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Injured right front shoulder. MRI done. What does the results suggest?

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Confused on MRI report of right front shoulder.

Injured right front shoulder on 3/1/12 when lifting a very heavy object. Have tried rest, ice, NSAIDs, prednisone, physical therapy, electronic stimulation therapy, and a cortisone shot. Shoulder and arm still in pain constantly.

Had an MRI and these are the results:

There is mild tendinosis or tendinopathy changes of the supra- and infraspinatus tendons present. No full-thickness tear is seen. There is minimal amount of fluid noted in the subacromial, subdeltoid bursa. No joint effusion is seen. There is however a minimal amount of fluid noted adjacent to the inferior aspect of the coracoid process of the scapula. Ther is a type II acromin. There is no lateral downsloping of the acromin seen. The biceps tendon and biceps anchor is grossly within normal limits. There are mild degenerative changes of the glenoid labrum noted, most posteriorly. No fatty atrophy of the rotator cuff muscles is seen. No bone bruise or bone edema is seen. There is a small amount of fluid noted in the bicipital groove.

Impression: 1) Mild tendinosis or tendinopathy changes of the supra- and infraspinatus tendons. No full-thickness tear is seen. 2) No tear of the biceps tendon or biceps anchor is seen. 3) Only minimal amount of fluid is noted in the subdeltoid bursa. 4) No bone bruise or contusion. 5) A small amount of fluid noted in the region of the bicipital groove and adjacent to the inferior aspect of the coracoid process of the scapula.

What does this mean? Doesn't sound too bad, so why does my right shoulder and arm hurt ALL the time?
Posted Wed, 25 Jul 2012 in Bones, Muscles and Joints
 
 
Answered by Dr. Atul Wankhede 10 hours later
Dear XXXXXXX
Thanks for writing your query, and for giving the details of MRI report.

We might feel glad that there was no bony injury sustained during lifting the heavy object (as suggested and confirmed by MRI). That leaves us with two possibilities for the source of pain-
1. Injury to musculo-tendino-ligamentous structures or
2. Injury to neuro-vascular tissues.

Your MRI suggests very specifically about tendinosis/tendinopathy in supra & infraspinatous muscles, and absence of full thickness tear. This means that you had a partial tear of the tendon just before it attaches to your Humerus(arm).

Besides this, the subdeltoid bursa also has inflammation, that leads to pain in a certain degree of range of motion. This particularly is the pain of impingement. So even if your report doesn't sound bad, the changes internally though small have not returned to normal(not completely healed).

In all, the injury might be in a healing process. You need to follow up with your physician regularly to check the improvement in painless range of motion. Repeat the MRI every 3 months to check if the partial tear is stable or progressing to complete/ near complete tear. If its improving then continue the physical therapy and NSAID's on SOS basis. If it detiorates you need to undergo a reinforcement arthroscopic surgery.

If the pain is felt only during a certain XXXXXXX of motion, you can attribute it to the inflammation in subdeltoid bursa and bicipital groove. Those can also be treated with key-hole arthroscopic surgery.

Your nerves or blood vessels doesn't seem to have been affected since they are not mentioned in the report.

I've suggested surgery since you have exhausted all the conservative modalities already. But before you plan one, make sure you have repeated the MRI as confirmation to previous diagnosis.

I hope this answers your query. If you have any doubt, I'm available for follow up.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Injured right front shoulder. MRI done. What does the results suggest? 30 hours later
Thank you for the information. If I continue with physical therapy, how long does it usually take for a partial tendon tear to heal completely? And if surgery is suggested, what does key-hole arthroscopic surgery entail?

One other question on the MRI report: It states the biceps tendon and anchor are "grossly within normal limits"? What does that mean?

Thanks,
 
 
Answered by Dr. Atul Wankhede 3 hours later
Dear XXXXXXX
Thanks for replying back.

Its difficult to predict the duration of healing. Partial tendon tears usually heal with fibrosis in approximately 8-10 weeks. If they don't, they keep hurting and impair functionality. Arthroscopic surgery are beneficial as compared to open surgeries since there is minimal tissue damage, easy access to target organ and benefit of definitive treatment in same sitting. It also allows diagnostic visualisation of rest of the joint which helps identify other incidental findings that might be missed on MRI.

The biceps tendon has two heads(origins)- long and short. The long head originates intra-articularly just anchoring the glenoid labrum. The report mentions that the tendon and the anchoring part seem fairly normal, without tear. If they were torn it would be called a SLAP (superior labrum anterior posterior) lesion.

Hope this helps you take the right decision.
Regards

Above answer was peer-reviewed by
 
Follow-up: Injured right front shoulder. MRI done. What does the results suggest? 3 hours later
One last question: The report notes mild degenerative changes of the glenoid labrum, mostly posteriorly. Is this anything to be concerned about?

Thank you for your help and expertise. I am making a follow up appointment with my Dr. next week.
 
 
Answered by Dr. Atul Wankhede 7 hours later
Dear XXXXXXX
Thanks for writing back.

The labrum is a cushion that eventually degenerates in every individual. And yours is showing mild changes, so there isn't much to be concerned about.

Go ahead with your appointment and I'm sure everything will be all right.
Regards.
Above answer was peer-reviewed by
 
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