Rotator cuff MRI results: partial RC tear

[Dr Damien]

Dear Rider Jen

It is quite difficult to really say whats going on without seeing you in person. It may be you are having two different conditions happening at once...or it may just be one condition. If we focus on a hypothesis that it is one condition, then its likely that the trouble is from the neck... (only speculating now), my hypothesis is you are having two conditions happening at once now...

I am presuming this because you have said the pain below your elbow does not affect your ability to use your arm...

Does your below elbow pain occur at the same time with the shoulder pain...? does any neck movement bring about any of the pains you've described?

It is quite rare to have bilateral rotator cuff tears...although i have noticed that a lot of people who get surgical decompression done, soon often require another surgery on the other shoulder...maybe because the same arthritic changes are responsible or perhaps they now use the other arm more making it susceptible to injury...really true shoulder problems rarely(if at all) radiate past the mid arm...if you are getting pain below the elbow, really you would need another look at your neck/spine...

What are the exercises you are doing? you describe them as gentle but what are they...?
Do you get any pain when you move your arm...or does this pain remain in intensity irrespective of any arm movement

perhaps injections to the subacromial area will help clarify what is happening...if you are still getting pain after such a treatment then the more likely problem is the neck however if the shoulder pain reduces but the below elbow pain remains then you have two conditions happening at once,if all the symptoms reduce then its probably a rare presentation of a shoulder problem,

Sometimes this is the only way to help make a certain diagnosis...If i took an MRI of my muscle after doing strenous exercises, it possibly will show up as multiple tears as well...what i mean is that MRI's are pretty accurate but they do not identify pain generators just pathology...you may have had these tears all along...besides an osteophyte encroachment would have likely been picked up by this anyway...

This sounds like going around the net really...

i dont know how thorough your neck exam was, but a good neck exam goes beyond simply looking up/down, side/side...

My suggestion is to consider injection therapy, that would help bring things into better light, offer you some temporary relief, and perhaps help with your physiotherapy...do you like needles? have you been icing that shoulder?

[RiderJen]

Thank you, Dr. D.

To answer your questions:

-- To explain the pain below my elbow, I took a closer "look" at it. As with the initial pain in my upper arm (near the shoulder), the pain there is difficult to pinpoint. But if I palpate the area, the pain is actually right AT the elbow, not below it. I feel it ONLY while moving my arm, but not always. I was assuming that it could be the result of the now-increasing fatigue in my upper arm and perhaps some other muscles having to compensate.

-- Neck movement does NOT bring about ANY of the pain I've described anywhere in my shoulder or arm.

-- If the cause of my RC cuff is anatomical, and is bi-lateral, then it stands to reason that my dominant arm would feel the pain first, followed by the non-dominant arm.

-- The exercises are to improve scapular strength/function, and include (always while keeping shoulder blades pinched): (1) Holding a short resistance band with both hands, elbows at 90 degrees and at my sides, gently pulling band from each end; (2) with one hand at my side and bent 90 degrees, pulling the handle attached to a resistance rope(?) until there is only gentle resistance, holding for 20 seconds, repeat several times, then repeat in other direction (gentle internal rotation / abduction, but always keeping my hand straight out in front with elbow bent 90 degrees; (3) full planks for 15 seconds; (4) gentle circles with arms at my sides; (5) small movements to wiggle a body blade. ***ALL OF THESE EXERCISES ARE DONE WITHIN MY LIMITED PAIN-FREE RANGE OF MOTION AND ONLY IF I AM PAIN-FREE WHILE DOING THEM *** However, even when these exercises don't cause pain while doing them, my shoulder hurts more the next day (by "hurt", I mean more intense sharp/tearing pain).

-- I have used ice after the exercises, but not always. The PT center sometimes offers ice after the exercises, but it's not always offered (however, it's always given if I do ask). About a month after this began, I iced the shoulder several times/day, but I did not feel any relief or improvement so I have not continued as often. Besides, I've read conflicting things about inflammation ---- some say it promotes healing, and others say it doesn't!

-- When I raise my arm close to 90 degrees or above, I feel intense/sharp/tearing pain about 4 inches from the top of my shoulder as well as the front of the joint (around the glenohumoral joint). If I raise it even once with some pain, the next attempt is even more painful and more limited. (i.e. each successive movement makes the next one even more painful and limited.) External rotation beyond about 20-40 degrees is very painful (again, each successive attempt is more painful and limited than the previous one).

-- Oh, one more thing.... if I pinch the shoulder blade (apply excellent posture) while raising my arm, I can raise it higher with less pain. The doctor and PT encouraged me to do this to put less strain on the RC.