Past shoulder dislocations, current persisting pain

BBM,

I’ve dislocated my left shoulder (“momentary” dislocations, never had to punch it back into the socket) at least 10 times over the years, to estimate the minimum very conservatively.

I’ve never had it diagnosed.

When these dislocations happen (e.g. from catching a punch on the elbow, “tweaking” the shoulder with the most leverage possible, while not keeping a tight guard i.e., shrugging appropriately, but instead letting the arm “hang”, or throwing hooks of my own, or doing other goofy stuff), an average level of “sharp pain”, as well as an unsettling numb feeling where the shoulder and arm feel “dead” (sorry about the amateurish terms), usually ensue. All the unpleasant sensations often disappear within hours.

When they occur, I tend to take the rest of the day, and possibly the next day, off from any non-everyday physical activity. If, for instance, there’s a bench session three days later, I normally bench as usual, and try to forget that anything ever happened.

My reason for never having looked it up is the tendency of the symptoms to not persist for very long at all.

About 10 days ago, I woke up with my left arm in a really weird, I suppose highly loaded, position, and had a very numb shoulder. The numbness persisted for a couple of hours and thus I wondered “what now?”. Of course I remained unfazed and looked forward to training (thanks). Today, as with all days following that sleep session, the numbness varies, and I’ve of course kept training (home workouts with dumbbells (rows, presses, squats, etc)). I’ve used my normal weights on all exercises (e.g. presses with 90lb dumbbells, 3x8, repRPE7-8). The only exercise that seems to “provoke” the shoulder, is the row – the left shoulder clicks during some sets, whereas it hadn’t before the current state of affairs. Workouts feel good overall, but, once again, numbness varies. Before that one sleep session, I almost never had any numbness emerge spontaneously, at least not for weeks on end as is currently the case. And, several times a day, I find myself feeling the shoulder to be “locked”, “stick in the wheel”, and I’ve found that a violent shrug “breaks the stick” and “unlocks” the shoulder, with a loud pop.

So, should I decrease weight/volume/frequency on any exercises?

And, can any intelligent speculation be done here regarding tissue damage? Is tissue damage being the cause of pain (the “bio” aspect of it) as (un)probable/(un)knowable in my case as in any other? I get that people with tissue damage can be asymptomatic, and that pain experiences consist of multiple factors… but, what are your thoughts? Is it likely that my shoulder is damaged somewhat, in a way that causes symptoms, that is? I mean, is it more likely than in the case of someone without a history of shoulder injuries? Can anything at all be said, or guessed, about the ‘bio’ aspect of my current experience, given my history? This is mostly out of curiosity. I’ve read most of your articles relevant to this. But I’m still not quite clear on what exactly, if anything, can be said about the ‘bio’ aspect of pain, in the sense of establishing a relationship between pain and tissue in some specific case… obviously a specific case is specific, but… like, someone may tweak their back deadlifting and see an abnormality in a subsequent MRI; well, that abnormality might’ve existed prior to the tweak. So, when, if ever, can we know, or be reasonably justified in believing, that damaged tissue is causing, or contributing to, a pain experience, aside from a deep cut or snapped tibia or something? I might’ve not been clear about what I’m trying to ask in this paragraph, but hopefully you get the idea.

Male, 25 yo

Hi RW,

I see two questions here:
Here are my thoughts. I’m sure others will provide better answers.

To your first question:
Train in the manner that allows you to keep training consistently. That means exercises you can load, load. Exercises that set you back; modify or delate. It doesn’t need to be more complicated than that. Based on your symptoms, I’m okay suggesting you do your best to not recreate or push through them.

To you second question
It sounds like you’re curious of possible “bio causes” in this situation. Here are some thoughts:

Based on your description you may be experiencing a subluxation. Not in the “chiropractic” sense, but “orthopedic” definition sense. It basically means the arm bone loses purchase with the socket, but returns to its resting place. Some people have the natural ability to do this, others may occur through trauma. For some its a pain free party trick, for others its a painful experience.

You may also be actually dislocating the shoulder. For some this requires it to be relocated by a physician and others have learned to “ram a tree trunk” to relocate. When this happens there can be collateral damage to surrounding structures. Its why physicians will do imaging to determine the treatment path. Shoulder dislocations can fracture part of the “cup.” It commonly results in a Hill-Sachs or Bankhart lesion. There can be injury to the labrum; a structure that helps improve the purchase of the arm bone to the socket. There can also be injury/irriation to the brachial plexus (nerves that travel out of your neck and down your arm); hence why some experience numbness, tingling, weakness to the shoulder, arm, elbow, wrist, hand. Of course the rotator cuff can also be injured. If someone really wanted to identify the structures involved, advanced imaging would be required. A true dislocation can result in quite a bit of collateral damage so its impossible to say what the exact mechanism of symptoms would be.

Does that answer your questions?

Thank you, @Matthew_Rupiper_PT

Train in the manner that allows you to keep training consistently. That means exercises you can load, load. Exercises that set you back; modify or delate. It doesn’t need to be more complicated than that. Based on your symptoms, I’m okay suggesting you do your best to not recreate or push through them.

Yeah. I felt like I knew this, but confirmation sounded nice. I’ll see if I can carry some plates and a backpack to the pullup bar place. Maybe pullups are click-free.

It sounds like you’re curious of possible “bio causes” in this situation.

Yes. I feel like I get the biopsychosocial model, I mean I’ve read about it, and it makes perfect sense, but I’m having a hard time applying it in my thinking. I tend to look at an injury scenario, have a first intuition of “something’s broken”, then clumsily try to observe the situation through the lens of “tissue damage =/= pain every time”, and therefore kind of fall towards the other extreme in concluding that the body might be completely intact, and that it’s just as likely as in the case of someone who’s not in pain… and while I’m not qualified to diagnose anything, it still feels like there should be some intelligent guesses a layman can make as to what might be going on in the tissues based on specific symptoms. For instance, I strongly felt, since before these ~11 days, that my shoulder might be somewhat “loose”.

…I mean, clearly pain experiences can be the result of tissue damage (or at least tissue damage can contribute to pain) – the account of my subjective experience implies to you, a qualified person, that xyz might be going on in my shoulder tissues. Like, I of course consciously know that yes, there are types of tissue damage that → pain, obviously (I’ve had broken bones and it felt unpleasant), and the biopsychosocial model even has “bio” in the name, but again, I’m having a hard time with, in my own thinking, integrating that into the idea that pain is underlied by multiple factors and that tissue damage need not be one of them. I know that acute injuries overlap the most with tissue damage, but even then, following the logic feels mechanical and dumb.

…That’s kind of what I was getting at.

Thank you for your thoughts. I guess I’ll wait and see, I’ll get it checked if it gets worse. And I’ll of course continue to train.

Btw, are there any actually good treatments for the things you listed? Or is training the best medicine across the board?

This might be way too broad, but is shooting stem cells into the area ever a good thing? The anecdotal accounts of healed shoulders, knees, hips, etc, sound incredible, but I’d feel like less of a fraud reading palms than deciding if those are true or not.

Regarding treatments:
Conservative self management is likely the best start for each issue I discussed.

For dislocations:

It doesn’t hurt to start conservative and modify activities to keep from having a recurrence. The evidence supports surgical intervention for younger populations with recurrences. The older population can get away without surgery.

For the labrum and rotator cuff:
The evidence is nuanced and typically depends on the patient’s demographics and lifestyle. Once again, it’s hard to go wrong starting with conservative management.

As for stem cells:
I’ve yet to see/read any evidence that would have me considering stem cells to treat a musculoskeletal issue.

Conservative self management

Noted.

The evidence supports surgical intervention for younger populations with recurrences.

Oh, ok. I wasn’t expecting this. I’ll book an appointment with an orthopedist I know, then. Can’t hurt to do imaging.

Thanks a lot, @Matthew_Rupiper_PT !