Infraspinatus Soreness That Won't Go Away: What Else It Could Be

Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey, and welcome to the Performance Place Sports Care Podcast. I'm your host, Sebastian Gonzales, Dr. Sebastian Gonzales. I am doing a YouTube video today, and we are going over one of the questions that we got for a shoulder. So if you do have shoulder issues, I think this would be a good one to listen to. The YouTube video this one was on was, it's called, right now it's called, What the Heck is Wrong with My Shoulder? Infraspinatus Treatment. After doing this video originally, I realized that there was so much more that I could have said. But kind of the criteria of YouTube, or at least attention spans of people, is that they only want to hear, you know, a couple minutes of stuff.

And if you're on this podcast, obviously, you're going to get way, way more. But there's a lot of other things that could be going on in this type of case or condition with the infraspinatus. And over the course of the years, I've seen a lot of people come in saying they have infraspinatus tendonitis, but there's actually a few other conditions which rank really, really highly up there in cases like this. And I'd say at least half the time, we're not looking at infraspinatus tendonitis. So before we start, I'll let you guys know how to contact me and get your question on the air. You can go to p2sportscare.com.

And right in the center of the screen or somewhere around the side should be a voicemail button. And you don't need a phone to do this. This is just basically you talk to your computer. It'll send an email to us alerting us that you left a voicemail, and we'll check out what you have to say. The ones that we're going to feature on the air are the ones that are the most detailed, in all honesty, and the most we want to feel. I really, really want to feel some emotion with it, and I want to feel frustration, just kind of like with this one I'm going to read today, because I want to be able to leave people with some clarity of these conditions.

And not necessarily that I want to hear pain and suffering, but I want to hear that someone has really invested some time and they're frustrated with the results. I don't want to hear just, something hurts, help me, because that's really, really hard to give information on. Now, before we start, too, I always have to do the disclaimer where this does not take the place of a medical exam. The pure intention of this is that we educate the rest of the people for a question that's been already submitted to me. So, obviously, the person listening can obviously get some information from it, but it's mainly to educate the masses.

Okay, so the first, or the question here is, I'll read it verbatim, and as always, it's really hard to sometimes get the grammar right on these things, so I'll do my best. I've had mild soreness in the infraspinitis area on my left side for over a year. MRI resulted in nothing. Doctor said, quote-unquote, maybe a little tendinitis and instability. He was able to move my humerus around my shoulder socket fairly easy with a little clicking sound. I've done two cycles of PT. I've seen a neuro, ortho, spine specialist, GP, massage therapist. I have no range of motion issues, just a feeling of soreness and occasionally light ache when I lift my arm laterally.

That is to the side, by the way. We'll digest this in a second. I've since removed overhead pressing from my workout routine. Pretty frustrating, any advice? Now, let's just break this down a little bit because they actually seem like they've been to quite a few people, and I want to make sure that the terminology they use makes sense to everybody. So, let's see. First off, the infraspinitis is a muscle of the rotator cuff, and it's typically found if you reach your hand over your shoulder and you kind of grip the backside of your shoulder, you'll run into a ridge, and you'll probably grip your fingers over it.

You're actually putting your fingertips into the infraspinitis area. That's the belly of it. But it does go over and attach to the actual side of the shoulder where most of the pain develops on these people. They said an MRI, which is a type of imaging that will look at soft tissues of the shoulder, muscles, tendons, and so on. They said they have a little tendonitis. This is inflammation or irritation to a tendon. And quite honestly, a lot of people now are going to the term tendinopathy because tendonitis means it's a really fresh injury typically because that itis or inflammation has a couple of specific characteristics to it.

But it seems like the itis is more moving towards the concept of pain or even chronic pain. They can say itis and so on. So I think more so we should consider tendon injuries as a tendon injury, and that would be more of a tendinopathy. Instability. They said instability and they can move the humerus around the shoulder socket fairly easily. Now an instability is just basically a rough reference point of a joint being less stable or has less ability to be put into position and hold that position than one that's stable. And they said the humerus, which is the bone coming down the arm, there's a head and ball and socket which goes in the shoulder, which forms the shoulder joint proper, which can become unstable.

And because this joint has so much motion in it, it has 180 degrees overhead, it has a lot of rotation in it because a ball spins very well in its socket, there is constantly instability with it. And it's actually really found in baseball pitchers and other overhead athletes that they are just unstable. So the clicking sound in there, there's a possibility that that could be a bursitis as well as a labral injury or cartilage injury. It's great that they don't have any range of motion issues, but it seems like they've seen a lot of people and no one's been able to help them. The PT, it looks like they've done a couple cycles, but we don't know how long.

And we don't know what was recommended. Now, that's one thing that I found across the sports rehab is that we have kind of a rough standard, but there's always, just like with any profession, there's great and bad of both, of all. And we don't know exactly what was done here, whether the PT was just ice, heat, maybe a little massage. We don't know if they did proprioceptive rehab or shoulder girdle rehab, which is usually typically needed in these cases. But I can tell you this, at least from looking over this condition, perhaps we should consider that something was not found and there's still something going on.

Because an MRI only finds some things and really, it sounds like they only have one type of image. An MR arthrogram is one that would evaluate deeper inside the joint and specifically look at the labrum or the cartilage cup of the shoulder. And the top diagnosis that I always like to rule in and out with shoulders are rotator cuff tears or tendonitis or tendinopathy, back on that same concept again, which is irritation to the tendons of the cuff. Or, cartilage injuries, which is labral tears. Or, we could have the possibility of an instability with none of the other things found. Now, when I'm reading this over, I feel that, like a lot of times, instability goes hand in hand.

And also clicking in the shoulder does go hand in hand with labral tears. And there's different degrees of labral tears. But you have to understand the function of the labrum. And think of it like a gasket of the shoulder. And it just deepens where the ball sits in the socket. And some references say that it provides actually 70% of the passive stability of the shoulder, which means that it holds the thing together really well. And with clicking, sometimes you can have little catches and frays in that labrum, which will result in the sound, but also instability, since it does provide a large amount of stabilization to an unstable joint.

So, I think that has to be all considered in here. But also, too, we have to consider what the person is doing as activity. What do they like to do? It sounds like they like to work out, which I think is important in this. And actually, I think overhead pressing is important in shoulder rehab as well, especially overhead hanging. But if the shoulder girdle is not stable, then the rest of the rotator cuff and the shoulder joint will not function well. And I've actually done an authority page on rotator cuff tears. And I will see if it's published at the time of this video or not. But it's going to be found either at p2sportscare.com.

Just look up rotator cuff baseball pictures or you can do the same thing at performanceplacehb.com. I might post it in both, but there should be a lot of infographics and pictures and so on. But what we found is that the rotator cuff is really, really good at holding the joint together. And what happens is when the rotator cuff is not put in an optimal position, it doesn't do a really good job. And what we found is that the rotator cuff gets put in a really terrible position when the shoulder girdle is not doing its job. Now, every muscle has what we call its ideal length-tension relationship.

And what that means is that it likes to be, let's just say if we have a muscle, let's just say the bicep. We have a muscle that wants to be one foot long, but then we require it to go one foot and one inch. It changes its ability to do its job well. And it puts a lot more strain on the area. And the rotator cuff is no exception with this. It holds the joint together well, and it does it within a very narrow window. And I found an article which is referencing that the rotator cuff has the ability to create more load and force than the deltoid and the brachioradialis. Which, these are large muscles, if you know what they are.

The deltoid is the one, like the cannonball one on the top of a big guy's shoulder. The brachioradialis one is the one, if you were to contract your forearm or contract your elbow, but nothing really goes anywhere, you'll see it pop up. And that's the brachioradialis. So, the goal, I think, with this case is to see if the shoulder blade functions well to create some stability of the rotator cuff region or the shoulder joint proper. Now, getting into the concept of shoulder blade stability, it can be a huge tangent topic. And I won't go too much down that road because it's a whole podcast on its own.

If, by the way, if you are listening to this late, perhaps I've done a podcast on the shoulder blades. So, consider that, just look at the bottom of the page and see if, sorry, had to do something real fast. See if there is a link to a rotator cuff one. And I will do my best to explain it all in there. But the shoulder girdle is only held on with one bony attachment. And I know I've said this quite a few times throughout articles and podcasts and so on. But it's really true. The whole thing is only held on in the body with one point, one bony point, and that's the clavicle or the collarbone. The rest of it is just muscle.

And the muscle resides within the shoulder girdle or the shoulder blade, in case I didn't explain that yet. And that's kind of it. So, you're only as strong as your weakest link. And if your shoulder girdle is not doing the job, your rotator cuff or shoulder, or I guess in this case, the quote-unquote infraspinatus, is going to suffer. It's going to suffer a lot and eventually probably tear. And there's possibly labral tears or instability all along the way. So, this, I would probably rehab this first in a very conservative fashion. And what I mean by that is that I would want to figure out whether this person did the right stuff or not.

And I'd probably give them the very, very basics. And that's going to be rotator cuff-based exercises. It's going to be shoulder girdle exercises. And I want to see it for a good period of time. And once I see they're doing it correctly and mastering it, then I would advance them a little bit further. But if they're having pain with overhead motions, perhaps we don't rehab in overhead yet. Now, I have a lot of people come in that say, well, it does hurt with overhead pressing. Well, I'm like, well, don't do it. And it depends on what the shoulder condition actually is. But I know with any time that you raise your arm above 90 degrees, there's a possibility of pinching, especially when there's these conditions, pinching or pain.

Now, I usually start people with rehabbing below 90 degrees just because it is a non-painful area for them. You know, it makes sense. Their movement patterns are normal. We don't have to worry about flaring things up. And if there is things in there getting pinched or frayed, then we're not doing any more damage. And eventually you move overhead. And overhead motion is really, really important since it's a normal motion. We have to reach up and grab stuff. We don't always lift, you know, 45-pound weights over our head. But it'd be nice to at least lift like a 10 or 20, you know. So where should I go from there?

Because I can tangent in so many different ways. Let's start with the last thing. Or let's go with the last thing is going to be realizing the body works as a unit as well. So I would probably eval a little bit further on this person to make sure that their trunk strength is good. And we find that their trunk is really weak or their core is really weak as well as their hips and glutes and legs and so on. I don't think this is going to get better. And they need to work on that first or in combination with their isolated cuff and shoulder blade exercises. Because it sounds like they're trying to do overhead pressing, according to their question.

And who knows? Maybe they're doing push press. Maybe they're doing snatches. We don't know what they're doing. And if their legs aren't generating power, their arms are doing all the work. And they're going to keep irritating that area. I truly believe the shoulder wasn't meant to press extreme amounts of load overhead. Because in a normal, everyday setting, if we are going to lift something over our head, we're probably going to use our legs to accelerate it up, float it up, and then lock out just as in like a snatch. If you don't know what a snatch is, it's an Olympic lift, and I strongly recommend looking at a video of that.

So if you have questions more, feel free to contact me on p2sportscare.com. There is that voicemail button. We haven't put these podcasts on social media yet. And if you can, actually, please leave a voicemail and see if you want us to do so. And I am not a tech junkie, so Twitter absolutely makes me insane. I know I have a Twitter handle. It is performancehb. But I don't typically go on it, and I really, really should. So if you're on Twitter and you're finding this on Twitter, tell me. Because I should probably start paying more attention to that area. But I typically spend more time with YouTube, honestly.

It is a way that I feel like I can get a little bit more information out there rather than just a couple snippets here and there. So I'll talk to you guys soon. Let me know what you want to hear about. And as always, have a good day.