mri results on shoulder

[bassplaya1960]

this is what the ortho dr.  did not tell me

ROUTINE NONCONTRAST MRI EXAMINATION OF THE RIGHT SHOULDER

COMPARISON: Radiographs dated 01/20/15.

HISTORY: Initial encounter. Right shoulder pain. Decreased motion.
No history of prior surgery or recent trauma.

TECHNIQUE: Multiplanar, multi-weighted images of the right shoulder
were obtained without IV or intra-articular contrast.

FINDINGS:

ROTATOR CUFF: Marked tendinosis along the distal cuff. No full or
partial thickness tear is identified.

ROTATOR INTERVAL: The CA ligament is visualized and appears intact.
The biceps tendon appears intact and projects in a satisfactory
position.

AC JOINT: Mild degenerative changes with prominent bone marrow and
capsular edema. There is moderate lateral downsloping of the type II
acromion.

GLENOHUMERAL JOINT: No focal chondral defects are identified.

LABRUM: Nondisplaced superior labral tear with a small posterior
superior paralabral cyst.

CORACOHUMERAL INTERVAL: No suspicious abnormality is identified.

ADDITIONAL FINDINGS:

IMPRESSION:

1. Prominent tendinosis along the distal cuff.

2. Ill defined superior labral tear with a small paralabral cyst.

3. Prominent bone marrow edema with mild degenerative changes along the
AC joint. Correlate for any history of recent trauma along this region.

[Tuckamore]

My best guess is the "locking" you're experiencing is probably due to the edema (swelling) and changes seen in your AC Joint. The AC Joint is very complex. There are several AC ligaments but the Superior AC Ligament may be part of this "locking" scenario. This complex ligament covers the superior part of the articulation. It extends between the upper part of the lateral end of the Clavicle and the adjoining part of the upper surface of the acromion. The acromion forms the highest point of shoulder - it comes off the scapula. I'm guessing this could be effected to some degree also.

Now add the Rotator Cuff Tendinosis and I'm surprised you aren't having more symptoms.

Obviously a good ortho will have the true diagnosis. All I can do is make a guess based on my experience and medical background - which wasn't in orthopedics. I could be very wrong - but it makes sense to me.

I think once your shoulder issues are resolved your "locking" will also resolve. Please let us know what your ortho has to say. I'll be very interested in reading the rest of the story.

As always I'll look forward to hearing from you again.

~Tuck

[bassplaya1960]

thank you. i do need a good dr to look at my mri. you see, those findings were the mri tech not my ortho, much of what you told me is true except  there are other factors, such as if my arm is in the normal position hanging down and i move my my arm slightly to the left, it will lock at my clavicle i cant move it without first changing its position with my left hand. and now i have constant pain and weakness from my elbow down. any thoughts on that?

[Tuckamore]

I certainly understand your mistrust of orthopedists.

I am far from an expert, especially when it come to reading MRIs. I just struggled through through reading three of my own - but here's what I think your MRI says - and the route most orthopedists would take. Remember MRIs, like most medical reports is filled with a lot of medical mumble-jumble that could be said so much easier.

The most painful issue I see is severe tendinosis (not tendinitis as I first indicated) - Prominent (basically means severe) tendinosis. Unlike tendinitis which is an acute inflammation of a tendon  tendinosis is often called chronic tendinitis.Tendinosis is a chronic problem, meaning it develops gradually and lasts a long time.

So let's go line by line on the MRI impression:

#1 line: Prominent tendinosis along the distal cuff - cuff refers to the rotator cuff. Distal means away from the center of the body, or in this instance from the center of the rotator cuff.

#2. Ill defined superior labral tear with a small paralabral cyst. Ill defined just means it isn't well defined or a clear tear. A superior (means on top) labral tear (The labrum is a rim of soft tissue that makes the shoulder socket more like a cup) - a small paralabral cyst is a common incidental findings found on shoulder MRI. These are thought of as harmless and indicate  presence of a nearby labral tear.

#3. Prominent bone marrow edema with mild degenerative changes along the AC joint. Correlate for any history of recent trauma along this region. The AC joint or Acromioclavicular joint, is a joint at the top of the shoulder - your MRI shows edema in the bone marrow, which would be normal and expected with an injury of the shoulder - in addition to mild degenerative changes. If you are over 45-50 get use to that "ugly term" degenerative changes - it means our parts are getting older, worn and degenerating.  

PT is the normal treatment for your condition. Believe me you wouldn't want surgery on your shoulder, especially for an "ill defined tear". In laymen terms, Surgery is always in a traumatic event for our body. The outcome is not always what we hope for - even when it is there is often a long and difficult recovery when it's the shoulder.

I hope this helps. As always a 2nd opinion can't hurt, especially if it will make you feel more comfortable. I'll look forward to any more additional comments or questions - feel free to ask.

Peace,
~Tuck

[bassplaya1960]

when i went in for my mri review, this is what happened. my orthopedic dr pulled the mr images to the screen turned back facing me while they loaded,looked over his shoulder at one image rotated that image 360 degrees turned back to me and said "i  dont see anything really wrong maybe some bursitis. i think you need a cortzn shot and ph/thrpy." that was his diagnosis, and prescription. the results i posted, i got from mychart listed as "final results"i guess what i need to know is what happens now. i would like to have a dr with integrity look at my mri and verify the results and review them with me. this is the second ortho that i have dealt with in the last 35 yrs that misdiagnosed and negligently prescribed ph/ thpy.in 1983 my ortho diagnosed my back injury as "a back sprain" and prescribed ph/thrpy. yet all my symptoms were indicative of  just 1 condition. and that was a herniated or rupture of a lumbar disk. anyway, my problem continues to worsen as my shoulder now locks from time to time at my clavical and i cant even grasp a fork or spoon to eat with half the time. everything im typing is done with my left hand because it hurts to much to try and use my right. im just at a loss

[Tuckamore]

Hello Bassplaya,

Welcome to our Pain Management Community. I am glad that you found us and took the time to post your lengthy MRI report.

So help me - do you have a question?

As you probably know bone marrow edema is an inflammation causing excess fluid in a bone. Usually caused by an injury - however it can also be caused by osteoarthritis and other joint disorders.

The other conclusions are self explanatory - nasty tendonitis with a small tear and a cyst. A Paralabral cyst usually indicate the presence of a nearby labral tear and are fairly common finding.

This must be very painful. I have extreme shoulder pain right now that is related to a cervical spine issue - I know the pain and it can be life changing. I'm so sorry.

So how did your physician treat the MRI findings? Sorry, again I am not certain of your question. I'll look forward to your updates.

My Best,
~Tuck