Suggest treatment for intermittent right arm pain after injury

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Posted on Thu, 11 Jun 2015 in Bones, Muscles and Joints
Question: Hello.

I fell forward 6 weeks ago and caught myself with my right arm.\

Ever since i have had pain off and on that ranges from 2 to 10.

Usually during the day it is close to a 2 or 3 pain wise, sometimes none 0.

The worst is when I sleep. I wake up in the middle of the night and it feels like someone punched me in the shouler. Pain at a 10! Its like a really annoying dull ache inside the shoulder, almost hard to pin point exactly where.

I had an MRI done and the following came back in the "Impression summary at end":

1. Mild to moderate tendinopathy/articular surface fraying of the supraspinatus tendon.

2. No evidence of rotator cuff tear.

3. Tear/detachmet of the anteroinferior labrum with minimal paralabral cystic change.

4. Minor hypertrophic acromioclavicular joint degeneration.

5. Minimal subacromial/subdeltoid bursitis.

Could you possibly comment on #1 - #5 and what each one actually means?

Also to add regarding your answer #3 above, in main report is said the following "There is abnormal signal undermining the anteroinferior labrum from the three to five oclock position, with minimal associated paralabral cystic change"

Lastly, do you think there could be a chance that something like this can heal on its own over time without surgery? I can move my arm freely but when I go over my head it starts to hurt?

Thank you in advance for your help with this. Very much appreciated!!!:)
XXXXXXX XXXXXXX



doctor
Answered by Dr. Sudhir Kumar 1 hour later
Brief Answer:
You require arthroscopic surgery.

Detailed Answer:

Hi
Thanks for your query

I'm Dr Sudhir Kumar

I have gone through your query and understand your concern. 1.There is mild to moderate tendenopathy ( pathology/ abnormality of tendon) of supraspinatus tendon. There is articular surface ( surface in the joint) fraying of same tendon. 5. minimal subacromian ( below acromian) and subdeltoid ( below deltoid) bursitis ( inflammation of empty space called bursa. 3.There is abnormal signal ( denoting tear) of Anteroinferior part of labrum ( boundary of socket formed by glenoid of scapula). The tear is in 3o clock and 5 o'clock when compared with positions of needles of clock. There is also paralabral( around labrum) cystic ( fluid like) changes.
It is unlikely to heal by itself. You probably require arthroscopic surgery.

You can discuss with your doctor about it.

Hope your query get answered. If you have any clarification then I will be happy to help you.

Wishing you a good health.
Take care.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Sudhir Kumar 35 minutes later
Thank you for your response.

Few other questions

1. When it says "Tear/detachment, is that the same as just saying tear? (detachment sounds more intense is there a difference or do they mean the same thing?)

2. Minimal associated paralabral cystic change...does that mean their are cyst's there but they are minimal so not that big of a deal? Can they clear up on there own?

3. If I want to try to not have surgery, what would I do besides anti-inflammatories, icing it and trying to not use the arm much? Any other suggestions? Do I need a sling? Can I still use my arm but just try to not reach higher than shoulder level or should I not be using it or really moving it much at all?

4. Can I carry things in that arm at my side like a bag of groceries or should I carry nothing, no weight?

5. Is it bad that in my sleep I wake up with my arm over my head sometimes or laying on that shoulder? I try to sleep on the other side or my back but sometimes wake up in other positions and then I have a lot of ache/pain in the shoulder? Could I be making the tear worse or just irritating it?

6. Why do you feel it is unlikely to heal without surgery?

7. Is there a chance it could heal without surgery? Could it heal completely? If so how long does this type of tear usually take the heal if I opt to try to go without surgery first? Several months or?

Thank you in advance for your help with my questions.
XXXXXXX XXXXXXX
doctor
Answered by Dr. Sudhir Kumar 5 hours later
Brief Answer:
You are unlikely to heal without surgery.

Detailed Answer:
Hi
Welcome back
Detachment is tear (separation)from its bony attachment (root).Basically it is same. Cystic changes means fluid like collection. They are unlikely to resolve their own. If you does not undergo surgery then you should avoid strenuous activity. You can do any activity but avoid strenuous activity. By strenuous activity there will be stess on tear and irritates it. It is unlikely to heal without surgery because it is detached so freshing of bone will be required. It is unlikely to heal without surgery.
You can discuss with your doctor about it.
Everything else already discussed.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.

In future if you wish to contact me directly, you can use the below mentioned link:
https://www.bit.ly/askdrsudhirortho

Wishing you good health
Take care

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Sudhir Kumar 10 hours later
Thank you for your response.

Two last questions,

If I want to try to wait and do ibuprohen, ice, physical theropy first to see if that will help, how long typically can it take for a tear like this to heal?

When you say not to do anything strenuous with that arm, can I carry a bag at my side, like a bag or groceries or a brief case for work, so the weight will be downward but I wont lift with that arm, is that ok or can that irritate the tear as well and I should carry absolutely nothing in that arm at all, even down at my side?

And thank you in advance for all or your help and support. This is a pretty scary thing that has happened to me and I appreciate you helping to guide me on what I should and should not do until I have my follow up appointment with my orthopedic doctor which unfortuanatly wont be for another 2 weeks:(
doctor
Answered by Dr. Sudhir Kumar 3 hours later
Brief Answer:
If it is fresh tear then healing will occur in nearly 3 weeks.

Detailed Answer:
Hi
Welcome back
I think this tear will heal in nearly three months if it is fresh. Otherwise if it is old say more than 3-4 months old then it is unlikely to heal without operation.
You can carry a bag at my side, like a bag or groceries or a brief case for work, it is unlikely to effect your tear.

Everything else already discussed.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.

In future if you wish to contact me directly, you can use the below mentioned link:
https://www.bit.ly/askdrsudhirortho

Wishing you good health
Take care

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Sudhir Kumar 3 hours later
Great glad to hear it may heal on its own in about 3 months.

I promise this will be my last reply;)

My friend told me today that he had pain in his shoulder last year and they found out it was tendinitis. His ortopedic doctor gave him a cortisone shot and it helped a lot with his pain and inflammation.

I have tendinitis, bursitis, and the labrum tear and it hurts and is achy on and off all the time.

Do you think a cortisone shot would be helpful in my situation or no? If yes, is there any danger with getting one, can they hit a nerve with the needle or anything or is it usually pretty safe to get and if so do you think it would help with the achiness and the pain I feel in my shoulder and help with the overall healing process? Would there be any reason not to get one (could it make anything worse?)

Lastly I like to go walking 30 minutes a day. When I walk my arms naturally swing at my sides and I noticed today when my arms were swinging it was bothering my shoulder.

Could the natural swinging of my arms when I walk be hurting the tear or do you think it is just the tendinitis or bursitis being bothered? Is it ok to walk regardless of it is bothering it or could I be making things worse? I really love to walk each day but if it could be making my shoulder worse i could stop for a while? Do you think it could be making anything in the shoulder worse, especially the tear or not really just irritating things and it would be ok to still go for walks?

Thank you again for all of your help and support and I will be sure to close this discussion out opon your reply and give you the highest rating possible!!!

Thanks again XXXXXXX Marie:)
doctor
Answered by Dr. Sudhir Kumar 12 hours later
Brief Answer:
Cortisone relieves pain and inflammation.

Detailed Answer:
Hi
Welcome back
Cortisone injection helps a lot in pain relief by reducing inflammation in tendinitis and bursitis but in labrum tear it has neither benefits nor harmful in healing process however it may relieve pain in this also by reducing inflammation. They does not hit any nerve but this is infiltrated in effected area so inflammation in area is reduced leading to reduced pain. However if surgery is planned early then it should be avoided as it increases chances of infection after surgery.
Walking doesn't cause any problems with it so you can continue your walking.
Everything else already discussed.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.

In future if you wish to contact me directly, you can use the below mentioned link:
https://www.bit.ly/askdrsudhirortho

Wishing you good health
Take care

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
Answered by
Dr.
Dr. Sudhir Kumar

Orthopaedic Surgeon

Practicing since :1993

Answered : 3338 Questions

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