I've had Bursitis of the shoulder now for about 4 months, maybe more. That has been brought on by a muscle in the shoulder being torn in a few places along its length. I can't raise my hand above my shoulder.



Basically means I can't sail until it is healed. The second cortisone injection did nothing. Ibuprofen is becoming a food group for me.

Now, I'm wondering if windsurfing did it to me. I doubt it as that muscle doesn't get sore from a big sail, and it doesn't hurt when I sail as I am now (except for getting sail out of water).

My question is: Has anybody else suffered bursitis of the shoulder/is it from windsurfing?

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Bursitis around the shoulder can be caused by a repeated minor trauma such as overuse of the shoulder joint and muscles or a single more significant trauma such as a fall.

Could it be from carrying gear?

Personally I reckon it is from too many vodka redbulls and overly enthusiastic dancing followed by morning push-ups.

Have you had an MRI ?
Shoulder ultra-sounds are notoriously unreliable, though they tend to overcall stuff rather than undercall it.
Was the cortisone done under USS control ?
Are you doing internal/external rotation exercises.
The shoulder is not designed for longevity. It's designed for maximum movement for 40 years, then it starts to crap out, so you do not need an acute injury to stuff it.
I put a small split in my supraspinatus tendon in a wee tumble while ski-ing, which caused me mucho pain for a good while.
My MRI showed that most of my pain is actually coming from arthritis on my AC joint, not from the tendon or from the bursa. I still get some pain, but with lots of strenghtening exercise and I'm pretty good.
Until you have an MRI, you don't really know what is going on. You may well have AC joint arthrosis too, which would explain the poor response to cortisone.
I resisted the idea of cortisone, because while it does settle inflammation, it also weakens everything, which I did not want.

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evlPanda said...

I've had Bursitis of the shoulder now for about 4 months, maybe more. That has been brought on by a muscle in the shoulder being torn in a few places along its length. I can't raise my hand above my shoulder.



Basically means I can't sail until it is healed. The second cortisone injection did nothing. Ibuprofen is becoming a food group for me.

Now, I'm wondering if windsurfing did it to me. I doubt it as that muscle doesn't get sore from a big sail, and it doesn't hurt when I sail as I am now (except for getting sail out of water).

My question is: Has anybody else suffered bursitis of the shoulder/is it from windsurfing?

Bursitis around the shoulder can be caused by a repeated minor trauma such as overuse of the shoulder joint and muscles or a single more significant trauma such as a fall.

Could it be from carrying gear?

Personally I reckon it is from too many vodka redbulls and overly enthusiastic dancing followed by morning push-ups.

Unlikely that windsurfing in the cause of such an injury. This is one of the most common shoulder complaints that occur without any specific mechanism. Two basic causes are, exactly as you highlighted

1 You fall and injure the soft tissues directly, whether it be a rotator cuff muscle tear or impact to the shoulder irritating the sub-acromial bursa resulting in inflammation, pain and limitation of movement (commonly known as impingement).
2 Through years of posture, repetitious activities, you develop a muscular imbalance and over time suffer from an irritation to the bursa +/- degenerative tear in the rotator cuff.

In both circumstances depending on where the muscles are torn, they have very poor healing potential, due to really poor blood flow. However, if your condition was not traumatic, the muscle tears are unlikely to be the cause of your problem, but are actually another symptom. The inflammation in the bursa (bursitis) causes the impingement (google it - it will explain the mechanism of pain) and hence pain.

Cortisone is a mass dose anti-inflammatory, it will not fix the problem, if your cause was due to muscle imbalance, posture and the like. Can you can't put your hand behind your back beyond your waistband? This would indicate the shoulder capsule is really tight, and until you lengthen this you will have gradually worsening trouble. You will also need to strengthen your rotator cuff, work on your upper back, address your working posture and a few other things.

If you haven't worked it out - I'm a physio, bored by the rain and lack of time on the water

Regarding an MRI. Yes it is the gold standard, but unless it is matched with clinical symptoms, it won't help you fix things any quicker. An ultrasound is more than adequate for diagnosis around the shoulder, for low level complaints like this. EP your GP will not be able to fix this and it is unlikely a surgical case from what you have described. Cortisone will not fix it!!!!!!! it may give you relief for a time, but in my experience your symptoms will come back, and if you have already had 2 injections, unlikely they will do a 3rd in that joint any time soon. Basically, go and see your physio if you have one. If not find one that will combine hands on treatment with a comprehensive exercise program. You want to avoid the electro physio approach - machines don't really help.

With good care and you doing your exercises, should be good as new in 4-6 weeks (assuming a simple bursitis). PM me if i can help further.

Edited due to lousy story telling!!!

All good advice above from DAM but didn't work for me. Then again, mine was caused by a catapault 6ft up in 40knots........not gradual overuse type injury.



Do the exercises and see a good pysio but if they don't work, go see a surgeon, get an acromioplasty (acromion ground off to make room for the bursa) and you'll be sailing pain free with full range of movement 8 weeks later.

BTW I disagree with DAM, ultrasound showed bugger all with mine, but an MRI showed i needed surgery. If you see a surgeon and they refer you for MRI then it is covered by Medicare, and you participate in an extreme sport and wanna be 100%, so why not go get one?

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evlPanda said...
Personally I reckon it is from too many vodka redbulls and overly enthusiastic dancing followed by morning push-ups.

Hmmm (scratches chin), I guess the "morning push-ups" after "enthusiastic dancing" may have more to do with something else swelling other than a bursa.

My advice is, if that's the case keep on doing push-ups.

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Mark _australia said...

All good advice above from DAM but didn't work for me. Then again, mine was caused by a catapault 6ft up in 40knots........not gradual overuse type injury.



Do the exercises and see a good pysio but if they don't work, go see a surgeon, get an acromioplasty (acromion ground off to make room for the bursa) and you'll be sailing pain free with full range of movement 8 weeks later.

BTW I disagree with DAM, ultrasound showed bugger all with mine, but an MRI showed i needed surgery. If you see a surgeon and they refer you for MRI then it is covered by Medicare, and you participate in an extreme sport and wanna be 100%, so why not go get one?

Mark, from a clinical perspective, your unresolving symptoms would be the reason you needed surgery. The MRI is a better image so it shows more precisely what has been damaged, but not why your symptoms did not resolve. I suppose what i am trying to say, is that get a good clinical diagnosis, and try conservative treatment, then if things have not improved, off to the surgeon. Not sure in WA but MRI will leave you out of pocket at least $200 in QLD even through medicare. And most physio's send for MRI's through non-medicare facilities for about the same cost.

Wotzy - not sure where you get your information, but your understanding of human physiology is incorrect. Arthritis is not related to the amount of fluid hydration, it is an inflammatory process related to either degenerative change associated with age or weight bearing wear and tear, or it is a disease state such as rheumatoid arthritis, that is much more complex to explain. If you are trying to explain the loss of fluid in cartilage with age, then one current treatment approach for such is via nutritional supplementation of glucosamine and chondroitin. But this is off the track EP is not describing and arthritic complaint.

Bowen therapy is a form of soft tissue therapy that has no more magical powers than any other. It's benefits lay in the hands of the practitioner, and his/ her ability to treat accordingly. Yoga is a wonderful exercise habit that will not help this injury in the least, and some of the poses will actually be harmful.

I am not offended by your comments, but unfortunately, the general public usually have the poorest understanding of how their own body and injuries work. As such some it is common to see a generalisation of "this worked for me so it must work for all," is just wrong, and i know you have the right intentions.

DAm, always a bit tricky giving medical advice on teh interwebz, but I can't agree on the adequacy of USS for shoulders. It's just more accessible, but not worth spit for accurate diagnosis.
The studies that have been done show such a poor correlation between USS and intra-operative findings, that they concluded USS is of low value (and that's being nice).
Yes, you still need to correlate to clinical findings and progress, but that is ALWAYS the case with any investigation and so obvious that it does not need to be stated.
The couple of hundred bucks is nothing against accurate diagnosis and saves both patient and the system a lot of money.
At this stage evlpanda does not have a diagnosis, so any treatment suggestions are fumbling in the dark.

History, examination DIAGNOSIS, then treatment plan...............

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DAM71 said...

Mark _australia said...

All good advice above from DAM but didn't work for me. Then again, mine was caused by a catapault 6ft up in 40knots........not gradual overuse type injury.



Do the exercises and see a good pysio but if they don't work, go see a surgeon, get an acromioplasty (acromion ground off to make room for the bursa) and you'll be sailing pain free with full range of movement 8 weeks later.

BTW I disagree with DAM, ultrasound showed bugger all with mine, but an MRI showed i needed surgery. If you see a surgeon and they refer you for MRI then it is covered by Medicare, and you participate in an extreme sport and wanna be 100%, so why not go get one?

Mark, from a clinical perspective, your unresolving symptoms would be the reason you needed surgery. The MRI is a better image so it shows more precisely what has been damaged, but not why your symptoms did not resolve. I suppose what i am trying to say, is that get a good clinical diagnosis, and try conservative treatment, then if things have not improved, off to the surgeon. Not sure in WA but MRI will leave you out of pocket at least $200 in QLD even through medicare. And most physio's send for MRI's through non-medicare facilities for about the same cost.

Wotzy - not sure where you get your information, but your understanding of human physiology is incorrect. Arthritis is not related to the amount of fluid hydration, it is an inflammatory process related to either degenerative change associated with age or weight bearing wear and tear, or it is a disease state such as rheumatoid arthritis, that is much more complex to explain. If you are trying to explain the loss of fluid in cartilage with age, then one current treatment approach for such is via nutritional supplementation of glucosamine and chondroitin. But this is off the track EP is not describing and arthritic complaint.

Bowen therapy is a form of soft tissue therapy that has no more magical powers than any other. It's benefits lay in the hands of the practitioner, and his/ her ability to treat accordingly. Yoga is a wonderful exercise habit that will not help this injury in the least, and some of the poses will actually be harmful.

I am not offended by your comments, but unfortunately, the general public usually have the poorest understanding of how their own body and injuries work. As such some it is common to see a generalisation of "this worked for me so it must work for all," is just wrong, and i know you have the right intentions.

Thanks peoples.

1. I've been doing yoga, very casually, for many years. By the way yoga is the bomb. I do perhaps once a week, informally, and the next day you feel like you've had a pro massage.

i.e. I have at least an average level of suppleness. I can easy reach my shoulder blades up my back.

2. Went to physio. We noticed a definite plateau after a few weeks so he forwarded me to a specialist, then the cortisone.

3. Ultrasound shows swollen bursa and muscle is frayed along its length.
X-ray showed no impingement from bones growing odd etc.


But the good news is that all seem to agree this is not the type of injury that would be sustained from windsurfing. Except for trauma from being catapulted 6ft up in 40 knots (nice), general freeriding ain't going to do this. I can now assure the family I'm not the only one that thinks so

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evlPanda said...

I've had Bursitis of the shoulder now for about 4 months, maybe more. That has been brought on by a muscle in the shoulder being torn in a few places along its length. I can't raise my hand above my shoulder.



Basically means I can't sail until it is healed. The second cortisone injection did nothing. Ibuprofen is becoming a food group for me.

Now, I'm wondering if windsurfing did it to me. I doubt it as that muscle doesn't get sore from a big sail, and it doesn't hurt when I sail as I am now (except for getting sail out of water).

My question is: Has anybody else suffered bursitis of the shoulder/is it from windsurfing?

Bursitis around the shoulder can be caused by a repeated minor trauma such as overuse of the shoulder joint and muscles or a single more significant trauma such as a fall.

Could it be from carrying gear?

Personally I reckon it is from too many vodka redbulls and overly enthusiastic dancing followed by morning push-ups.

Off topic a bit as I know you are trying to find out what caused it which is really important so you can deal with it.
Just my two cents worth.I haven't had bursitis but I have work induced tendonitis ( medically retired) of the right neck & shoulder that has slowly been improving over the last 6 years( since I left work)..My advice would be to avoid cortisone injections / painkillers or anti imflammatories as they are bad news as they only mask the problem which gets worse as you are still doing whatever it is that caused it.So as you are doing you need to work out what is causing the problem and then stop doing it until it heals then build up muscles to cope & avoid the thing that caused it or do things differently.

Hi Ken,

With respect my advice and suggestions for EP were by no means un-informed. He asked for an opinion re the condition bursitis - that is a diagnosis by the way, the fact he described the shoulder its a safe bet he is talking about the sub-acromial bursa.

Regarding MRI's vs USS. USS is more than adequate for intial diagnostic purposes for the majority of conditions. I agree that it's accuracy is not as good as MRI, but then the true gold standard of investigation will be arthoscopy, but i doubt many will line up for a quick surgical look. However, an MRI cannot indicate which structure is causing you pain as you mentioned in your origial post. It will only show a more detailed picture of what is damaged, it will not highlight muscle function, soft tissue tightness and so on. Only the full clinical picture, including history and physical examination and then further on the course of progression are what determines the course of management we take, not the investigation. The shoulder is a particular joint where there are cases of degenerative muscle tears that have little to no pain and minimal functional loss, however, if we were to investigate with USS or MRI the reports would indicate significant injury ie full thickness tear of supraspinatus, which can be only repaired with surgery. The outcome of such surgery may result in no further improvement in the condition, with the associated risk of a poorer outcome. So what should the clinical decision be made on? The investigation or the clinical picture.

I apologise for this going off track, and it sounds like EP is doing everything right. EP it may just take time and persistence with your strengthening program, furthermore, you may have to look at your day to day activities, and try and identify if something there is the cause of your aggravation. Either way good luck, and if surgery becomes the next step, make sure you go in fully informed, and having done all the rehab prescribed.

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evlPanda said...

.[/b] Except for trauma from being catapulted 6ft up in 40 knots (nice), general freeriding ain't going to do this.

Oh yeaaaah

Sail hits water on the flat, and stops dead. Body still travelling at about 60kph (board speed plus catapault speed?)
If the front hand is still on the boom and the arm is straight, it tries to separate from the rest of the body. Strangely enough.......

when i get up in the morning it's like an orchestra of clicks and pops. every joint in my body makes noises

may not be of any assistance to you ep but ive just recently had quite a bit of shoulder trouble and my local phisio who is trained in KINESIOLOGY strapped it and sent me home with instructions to start exersising, the strap lasts about a week before it comes of so went back several times to get it re strapped.i was totaly blown away by the imediate relief and at how it has improved over the last month -six weeks,also been getting the opposite arm strapped for tinnis elbow ,not as quick to recover but probably spent 5-6 hours on the water yesterday[1st sail since last summer]and had to call it a day when my hands started bleeding,no shoulder probs and no elbow probs although its [elbow] a bit tender today.

Woah dude, I in no way suggested that you are un-informed.
However, I am equally well-informed, by dint of my medical degree, FRACGP and 20 years of clinical experience.
I just have a difference of opinion about the validity of USS. They are crap for shoulders !!
I am aware that "bursitis" is a diagnosis, but I dispute that there is enough evidence for that diagnosis to go unchallenged at this point, particularly since it tends to respond well to cortisone injections. Of course, if the injection was done "in rooms" without USS guidance, the precision of site may be an issue.
With the extra info provided in his last post, I think it is more than reasonable to suggest that EP have an MRI. He has on-going symptoms in the face of good conservative treatment.
MRI will show things that cannot be seen on any other imaging modality, and whilst arthrsocopy may be the gold standard, as you pointed out, it's invasive and difficult, vs the non-invasive ease of MRI.
Even some of the recalcitrant shoulder orthos on the GC who were resistant to MRI are coming around to appreciating it.
Call me a fan-boi, if you will.
At no point did I suggest that the MRI result be treated, rather than the patient.
I don't think you can argue that he has an asymptomatic degenerative tear. If you want an investigation that will overcall injuries, then look no further than USS. I've seen simple bursitis reported as full thickness tears of 3 tendons. I would not accept the USS report EP has conveyed of multiple site of tendon tears as valid.
I don't mind the discussion, and I don't think it's off-track to raise these issues for EP. It's a complex subject with a lot of grey areas.
Just don't patronise me.

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DAM71 said...

Hi Ken,

With respect my advice and suggestions for EP were by no means un-informed. He asked for an opinion re the condition bursitis - that is a diagnosis by the way, the fact he described the shoulder its a safe bet he is talking about the sub-acromial bursa.

Regarding MRI's vs USS. USS is more than adequate for intial diagnostic purposes for the majority of conditions. I agree that it's accuracy is not as good as MRI, but then the true gold standard of investigation will be arthoscopy, but i doubt many will line up for a quick surgical look. However, an MRI cannot indicate which structure is causing you pain as you mentioned in your origial post. It will only show a more detailed picture of what is damaged, it will not highlight muscle function, soft tissue tightness and so on. Only the full clinical picture, including history and physical examination and then further on the course of progression are what determines the course of management we take, not the investigation. The shoulder is a particular joint where there are cases of degenerative muscle tears that have little to no pain and minimal functional loss, however, if we were to investigate with USS or MRI the reports would indicate significant injury ie full thickness tear of supraspinatus, which can be only repaired with surgery. The outcome of such surgery may result in no further improvement in the condition, with the associated risk of a poorer outcome. So what should the clinical decision be made on? The investigation or the clinical picture.

I apologise for this going off track, and it sounds like EP is doing everything right. EP it may just take time and persistence with your strengthening program, furthermore, you may have to look at your day to day activities, and try and identify if something there is the cause of your aggravation. Either way good luck, and if surgery becomes the next step, make sure you go in fully informed, and having done all the rehab prescribed.

Hey, this is better than going to the doctor.

The cortisone injections were done under Ultrasound. Question: Is it supposed to go into the bursa or right next to the bursa? To be honest I looked away at that point, but I'm pretty sure it was right next to.

Also, keeping it related to windsurfing I think/fear it was caused by carrying big gear and/or carrying luggage through airports. I do a lot of it.

Regarding the muscle tears, the doc gasped when he saw them. Bursa is huge.
Seems to have calmed down a bit this week with ibuprofen, of course it could be simply masking it.

But, am I right in thinking that because the injury works on a bit of a feedback loop, the muscle is damaged so bursa swells leaving less space for muscle so muscle is damaged and bursa swells... I should be trying to reduce swelling of bursa as much as possible? Thus anti-inflammatories or ibuprofen. I am taking about 1/3 - 1/2 recommended dose, like a good boy. Just enough to reduce pain.

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KenHo said...
I think it is more than reasonable to suggest that EP have an MRI. He has on-going symptoms in the face of good conservative treatment.
MRI will show things that cannot be seen on any other imaging modality,

And that is what I said even though I am not a quack or a joint bender

Maybe I should charge as much money as you blokes (Ken and DAM71) do

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evlPanda said...

Hey, this is better than going to the doctor.

Really?

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evlPanda said...

I've been doing yoga, very casually, for many years. By the way yoga is the bomb. I do perhaps once a week, informally, and the next day you feel like you've had a pro massage.

A "pro" massage do you say? We wouldn't know about that...

I tore my shoulder in a jetskiing accident in May 2007. I had 11 rounds of cortisone between then and August 2009 - I was desperate not to have the surgery - so many bad stories. I got jack of nursing myself so I went back to windsurfing. It did take some time to work out the optimum boom height (lower than I used to have it) and now I am almost pain free. I was under the care of a specialist during this time who said "no more" to the cortisone. So I may be kidding myself and my recovery could be all in my head. Mind you, I don't care. I've been back windsurfing for over a year now and my shoulder is holding up well. I am very careful how I use the shoulder and any sign of pain I stop what I'm doing. I also found full extension bicep curls with dumbells irritate the injury so I only use a barbell and really watch my angles.

I hope it gets better for you.

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DAM71 said...

Mark _australia said...

All good advice above from DAM but didn't work for me. Then again, mine was caused by a catapault 6ft up in 40knots........not gradual overuse type injury.



Do the exercises and see a good pysio but if they don't work, go see a surgeon, get an acromioplasty (acromion ground off to make room for the bursa) and you'll be sailing pain free with full range of movement 8 weeks later.

BTW I disagree with DAM, ultrasound showed bugger all with mine, but an MRI showed i needed surgery. If you see a surgeon and they refer you for MRI then it is covered by Medicare, and you participate in an extreme sport and wanna be 100%, so why not go get one?

Mark, from a clinical perspective, your unresolving symptoms would be the reason you needed surgery. The MRI is a better image so it shows more precisely what has been damaged, but not why your symptoms did not resolve. I suppose what i am trying to say, is that get a good clinical diagnosis, and try conservative treatment, then if things have not improved, off to the surgeon. Not sure in WA but MRI will leave you out of pocket at least $200 in QLD even through medicare. And most physio's send for MRI's through non-medicare facilities for about the same cost.

Wotzy - not sure where you get your information, but your understanding of human physiology is incorrect. Arthritis is not related to the amount of fluid hydration, it is an inflammatory process related to either degenerative change associated with age or weight bearing wear and tear, or it is a disease state such as rheumatoid arthritis, that is much more complex to explain. If you are trying to explain the loss of fluid in cartilage with age, then one current treatment approach for such is via nutritional supplementation of glucosamine and chondroitin. But this is off the track EP is not describing and arthritic complaint.

Bowen therapy is a form of soft tissue therapy that has no more magical powers than any other. It's benefits lay in the hands of the practitioner, and his/ her ability to treat accordingly. Yoga is a wonderful exercise habit that will not help this injury in the least, and some of the poses will actually be harmful.

I am not offended by your comments, but unfortunately, the general public usually have the poorest understanding of how their own body and injuries work. As such some it is common to see a generalisation of "this worked for me so it must work for all," is just wrong, and i know you have the right intentions.

Sorry mate,
I re read my post and yes it doesnt quite read how i intended.

I wasnt trying to say dehydration causes arthritis, I was saying

-good hydration helps healing by helping circulation,

-healing is helped by good circulation, as it feeds cells and gets rid of waste (in this case the nasty bursa)

-supple joints experience less wear and have better circulation. This slows degeneration, promoting longevity of the joint and releiving pain. And in my case the earliest stages of arthritis (not rheumatoid) as diagnosed by specialist who scraped my knees.

-muscle that is strong through out its range of travel will support joints better in extreme ranges of tweak (technical terms) and will hopefully not tear trying to protect the joint.

I said to rest for close to the same amount of time you said to rest. I then said do yoga and I meant after rest...this doesnt read very well..my bad

Im not the greatest writer so my points may not be very clear in my original post.

My opinion is pureley based on the releif of symptoms fast healing and the prevention of future injury so I can still enjoy falling off... coz with out wipeouts I cant push limits!!! Yeah best of intentions for sure...
Hey ice would also help the inflamation but not a cure!!!
...I find lots of little things make a great whole. A little work in areas not specifically at the source of discomfort benifit the whole.

for me its water, massage, strechting, and bloody good practioners to guide your way!!

I also agree with everything you have said...Physios are great...I had a great one called damo too!!!!! he used to crack my toes...I miss that

Good luck with the shoulder evl panda. And ignore my scratchings in the earlier post! You sound pretty fit so "good" surgery will be easy to come back from probably...but geez the anesthetic makes me crook..I hope it just goes away mate. And when you get healed try a bikram hot yoga. It will blow your mind.

If you have huge tears then you will probably do well with surgery.
The injection goes into the sun-acromial space, so next to the bursa.
I never really commented on whether windsurfing can cause or aggravate shoulder injuries, but I think it would be naive to say it would not.
The comment below about boom height is pretty relevant, I think.
A higher boom puts more stress on the shoulder joint. My shoulder gets a bit sore after a big sail. I favour a lower boom these days to help look after it.
I was talk to a SUP shop owner recently about paddle length, and he said that all the old blokes doing SUP are reporting that too long a paddle will stuff a shoulder in no time.

I get the impression that you have seen an ortho, but if you have not, then a visit to an upper limb specialist is in order.
There are some very good ones in Brisbane, one in particular, whose name I can't think of at present, though I've been trying to remember for you.
I still think you need an MRI.
Tears on USS appear as dark spots, but severe bursitis will produce the same appearance because of free fluid, hence my issues with the accuracy.
USS accuracy in chronic degenerative tears is irrelevant and untested, as those patients do not go to surgery and do as well as they are going to with conservative management.

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evlPanda said...

Hey, this is better than going to the doctor.

The cortisone injections were done under Ultrasound. Question: Is it supposed to go into the bursa or right next to the bursa? To be honest I looked away at that point, but I'm pretty sure it was right next to.

Also, keeping it related to windsurfing I think/fear it was caused by carrying big gear and/or carrying luggage through airports. I do a lot of it.

Regarding the muscle tears, the doc gasped when he saw them. Bursa is huge.
Seems to have calmed down a bit this week with ibuprofen, of course it could be simply masking it.

But, am I right in thinking that because the injury works on a bit of a feedback loop, the muscle is damaged so bursa swells leaving less space for muscle so muscle is damaged and bursa swells... I should be trying to reduce swelling of bursa as much as possible? Thus anti-inflammatories or ibuprofen. I am taking about 1/3 - 1/2 recommended dose, like a good boy. Just enough to reduce pain.

I've got the same thing right now. Had the MRI which showed some delamination of the supraspinatus and a little cartilage damage.

I've had a shot of cortisone two weeks ago and have been put on a rotator cuff strengthening regime. I don't think there has been any improvement yet and my range of mobility is limited, but I'm still windsurfing OK even though I can't lift my arm over my head or swim fast (one arm only).

My Dr has told me to treat my shoulders with respect from now on (45yo this year). When I get back into weight training (he said hopefully) there can be no more heavy stuff, and he reckoned I should never do chinups again... (may well be what caused it). He also thought my shoulder looked like I may have had a dislocation at some stage but I certainly don't remember one.

Hi EvlPanda, Im no doctor but for what its worth I go in for my second Op in 7 days, I had my right done 13 months ago after major off destoryed right sholder, and tore the left sailing in Maui. If you sail regularly it will not improve and sounds serious as with two torn ligiments and muscle tears I could still hold my right arm above my head. I would suggest go to a surgen and have the decompression done. The injections are a waste of time and money, also you can only have a number of them before they weaken the tendons in the shoulder.

If you live on the Gold Coast I can recomend Terry Hamond as a surgeon he is also a windsurfer and understands your plight.

Just curious.
If your MRI showed a small de-lamination tear only, why did you have a cortisone shot ?
I resisted the idea myself, because of the weakening effects.
Then rotator cuff exercises are really valuable and need to be done. I am sure they are what turned the corner for me.

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ikw777 said...

I've got the same thing right now. Had the MRI which showed some delamination of the supraspinatus and a little cartilage damage.

I've had a shot of cortisone two weeks ago and have been put on a rotator cuff strengthening regime. I don't think there has been any improvement yet and my range of mobility is limited, but I'm still windsurfing OK even though I can't lift my arm over my head or swim fast (one arm only).

My Dr has told me to treat my shoulders with respect from now on (45yo this year). When I get back into weight training (he said hopefully) there can be no more heavy stuff, and he reckoned I should never do chinups again... (may well be what caused it). He also thought my shoulder looked like I may have had a dislocation at some stage but I certainly don't remember one.

Hi Ken, sorry if read into my last post that i was patronising you, that was not my intent. I think you may not have been getting the gist of what i have been trying to say - which is always difficult with the typed word.

For instance i did not claim that EP had an asymptomatic degenerative tear, but merely used that as an example. BTW I'm sure you are aware the prevalence of such injuries is actually quite high >20% in the over 50's, and increases with age. The question that is much harder to answer is what could cause an asymptomatic tear become symptomatic in the absence of trauma. I have just read an interesting paper from Acta Orthopaedica regarding such - for another day.

Anyway, you got me thinking so i have done a little research, and in light of your medical opinion, you may be interested to know that a 2009 paper in the American Journal of Roentgenology reported that there are no significant differences in either sensitivity or specificity between MRI and ultrasound in the diagnosis of partial- or full-thickness rotator cuff tears (p > 0.05). It highlighted that MR arthrogram is more specific and sensitive than either MRI or ultrasound. Now i believe that MRI is a better quality image, as i have said all along, and believe it will show tear characteristics such as location and extent with more clarity, but i stand by my original position that it is more than adequate as an intial diagnositc tool for assessing shoulders.

But again this is most probably whilst interesting for you and i to discuss, of little benefit to EP. I agree that in the light of EP's more recent post, he may well need further investigations, however, i find it more interesting that low dose ibuprofen is offering him relief, where cortisone did not. For the record, my observations regarding cortisone would have more failures than successes, it may calm the symptoms temporarily, but usually the pain returns, especially in conditions that are more chronic. Keep in mind my figures will be skewed, because the people that i tend to see, have already had cortisone fail. Interesting they usually have never had any rehab prior to the injection, which leads me to believe, it is still widely used in medical practice.

Regardin EP's particular complaint, if you have been diligent with rehab, and followed advice and are not improving then it may be necessary for further investigation. Sometimes, however, it just takes a long time, and persistance, and like i mentioned earlier, try to determine what / if any things you may be doing to continually aggravate the shoulder, and be comfortable that your physio has addressed all potential biomechanical problems; including but not limited to scapular stability, (not just rotator cuff exercises), thoracic mobility, shoulder capsule length, shoulder position (fwd/back) ie tight chest / round shoulders and stuff like that, and finally if there is a neuro-mechanical component (type of nerve irritation).

On a general health note if you smoke stop - decreases oxygen in blood therefore slow healing, vitamin B supplement - good for mitochondrial action may help improve soft tissue healing (eat your spinach), heat promotes blood flow - get a wheat pack. Decrease stress - its not good for you, eat healthy, and exercise.

Good luck.

I left some stuff out. Can't cut n paste the whole conclusion from the MRI but I think these are key:

"intrasubstance delamination tearing at the mid portion of the insertion of the supraspinatus tendon with tendinosis of the remainder of the tendon and some moderate subacromial bursitis"

"some labro-cartilaginous irregularity... with a cleft between the glenoid cartilage and adjacent labrum in keeping with a cartilaginous Bankart lesion..."

"some degenerative change on ... the humeral head"

So - fun and games. Doing the exercises and I guess I am pretty mobile. I am not sure thgat I am getting better just yet though and will soon go back to my Dr with some research under my belt and a laundry list of questions.

I expect to handle the next three days of 20-30kts OK so I guess I'm not as bad a some, I willl be pretty conservative in my sailing though.

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KenHo said...

Just curious.
If your MRI showed a small de-lamination tear only, why did you have a cortisone shot ?
I resisted the idea myself, because of the weakening effects.
Then rotator cuff exercises are really valuable and need to be done. I am sure they are what turned the corner for me.

ikw777 said...

I've got the same thing right now. Had the MRI which showed some delamination of the supraspinatus and a little cartilage damage.

I've had a shot of cortisone two weeks ago and have been put on a rotator cuff strengthening regime. I don't think there has been any improvement yet and my range of mobility is limited, but I'm still windsurfing OK even though I can't lift my arm over my head or swim fast (one arm only).

My Dr has told me to treat my shoulders with respect from now on (45yo this year). When I get back into weight training (he said hopefully) there can be no more heavy stuff, and he reckoned I should never do chinups again... (may well be what caused it). He also thought my shoulder looked like I may have had a dislocation at some stage but I certainly don't remember one.

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ikw777 said...

I left some stuff out.

irregularity... labrum ........some degenerative change

Ok so you are a female who is not a virgin.

Just an addenda to this old thread.

As someone who has had major shoulder surgery in the past, and still sails with bad shoulders 20 years later, I hope the following practical, cheap observations can help someone.

Before my practical advices:

- rest: this has never helped me, but it's probably because I was a lost cause to start with, damage-wise (at least 3 O-Ss told me so). However still recommended to others, it falls in the category of "it can't hurt". The items below apply only once you've rested until no pain, and that you have a strong feeling that you're getting better.

- don't take anyone's advice, including mine : the shoulder, like the back, seems to be an incredibly complex set of joints - everyone's pathology seems to be different. Certainly one single individual can't apply his-her own experience to someone else. Of course the right doctors can apply 100-1000 cases to generalise for a specific case.

Practical advices:

- ice, ice, ice soon after the outing. I do not know that there is a down-side when this is well-applied, but it really seems to work all the time. Work as in "don't hurt", "feels better", "seems to help in the medium run", "I can sail longer for the same level of pain". Of course as with any treatment, one can never formally prove that it works, but after 20+ years, there is a very strong correlation.
Basically, it works wonders here. I had a couple of comps where in fact I was freezing myself before just in order not to feel myself for the duration of the routine. This has got to be wrong though, don't do it. (I have a comp in a month, and I'll do it again, times 2-3-4 routines )

- the grip: changing the grip often helps, and I believe it can't possibly hurt just to try. Basically there are 8 different grips, right? (up-down front-rear hand, left & right). I mix them a lot, never stay for a long time with the same grip on a same tack. Of course some boom types lend themselves better to the front-hand underhand grip. Just switch 1-2 minutes makes a diff. I actually do the Codman exercises whilst sailing, and I find it helps too.

- boom height: boom height really makes a big diff here. Obviously it changes drastically the angles at the shoulder joints - how I don't know, me not a doctor nor a quack. For non-planing freestyle or small-Goya freestyle (fooling around), low booms !! Anyways look at some of the pros on the circuit, booms are often low indeed.

- variety: I find cruising for 3 hours on a tack before gibing makes me prone to soreness, even when fully hooked in and reading a book. Probably a case of repetitive strain or something like that. I hurt less with frequent transitions, they seem to change the hurt around, or something like that. As I said, me no doctor. Can't hurt to try short tacks for a couple of outings just to see if there's a diff, right?

- variety: I find freestyling my 95L in 20-25 knots hurts much less than racing around or simply cruising in strong winds. Probably because the joints move around. Of course I break or bruise all of the other bones in the process, but that's a different topic...

- use the front-to-back (pushing the sail) a lot, often: this rests the entire shoulders set, with the bonus that it allows you to use the opposite set of muscles (pushing instead of pulling, triceps, abs instead of dorsals, etc.). This applies to most types of sailing - freestyle, cruising 90-95+ liters, and non-planing. In strong winds this is an excellent exercise. I was at a freestyle jam last year in a 20-25 knot wind, and basically we all spent about one-third our sailing time pushing, in various formats.

- keeping in shape: there are long lulls here, and you have some in NSW too (Canberra!). In the 10-15 knot range, I go out on a larger board and I fool around, with no harness. I find this keeps the muscles in shape for when the wind picks up. The non-doctor of me reckons it's no good to be out for a month as a wind-snob, and then go out for 2 hours in a 25 knotter with borderline shoulders.

Hope any or all of these help a bit,
'luck,
PC45.