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Shoulder Update - Day 30 Post-Prolo

Posted Apr 09 2010 6:28am

Day #30

Friday, April 8, 2010

"Hey - you can feed your self this time! You seem to be doing a lot better!" Ellen said as we ate dinner.

"Really...you know I had forgotten about that but, yeah, you're right. My shoulder isn't as beat up this time around as last time," I replied.

About five hours earlier, I had finished the second round of prolotherapy administered by Brad Fullerton, MD. The process was still painful. He hit some real zingers but overall, I had fewer injections and when I left, I noticed I could move my arm without much pain. Of course, I knew that wouldn't last as the lidocaine wore off but it meant that he hit the right structures this time.

Last time, Dr. Fullerton spent quite a while trying to track down the source of the pain I was having with rotation and flexion of the shoulder. He couldn't find it but this time he seemed to have a renewed level of resolve. "We've got to zap that thing this time," he said in between bars of humming to Warren Zevon's "Lawyers, Guns, and Money".

He found two trigger points in my shoulder that were really sore and painful and when he punched on them, pain galloped up into my head and down the front of my arm. As my body sort of twisted around like Gumby, he said something like, "Freddenbocker schmoker socker" to help me not turn into Steve Carell in the scene from "40 Year Old Virgin" when he gets hair ripped off his body. I appreciated that - made me laugh.

Dr. Fullerton then took a needle and stuck it into the trigger points until he got a twitch from the muscle. Ok, so that hurts. Not like child birth or anything but still, it makes your toes curl. He had to hit the muscle a few times. When he was done, he re-tested my arm. Bingo. Full motion with almost no pain.

"So, this pain is not from the tear then, right?" I asked.

"Yep. Looks like it's trigger points. But, you have to wonder why you have some many of them though," he replied.

Trigger points. Some days I feel like somebody slipped into my brain and padlocked the file drawer that says, "What You Know About Pain and Movement".

The weird thing about trigger point pain is that where you hurt is not where the problem is and still, you can be really tender there. So, it's easy to get distracted. You think, for example, that the problem is in your neck. Your neck hurts, it's tender to touch, to stretch. But, the source could easily be a trigger point in the upper trapezius muscle belly several inches away from the pain.

For my shoulder, one of the trigger points was the infraspinatus muscle on the back side of the shoulder. It refers pain to the front. In the image, the "X" is the Shoulder_infraspinatus trigger point and the red area is where you feel the pain. Notice that it goes into the hand so you can misinterpret the issue. Because you hurt in the hand and arm, you might think, and logically so, that the source is the neck. I also had a lot of tenderness in the red zone. After the point was needled, most of the pain and tenderness was gone.

Next, I chill for a few days. I can do some general conditioning but I have to let my shoulder rest. Then, I start Phase I drills for about ten days and then move into Phase II. I'm headed back for a third prolotherapy session in the middle of May.

I'm optimistic about this whole process. I think in a few weeks, just based on how I feel and can move today, that I'm going to be a lot better. It takes a while for the tissue to heal, remodel, get stronger but when I'm done, I'll have a solid shoulder.

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Follow my recovery from a rotator cuff tear here. I post new stuff every day or two generally.

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