Shoulder MRI results

[anemi1435]

I have pain in my Lt. shoulder for almost a year now that started with lifting a heavy object. My pain is constant and is worst at night that's keeping me not to have a good sleep. The MRI results revealed: The acromion is downward sloping and the lateral margin of the acromion compromises the rotator interval. The supraspinatus tendon shows focal thinning at 12 o'clock position and mild thickening and signal abnormality just proximal to the humeral insertion. Small amount of fluid in the subacromial bursa. The acromioclavicular joint is unremarkable in appearance. The impression: the acromion is downward sloping and narrows the rotator intervallaterally and partial vs full thickness tear of the supraspinatus tendon. My ortho said that there is no tendon tear when he review the results. Can the ortho doctor override the radiologist findings? Thank you very much for your response

[JD1963]

That's great anemi! I hope it all works out good for you!

Talk later, JD1963

[anemi1435]

That sounds good but I will be conferring it to the Ortho Doc that is seeing me now. So she can refer me to workmans comp. Thanks

[JD1963]

Well, that makes 4 correct surgical calls today! I thought it might be SIS! Anyway, as far as Workman's Comp. Will you be conferring with your Doc or directly with Workman's? If it is for Workman's I would try something like "Due to my previous claim on (date), I am now required to have surgical intervention. I am requesting that my claim be reevaluated and reestablished. Thank you for your assistance in this matter". Something along those lines. Let me know of any further questions. jd1963

[anemi1435]

The procedure is subacromial decompression. I've saw it done in our department so i already have an idea how it is going to be. I wanted to ask her to refer me back to workmans comp so my symptoms is justified but i don't know how will i phrase my word. Any suggestions? Many thanks.

[JD1963]

Absolutely! I am not a Doctor, but I am a Orthopedic First Assistant and have dealt a little with these type of issues.

If you post back, could you tell me what type of Arthroscopic procedure he/she is planning? I can give you all the info you want on that too.

jd1963

[anemi1435]

My Ortho reviewed the MRI findings and emailed me suggesting to have surgery. I don't want to open this up to you because i know this is going to be out of the topic, but if you've noticed i mentioned that  my injury started when i lifted a heavy patients leg. Workmans comp, took care of me when i first filed for a claim, discharged me after 3 months with no future treatments but i started hurting again. I tried to reopen my case but denied it. If you're the doctor seeing me now, would you be able to relate the etiology of my symptoms now to that of my original injury? Thank you.

[JD1963]

I wish you the best of luck, please keep me updated if you get the time. jd1963!

[anemi1435]

I appreciate all your input. Now, i have clear understanding of the things that's not clear to me. My ortho is not available for 2 weeks, i have been taking the prescribed meds with temporary relief. Since pain clinic is an option, i think i'll give it a try. More power to you!

[JD1963]

This is the norm, there could be a little various. They will have you sit with your arm hanging (to distract the joint), inject 10cc of Lidocaine (plain) under the Acromion. If you have any say in the matter, have them add (or get it later) a Cortocosteroid in the same spot. jd1963

[anemi1435]

I understand, i don't want to have surgery myself either but if this pain causes my life miserable, i don't have any other choice. Do you have any idea what they do in pain management clinic? Thanks.

[JD1963]

The pain management is a good idea - temporarily! You know you don't want to get caught in that vicious cycle. You are correct in trying to get to the root of the problem. I don't understand why Impingement Syndrome has not been addressed. Acromioplasty Surgery would completely cure that and it's a ambulatory surgery. While there the supraspinatus can be examined under direct vision and repaired if necessary. I am not trying to talk you into surgery by no means, but the options are running out. I wish you the best of luck! jd1963

[anemi1435]

I'm in my early 40's, female with 3 kids and very healthy. I'm in medical field working in ambulatory surgery. I hurt myself helping to position a heavy patients leg. I had MRI taken last Sept. with the impression of tendinopathy or partial tear of supraspinatus, but the ortho that saw me said that i only had tendonitis of rotator cuff. I did not want to have steroid injection but because of my pain and his findings, i agreed to try it. The x-ray revealed no bone spurs. I was back to work after 3 months of treatment with minimal improvement. Then after 21/2 months of working my shoulder starts to hurt again, but this time my ROM is limited. My normal activity at work is pushing, lifting a lot repititive movement of my arm and hand. I'm seeing another ortho in the same clinic as the other one that thinks my shoulder pain is very complex and its just muscular in origin and said that even surgey is not going to help. I was prescribed with pain meds and a strong kind of NSAIDs and muscle relaxant and she said that if my pain is not going to improve, will refer me to pain clinic. She does not even want to recommend to have PT. My thought of this is, I want my doctor to address the root cause of my pain, not to mask it by giving me  medication which i really don't to take in the first place. If you're the one seeing me based on my recent MRI results and my ongoing symptoms, what would you recommend?

[JD1963]

I hate to get personal, but you know I'm trying to help (I am the Orthopedic Community Leader for MedHelp), but can you tell me your normal activity level, mechanism of injury and a range your age falls in? Who suggested accupuncture? You may start thinking about another Orthopod. If you switch make sure you take all X-rays, MRI's and your medical record/copy. jd1963

[anemi1435]

I'm having pain to all the movements that you mentioned. What bothers me most is putting my bra on, i don't have a lot of strength to raise my arm up due to pain in front of my shoulder by my biceps tendon. I can't also sleep in my affected side. My issue right now is, because of this pain it seems like my shoulder is starting to freeze. I was placed on physical therapy for 3 months, accupuncture, NSAIDS that did not help and steroid injection which flared up my symptoms. What do you think is the best thing to do? Thank you for taking time to response to my inquiry.

[JD1963]

Well, my personal thoughts are that you probably have Shoulder Impingement Syndrome. It sounds like you have a small Supraspinatus tendon tear as well. If it's painful to raise your arm from your side, straight out, then over your head (like a jumping jack in slow motion), it's a good indication of SIS. Try the same thing with resistance, is it more painful? Keep me updated if you have the time. Best wishes! jd1963