it has been just over 2 weeks since i returned from morocco and i'm missing the action! i am at least in the desert, well semi-desert of dubai, so have enough sand and heat to get over those withdrawal symptoms ; )
martin did not return home until the thursday after the race, it took that long to get back through morocco, spain and france, all the while threatened by the french fuel strike. but he made it back in one piece. so, effectively it took martin and colin a month to prepare, transport and support the team for a one week rally, that's a huge commitment, so i would like to thank them once again. and of course massive thanks to patsy, who coordinated everything while also preparing, transporting and supporting another team of riders on the heroes legend, a 2 week rally from paris to dakar (not the dakar rally!)...... pure craziness!
i did not make it to the gym in the first 5 days after the rally, i was shattered, plus my left shoulder was a little sore. i think it was the first week this year that i did not do any training of some kind or other. however, i did pay a visit to sam and one ultrasound and one mri scan later......
Diagnosis:
1. Bone contusion greater tuberosity of left shoulder (crash in dunes on day 4 of rally)
2. Small articular sided partial tear of the supraspinatus (crash on road back in september)
3. Posterior labral tear (crash in dunes on day 4 of rally)
I reviewed Toby with his MRI scan results. The scan demonstrates a contusion of the greater tuberosity but no obvious displaced fracture. There is minor increased signal within the articular surface of the supraspinatus attachment consistent with a small articular sided partial tear. In addition, there is a cleft in the posterior labrum extending to the superior labrum with secondary swelling of the capsule.
I explained the results to Toby in some detail. The posterior labral tear will not cause ongoing instability and should settle with conservative treatment. I think the majority of his pain is related to the bony contusion in the greater tuberosity and the small articular sided supraspinatus tear. Certainly, examination today demonstrated a positive left sided Hawkins impingement test with some pain on empty can testing and there was also tenderness over the greater tuberosity. There was no posterior laxity or evidence of posterior instability.
I recommend Toby continue to see you for a conservative strengthening programme. In addition, I
discussed the benefits and risks of a corticosteroid injection into the left subacromial space or glenohumeral joint. As I suspect his symptoms are more subacromial, I suggest a subacromial bursal injection to reduce pain and encourage more aggressive rehabilitation.
After a discussion of the risks including infection, cortisone flare and skin changes, I injected 40mg of
Kenalog and 5ml of Lignocaine 2% into the left subacromial bursa under ultrasound guidance.
Toby will rest from all upper body weights and exercises for at least a week. He can continue with lower body exercises and running. After one week he should see you to start an aggressive rehabilitation programme and I will see him in approximately four weeks to assess his progress.
END
.....well, i've done 7 training sessions in the past 10 days and i'm seeing leah on friday to give me a new suitable regime, bring on the winter training!!
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