MRI scan - right shoulder - results!!

[josehaigh]

Hi, following shoulder surgery early this year ( arthroscopy with debridement) I was recently referred for another MRI scan due to intolerable pain - worse than before surgery!

These are the results I got from my GP today:

Findings:

There is a widening of the AC jointspace, with mild effusion and an ill-defined acromium.

There is increased signal intensity of the distal infraspinatus tendon suggestive of either moderate tendinosis or an intrasubstance tear.

Mild subdeltoid/subacromial and subcoracoid effusion.

Can anyone help me to understand whats going on here and whether further surgery is likley??

Many Thanks

Jose.

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[Dr Damien]

this intolerable pain...is it new? how old are you?

what was the old MRI result...

It sounds to be like you have been lifting heavy objects, carrying a heavy object with it causing ur arm to drop downwards...or trying to pull something tough...

hard to say...unless a comparison can be made with the old one

In a nutshell, what that suggests where your collar bone joins with your shoulder blade is wider perhaps, one of the muscles that help you turn your shoulder outwards has undergone some trauma? or some degeneration at the point where it connects with your arm...and this is causing some swelling in the shoulder joint in general.

again is the pain new?

[josehaigh]

Hi Dr D.....thanks for your response!

Yes the intolerable pain is new - started maybe 2 months following my previous surgery!

I am 36!

Initially I first felt pain about 5 years ago, I was given a steroid injection which sorted it and then I would say about 2 years ago I started to get pain again, which was classic of supraspinatus tendonitis, I had 2 further steroid injections which were unsuccesful, so they sent me for my first MRI which showed nothing other than supraspinatus tendonitis - so they referred me to have a SAD procedure!

Following the initial recovery period I was pain free and then 2-3 months later is when this intolerable pain that I have now began. The difference being that the pain was now coming from the top of my shoulder as opposed to the arc of my shoulder!

I struggle to carry a small handbag at times - feeling intense pain and like my shoulder is going to come out of its joint!

I did have a very bad fall downstairs a couple of years ago and my elbow took the brunt of the force of the fall which Im sure hasnt helped in all this!


Does this help to give you a better picture/understanding???

Is it possible to predict the likley outcome/prognosis of all this??

Jose.

[Dr Damien]

Thanks Jose

I feel your shoulder needs some stability, the recurrent issues you are having now indicates that although the cause of your re-occurring supraspinatus tendinopathy is due to reduced subacromial space (which SAD) sorted out, you do not have the right muscle balance in your shoulder joint complex to keep that space free everything time you use your arm.

My thoughts on these new problem is an acromioclavicular joint lesion.

Im not sure what another surgery will be hoping to achieve except draining some of the fluid or stitching the muscular tears (unlikley since it does not feel like a significant tear)...

Try a physio...(which you should have seen soon after your surgery)...

The aim of Physio should be to

1) reduce your pain... (cold treatment)
2) provide temporary shoulder stability so that the weight of your arm does not pull on the AC joint anymore than usual
3) maintain the Range of motion available within pain free limits through self active assisted exercises
4) once pain is better controlled and the AC joint is not as painful, gentle but progressive strengthening exercises aim at maintaining flexibility and strength in the supraspinatus muscle (eccentric )

You would need a detailed examination to see what pathomechanics are occuring in your shoulder to provide you with specific exercise to improve scapulohumeral rythmn.
All these should only be considered when your pain has significantly improved and you are virtually painfree on active and passive movement

in the meantime, I would suggest putting your arm in a sling, or always giving it some support and not letting it hang down by your side i.e...always resting it on an arm rest when sitting...
avoid trying to lift anything with that arm...
use the other arm to assist in lifting it up if you want to reach for something above
avoid any painful range even if all you feel is little pain...

I think the prognosis for your arm can be good

cheers

[soodyogesh]

hie Dr. Damien

m yogesh frm india

i hv prblm in my right shoulder Dr. has told me to do MRI test

i m volleyball player wen i go for smash my shoulder gt start paining for less than 5 mints aftr dat it gt normal..... it repeats evrytym wen i go for smash or else while playing cricket wen i throw ball dat tym same thing happens..... it is happening frm last 1 yr....

is it major prblm ...??? or in future i hv to do surgery awat...???

plz rpl soon

[Dr Damien]

hello soodyogesh

my apologies for responding so late...
With regards your query, my opinion is that you possibly have a rotator cuff problem. this is a common injury with sports that involve overhead activities, by over head i mean sports that involve you raising your arm literarilly above your head i.e tennis, javelin, short put, volleyball...
this again happens when the stability in your shoulder is not optimal , with tennis/volleyball, the force of the ball on the racket/hand and the position of your shoulder are in opposite directions..if your shoulder joint complex is not optimal as you would have it with the wrong technique of smashing, then you could have too much anterior displacement of the humeral head within the joint, this can cause some trauma to the capsule as well as the rotator cuff muscles..
my guess is you naturally have an anteriorly displaced humeral head naturally. This means that (and im only speculating from your description of your mechanism of injury) your arm bone head lies too much infront of the joint either because things are too tight at the back or you have certaim structures within your shoulder joint being too shortnaturally pulling the head in the position.

With regards whether this may be a problem in the future, its hard to say, it probably will lead to some early joint changes what we call arthritis (if the problems are not corrected and you keep pushing it through its limits) because it this does not heal properly then there would be compensations happening forcing certain joints of the complex to take the brunt of the punishment.
it is safe to say that you need to slow down on your volley balling, get the MRI test as your doctor has suggested, visit a good sports physio to assist you in correcting the issues that you might have with your shoulder...

If you feel you need to keep playing volleyball then you need something to help stabilize or at least show you where the stability should be when trying to smash. My suggestion is the sports physio can try some taping techniques with you..

the last suggestion would be to work with your volley ball coach to get the right technique when playing this sport to avoid future injuries...

Best of luck

[soodyogesh]

hey hiee Dr

i hv done my MRI test

i wrk wid ur suggestion

thnx a lot

m sending u my report of MRI test

Examination: MRI- Right shoulder
Findings:
Hyperintense signal abnormality is seen in the distal supraspinatus tendon with extension to the capsular surface. This is suggestive of partial thickness tear. The signal abnormality is located approx. 11-12mm proximal to the insertion on the greater tuberosity.

Acromial contour is normal.

The shoulder joint space appears normal without any evidence of effusion.

The articular cartilage & labrum appears normal.

The bones around the shoulder joint reveal normal intensity.

Rest of the muscles around shoulder and their attachments also appear normal.

Conclusion:
Partial thickness tear in the distal supraspinatus tendon.
No other significant abnormality detected.


This is my report

plz let me knw wat is d prblm

n how to resolve it .....???

is any chance of operation....???

[Dr Damien]

Dear Soodyogesh

The MRI results reports exactly what I pictured in my head. You may want to consult with an orthopeadic surgeon to find out the extent of damage, they will be in a better position to advise whther surgery will be indicated. i would say that because of your age, the prognosis of a surgical intervention would be very good if no complications occur...

However, you can try a conservative management route, where a sports physio or doctor helps you rehab the shoulder to the point it heals...
this is very subjective...if you have a partial thickness tear, this would depend on how the tendon is ton really...if it is torn along its length then the rehab should be good but may take a long time to heal as you keep having to use your arm anyway...a transverse tear, which means across the fibers is very unlikely to respond well to rehab...

partial tears are notorious for very slow rehab...

One thing is for sure...you need to take time off volley ball or any activity that involves extreme overhead movements...
get the opinion of a sports doc or physio first...

In very simple English, one of the muscles that stabilize your shoulder is torn but not fully...

Wish you the best of luck

[soodyogesh]

Hiee sir Dr. damien

m really grtful to u

thnx a lot for suggestions

ill go wid u n ill stop playing volleyball for some months

n here my aunty wants to say sumthn abt her husband prblm

hiee sir

i am kalyani from India
My husband suffering frm gout [Uric Acid}
he is using goutnil tabs please suggest him diet, and what is the treatment.....???

[Dr Damien]

Dear soodyogesh and kalyani,

I am not a medical doctor and neither am I a dietician, but in the capacity of a physiotherapist...understanding what is causing the gout should be the first step to treatment. If he is on gout medications then it should take some time to clear. there are many causes of gout, as I am not the medical doctor who assessed your Uncle and husband respectively, I cannot give advice for any treatment forms.

Kidney problems, excessive intake of alchohol, some diuretic medications all can predispose to gout so a thorough knowledge of a man's medical hisstory is required in managing gout effectively.

Clients i have managed with physiotherapy rarely make any significant improvement because it is a systemic issue that physical treatment cannot address. whereever the gout may be prominent, it is however important that the joint is moved within the pain limit to avoid stiffness. Trying to manage with heat or cold in my own opinion rarely makes any difference.

So my suggestion is to speak with your medical doctor if you have any concerns about the prognosis of this gout issue

have a good week ahead