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Wretched Shoulders - Powerlifting

2021; Lippincott Williams & Wilkins; Volume: 53; Issue: 8S Linguagem: Inglês

10.1249/01.mss.0000764040.41974.ef

1530-0315

Cecilia Córdova Vallejos, Julio Vazquez-Galliano,

Musculoskeletal synovial abnormalities and treatments

HISTORY: 41-year-old right-handed powerlifter referred to MSK/Sports Medicine clinic in rehabilitation department after 5 years of bilateral throbbing, non-radiating shoulder pain, worse with overhead lifting and reaching backwards, better with arms in neutral position, treated only with subacromial steroid injections every 3 months, and one time suprascapular nerve block. He had never stopped training, approximately 4-5 days a week, including dead-lifts shrugs and incline bench press in excess of 300-400 pounds. PHYSICAL EXAMINATION: Examination revealed no bony deformity; muscle hypertrophy BUEs, very limited passive-ROM bilateral shoulders (forward-flexion to 80, extension 0-5, abduction 60, internal and external rotation 5 degrees). Positive Neer's, Hawkins, Painful Arc, and Speed's. Sensation intact, MMT: 5/5 biceps, triceps and wrist extensors bilaterally, 2/5 shoulder abduction and flexion bilaterally. Noted to have pain-inhibit behavior. DIFFERENTIAL DIAGNOSIS: 1. Bilateral Rotator Cuff Tendinopathy2. Bilateral Adhesive Capsulitis3. Bilateral Shoulder Osteoarthritis4. Avascular Necrosis of bilateral shoulder TEST AND RESULTS: MRI Bilateral Shoulder 2017: severe degenerative disease of glenohumeral joint with significant cartilage loss, subchondral cyst and osteophyte formation. Synovitis within the glenohumeral joint and tenosynovitis of the biceps tendon sheath. Mild infraspinatus tendinosis. Mild acromioclavicular degenerative disease. FINAL WORKING DIAGNOSIS: Severe bilateral glenohumeral joint osteoarthritis TREATMENT AND OUTCOMES: - Education: conservative treatment vs. shoulder surgery (arthroplasty), immediate pain relief vs chronic steroids use, current vs future functional outcomes. Patient focus on immediate results, no surgery.- Therapy/exercises: history of multiple OT attempts with poor pain relief and compliance, exercise modification (lower load with increased repetition), patient refusing change in current gym routine.- Integrative Medicine trial: OMM and Acupuncture, patient agreeable- Injection: US-guided bilateral suprascapular nerve blocks (prior pain relief for 2-3 months) and RFA, patient wants to continue injection interventions but not RFA. - Follow up after injection and integrative medicine trial.