Joe A Shaw PA-C - 6/23/2008

Question
41 year old male, athletic and muscular.  Lifted weights all my life as well as participated in baseball (catcher), volleyball, as a teen and into my adulthood.

Prior to current condition, experienced occasional shoulder discomfort while weight lifting.  Pain would occur while doing bench presses and dips.  Pain felt deep in shoulder.  Did not affect strength.

Current condition began after not playing baseball for over 10 years.  Joined an adult men's league and went out day one and threw like I was a teen again.  I felt extremely strong and realized very little difference from the way I throw now to the way I threw as a teen.  Clearly was a foolish move on my part.  The next day, typical and expected muscle soreness but nothing out of the ordinary.  Three days later I played again and found my arm to be DEAD.  I had very little throwing strength.  At that time, I was doing some physical therapy for my lower back so I consulted with my therapist regarding the issue and he prescribed some exercises to strengthen the infraspinatus and supraspinatus using a rubber band and some light weights (2- lb.).  I proceeded with the exercises for the next three weeks and found little change in my ability to throw.  Also found that if I attempted to throw with any velocity, I would get an awful shooting pain from my that felt like it emanated from my infraspinatus over my should and running down my biceps and triceps.  At that point I went to my doctor with a self diagnosis of subscapular nerve entrapment.  I was examined and tested and he concurred that it was a possibility and prescribed 4 weeks of physical therapy.  I was placed on a rotor cuff program and proceeded with the exercises religiously.
 Last Friday was my final day of therapy and prior to my follow up with my doctor, decided to test the shoulder with some light throwing.  I was fine and pain free until I again attempted to throw with any velocity.  When I did, the shooting pain from the infraspinatus, over my shoulder and down my arm was as significant and pronounced as ever.  I have no pain or significant discomfort during normal everyday activity.  Sleeping is somewhat uncomfortable when lying on the shoulder.  When working out, I have some some mild discomfort when bench pressing flat and on an incline.  I do feel the pain when bench pressing in a declined position.  I do not feel any pain while doing any rowing type of action.
 At this point I am very frustrated and met with my doctor today.  He has requested an MRI.
 I really did not want surgery and have worked hard on my physical therapy so I wouldn't have to have surgery.  Does it sound like there is anything else I can do?

Answer
Ray ,
You need to have a diagnosis..sounds like a rotator cuff tear to me. The MRI should reveal what is going on 90-95% accurate. Depending on what type of tear and where it's at you may need to have your shoulder scoped for repair. I know the PT was trying to help but they are not really in the biz of giving out diagnoses. If you do end up w surgery you may again do some shoulder rehab exercises w bands and such.
Subscapular entrapment is fairly uncommon relative to rotator cuff tears etc..so I would look for horses rather than zebras until proven otherwise.