Joe A Shaw PA-C - 7/27/2008

Question
Hi,

I have had pain for about 13 months in my scapula muscle.  I am 20 years old and a very active person.  I play basketball 4-5 times a week.  I was on a workout plan and I weight lifted about 4 days a week. I believe I hurt it from working out.  It happened gradually.  I really noticed it when I was doing bench press.  It抯 a sharp pain.  Later that week I went to the doctor and she sent me to an orthopedic.  I took an x-ray and it turned out fine.  They both said it was probably tendonitis.  The orthopedic sent me to physical therapy.  I went twice, but I stopped going because I was very busy with school.  I stopped weight lifting for about 5 months(I did continue to play basketball).  I began to lift again, but stopped after 3 days due to the pain.  This was in December 2007.  I haven抰 worked out since.  The pain has been consistent.  It hasn抰 gotten worse or better.  This summer I went to get acupuncture.  He said I would be healed in 3 treatments.  It didn抰 really work.  Then I tried electric therapy.  He said I had a small torn muscle in my scapula(between my spine and shoulder blade).  He said it would only take 2 treatments and I would be fine.  He told me to take a week off from all activities, which I did.  I felt a little better after the treatment.  I didn抰 do anything active that week and it actually felt worse.  When I play basketball or do cardio it actually feels better.  So, I went to see a different family doctor.  I told her I抳e been having this problem for about a year.  She sent me to a shoulder orthopedic.  They took an x ray and it was fine again.  He said that I have loose joints and that my shoulder partially comes out of the socket when I do activities such as bench press.  He says this strains the stabilizer muscles.  I have never felt it come out the socket.  Not even a little bit.  I don抰 really think that is the problem.  I haven抰 worked out in about a year, except for those 3 times in December.  I took an MRI of my shoulder and it turned out fine.  The MRI covered part of the scapula, but not all of it.  He didn抰 think anything would show up if I took a scapula MRI.  I still want to take an MRI of the full scapula.  I asked him why it hasn抰 healed in a year, considering I haven抰 lifted in so long, and he said, 搕o be honest with you I don抰 really know.? He sent me to physical therapy, and that is what I抦 doing now.  I have had 2 sessions and plan on continuing.  The therapist says from the symptoms that it抯 a muscle problem.  I agree.  It is a sharp pain.  I don抰 have shooting pains down my arm or anything.  When I play basketball, I dunk and hang on the rim about every time I go.  I don抰 really feel the pain, but I think maybe because of the adrenaline.  As of right now I have stopped attempting dunks.  I have tried to take everything into consideration.  Oh, also, hot showers make it feel better.  I have never had an injury last this long.  I am a really active person and I really want to get healed.  Do you have any advice on what exactly I have and what I should do to treat it?  Thank you for your help.


So in summary:
At the beginning I went to a family doctor and orthopedic.  They thought it was tendonitis and sent me to physical therapy.  I did that a couple times.  About a year later(this summer 08? I tried acupuncture, electric therapy, seen a different family doctor and shoulder orthopedic.  Now I am back in physical therapy.


Answer
Matt,
You have done about all you can do..it sounds like?..I guess I would go back to shoulder ortho? and eventually he may refer you or get another MRI of scapula..You may want to see a physiatrist (Fizz-i-ah-trist) or pain mgmnt specialist..they can do trigger point injections and blocks etc...