Rotator Cuff/ Delt/ Shoulder Injury - Looking for advice.

This past Memorial Day, Marc H and I climbed Devil's Tower via the Durrance route. I led P1 at 4am, and did not properly warm up. I made a big shoulder press behind the back type of move, heard a click, and had instant dull pain. I surrendered the lead to Marc thereafter and chuffed my way up the rest of the route. Great climb! My hypothesis is that I badly strained one of the rotator cuff muscle/tendons - supraspinatus or general anterior delt maybe - and then made it worse by climbing 6 more pitches. 

I could not move my arm without sharp pain for 24 hours after and have been improving maybe 5% a day since then. The movement has improved, but popping/ clicking has not. I have strained muscles many times before, but this one is different. It seems not one specific muscle or tendon has been affected, but the entire shoulder. Probably from having to support the damaged area for the remainder of the climb. 

Since I am a hypochondriac, I went to the Doc's and he did an X-ray to make sure everything was sitting in the correct place. The X-ray came back all good, so it is pretty unlikely I have seriously torn anything. Minor tearing and serious spraining is still possible, but there's no way to know for sure without a pricey MRI. 

SO the challenge I'm having is nailing down exactly what is wrong. External rotation, overhead movement, has clicking with some pain. I can't comfortably hang from a bar, especially at a dead hang. If I really engage the scaps and rotation the shoulder into the correct position, there is much less pain. Pinching/ pain along the top of the shoulder. Just moving my arm up to my desk, I am experiencing some "catching" of the deltoid against the front of my shoulder. Could the popping simply be from inflammation, or would you suspect a tear? Should I bite the bullet and pay for the MRI?

Has anyone experienced anything like this and have any advice? I was climbing outside 2-3 times a week and the same indoors, and am super bummed to have to take time off. 

Did you feel the shoulder pop out of the socket?

https://m.youtube.com/watch?v=oMJwwJWSxMA

Unfortunately it was so early I can’t remember clearly. When Marc came up behind me, that was the first thing I said, “It felt like it might have popped out and popped back in.”

Do these seem like symptoms of a subluxation? That was my other thought. 

Glowering wrote:

https://m.youtube.com/watch?v=oMJwwJWSxMA

Negative for all symptoms except instability. New theory based on this: a subluxation that has caused some grade II muscle/tendon tearing, leading to tons of inflammation. That might crowd joint spaces and cause the popping and catching. 

The question now is what steps, proper Dr. to see for subluxation diagnosis. Because the GP did not know. 

Get an mri

Go to PT. They’ll do more in-depth functional testing, snd work with you on rehab. 

Thanks for your advice, everyone. 

I found doctors other than orthopedic surgeons to be useless for my shoulder. I really liked Dr. Hatzidakis in Denver: https://www.western-ortho.com/provider/armodios-m-hatzidakis-md

He specializes in shoulders and elbows and his office is very well run. I think you will need the MRI.

I second the PT idea and was very happy with Functional Physical Therapy https://functionalphysicaltherapyllc.com/

It looks like they closed their Denver office where I went and just have a Boulder location now.

My shoulder is now almost 100% after being pretty well f**d

Also recommend seeing a PT. They'll do some tests and tell you what weaknesses/imbalances you have in the joint and how to stabilize them. Even better if you can find one who understands climbing movement

If you experience recurring issues with PT then consider consulting with a surgeon

"..especially at a dead hang. If I really engage the scaps and rotation the shoulder into the correct position, there is much less pain"

Sounds like a torn labrum to me. Slap tear in particular.

As others mentioned, MRI would be the way to go unfortunately. But maybe start with PT first to see how that goes.

But yes, a whole lot of rotator cuff PT for many months and years to come.... those will need a bunch of strengthening if you don't do surgery.

If you need surgery, see Tom Hackett at the Steadman Clinic in Vail/Frisco.  He's the best shoulder doc in the state.

Period.  I had my right shoulder repaired by him, and another friend of mine had both his shoulders fixed.  He's not cheap,

but he is worth every penny you pay.

Dam - welcome to the club. We aren’t doctors here by any means but probably more experience with this than any other athletes.
The three steps to healing are: Rest, Stretching and finally Strength.
During the “rest” phase avoid the “frozen shoulder” - several PT things to do- pendulum, clock swing etc. See PT folks
Stretching is best done under supervision of PT folks- they know what to do.
Strength- you will know if things are working OK again - take it EZ listen to your body.

If none of this works within about 4-8 weeks- get a doctor. The more experienced working with athletes who wish to remain athletic the better.

I’ve had both shoulders worked on - surgery- 2 times each. 3 times because of climbing one, the worst, because of a Karting crash.

How long??? As long as it takes.

Good luck with it. 

Typically an ortho will start with an x-ray looking for fractures, grossly displaced or dislocated stuff. But they can't see soft tissue injuries well without a contrast mri. It's especially good to find an ortho who can read his own mri's. Relying on the radiologists report can be misleading, since that person is going to be looking at the joint globally, not necessarily distinguishing between older injuries and what's got you now. 

I've had both shoulders looked at by the same doc, El'Attrache at Kerlan Jobe. First time in I new it was gonna be surgery just by the pain and immobility. He looked at the MRI, turned to his Fellow, and said "Look at this. He tried to tear his arm off but the skin held it on." Surgery + PT=100% in a year. 

Second shoulder all I needed was P/T.

Keep in mind that if you have a significant tear(s) you are in a race with scar tissue. MRI, and an ortho who can read it, is the best diagnostic tool. And don't forget to get a disc of the mri study. It's yours, and can be invaluable if you want second opinions.

Good luck. Hopefully it's a walk in the park...

Update for anyone following along, or who have found this post when searching for ideas on the same issue. 

I'm going to w work primarily with my great PT, Kevin at the Climb Clinic in Broomfield, CO. Based on the causality and current symptoms, the greatest likelihood is a subluxation. Popped out, popped back in. The big giveaway is that the entire shoulder is affected, not one specific muscle, tendon, or structure. The popping and catching I've been feeling are probably from inflammation since it's been happening less and less every day. 

The previs X-ray ($73) suggests everything is well in place, so structural damage is not likely. If I keep using it while it's weak, I could do more damage. Obviously, continuing to climb the next 6 pitches of off-width, shoulder heavy climbing brutally worked the sprained shoulder muscles/ tendons from the subluxation. That is why the injury felt so extreme that I feared a tear. Just super worked!

An MRI to confirm or deny labral or other tears would be 8x the cost of the X-ray. This money would be better spent on working with Kevin, as the treatment would be the same regardless. Surgery at 24 would probably not be recommended for anything other than a super serious tear, which is unlikely. At least I'd have to guess.

SO I just need to continue resting it until the sprained muscles and tendons calm down. This could take up to 2 months, I guess it's been almost 3 weeks now. Based on my 2-4% daily improvement, that seems like an accurate timeline. Once I can move the shoulder through its ROM without pain, I'll start on stability and strength. Whatever the PT prescribes!

Thanks again everyone for your advice and well-wishing. I think its just going to be some time off, and so long as I'm patient I'll be back at it by fall. If no improvement in the 4-8 week timeline as others suggest, I'll see an Ortho and escalate diagnostics and treatments from there.  

Let me know if you would sacrifice your shoulder for 3 months to climb Devil's Tower...

Doug Simpson wrote:

An MRI to confirm or deny labral or other tears would be 8x the cost of the X-ray. This money would be better spent on working with Kevin, as the treatment would be the same regardless. Surgery at 24 would probably not be recommended for anything other than a super serious tear, which is unlikely. At least I'd have to guess.

So, I dislocated my shoulder a bunch of years back. Even had to visit ER, ortho, do the whole x-ray/mri/pt thing.

So, do you know what is better than guessing? - doing your research. It might be somewhat surprising, but one can easily find out what damage may occur when a shoulder is dislocated, what treatment is advised, and how that treatment depends on the age of patient. Also,  finding out what sort of recovery to expect with proper PT is mentioned as well.

amarius wrote:

So, do you know what is better than guessing? - doing your research. I might be somewhat surprising, but one can easily find out what damage may occur when a shoulder is dislocated, what treatment is advised, and how that treatment depends on the age of patient. Also,  finding out what sort of recovery to expect with proper PT is mentioned as well.

I should clarify I am guessing based on my own research, diagnostics tests from suggestions above and others, and in-person conversations/ testing with Kevin the PT, my GP, and a sports injury massage guy. I read that surgery is not usually suggested for what I have going on and my age. I agree an MRI would be best, but expensive and potentially unnessecary. 

Oh man, didn’t realize it was a long-lasting injury. Hope you heal up as quickly as possible so we can climb again together soon!

Doug Simpson wrote:

I should clarify I am guessing based on my own research, diagnostics tests from suggestions above and others, and in-person conversations/ testing with Kevin the PT, my GP, and a sports injury massage guy. I read that surgery is not usually suggested for what I have going on and my age. I agree an MRI would be best, but expensive and potentially unnessecary. 

OK, perhaps I spent too much time doing research for work and  it makes it hard for me to understand how difficult research  is.
This took 5s on google:

Individuals younger than 25 years old are likely to re-dislocate with non-operative management. Surgery reduces risk of recurrent instability. Patients with recurrent instability appear to be at a higher risk of OA. Those who have surgical stabilisation do not appear to be at a higher risk than those who dislocate just once, but are less likely to develop OA than those with recurrent instability. Delaying surgery makes the stabilisation more demanding due to elongation of capsule, progressive labro-ligamentous injury, prevalence and severity of glenoid bone loss. Recent studies have failed to match the preliminary outcomes associated with external rotation braces. 

From https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852033/ 

Again, keep in mind that your chosen recreational activity gives ample chances for repeat dislocations. If you desire a qualified opinion, that is not something your heard on the internet, you should seek it  from a medical doctor/orthopedist  who specializes in treatment of athletic minded individuals.

With this in mind, I will see if the GP wants me to get an MRI. You’re all a convincing bunch…

Amarius - I did not fully dislocate the shoulder it was more of a quick roll out and rolled right back in, if that makes a difference.

Doug Simpson wrote:

With this in mind, I will see if the GP wants me to get an MRI. You’re all a convincing bunch…

You may call us whatever you want as long as you see a shoulder specialist who deals with athletes and can read MRIs.