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shoulder tendinitis
I was in a car accident 4 months ago and have been diagnosed with left rotator cuff strain, left bicep tendinitits, cervical facet injury, and left ulnar neuropathy. I did 2 months of physical therapy for my shoulder and neck with little to no improvement so my doctor had me stop going. I have since then had 2 steroid injections in my shoulder which helped a little and 2 cervical facet injections which did not help at all. The problem is the pain and spasms in my neck and shoulder are just not going away. The ROM in my shoulder is fine...it just hurts to move. The left side of my neck hurts from the base of my skull done to the bottom of my scapula. I've had MRIs which are not overly impressive and just dont know what to do anymore. Im very frustrated. Where do i go from here...
Wow - we could be twins- as far as our shoulder pain and treatment plan of care, as well as end results - STILL IN PAIN!
How are you now? Did you every find relief, if so could you please share your plan of care?
How are you now? Did you every find relief, if so could you please share your plan of care?
Hi,
What is your name?
Cystic changes at humeral tuberosity are common findings on MRI. They do communicate with the joint spaces, but at this location they don’t cause any rotator cuff injuries.
There are studies conducted which says that cystic changes and rotator cuff tear are not interrelated.
You need to monitor changes over a period of time with help of imaging study.
Keep me informed if you have any queries.
Bye.
What is your name?
Cystic changes at humeral tuberosity are common findings on MRI. They do communicate with the joint spaces, but at this location they don’t cause any rotator cuff injuries.
There are studies conducted which says that cystic changes and rotator cuff tear are not interrelated.
You need to monitor changes over a period of time with help of imaging study.
Keep me informed if you have any queries.
Bye.
I recently went back to my doctor for my left shoulder pain which isnt getting any better. He had me stop OT, started me back on Celebrex, and ordered a second MRI of my shoulder which im awaiting insurance approval. My first MRI was in september. I have my doctor stumped.
My question is: what exactly is "cystic changes in the greater tuberosity" as was reported in my first MRI. Could something more be wrong that is not showing up on an MRI? Also my doctor mentioned exploratory surgery. Should this be considered at this point?
Any help is appreciated...
My question is: what exactly is "cystic changes in the greater tuberosity" as was reported in my first MRI. Could something more be wrong that is not showing up on an MRI? Also my doctor mentioned exploratory surgery. Should this be considered at this point?
Any help is appreciated...
Hi Sweetgrl,
You said your MRI report of cervical spine showed only straightening of cervical spine. They did not find ant nerve compression or spinal disc pathology at cervical level.
It indicates that your cervical spine is fine, but shoulder joint is of concern.
When was this MRI done?
When you say that only your 4th and 5th finger goes numb, means it is indeed ulnar nerve neuropathy.
Impingement syndrome is inflammatory condition of the soft tissues of the subacromial space.
It is the most common cause of presentation for shoulder complaints to a physician's office.
What diagnosis your doctor had given you earlier (what you mentioned in first post) is actually differential diagnosis of Impingement syndrome.
What could be done for Impingement syndrome?
Well firstly, no shoulder abduction or flexion >60° during early inflammatory stage.
Secondly Physical therapy should continue which improves ROM, particularly internal rotation through Rotator cuff program. Exercises which help in strengthening of Scapular stabilizers, Rotator cuff muscles. Ice, ultrasound, electrical stimulation should be tried.
Medication should include first line as NSAIDs and second line as Subacromial corticosteroid injections.
Surgery is indicated if symptoms continue after 6 months of a well-designed and monitored nonoperative regimen.
I would be interested to know about your disease progression.
Bye.
You said your MRI report of cervical spine showed only straightening of cervical spine. They did not find ant nerve compression or spinal disc pathology at cervical level.
It indicates that your cervical spine is fine, but shoulder joint is of concern.
When was this MRI done?
When you say that only your 4th and 5th finger goes numb, means it is indeed ulnar nerve neuropathy.
Impingement syndrome is inflammatory condition of the soft tissues of the subacromial space.
It is the most common cause of presentation for shoulder complaints to a physician's office.
What diagnosis your doctor had given you earlier (what you mentioned in first post) is actually differential diagnosis of Impingement syndrome.
What could be done for Impingement syndrome?
Well firstly, no shoulder abduction or flexion >60° during early inflammatory stage.
Secondly Physical therapy should continue which improves ROM, particularly internal rotation through Rotator cuff program. Exercises which help in strengthening of Scapular stabilizers, Rotator cuff muscles. Ice, ultrasound, electrical stimulation should be tried.
Medication should include first line as NSAIDs and second line as Subacromial corticosteroid injections.
Surgery is indicated if symptoms continue after 6 months of a well-designed and monitored nonoperative regimen.
I would be interested to know about your disease progression.
Bye.
Thank you for helping me, JainMD. It is much appreciated. To answer your questions, I am a 29 year old otherwise healthy woman. I have a physically demanding job and really need to start feeling better. You are exactly right that the pain (and also clicking) in the shoulder is only when my arm is at shoulder level. Then it goes away when raised straight up. At that point is when my hand falls asleep though. Actually only the 4th and 5th fingers. My hand also turns red and then horribly white when above my head or during any strenuous activity. As for my neck, my MRI only showed straightening of the cervical spine possibly due to muscle spasms. I dont have my shoulder results but I remember the doc saying there's cystic changes in the greater trochanter and arthritis in the AC joint.
In PT I tried electical stim, ultrasound, and manual massage. Although at first helpful, something eventually starting aggravating my condition and I would leave PT in tears. The pain was mostly shooting down my left scapula. A heating pad was the only thing that helped relieve it.
As for meds...i take motrin and tylenol to get me through my day and flexeril to help me sleep at night. I've tried vicodin, celebrex, ultram, and skelaxin, but found the motrin/tylenol combo to work the best. I'm not a big pill taker.
My question is is the neck causing the shoulder problems or is the shoulder causing the neck problems or are they 2 completely different conditions. And if I do have impingement which it sounds like i do...what can be done to fix it? Should I go back to PT? Thank you in advance.
In PT I tried electical stim, ultrasound, and manual massage. Although at first helpful, something eventually starting aggravating my condition and I would leave PT in tears. The pain was mostly shooting down my left scapula. A heating pad was the only thing that helped relieve it.
As for meds...i take motrin and tylenol to get me through my day and flexeril to help me sleep at night. I've tried vicodin, celebrex, ultram, and skelaxin, but found the motrin/tylenol combo to work the best. I'm not a big pill taker.
My question is is the neck causing the shoulder problems or is the shoulder causing the neck problems or are they 2 completely different conditions. And if I do have impingement which it sounds like i do...what can be done to fix it? Should I go back to PT? Thank you in advance.
Hi Sweet Grl,
How are you feeling now? What is your name? How old are you?
Normally, when the arm is moved away from the body, the tendon (which is referred to us as conjoint tendon) slides under an arch in shoulder joint. As your movement makes arm in line with shoulder joint, there is natural tendency to rotate the arm externally, thus allowing the rotator cuff to occupy the widest part of the space. If the arm is held persistently in such a position and moved to and fro (repetitive) movements, the rotator cuff may be compressed and gets irritated and causes pain. Once you have crossed this junction in your movement, after this stage if you take your hand above head, it will be pain free.
Try raising your slowly and see.
What you are feeling is while taking your arm away from your body and reaching at the level of shoulder joint you feel pain.
You might be feeling pain as in cleaning a window, painting a wall or polishing a flat surface.
This is sometimes referred to as rotator cuff syndrome; however there are at least five conditions with distinct clinical features and history.
Your symptoms come close to a diagnosis of Impingement syndrome.
It is an estimated diagnosis based on your presentation.
You said MRI of cervical spine is not impressive, can you explain this?
Can you type MRI report here?
What pain meds are you on and how are they spread over the day?
Have you tried cryotherapy and steam therapy?
Have you heard about Transcutaneous Electrical Nerve Stimulation (TENS)?
How are you feeling now? What is your name? How old are you?
Normally, when the arm is moved away from the body, the tendon (which is referred to us as conjoint tendon) slides under an arch in shoulder joint. As your movement makes arm in line with shoulder joint, there is natural tendency to rotate the arm externally, thus allowing the rotator cuff to occupy the widest part of the space. If the arm is held persistently in such a position and moved to and fro (repetitive) movements, the rotator cuff may be compressed and gets irritated and causes pain. Once you have crossed this junction in your movement, after this stage if you take your hand above head, it will be pain free.
Try raising your slowly and see.
What you are feeling is while taking your arm away from your body and reaching at the level of shoulder joint you feel pain.
You might be feeling pain as in cleaning a window, painting a wall or polishing a flat surface.
This is sometimes referred to as rotator cuff syndrome; however there are at least five conditions with distinct clinical features and history.
Your symptoms come close to a diagnosis of Impingement syndrome.
It is an estimated diagnosis based on your presentation.
You said MRI of cervical spine is not impressive, can you explain this?
Can you type MRI report here?
What pain meds are you on and how are they spread over the day?
Have you tried cryotherapy and steam therapy?
Have you heard about Transcutaneous Electrical Nerve Stimulation (TENS)?
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