Osteolysis on clavicle. Causing scapular pain? Help Needed!

kdsjlkdjasjdlkjaslkdj
kdsjlkdjasjdlkjaslkdj Posts: 7 Member
edited May 2019 in Health and Weight Loss
Hi. Not sure if this is the correct forum for this kind of question but i was reading another thread and some people gave pretty helpful info so i figured id start here.

Sorry for the long story and description. Ill make sure to sum it up at the end. I try to give as much detail as possible to help you help me and to help anybody who may stumble upon it in the future.
If you scroll down i made a Q with
where the question starts.

Story:
So one day i felt a pain in my left shoulder randomly. Like after sitting on the couch random. Actually i thought it was from falling asleep while laying with my head on my hand propped up on my elbow. Picture Jeff Goldblum posing.

No big deal. Light pinch feeling. Except i surf and I've had a previous tear of some kind on the opposing shoulder. So BIG DEAL... Maybe.

Aside from surfing i go to the gym on any day i cant surf. Was definitely bench pressing wrong (arms straight out).
I work out fairly hard (never get results but that's a different topic lol).

So i started babying it. Once in a while I went to the gym just to see if it would alleviate some pain. It did not.
Weird thing is, around the same time i started getting intense back pain under my left scapula starting from the muscle close to the spine in the middle of my back and going out under the scap and going all the way up to my neck at times . Left side only.

It took about 4 months to get on health care and another to see a doctor. In the mean time i stayed off it as much as possible. It just kept feeling worse. All the typical things did not work. Ice then heat, Stretching, Ibuprofen, etc.

One day i was just getting tired of it and my friend was in town and wanted to surf so i said EF it and rolled the dice. Surfed lightly for about an hour and it did not cause any pain. So i went out the next day. This time 2 sessions of 2 to 3 hours. Basically surfed all day.
Later that night I noticed that for the first time in months, the pain was at about 25% of normal.
So I surfed almost everyday for a month. It seemed to be the only thing relieving the pain.

So when i finally got to see a doctor they asked me the typical questions and did all the same test i used to self diagnose myself.
I told them i go to the gym, they gave the proper (lazy by the books) diagnosis that it was a tear in the AC joint.
Of course I had already "self diagnosed" this which is why i stayed off it for so long. But i had kind of ruled it out since surfing actually helped. I saw a PT and everything i did seemed to make it worse.

So after a few more months of nagging they finally sent me to an orthopedic surgeon.
He gave me an x-ray and MRI.

Turns out it was Osteolysis (the pathological destruction or disappearance of bone tissue) Basically arthritis. At the end of my clavicle near the acromion. Or where the AC joint attaches.
The only real solution is to cut off a couple mm at the end of the clavicle to make some separation and hopefully remove most of the deteriorating bone. It does not spread. Just kind of stays at the end there.
Also offered a steroid shot but i declined because i read it weakens the tendons in the area. And id hate to trade arthritis for an actual torn ac joint.

So now you know the backstory i can ask my question that is apparently hard to diagnose.

Q:

-Where is the pain in under the scapula coming from?

The osteolysis is a 2 compared the 7 that is the scapular muscle pain.

Here's the few things that over the course of a year i have found to help.
1) surfing (everything else has pretty much stemmed from this knowledge)
2) the second thing i found was the I's Y's and T's that the PT showed me since i told them surfing helped. They helped a little.
3) Im a little embarrassed to say it took a year to figure this out but Trap exercises with the cable machine. I pull down with my arms straight in front of me with fairly light weight. i was trying to imitate surfing. This has been the best most relieving exercise so far.
4) I think it has forced me to correct my posture a little and pull my shoulders back.
5) Last but not least is NOT SITTING DOWN EVAR. Another thing i recently learned. Sitting is the number one thing that causes the pain.

What i found that makes it worse.
1) sitting back. Relaxing on the couch. WTF?
2) Not doing the scapular and trap workouts.
3) Bench pressing with a bar. I think because it allows me to push more with the opposing arm and then use all the wrong muscles to compensate for the weakness with the left arm. Also i think the tight pecs pull my shoulders forward a little. Or maybe it uses scapular muscles that i am unaware of.
4) Stress. Sometimes i find myself pulling my shoulders forward so i have to take a minute and try to relax everything. (but not by sitting)
5) Im not positive but i think running really effects it. Thats one thing that i added to my routine everyday about a month before the pain started.
6) Im sure just random things like yard work or moving things around driving pretty much everything.

Oh and one last thing. Sometimes when its really painful and stiff. If i push my shoulders all the way forward and stretch the muscle as much as possible and flex a little, there is a tiny pop in the middle right under where the scapula would be if i was standing straight and it feels like it might relieve some pain. Except there is no bone to pop. One doctor seemed to think nothing of it and the younger doctor that still seems to care said there would most likely be a strain if something is popping in that area.

Ok. Sorry for the super long post. Hopefully this is the right place for it. At least its logged so i can copy paste it if necessary.
Any advice would be greatly appreciated. Even if its just stories about similar pain you had. Very least it will keep it at the top of the forum for a while.

Thanks in advance.

Replies

  • jdog022
    jdog022 Posts: 693 Member
    edited May 2019
    I have the same thing. Did first cortisone shot in Jan and did zero upper body for 6 weeks. Began slowly adding back pull and push and eventually pain came back. Second shot 3 weeks ago. Pain will come back. Surgery planned for July. Arthroscopic Mumford procedure
  • KathyL07
    KathyL07 Posts: 27 Member
    I had surgery for my Clavical/AC joint problem. Had a lot of pain prior and some days were good, some were bad. Nothing in particular helped but it depended on the day. Finally had Arthroscopic Surgery. They went in and shaved off part of the clavicle so the pressure and tearing stopped. Took a few days to heal from the surgery and I've had zero pain or problems with it since. This was in November 2003.
  • lynn_glenmont
    lynn_glenmont Posts: 10,093 Member
    Looking past the specific medical details, what I understand you to be saying is that you have a physical condition that causes pain, but is not otherwise a health threat and is not progressing ("it does not spread")? And that there is surgery that might relieve the pain, but that you also have found a physical regimen that you enjoy (surfing) that, at least for now, reliably alleviates the pain? If it were me, I'd just stick with surfing as long as that continues to work, unless you have specific physical goals that surfing won't get you to and it is reasonable to think that surgery will get you there.
  • laurelin821
    laurelin821 Posts: 4 Member
    This is actually a pain I have been dealing with a lot (actually a couple of months now because I was going for the rest it method) and from everything I have seen it seems like the Rhomboid muscles (they are the ones directly on shoulder blades to spine) and for me it started going to my last because I am guessing I was countering the pain in a weird ways. As of now I’ve been given physical therapy exercises similar to what you talked about and a lot of what I read is that bad posture can be a huge cause of it as well as generally weak muscles.

    In addition to the exercises I’ve also been told to relax (I have anxiety and it’s been tensing up the shoulders and stuff), stretch (yoga stuff is supposed to be good but there are just stretches such as the I’s and Y’s, and plenty of others you can find online), and I was also given a Theracane which is a stick thing that helps you massage the points on your back that are having the muscle issues. I specifically asked about swimming at one of my PT appointments and was told it is great for this and pretty much anything that targets these muscles (like the cable machine) is beneficial. My guess is that’s why surfing is good but resting/couch time hasn’t been since that contributes to bad posture and such.
  • kdsjlkdjasjdlkjaslkdj
    kdsjlkdjasjdlkjaslkdj Posts: 7 Member
    edited May 2019
    jdog022 wrote: »
    I have the same thing. Did first cortisone shot in Jan and did zero upper body for 6 weeks. Began slowly adding back pull and push and eventually pain came back. Second shot 3 weeks ago. Pain will come back. Surgery planned for July. Arthroscopic Mumford procedure


    Thanks for the reply. I hope the surgery fixes everything. Did you think it was an AC joint tear at first too? Its such a weird issue.
    Was your pain only in your clavicle? or was it in your back under your shoulder blade as well?
  • This is actually a pain I have been dealing with a lot (actually a couple of months now because I was going for the rest it method) and from everything I have seen it seems like the Rhomboid muscles (they are the ones directly on shoulder blades to spine) and for me it started going to my last because I am guessing I was countering the pain in a weird ways. As of now I’ve been given physical therapy exercises similar to what you talked about and a lot of what I read is that bad posture can be a huge cause of it as well as generally weak muscles.

    In addition to the exercises I’ve also been told to relax (I have anxiety and it’s been tensing up the shoulders and stuff), stretch (yoga stuff is supposed to be good but there are just stretches such as the I’s and Y’s, and plenty of others you can find online), and I was also given a Theracane which is a stick thing that helps you massage the points on your back that are having the muscle issues. I specifically asked about swimming at one of my PT appointments and was told it is great for this and pretty much anything that targets these muscles (like the cable machine) is beneficial. My guess is that’s why surfing is good but resting/couch time hasn’t been since that contributes to bad posture and such.

    Yah. The rhomboid looks pretty much right where it hurts. I just realized when i said the exercise that helps the most is working the traps what i meant to say was the LATS. And now i cannot edit it for some reason. Hope it doesnt conflict with any good advice or people seeking advice.
    Similar workouts but the working the lats specifically works waay better then anything else so far. Maybe it takes stress off the rhomboid?

    I agree with the posture and anxiety part. I wish i carried my anxiety in my abs and glutes lol.
    I found a product that may help with keeping your shoulders back. Its just a brace thing you wear. I got mine a day ago and it basically makes it uncomfortable to slouch. also helps keep my butt tucked in. they"re like $6
    https://www.ebay.com/sch/i.html?_from=R40&_trksid=p2334524.m570.l1311.R1.TR12.TRC2.A0.H0.Xposture.TRS0&_nkw=posture+corrector&_sacat=0&LH_TitleDesc=0&_fsrp=1&_osacat=0&_odkw=+CP-10-SE3&LH_TitleDesc=0

    Also upon researching for the last year i realised i have anterior pelvic tilt. And i dont think i have "activated" my glutes in my life. Thats the next project.
    But i just read last night that not using you glutes can cause tight lats. Lots of research to do there but maybe part of the cause. Slouching is im sure a big reason for the osteolysis.

    Thanks for the suggestion of the rhomboids. I will research them more.

  • Looking past the specific medical details, what I understand you to be saying is that you have a physical condition that causes pain, but is not otherwise a health threat and is not progressing ("it does not spread")? And that there is surgery that might relieve the pain, but that you also have found a physical regimen that you enjoy (surfing) that, at least for now, reliably alleviates the pain? If it were me, I'd just stick with surfing as long as that continues to work, unless you have specific physical goals that surfing won't get you to and it is reasonable to think that surgery will get you there.

    Yes the surfing and working the Lats at the gym help. but i have to do them every day. When it gets bad it feels like a hot iron on the left side of my back. It takes like a week to slowly go away. Or just stays for months if i dont at least work the lats. or do y's i's and t's.
    I wish i could surf everyday but mother nature does not permit that lol.
    The thing is that its not in my nature to except things that do not make sense to me. I will be hellbent on at least figuring out the root of the problem. I will have a very hard time excepting that its just a chronic pain and do your best to relieve it. Unfortunately im not financially able to just go see the best doctors osteopaths and PTs. I kind of have to take what they give me and keep trying until i find someone who actually cares and is knowledgeable.
    The woes of my generation.
  • jdog022
    jdog022 Posts: 693 Member
    jdog022 wrote: »
    I have the same thing. Did first cortisone shot in Jan and did zero upper body for 6 weeks. Began slowly adding back pull and push and eventually pain came back. Second shot 3 weeks ago. Pain will come back. Surgery planned for July. Arthroscopic Mumford procedure


    Thanks for the reply. I hope the surgery fixes everything. Did you think it was an AC joint tear at first too? Its such a weird issue.
    Was your pain only in your clavicle? or was it in your back under your shoulder blade as well?

    At first I thought it was impingement. Once I finally saw the dr he knew in two seconds what it was. Confirmed with an X-ray. And additional confirmation when the lidocaine from the steroid shot instantly took all pain away.

    The pain was all over my shoulder and a bump on top of the end of my clavicle. Painful to the touch at that bump. Day to day activities are very hard especially picking up a 2 year old all the time. The shots have been a life savor for now but they slowly stop working and you can only have so many.

    Yes my shoulder blade and the nearby trigger points hurts. A lot. The entire joint becomes unstable which impacts the scapula. I can’t wait to get it done and begin recovery.
  • lynn_glenmont
    lynn_glenmont Posts: 10,093 Member
    Looking past the specific medical details, what I understand you to be saying is that you have a physical condition that causes pain, but is not otherwise a health threat and is not progressing ("it does not spread")? And that there is surgery that might relieve the pain, but that you also have found a physical regimen that you enjoy (surfing) that, at least for now, reliably alleviates the pain? If it were me, I'd just stick with surfing as long as that continues to work, unless you have specific physical goals that surfing won't get you to and it is reasonable to think that surgery will get you there.

    Yes the surfing and working the Lats at the gym help. but i have to do them every day. When it gets bad it feels like a hot iron on the left side of my back. It takes like a week to slowly go away. Or just stays for months if i dont at least work the lats. or do y's i's and t's.
    I wish i could surf everyday but mother nature does not permit that lol.
    The thing is that its not in my nature to except things that do not make sense to me. I will be hellbent on at least figuring out the root of the problem. I will have a very hard time excepting that its just a chronic pain and do your best to relieve it. Unfortunately im not financially able to just go see the best doctors osteopaths and PTs. I kind of have to take what they give me and keep trying until i find someone who actually cares and is knowledgeable.
    The woes of my generation.

    OK, I got nothing on the explanation front.

    If you're interested in possible alternatives to the surfing/lats that you could do every day -- how about trying just balancing or exercises on one of those partial sphere balls (BOSU, BESU -- something like that -- it's an acronym for something, but I don't remember what) plus very low-weight or body weight movements mimicking the lat exercises that give you relief?
  • jdog022 wrote: »
    At first I thought it was impingement. Once I finally saw the dr he knew in two seconds what it was. Confirmed with an X-ray. And additional confirmation when the lidocaine from the steroid shot instantly took all pain away.

    The pain was all over my shoulder and a bump on top of the end of my clavicle. Painful to the touch at that bump. Day to day activities are very hard especially picking up a 2 year old all the time. The shots have been a life savor for now but they slowly stop working and you can only have so many.

    Yes my shoulder blade and the nearby trigger points hurts. A lot. The entire joint becomes unstable which impacts the scapula. I can’t wait to get it done and begin recovery.

    Man I hope it goes well. If you dont mind posting your results that would be awesome.

    Yah it was the same thing with me. Had about 5 doctors try to diagnose it. But they could never press on the point where it hurt. The Ortho asked me a few questions then pressed exactly where it hurts first try. Then told me it was osteolysis (which I had suggested the first time i saw a doctor 6 months earlier) . But still gave me an mri to be sure. Best doctor so far but i want to exhaust every other option obviously.

    That makes sense that it is unstable. The achromion is part of the scapula. which is connected to all those muscles back there. I keep telling the doctor that it feels like the mechanics of my shoulder are out of whack.

    Its so complicated and the only part attached to the skeleton is where the clavicle attaches right near the neck.
  • Azdak
    Azdak Posts: 8,281 Member
    This is actually a pain I have been dealing with a lot (actually a couple of months now because I was going for the rest it method) and from everything I have seen it seems like the Rhomboid muscles (they are the ones directly on shoulder blades to spine) and for me it started going to my last because I am guessing I was countering the pain in a weird ways. As of now I’ve been given physical therapy exercises similar to what you talked about and a lot of what I read is that bad posture can be a huge cause of it as well as generally weak muscles.

    In addition to the exercises I’ve also been told to relax (I have anxiety and it’s been tensing up the shoulders and stuff), stretch (yoga stuff is supposed to be good but there are just stretches such as the I’s and Y’s, and plenty of others you can find online), and I was also given a Theracane which is a stick thing that helps you massage the points on your back that are having the muscle issues. I specifically asked about swimming at one of my PT appointments and was told it is great for this and pretty much anything that targets these muscles (like the cable machine) is beneficial. My guess is that’s why surfing is good but resting/couch time hasn’t been since that contributes to bad posture and such.

    Yah. The rhomboid looks pretty much right where it hurts. I just realized when i said the exercise that helps the most is working the traps what i meant to say was the LATS. And now i cannot edit it for some reason. Hope it doesnt conflict with any good advice or people seeking advice.
    Similar workouts but the working the lats specifically works waay better then anything else so far. Maybe it takes stress off the rhomboid?

    I agree with the posture and anxiety part. I wish i carried my anxiety in my abs and glutes lol.
    I found a product that may help with keeping your shoulders back. Its just a brace thing you wear. I got mine a day ago and it basically makes it uncomfortable to slouch. also helps keep my butt tucked in. they"re like $6
    https://www.ebay.com/sch/i.html?_from=R40&_trksid=p2334524.m570.l1311.R1.TR12.TRC2.A0.H0.Xposture.TRS0&_nkw=posture+corrector&_sacat=0&LH_TitleDesc=0&_fsrp=1&_osacat=0&_odkw=+CP-10-SE3&LH_TitleDesc=0

    Also upon researching for the last year i realised i have anterior pelvic tilt. And i dont think i have "activated" my glutes in my life. Thats the next project.
    But i just read last night that not using you glutes can cause tight lats. Lots of research to do there but maybe part of the cause. Slouching is im sure a big reason for the osteolysis.

    Thanks for the suggestion of the rhomboids. I will research them more.

    I would caution about going off on tangents due to new things you read while researching. Almost everyone has some biomechanical imperfections and they are just fine. Half the population has anterior pelvic tilt and it doesn’t affect them at all.

    Addressing shoulder issues involves strengthening all of the involved muscles, maintaining and improving range of motion, and learning to stabilize the scapula/shoulder during your movements. As you have discovered, for something like this, complete rest doesn’t really help. You need activity and movement, but the right kind.

    This condition is not uncommon for people lifting weights—esp heavy weights. Since you have a diagnosis, I would spend some time looking for specific rehabilitation exercises for your condition. Google “distal clavicle osteolysis” or “weightlifters shoulder”. For obvious reasons, medical groups are reluctant to put specific rehab routines online, but if you keep looking you should be able to find some specifics and maybe some videos as well.

    Here is a link that has an overview—you probably already know 90% of what is in the article, but there might be some new information:

    https://www.humpalphysicaltherapy.com/Injuries-Conditions/Shoulder/Shoulder-Issues/Weightlifters-Shoulder/a~4389/article.html

    One other thing: I would recommend not rejecting an injection out of hand. I understand the concern about cortisone shots, but a) one or two shots should not have any long-term weakening effect and b) the inactivity you are experiencing because of the pain is also weakening your tendons—and everything else in that area.

    I agree 100% with being skeptical about injections, since they are often pushed as a short-term “quick fix”, without any follow up. However, I have also worked with many clients who benefited from them—the decreased inflammation and pain allowed them to perform more exercises that helped build up the area so that the pain was decreased and they did not need another one. Not saying to run out and get one tomorrow, but I think that the combination of an injection followed by a rehab program can be helpful if you cannot resolve the pain through exercises alone.
  • swirlybee
    swirlybee Posts: 497 Member
    My frozen shoulder started out as pain right under my scapula, exactly as you described. The pain wasn't that bad. it just caused a lot of tightness and after a bit of warm up, I would be ok. I do judo and at the end of the night, the pain would come back. This went on for about three months and then I was doing some gymnastic stuff and there was searing pain on the side of my deltoid. Pain level was close to a 10. Xrays showed I have arthritis on the ac joint. My primary care doctor said I had shoulder impingement and prescribed cortisone shot. That made it worse for about 2 weeks and then the pain went away, but I had absolutely no range of motion. I had limited range of motion before but it seems like it was a lot worse after the cortisone shot. Did physical therapy for a month with no results. The occasional massage and stretching they did helped with the pain/tightness but did absolutely nothing for range of motion. I have a hard time putting on a bra, reaching for my seatbelt, and other everyday stuff.

    MRI shows no tears but it did show that I have adhesive capsulitis, aka frozen shoulder.

    Went to see a sports medicine specialist earlier this month. He says the arthritis on the ac joint is nothing to worry about. He gave me another cortisone shot to create a gap between something and something. It gave me the smallest bit of range of motion, but shoulder is frozen. Trying to schedule a surgery now.

    All that to say that the shoulder is a very complicated joint. The pain you feel might far away from the rotator cuff but they all work to support each other. The lats, the pecks, delts, etc. At various times, my pain radiated all the way down to my forearms, I had tightness in my pecs (mainly near my armpit), and my biceps felt like I had no strength whatsoever. I'm hoping that the surgery will help.
  • Azdak wrote: »

    I would caution about going off on tangents due to new things you read while researching. Almost everyone has some biomechanical imperfections and they are just fine. Half the population has anterior pelvic tilt and it doesn’t affect them at all.

    Addressing shoulder issues involves strengthening all of the involved muscles, maintaining and improving range of motion, and learning to stabilize the scapula/shoulder during your movements. As you have discovered, for something like this, complete rest doesn’t really help. You need activity and movement, but the right kind.

    One other thing: I would recommend not rejecting an injection out of hand. I understand the concern about cortisone shots, but a) one or two shots should not have any long-term weakening effect and b) the inactivity you are experiencing because of the pain is also weakening your tendons—and everything else in that area.

    I agree 100% with being skeptical about injections, since they are often pushed as a short-term “quick fix”, without any follow up. However, I have also worked with many clients who benefited from them—the decreased inflammation and pain allowed them to perform more exercises that helped build up the area so that the pain was decreased and they did not need another one. Not saying to run out and get one tomorrow, but I think that the combination of an injection followed by a rehab program can be helpful if you cannot resolve the pain through exercises alone.

    Yah thats true about the tangents lol. Should never google certain things. But I feel like that particular one effects my posture quite a bit. Which effects my shoulder a lot. And having weak glutes effects everything. So Ill stick with that one.

    Yah the more I ask about the shot, the more i get people telling me that one shot wont cause any weakness to the tendons. It will most likely come soon. But at the same time i havent really read of any really effective cases of a cortizone shot for this particular problem (osteolysis).
    I would love to try stem cell therapy. Seems like it would be the perfect thing for a bone thats not regenerating as fast as it deteriorates. But its so damn expensive.

    I think the major problem is most likely that its throwing off the mechanics of my shoulder. Seems like since ive been researching. people with similar pain has been caused by many different injuries that causes the shoulder blade to shift slightly. Or be used differently.