Shoulder Pain/Injury, who do I go see?

[BigJosh]

I have been trying to ignore away a shoulder injury for the last 3-4 months. It is at the point where I can no longer do any direct shoulder work, and the only chest work I can do really is flat bench. The only way I can flat bench is by warming up extensively. And even at that it is uncomfortable.
However it has had no effect what so ever on any pulling motions.
I'm not sure what the problem is, but based on what I've read I believe it to be either a shoulder impingement or rotator cuff related.

My question is, what sort of medical professional do I need to see about this issue? A sports medicine doctor? A physiotherapist? I'm just not sure who to go to first.
Any advice or comments would be apreciated.

[BendtheBar]

I would see someone in sports medicine, or someone locally that specializes in this. I would probably call a clinic and ask who you should see for a possible impingement.

Treatment can vary, from what I understand. I am far from an expert though.

Shoulder Impingement/Rotator Cuff Tendinitis - Your Orthopaedic Connection - AAOS

Treatment

The goal of treatment is to reduce pain and restore function. In planning your treatment, your doctor will consider your age, activity level, and general health.
Nonsurgical Treatment

In most cases, initial treatment is nonsurgical. Although nonsurgical treatment may take several weeks to months, many patients experience a gradual improvement and return to function.

Rest. Your doctor may suggest rest and activity modification, such as avoiding overhead activities.

Non-steroidal anti-inflammatory medicines. Drugs like ibuprofen and naproxen reduce pain and swelling.

Physical therapy. A physical therapist will initially focus on restoring normal motion to your shoulder. Stretching exercises to improve range of motion are very helpful. If you have difficulty reaching behind your back, you may have developed tightness of the posterior capsule of the shoulder (capsule refers to the inner lining of the shoulder and posterior refers to the back of the shoulder). Specific stretching of the posterior capsule can be very effective in relieving pain in the shoulder.

Once your pain is improving, your therapist can start you on a strengthening program for the rotator cuff muscles.

Steroid injection. If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine. Injecting it into the bursa beneath the acromion can relieve pain.
A cortisone injection may relieve painful symptoms.
Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.
Surgical Treatment

When nonsurgical treatment does not relieve pain, your doctor may recommend surgery.

The goal of surgery is to create more space for the rotator cuff. To do this, your doctor will remove the inflamed portion of the bursa. He or she may also perform an anterior acromioplasty, in which part of the acromion is removed. This is also known as a subacromial decompression. These procedures can be performed using either an arthroscopic or open technique.

Arthroscopic technique. In arthroscopy, thin surgical instruments are inserted into two or three small puncture wounds around your shoulder. Your doctor examines your shoulder through a fiberoptic scope connected to a television camera. He or she guides the small instruments using a video monitor, and removes bone and soft tissue. In most cases, the front edge of the acromion is removed along with some of the bursal tissue.

Your surgeon may also treat other conditions present in the shoulder at the time of surgery. These can include arthritis between the clavicle (collarbone) and the acromion (acromioclavicular arthritis), inflammation of the biceps tendon (biceps tendonitis), or a partial rotator cuff tear.

Open surgical technique. In open surgery, your doctor will make a small incision in the front of your shoulder. This allows your doctor to see the acromion and rotator cuff directly.
Anterior acromioplasty techniques. (Left) Arthroscopic repair. (Right) Open surgical procedure.

Rehabilitation. After surgery, your arm may be placed in a sling for a short period of time. This allows for early healing. As soon as your comfort allows, your doctor will remove the sling to begin exercise and use of the arm.

Your doctor will provide a rehabilitation program based on your needs and the findings at surgery. This will include exercises to regain range of motion of the shoulder and strength of the arm. It typically takes 2 to 4 months to achieve complete relief of pain, but it may take up to a year.

[5kgLifter]

Can't help with the advice on who to see, but is this of any help? It may shed light on whether it's rotator cuff related.

Test your rotator cuff strength!

[bb12]

Keno Guy

[ricka182]

You want to see an Orthopeadic specialist/surgeon. You'll probably need a referral from a Genral Doctor, but some smaller clinincs allow direct appointments. If you have health insurance, call and ask them to find you a good Ortho Doctor.

And stop lifting if it hurts...you're only doing more damage, which will require more healing time..

[BigJosh]

Thanks for all the replies. It is much appreciated.
BTB- Good info!
Ricka- I will heed your advise and not doing any lifts that hurt. However, I am still going to try flat bb bench. When I warm up properly it doesn't seem that bad.

What I am going to do is call my insurance provider and ask for a recommendation for a orthopedic specialist and/or sports medicine doctor.

Thanks again guys!

[MC]

Went through this last year Josh.

I was first referred to a sports medicine clinic, but that doctor gave me a BS response (stop doing what hurts and take pills), so I then went to see a PT (who himself lifts and is into sports medicine).

I should have gotten an MRI, but did not. A MRI would have let the PT know if what was wrong possibly required surgery. His stance was, we will treat it as if it does not--if it does not respond, you need to get an MRI and then be referred to a surgeon (which he wanted to avoid).

Even without that, he diagnosed my problem and put together a plan that eventually got me back into the gym again. I had to relearn how my shoulder blade was supposed to behave and strengthen my RC and a lot of other muscles.

Good luck!

[BigJosh]

Originally Posted by *MC*

Went through this last year Josh.

I was first referred to a sports medicine clinic, but that doctor gave me a BS response (stop doing what hurts and take pills), so I then went to see a PT (who himself lifts and is into sports medicine).

I should have gotten an MRI, but did not. A MRI would have let the PT know if what was wrong possibly required surgery. His stance was, we will treat it as if it does not--if it does not respond, you need to get an MRI and then be referred to a surgeon (which he wanted to avoid).

Even without that, he diagnosed my problem and put together a plan that eventually got me back into the gym again. I had to relearn how my shoulder blade was supposed to behave and strengthen my RC and a lot of other muscles.

Good luck!

I'm encouraged to hear that you got through it.
Anymore I have little faith in medical professionals and I fear that, unless I go to the right person, I will get the don't lift weights and take pills answer.