said:

Try scapula retraction and protraction exercises . And work on your posture.

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I've been doing a lot of this through physical therapy. 30 second holds for multiple sets and such with my arms in different positions.

Posture could use some work as I still need to constantly remind myself to be self aware.

I'd like to help you out because I'm pretty knowledgeable in this area.

Have you had any imaging done to rule out  shoulder impingement, tears and/or nerve impingement?

GetBack said:

I'd like to help you out because I'm pretty knowledgeable in this area.

Have you had any imaging done to rule out  shoulder impingement, tears and/or nerve impingement?

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I've never had any imaging done as I'm unsure what that is. The doc said I have a slight shoulder impingement since it becomes numb and tingles.

you frail b

Jordan Novice said:

I've never had any imaging done as I'm unsure what that is. The doc said I have a slight shoulder impingement since it becomes numb and tingles.

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Numb and tingling are symptoms of nerve involvement. If I were you, I would push for imaging and other tests such as an MRI (with arthrogram) and EMG (nerve conduction).

What type of doctor did you see?

You always want to have a diagnosis before you begin doing any PT or treatment. It's tough to diagnose shoulder impingement without a battery of tests.

An MRI with an arthrogram (dye injection for contrast) is capable of finding tears and abnormalities within the shoulder girdle. For example, in cases of impingement, an MRI could reveal the fraying or inflammation of the structures between the acromion and humerus whether it's the bursa or supraspinatus (rotator cuff muscle).

An EMG will determine if certain muscles aren't firing or contracting, which will give the doctor an idea of what nerves are being affected in the case of the numbness and tingling you're experiencing.

Are you internally rotated? (head forward posture, shoulders rolled/slumped, tight pecs, poor shoulder mobility)

A lot of people who have impingement are also overly internally rotated from too many pressing patterns in their workouts as well as other factors such as working at a desk all day, typing, etc.

He knows what he is talking about ^^^.

Sounds painful. Hopefully have to never go through this.

GetBack said:

Numb and tingling are symptoms of nerve involvement. If I were you, I would push for imaging and other tests such as an MRI (with arthrogram) and EMG (nerve conduction).

What type of doctor did you see?

You always want to have a diagnosis before you begin doing any PT or treatment. It's tough to diagnose shoulder impingement without a battery of tests.

An MRI with an arthrogram (dye injection for contrast) is capable of finding tears and abnormalities within the shoulder girdle. For example, in cases of impingement, an MRI could reveal the fraying or inflammation of the structures between the acromion and humerus whether it's the bursa or supraspinatus (rotator cuff muscle).

An EMG will determine if certain muscles aren't firing or contracting, which will give the doctor an idea of what nerves are being affected in the case of the numbness and tingling you're experiencing.

Are you internally rotated? (head forward posture, shoulders rolled/slumped, tight pecs, poor shoulder mobility)

A lot of people who have impingement are also overly internally rotated from too many pressing patterns in their workouts as well as other factors such as working at a desk all day, typing, etc.

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I just went to my primary and I asked if he could point me to physical therapy.

That's where they diagnosed me and informed me of my winging scapula and shoulder impingement.

I also got an x-ray done but there didn't seem to be anything to worry about, I'm thinking bone spurs are what they look for?

Then after several months of pt, I was sent to orthopedics and that's where they just gave me anti-inflammation pills and told me to continue strengthening my back. If it doesn't improve in 3 months or so, go back and talk to them.



I'm unsure if I'm internally rotated but I suppose so as I have somewhat 'lazy' posture. And yeah, I'm on a laptop a lot, I would say I'm practically never fully upright as I find that uncomfortable since tables feel rather low. Is internal rotation the same as something called thoracic outlet syndrome? I see the term TOS a lot when doing research on my shoulder/scapula.

And I can't exactly feel push exercises since my shoulder problem is troublesome and stops me from doing so.



So what should I ask the doctor for? An MRI? EMG? TENS?

I'm unsure if this is related but I feel a disconnection to the right side of my body. I have trouble contracting certain muscles such as my right pec, or parts of my back.

And since I can't engage my back fully, I feel it even effects my squats as I can't build a good tight core and support for the weight. And on occasion, my right arm will tingle/become numb from the squatting. I'm pinching a nerve aren't I?

Edit - I don't think it helps that I have slight scoliosis as well, smh.


Thanks for any help you can give me. I want to enjoy working out and I hate trying to work through or around this issues.

That's where they diagnosed me and informed me of my winging scapula and shoulder impingement.

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Winging scapula is indicative of either a weak serratus anterior or damage to the long thoracic nerve. Most like serratus weakness, unless you've had some sort of traumatic injury that could have affected your long thoracic nerve, like a car accident, surgery, or a big fall. I also have some winging and I try to strengthen my serratus at the end of my chest workout. You can find serratus punches and pushup plus exercises online. Those help with strengthening the serratus.

I also got an x-ray done but there didn't seem to be anything to worry about, I'm thinking bone spurs are what they look for?

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What were they looking for exactly? What did they take an x-ray of?

X-rays can't find damage to nerves or soft tissue. That's why I suggested pushing for an MRI and EMG. Those tests are more comprehensive.

Then after several months of pt, I was sent to orthopedics and that's where they just gave me anti-inflammation pills and told me to continue strengthening my back. If it doesn't improve in 3 months or so, go back and talk to them.

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What did they give you anti-inflammation meds for? Also, why did they tell you to strengthen your back?

There had to be a reason they prescribed these treatments. You should always be thorough with your doctors. Ask questions. Don't be a sheep and just do what they say. Understand why. Also, second opinions are always a good idea. Doctors make mistakes in their diagnoses.

I'm unsure if I'm internally rotated but I suppose so as I have somewhat 'lazy' posture. And yeah, I'm on a laptop a lot, I would say I'm practically never fully upright as I find that uncomfortable since tables feel rather low. Is internal rotation the same as something called thoracic outlet syndrome? I see the term TOS a lot when doing research on my shoulder/scapula.

And I can't exactly feel push exercises since my shoulder problem is troublesome and stops me from doing so.

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Honestly, most people are internally rotated. Just think of what we do all day. We eat, drive, sit on our phones, type on our laptops and tablets, then add insult to injury by emphasizing chest too much when we go to the gym. Everything we do for the most part trains our anterior chain while neglecting our posterior chain. That's probably why your doctor recommended training your back, to balance your tight chest, shoulders, etc.

Thoraic Outlet Symptom can be caused by different things, but is essentially the nerve(s) of your brachial plexus nerve bundle being trapped somewhere by another structure like your collarbone, neck muscles, pecs, etc. There's home tests for TOS online that you can find and do on your own, but again I'd want a neurologist to diagnose something like that.

And I can't exactly feel push exercises since my shoulder problem is troublesome and stops me from doing so.

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Do you make sure you retract your scapulae when performing the bench press? That's pretty important if you want to protect your shoulders. Look up the video on youtube: "retract the f****ng scapula."

It's also important to strengthen your rotator cuff muscles: external rotations, Y's and T's, scapular retractions and protractions, internal rotation. Very important. A lot of people neglect the rotators. Read this article:

https://www.t-nation.com/training/how-to-build-bulletproof-shoulders

T-nation in general has a ton of good articles about shoulder health and safe lifting techniques. Eric Cressey is great. ATHLEAN-X is also an excellent source on Youtube with exercise demonstrations.

So what should I ask the doctor for? An MRI? EMG? TENS?

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If I was in your position I would want answers. Why is my shoulder hurting? Why am I having numbness and tingling sensations? Doctors can speculate all they want, but imaging and tests like MRI (with an arthrogram) and EMG don't make mistakes. They will reveal if there's any structural damage or trapped nerves or any type of abnormality that is causing you these symptoms.

TENS is just a type of pain treatment that stimulates muscles using electric pulses. You can buy them on amazon, but there's no point in using one until you find out what's wrong.

I'm unsure if this is related but I feel a disconnection to the right side of my body. I have trouble contracting certain muscles such as my right pec, or parts of my back.

And since I can't engage my back fully, I feel it even effects my squats as I can't build a good tight core and support for the weight. And on occasion, my right arm will tingle/become numb from the squatting. I'm pinching a nerve aren't I?

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It sounds like a pinched nerve, but there's no way to tell without having the right tests performed. I wouldn't do any working out if you have pain. Lifting through pain is a bad idea.

When you do get back to the gym, do RESEARCH. Use some of the channels and websites that I've suggested to learn how to use proper form. Drop the weight if you have to. Form > resistance. If you're not using correct form, you open yourself up to injury risk. Form form form form. I've learned that over the years.

Also, ditch risky movements like pressing behind the neck, pulling behind the neck, upright rows, etc. Those put your shoulder at a mechanical disadvantage and risk injury, especially if you already have issues. All they do is jam your rotator cuff and bursa between your acromion and humerus, which is shoulder impingement. You should learn all about impingement before doing anything overhead too. Working with a PT and expressing all these concerns may help you. I've spent entire sessions with my PT just picking his brain to learn how things function anatomically and what I can do to relieve symptoms.



Like I said, I wouldn't do anything if you don't have answers and are still experiencing pain. Some things you can do probably without irritating your symptoms:





 

getback

I've incorporated several workouts from pt to help with my serratus. Like you said, push up plus and weighted serratus punches. I also do woodchoppers, for the lack of a better term. The same motion made when a baseball player swings.

A list of exercises I've added from pt also include
scapular retractions, several variations.
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Plank holds, but instead of mostly abdominal strength, it's more of a plank plus, similar to a pushup plus
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Shoulder rotation, internal and external
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Single arm pulls to shoulder rotation 90degree abduction
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As well, several of these stretches with either a pvc pipe or resistance bands.
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The anti-inflammatory meds were for my shoulder acting up as they told me to ice it too. The back exercises because I have poor support of my scapula as well as have trouble engaging muscles on that side.

As for my bench, or just about any other workout, I've read a lot and watched several youtube videos, like those you have mentioned. I love watching Elliot and reading T-Nation.

I emphasize on form a lot and if I experience discomfort, I practically skip the workout altogether.

With scapular retraction during bench press, I can do it just fine with my left, but my right side has trouble and doesn't engage and support as well.

Since benching has given me so much trouble, or push ups even, I only do decline bench press, or skip the workout altogether in favor of something better like back work.

Same with shoulders, I avoid any pressing motion that is overhead. Shoulder presses are a no go so I do shoulder flys instead and variations.

I just need to keep reminding myself of my posture though. Head up, shoulder blades back, thumbs pointed forward.

I've seen that it isn't exactly chest puffed out that is good posture but back and shoulders back so the body is more upright.

I'm thinking about making myself a bracelet to wear as a constant reminder to keep good posture every time I see it.

Deadlifts performed correctly also really help to strengthen your core and postural muscles.

If you can't do bench press, try some alternatives. I know of people who have switched to dumbbells for pressing. Dips, cable crossovers and pushups are alternatives too.

As for shoulders, make sure if you do lateral raises you're doing them in the scapular plane and do not have your thumbs facing down. There's a good ATHLEAN-X video on how to do lateral raises. Also see if you can do landmine presses for you shoulders if OH press bothers you.

A good cue for bench press if you can do it is to keep your chest up and shoulder blades down by pretending like your pulling the barbell apart. It helps to engage your lats and scapular muscles. Do this while maintaining a natural arch in your back (don't hyperextend), keep your chin tucked, don't flare your elbows, and stay tight.

Stretching is extremely important too. I discovered how tight my pecs, lats, and neck muscles were and learned how to stretch do self myofascial release.

Learning how to shoulder girdle is designed to move will also help you understand movements like bench press, shoulder press, and pulling movements better.

Learn how to row correctly too.

I feel muscle imbalances which I'm unsure are due to lack of the ability to train one side due to my shoulder, or due to scoliosis, or just because that's how my body is constructed as all bodies are different?

I do deadlifts with good form but my right side just doesn't engage as strongly as my left. I have been doing lower back extensions to strengthen it.

As well, during squats or deads, I often offset my feet so that my right side can 'engage' better and my workout can be better distributed to both sides of my body.

My feet are not crazy staggered, it looks similar to this, maybe not as drastic. My left foot is maybe half an inch to an inch at most forward compared to my right.
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Do you think this is just my scoliosis, unsure if you have any insight on something like this.

It just feels like the left side of my body is a straight line, I can vividly see it in my mind. My right just doesn't register the same.

I feel tension all through the left side of my body from my upper back down to my leg after a good work out, but my right feels 'loose' for the lack of a better term.

Will EMG be able to help me diagnose this body disconnection?


As for benching, dumbbell press cause the same issue so I often only do neutral grip. Cable crosses are doable, but dips are not.

My shoulder has even even affected my ability to do tricep work like chair dips and single arm tricep extensions. With dips, I feel a lot of pressure sitting into my shoulder.

As well, I've heard of the pulling the barbell apart cue during bench. I try and incorporate a bending motion, almost like bending the bar into a horseshoe shape.

Thanks for the lat raise video. The illustration on the shoulder helps give a better idea of what's going on. And landmine presses is a workout I forgot about, thanks!

But what is shoulder girdling? Unless that was a typo and was meant to say "learn how the shoulder girdle is designed.."

Along with stretches, I just feel there are so many and am overwhelmed to the point where I don't want to do them all. There are so many that seem important that people have never even heard about.

Elliot at Strength camp has a plethora of stretches but if I were to do all of them, it would take me 2 hours I'd imagine!!

Sounds like long thoracic impingement to me, especially since strengthening hasn't helped.

Also, the multiple areas of weakness make me think it might be a lesion higher up. Have you tried to stretch out your scalene muscles?

Jordan Novice said:

But what is shoulder girdling? Unless that was a typo and was meant to say "learn how the shoulder girdle is designed.."

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Yeah that's what I meant. Sorry about that. Learn how your scapula and humerus are supposed to move and work in sync with one another.

I know how frustrating it is when you have pain or strange symptoms and you feel like you don't know what's going on or aren't getting any answers from professionals. I was and still am to a certain degree in the same boat. The best thing you can do is your own research and be assertive with doctors.

I would still urge you to get an MRI to make sure there's nothing structurally wrong with your shoulder since you're experiencing pain. Pain is the greatest teacher. It's telling you something wrong.

Also an EMG since you are experiencing tingling and numbness.

Find out what type of Acromion you have. Usually type II and type III acromions increase the risk of impingement. Notice how there's less space between the type III acromion and humerus, causing a greater impingement of the structures (yellow dot).

girlslovewaffles said:

Sounds like long thoracic impingement to me, especially since strengthening hasn't helped.

Also, the multiple areas of weakness make me think it might be a lesion higher up. Have you tried to stretch out your scalene muscles?

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I thought if it was the nerve itself, I would have difficulty using my arm altogether? And on rare occasions I stretch out my neck, but it's not very often. That's what I mean by too many stretches in my prior posts.

GetBack said:

Yeah that's what I meant. Sorry about that. Learn how your scapula and humerus are supposed to move and work in sync with one another.

I know how frustrating it is when you have pain or strange symptoms and you feel like you don't know what's going on or aren't getting any answers from professionals. I was and still am to a certain degree in the same boat. The best thing you can do is your own research and be assertive with doctors.

I would still urge you to get an MRI to make sure there's nothing structurally wrong with your shoulder since you're experiencing pain. Pain is the greatest teacher. It's telling you something wrong.

Also an EMG since you are experiencing tingling and numbness.

Find out what type of Acromion you have. Usually type II and type III acromions increase the risk of impingement. Notice how there's less space between the type III acromion and humerus, causing a greater impingement of the structures (yellow dot).

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I will try and get an MRI and EMG done when I see the doc next, or try and push for an appointment when I see them. Will these tests show my acromion?

As well, here are some videos of my winging scapula. You can see it has gotten a lot better since beginning, but it still persists.

An X-ray should show your Acromion type since it's bone

When you have an MRI though, the doctor will note your acromion type and detail the condition of the structures of your shoulder. See if you can find an example of an MRI arthrogram online.

GetBack said:

An X-ray should show your Acromion type since it's bone

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When you have an MRI though, the doctor will note your acromion type and detail the condition of the structures of your shoulder. See if you can find an example of an MRI arthrogram online.

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I went to the orthopedic specialist today. He said I have close to acromion type 2. I'm scheduled for an MRI arthrogram in the upcoming weeks. I'm excited to see what's going on in there.

The specialist said he thinks it's not so much shoulder impingement, but shoulder or scapular tendinitis? As well as tendinitis at the top of my bicep?

(Not sure what counts as a shoulder impingement then?)

He was talking about the bursa and he thinks that is the main culprit leading to the other pieces becoming inflamed?

Following the MRI, he wants to see if there is a tear anywhere and wants to go from there.

He said the EMG wasn't necessary, at least not for what's going on with this. Or he wants to take care of the shoulder before moving onto anything else.

The million dollar question was if the impingement caused my winging scapula or was it my winging scapula that caused my shoulder impingement.

I'm just happy this is advancing.

getback

Just an update if anyone was curious or who may be dealing with similar injuries and it just so happens to lead them here.

Got my MRI done and talked with the specialist.

No tear, which is good. He says I have bicipital tendonitis and scapular tendonitis.

He gave me a shot and put me back on some meds as well as back on PT.

I have yet to see the trainer again yet.

So far though, the shot has reduced the pain a lot.

Jordan Novice said:

@GetBack

Just an update if anyone was curious or who may be dealing with similar injuries and it just so happens to lead them here.

Got my MRI done and talked with the specialist.

No tear, which is good. He says I have bicipital tendonitis and scapular tendonitis.

He gave me a shot and put me back on some meds as well as back on PT.

I have yet to see the trainer again yet.

So far though, the shot has reduced the pain a lot.

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Glad to hear the pain has decreased. Usually those shots are just a short term fix, so PT is critical. Don't forget to pick his brain and find out the "why's" and "how's". Don't just go through the motions of PT. Becoming informed will be extremely beneficial. Keep icing it too. Ice helps reduce inflammation.

What was your physical activity like leading up to the injury? A lot of certain repetitive movements?

I'm recovering from some type of mysterious shoulder injury now. At its worst, it was even difficult for me to sit up in bed. While lying on my back, I had to tilt the back of my head up slightly in order to be able to sit up. It was also difficult for me to turn my head to the right. It began as a kink in my neck and slowly spread to my shoulder. I think I tore something in the gym, and I haven't been in two months. Sounds like some very knowledgeable people are in this thread. A coworker described similar symptoms and a doctor diagnosed her with tendinitis and bursitis. She said it felt like the bones were running against one another.

sooperhooper said:

I'm recovering from some type of mysterious shoulder injury now. At its worst, it was even difficult for me to sit up in bed. While lying on my back, I had to tilt the back of my head up slightly in order to be able to sit up. It was also difficult for me to turn my head to the right. It began as a kink in my neck and slowly spread to my shoulder. I think I tore something in the gym, and I haven't been in two months. Sounds like some very knowledgeable people are in this thread. A coworker described similar symptoms and a doctor diagnosed her with tendinitis and bursitis. She said it felt like the bones were running against one another.

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Have you seen a doc?