Question
--history;
6'4" 160# male in good-great health and strength. -sept 04 @ work a 750# box was on hand truck(held by right hand) it started slipping to the left and i extended my left arm out straight and cuaght unit as it fell to the left. immediate sharp pain (no noise) at top, outside corner of left shoulder in tendon area. burning pain on motion in a spot about the size of a dime.
-x-ray, sonogram, MRI all inconclusive. PT and excersizes 3x/week of manipulation, stim, electric induced patch of medicine and heat till april 05.
(no change in pain on motion)
-started developing frozen shoulder in march, cortozone shot-no effect. cocktail shot in june immediatly fixed frozen shoulder-no froze since. but pain still persists on motion.
--range of motion;
left elbow not elevated above halfway between waist and shoulder without severe, sharp pain on dime spot(tendon?)
no reaching behind me, no supporting wiegth on that arm, no extending arm out straight in any direction, about 60' rotated out to left, unlimited curls with bicep as long as elbow is firmly lodged at waist...
-very frustrated... no more hot rod wrenching...

what can be done? what is it? exploratory surgey offered but i dont like the idea of digging around for fun...
im in nor-cal. thanks!!
mark
http://customclassics.org  

Answer
Mark,

Thanks for the question and the great history and explanation.  I wish all of my patients would come with a detailed explanation such as this.  Also, I am very sorry that you have had to endure this problem.

I know you don't want to hear this, but my first thought is, even though the diagnostics were inconclusive, you have torn something.  It is classic for a tear, muscle, tendon or ligament, to result in pain on activity, resistance and certain motion.  It is also common to see it turn into frozen shoulder.  You are fortunate that the injection helped that aspect, the majority of the ones I have dealt with do not.

I understand that the idea of exploratory surgery is not popular; however, at this point, I would suggest that it may be your only option.  I also perform acupuncture in which I do have some great results with problems such as yours.  You may try a course of 8-12 treatments of acupuncture and try some strengthening rehab utilizing the motion in which the pain occurs.  If you see some improvement, continued course of acupuncture would be appropriate.  However, if improvement does not occur, even minimal, within 4-6 visits, then it probably will not.

At that point, I would suggest that surgery would be the only option to attempt to create a situation in which you can rehab it correctly.

I would appreciate it if you would let me know how you do.  You are an interesting case and your outcome would be valuable to the future of others in your case.

Dr. Boss