Rehab instable shoulder with AC joint injury

Medical Q&A [Moderated]
1

Hi Doctors!

I’m a 35 year old male who started strength training 8 months ago. About a month in to my training I hurt my right shoulder bench pressing, and the AC joint inflamed. I went to a PT for 4 weeks for rehab and the pain and inflammation went away. Since then I’ve eliminated the bench press from my training and focus solely on press, squat and deadlift. Occasionally I get mild AC joint pain again, but not as serious as with the bench injury. My doctor referred me for an MRI of my right shoulder, and I just got the results:

  • Evidence of AC joint osteolysis from repetitive exercise or trauma
  • Mildly thickened coracoacromial ligament with very small subacromial enthesophyte accentuating the acromial rim. Small fluid collection in underlying bursa
  • Mild tendinosis in distal supraspinatus, with subtle irregularity along distal tendon’s bursal and articular sided surfaces
  • Negative for partial or full rotator cuff or labral tear

This isn’t the full story on my right shoulder. Although both my shoulders have the same range of motion, my right feels quite unstable compared to my left. When I bench press, it feels as though my right deltoid is “taking over” from my pec. With dumbbell curls, I have to consciously pull or roll my right shoulder back. This isn’t all in my head either: barbell curl, bent over row and parallel bar dip form all look strangely asymmetrical. It’s been this way for at least 10 years (no pain), but I don’t remember if I was born with it or a sports injury caused it.

I’d like to bench again but I’d also like to avoid chronic shoulder issues. What are your thoughts?

Many thanks.

2

How much do you press? What does your pressing/benching programming look like?

I don’t really know what your sensation of instability/asymmetry is coming from, unfortunately.

3

My program is:

Squats
Press
Bodyweight Chinups
Deadlift

3x per week, at 70, 75 and 80% of 1RM. My most recent 80% press performance is 108lb x 4 reps.

4

Evidence of osteolysis on imaging is a fairly common finding. I do not see any other findings reported on the MRI that would explain a sensation of instability (such as labral injury or large rotator cuff tear). Fortunately, symptoms / perception of instability do not necessarily reflect “true” instability or danger in the joint. If you can press without significant discomfort, I would continue doing so. I would also not worry about your perceived asymmetries.

5

Thanks for the response Austin, appreciate it.