Joe A Shaw PA-C - 5/6/2008

Question
i have a interesting case going on.. at least for my self.. i think..

I am a baseball player.. pitching at the time of the injury. I was on the mound, as i was throwing a pitch, something popped in my shoulder. felt it in my should and could hear it. didn't really hurt in time of action, so i just kept on pitching.
as days went on  i started noticing it more.. the popping..the pain..through normal activities and pitching; even sleeping there was discomfort.
so i went to a doctor and didn't really say much..and put me in PT for stability and strength. after PT ended i noticed i was still having the same problems.. popping..discomfort.. and pain while throwing and normal activities.
i went to another doctor. He gave me a cortisone shot and put me in PT again. Again after PT ended same problems.
at this point its has already been at least a year from the injury.
after this PT and cortisone shot, i decided to just trying to play through the pain. and i am one who plays with pain until it kills me to do so.
i got on a elite team, looking to pitch.. but with the injury still taking effect i could not throw the speeds i was throwing before the injury. so i moved to 2nd base. where i threw less and also most of the time was a shorter throw.
the problem still proceeded.
one of my player on my team was recovering from a rotator cuff surgery from Dr. Andres in Alabama.
i decided i would take a trip down to see him. we all know he is the best when it comes to should and pitchers. so i took some x-rays and a MRI down with me to show him. took a look at them and just like the other docs i saw.. said "i don't see anything."
so i went back home and just decided to keep playing and suck it up. one of the pitching coaches saw i was having a troubled time with my shoulder and recommended me to a shoulder doctor.
so i went again and we did another MRI. and it showed, very small rotator cuff tear. so we went ahead and did the surgery to fix it. after the surgery PT for longtime as i was going through PT i noticed i still had my popping and pain, discomfort. and didn't make sense to me why.
but wont i was clear to play again.. i did.
same old problems. so i went to another doctor.
had an MRI on the neck and shoulder twice. and is now up to where i am right now.
MRI show Nothing at all
so i am left with doing nothing and just whatever.. or exploratory surgery.
but i honestly trust the MRI machine. so i dunno what to do and i want to play baseball Badly and pitch again.

here are all my symptoms
Symptoms
Popping and cracking all up and down my right arm.
pain in the shoulder and down the humerus.
muscle spasms
acromion seems to stick out a little higher than the other.

i was reading about winging scapula today and just trying to do as much research as i can before i make up my mind as of what to do.
it seems like the scapula on my right side moves more when i use my shoulder as compared to the other side where it seems to stay more stationary.
i even press down on my shoulder and kinda keep my scapula from coming froward and seems to work.
i dunno much about the scapula or its injuries
but im just looking for answer and it looks like it could be a victim.
what are some causes and symptoms from a winging shoulder?
and does any of mine match it or say that i have a winging scapula?
i have had many doctors look at my shoulder 3 MRI
a cortisone shot
and plenty of x-rays.
something is telling that the problem is somewhere else and is effecting the shoulder area.


thanks for your time and everything.
Mike Harris

Answer
Mike,
You have just about done everything you can do sounds like... I would try and find a sports medicine ortho who primarily does shoulders say 75-85% of his pts...you may even try a university type hospital (with the Tide and tigers down there, there has to be some shoulder specialists?. The xrays of course only show bone/tumor kind of things, MRI's are about 90-95% accurate as far as rotator cuff tears. I'm kind of suprised you havent had an arthrogram...where they inject shoulder w dye and take MRI..to show if there are in "leaks" in the joint capsule area..indicating tears, it can be a little more denfinitive.

You also need to rule out something called snapping scapula syndrome..it is uncommon but kind of sounds like what it could be..xrays and MRI's are normal usually, unless you have an abnormality on the scapula edge..which they would have seen im sure. But it has an audible grating or popping/snapping sensation w certain shoulder motions. Often no cause is found. The onset is gradual, but the process is frequently brought on by a traumatic event. PT and cortisone injections and correcting poor posture can help..if there is some type of abnormal scapula growth etc..then surgery to remove it may be needed.

There are different types of winging..you may want to research "Dynamic winging"..winging w movement..the 2 most common causes are Long thoracic nerve palsy and spinal accessory nerve palsy..which can cause different positioning of the scapula

Again I think a shoulder ortho in sports medicine is the way to go

http://www2.aaos.org/aaos/archives/acadnews/2000news/c3-18.htm

http://www.shoulder1.com/forum/messageview.cfm?catid=70&threadid=7102&STARTPAGE=...

http://www.eorthopod.com/public/patient_education/6533/snapping_scapula_syndrome...