The physio seems to operate on that principle, correct shoulder movement and a very high frequency of elastic band exercises. I haven't questioned the reasoning behind the prescribed 2 sets of twenty reps twice a day regimen. I just do it and its been good for the mental health to get a feeling that I am doing something positive for recovery.
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Nerve damage to shoulder
- Thread starter Mr J
- Start date
cheers, the initial thought was that the muscles had switched off in response to the trauma and certainly I did have that going on. However when the most damaged part (supraspinatus) appeared to be the only thing that moved my arm away from my side was when I got worried and started to do my own internet questioning on nerve damage. The physio isn't doubting it. Initial recovery showed itself with the front and side deltoid recovering some shape and the physio said that there must be some nerve activity for that to happen even though I had no ability to isometrically contract them - the muscles just wouldn't listen. After about a month and a half they had recovered decent muscle tone and I can now see the individual muscle bundles (or whatever they are called) when tensed. At this time the physio put an ultrasound device which could measure increased thickness of rear deltoid under contraction and nothing at all showed
I asked ChatGpt if that mysterious looking "nerve flossing" exercise could help regenerate nerves and the answer was "can find no information on that". I said to the physio that other than eat good food there is nothing really I can do to help nerves recover is there? He said no, usually it comes back, but its not guaranteed.Then a couple of weeks later when I had my next appointment I told him that something seems to have come back - I can now put my arms behind my back. Although I couldn't see anything looking like a rear delt I asked him if something was returning or was it all just the other muscles learning to compromise. He put the machine back on my delt while I did an elastic band row, played the recording back to me and the was a measureable amount of rear deltoid thickness under contraction
Every clinic operates with its own specialties and you are fortunate that yours offered e-stim acupuncture which helped. My clinic did not suggest it. It seems acupuncture is used to sooth nerve pain and maybe it would have helped me during that phase when my delts went into a painful spasm, but it wasn't offered. Maybe it could even have helped in early stages of paralysis, but there seems to be no information on that.
Glad to hear there’s progress. That initial phase of being broken with an unclear prognosis takes a toll on the emotions. Keep on pushing!!!cheers, the initial thought was that the muscles had switched off in response to the trauma and certainly I did have that going on. However when the most damaged part (supraspinatus) appeared to be the only thing that moved my arm away from my side was when I got worried and started to do my own internet questioning on nerve damage. The physio isn't doubting it. Initial recovery showed itself with the front and side deltoid recovering some shape and the physio said that there must be some nerve activity for that to happen even though I had no ability to isometrically contract them - the muscles just wouldn't listen. After about a month and a half they had recovered decent muscle tone and I can now see the individual muscle bundles (or whatever they are called) when tensed. At this time the physio put an ultrasound device which could measure increased thickness of rear deltoid under contraction and nothing at all showed
Then a couple of weeks later when I had my next appointment I told him that something seems to have come back - I can now put my arms behind my back. Although I couldn't see anything looking like a rear delt I asked him if something was returning or was it all just the other muscles learning to compromise. He put the machine back on my delt while I did an elastic band row, played the recording back to me and the was a measureable amount of rear deltoid thickness under contraction
Every clinic operates with its own specialties and you are fortunate that yours offered e-stim acupuncture which helped. My clinic did not suggest it. It seems acupuncture is used to sooth nerve pain and maybe it would have helped me during that phase when my delts went into a painful spasm, but it wasn't offered. Maybe it could even have helped in early stages of paralysis, but there seems to be no information on that.
I'm back in regional Vic now and this is my outdoor rehab elastic setup. I've got 3 different strength elastics with handles and outdoor post anchors. Also got indoor door anchors. Except on days when I paddle my boogie I've been doing 2 sessions a day of the following.
Prescribed:
Carry dumbbell in each hand, special shrugging/shoulder blade movement followed by 5 steps, turn around, repeat the shrug and steps - twenty times. Actually all these exercies are done with that special shoulder blade control at the start.
Elastic rows,
Elastic presses ( rotating fists outwards and inwards).
Elastic external rotation.
Elastic internal rotation.
Dumbbell presses (recently introduced).
Extra stuff that my physio is happy with because it doesn't hurt.
Elastic face pulls (like on GromsDad's thread, but with back of hand facing me) - this is because it targets teres minor which is fed from the most damaged (rear) branch of my axillary nerve, although interesting this and the tricep came back way before the rear delt which also is from the same nerve branch).
Tricep elastic push downs.
Elastic pull overs.
Exercise ball one arm balancing (ball between legs - one arm on floor).
Exercise ball push ups - only a few reps at a time.
Non related hip flexor exercises using elastic bands not tubes - just to give me something to do and keep the whole body in shape.
Yoga triangle, reverse triangle and something else I don't know the name of as a more interesting exercise substitute for prescribed range of motion.
I'm in no rush to get back on the surfboard, just paddling the boogie is a relief and I've been able to get some whitewater standups which helps keep it more interesting. Maybe a month away from surfing, I'll see how it goes. I can do a reasonable motion of paddling where I lift my arm out of the water at the end of the stroke. If my nerve regeneration in my rear delt hadn't started then I'd probably end up giving up surfing - paddling would be too hard, but recovery seems to be quite steady there.
"program" is a strong term.
After my son was born, my fitness efforts tanked.
Now that he's 15 months, I'm starting to sneak it back in.
The wife and I are starting with a run streak. Running everyday from Memorial day to July 4th.
Nothing crazy. 1 mile minimum, but often 2-3. She was going to do do a 6 miler yesterday but lil man was up all night so we pulled it back. We didn't have enough time after trying to sleep in a bit.
I need rest days. Well after long runs. Do you have one of those running strollers?
But your back is OK?
Recovery days are essential. But these are, more often than not, pretty short.
That being said, my knees have been feeling more than ever. Just full feeling and sore
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Shoulder flared up again last night after my little run. I'm sure the jogging stroller doesn't help.
Feels a lot better this morning.
Feels a lot better this morning.
How is the shoulder Bob, settling down? Have you had an official diagnosis or advice from a physiotherapist?
The method for much of rehab seems to be treat the symptoms rather than the pathology. My physiotherapist's educated guess/diagnosis was quite wrong (rotator cuff not torn), it took over 2 worrying weeks to get the MRI and results, I had hurt myself just before the Easter holiday's which delayed thing. The advice regarding that special shoulder blade squeeze exercise didn't change.
The MRI said HAGL tear - lower ligament pulled away from bone, a well understood but uncommon injury. Youtube is full of videos of people documenting their experiences with rotator cuff repair, but I could only find two with a HAGL, one of which was a young competitive weightlifter who said that once the surgeon went in with the knife it wasn't a HAGL tear after all, but other damage, so the MRI's don't seem absolute. The surgeon told me no, he should not rush in with surgery to repair, the chances are I won't need it and come back in 3 months to see whether it is feeling unstable. I wasn't convinced about having a stable shoulder without surgery due to my hypermobile joints, but he is a surgeon with a very good reputation and I should trust him, plus due to the paralysis I couldn't see how I could do the post-op rehab anyway (although he didn't give that as a reason).
The follow up appointment with the surgeon is in one months time. My shoulder is feeling stable, hopefully its a correct perception and I won't need surgery.
In the last week recovery of the rear deltoid has been rapid, I can hold a light dumbbell behind my back, one month ago I couldn't even plug in the car seat belt, not because I couldn't push down, but because with a paralysed rear deltoid the arm will not be able to go behind the back at all.
One week ago it felt like I had forgotten how to paddle - does the elbow bend at the end of the stroke, or does the arm remain straight and lift out? I was also having to swing the arm outwards more to compensate - observing what the good arm is doing is confusing. Today when paddling the boog it is feeling a reasonably natural motion now and most of the time I wasn't thinking about it. I've had some proper before the wave breaks and drops on the standup boog, only in gentle waist high waves though. When its dumping like today I'm playing it safe and only trying white water standups with some success. The whitewater takeoff bumps me forward and the temptation is to get to the feet once the board slows and feels under control, but that always ends in a stall. The trick seems to be to choose a moment when the board is accelerating and pop up then. Still not in a rush to try a surfboard, I'm happy enough with this for now, actually very happy just to be getting wet regularly.
I have been doing some of this, although not in that formal pose.
At the stage when even going for a walk sent my front and side delts into a painful spasm and no sign of movement at all in my atrophied rear delt it felt like my world had fell apart. I was getting depressed at times, although work helped keep my mind off things. So I started to focus and meditate on the pain which built in the evenings and night. I don't believe in anti-inflammatory drugs and pain killers and have taken none. The body uses the post trauma inflammation response to clear out the debris from the damage, to make way for new. So when the pain starts I tell myself this is good, it is nerve regeneration.
Currently I get no pain in the day and no pain after exercise, but every other day or so aching at night and when I wake up. Nice video on the 3 categories of peripheral nerve recovery here. 1. Complete recovery. 2 Partial to good recovery. 3. None to very limited recovery.
I think this is about signaling.
You are telling the nervous system to build back these nerves.
The build back process is slow and tedious.
You need to have a certain kind of grit to do it.
But avoiding paralysis is a good motivator.
There's no such thing as incorrect shoulder movement.
I agree starting light with high repetitions to keep things moving, but this only lasts for a short period of time. Your body responds to stress, which hastens healing. Rubber bands are a short term feel good thing.
Doc, you always offer sensible sounding advice. Essentially that's what my physio has me doing and I do. Despite me doing some overhead unassisted stretching exercises my physio wanted to restore more range of motion and got me to use a stick to pull my arm up straight. I can now just about hold my arm straight up and have it touching the side of my head, although to achieve that there is still some compensating motion going on compared to my right good arm.
Physio is prescribing a gradual increase in load at reduced reps, reduced frequency so that I can handle it.
Since I started this thread 3 weeks ago I've made remarkable progress, in the words of my physio I am "getting the best possible outcome". 3 weeks ago my rear deltoid was at most 1/4 of the size of that of my good arm, self observed in the mirror by holding my arm out behind me and slightly abducted. Before that it seemed to have completely disappeared and I think revealed some of normally hidden teres minor. Now it is approximately 2/3 of its original size (I presume by comparing with the right, I never used to look at it before).
So I wrote this
My diet was always good, now its really good. I've read that low inflammatory diets and certain nutrients such as alpha-linolenic acid can help nerves however a lot of those sources seem to be from nutritionists who operate in the same magic world as physios, chiropractors etc. It also sounds contradictory to the idea of not taking chemical anit-inflammatories. I don't understand it, maybe initial post trauma inflammation and ongoing inflammation operate in totally different ways? Anyway the foods suggested such as walnuts, chia seeds, avocado, tumeric, pepper seem to be of good nutritional value regardless.Mr J said:
For a while I completely stopped drinking my usual 150ml glass of red wine daily, because I read alcohol can be a nerve poison. I've since gone back to a modest half glass 75ml of red wine daily. I haven't eaten any processed meat such as ham for ages, because its meant to be inflammatory. Keeping a really tight control on glycemic index. Lots of fish, olive oil etc. I don't know if helps, but paralysed deltoids is a terrifying prospect for a surfer, so I've been desperate with my attempts to restore them. I seem to be sleeping better, so maybe the diet is good for that. I'm also handling the workload prescribed by my physio with extra exercise without getting muscle soreness, maybe that's because I took it slow and gradual with the rehab.
I asked ChatGpt about this subject. Not the answer I was hoping for, but seems no harm either.
[/quote][/quote]My physio has me heading in this direction ie. reduce the rubber bands, have me on higher load lower rep dumbbells, lower frequency once a day instead of twice in a day. I said I've been keeping up the rubber bands anyway and he said "that's a bonus" if I can do it without fatigueing myself. I just like exercising, so feel good after doing the bands, which is what you said they are good for.
Regarding incorrect shoulder movement, my physio has quite strong and precise ideas and instructions on that. I asked ChatGpt. I use ChatGpt quite a lot for work, I get it to write chunks of code for me, its really good at that particularly with scripting languages I am not familiar with. Don't know how good it is at medical assessments. Have I misrepresented what you mean in my question?
@VonMeister is right about there not being a correct shoulder movement.
Band exercises are novel and can be done anywhere so patients believe in them and will do them - that’s why they “work.” their shortcomings are that most of the load is at the end range of the concentric but you want the exact opposite for hypertrophy - for the end range of the eccentric to be the most loaded, if anything. You want the muscle to be stretched under load.
Band exercises are novel and can be done anywhere so patients believe in them and will do them - that’s why they “work.” their shortcomings are that most of the load is at the end range of the concentric but you want the exact opposite for hypertrophy - for the end range of the eccentric to be the most loaded, if anything. You want the muscle to be stretched under load.
After shoulder dislocation there is soft tissue damage. That's why people who dislocate their shoulders many times keep dislocating them until ultimately there is soft tissue repair. A shoulder moving out of the joint would be an incorrect shoulder motion. Accessing the complete range of motion of the shoulder in any way you feel like it should not be described as incorrect motion. Also there's no such thing as a shoulder imbalance in an otherwise healthy shoulder. The only possibility for a shoulder imbalance would be a partial or full thickness tear of one or more of the muscles that make up the shoulder. In the rare case that that happens you will know it. Most shoulder injuries are small bouts of tendonitis. You manage them with measured amounts of stress and volume and move on. As you get older it feels like these aches and pains get more common...and they do but if you stay on top of things they don't become long term issues. Active men have a lot of trouble slowing down and tend to not let things heal.
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@PRCD I have noticed that limitation of the bands - the resistance greatly increases at the end of the motion. I am interested in hypertrophy - my left front and side delts are still a little smaller than my right side and the surgeon reckoned that I needed some more muscle on my right too!
Anyway a couple of dumbbell exercises that I have been doing is overhead press stopping when the dumbbells reach face level, hold 3 seconds, then full press another hold, down to face level hold 3 seconds, then down to sides. What do you reckon? Physio showed me with thumbs pointing towards my face, no forearm external rotation or anything.
Another one - bent dumbbell rows, pull up, hold 3 seconds and down. Any thoughts extra suggestions, my physio is definitely open to me doing extra stuff.
Rows, whether they be elastic or dumbbell are for the rear delt, however as I discovered when I had no rear delt the first bit of the row is done by something else - I guess the lats? Its only when the elbow reaches the side of the ribcage that the rear delt takes over. When I had no rear delt, that's when my arm would stop, there was just nothing there at all to take my elbow behind my back and get my hand to my side like my right side was doing, so that's really only operating at the contracted rather than extended isn't it?
Anyway a couple of dumbbell exercises that I have been doing is overhead press stopping when the dumbbells reach face level, hold 3 seconds, then full press another hold, down to face level hold 3 seconds, then down to sides. What do you reckon? Physio showed me with thumbs pointing towards my face, no forearm external rotation or anything.
Another one - bent dumbbell rows, pull up, hold 3 seconds and down. Any thoughts extra suggestions, my physio is definitely open to me doing extra stuff.
Rows, whether they be elastic or dumbbell are for the rear delt, however as I discovered when I had no rear delt the first bit of the row is done by something else - I guess the lats? Its only when the elbow reaches the side of the ribcage that the rear delt takes over. When I had no rear delt, that's when my arm would stop, there was just nothing there at all to take my elbow behind my back and get my hand to my side like my right side was doing, so that's really only operating at the contracted rather than extended isn't it?
Thankfully I was spared any tearings of my rotator cuff, tendonitis showed up in the supraspinatus and mildly in the subscapularis on the MRI, but the surgeon thought it was acute stretching not chronic tendonitis. I suppose the radiologists or docs who prepare the MRI report don't have the background history to the accident when they prepare their report.
Its been about 4 days since I woke up with a shoulder ache, but I won't let aches that disappear shortly after getting out of bed worry me. I've had an enforced immobilization and soft tissue healing from the axillary nerve damage. Shoulder feeling quite stable now, not clicking at odd moments like it used to. It doesn't feel 100% normal though, every morning my arm feels sort of heavy.