Shoulder MRI and PT

physeek · 08-07-2006, 08:46 AM

A quick summary: hurt late dec. (front raise type lift of airline carry-on), rest, ART sessions, light workouts, otho x- ray (calling it tendinitis) type II acromion, NSAIDS with rest then PT that was only e-stim./heat and massage therapy with no exercises.
(A more detailed, or drawn out desciption is in older "Rotator cuff/Shoulder" thread)
MRI - the radiologist report found no tear and labrum intact. They found Impingement and a degenerative cyst (ortho said it's arthritis whenever you see the term "degenerative"). The ortho agreed with the report and while viewing he also noticed a few small bone spurs not included in the report.
PT - new place, seemed to be the right direction. I was getting exercises and typical pain on the outside of upper arm was occuring less. Scapular stabilization was helping. Adduction exercise? (pulling inward an slightly back with thera band attached to upper arm) felt like it got the scap at the right spot just outside and bottom of shoulder blade). This scap area feels different than the other side. It's more tense, not as smooth or in correct position. Maybe some winging, not moving in right ratio? External rotation work was always static or limited range. It seemed scap function was the ticket. Then I get a different PT because the other guy is on vaca/seminar. He does ultrasound, massage, then has me do a bunch of exercises with a blue thera-band. External rotations at natural range of motion really burned (some burn on un-injured side also). Aggrivated the shoulder to a depressing extent. He had recent shoulder surgery and his MRI showed 1 tear, but they found 3 and some other stuff. He suspects I have a partial subscapularis tear. The next session external rotation exercise modified to static/dynamic hold.
Shoulder is still more irritated than it's been.

I have a follow up ortho this week and don't know what direction to continue. The ortho last time talked about an injection being the next step. Since this doesn't heal/cure the problem, I don't know if it's the right move.

Bill Hartman · 08-07-2006, 12:30 PM

First, shoot the dufus with the ultrasound machine.

Sounds like you were on the right track in trying to get the scapula under control. In 100% of the cases of scapular instability, the the glenohumeral joint (shoulder) is unstable. Mr. Ultrasound should know that and you may want to tell him to start reading the previous therpist's notes.

A subscap tear is possible, but would be more likely if your palm was up (external shoulder rotation) when the injury occurred.

Does it hurt when you push on your belly with the affect side hand?

Does it hurt in the front of the shoulder in a high five position?

Can you tuck in the back of your shirt with the affected side?

Can you put the affected side hand on your lower back and lift it off with the same strength as the opposite side?

If yes to all, it may be a subscap tear. That's not saying it could be something else like a "typical" impingement. Exam via the internet is difficult.

As far as the injection is concerned. Your subacromial space seems very irritated. The injection may calm things quickly and get you back on track (preferably with the original therapist working on scapular issues).

Ultimately, the decision is yours. I wouldn't make injections a habit, but it depends on your level of pain and progression of function.

Bill

physeek · 08-14-2006, 10:12 AM

Thanks, Bill
The regular PT returned, so no more dufus w/ ultrasound, full range external rotations, or not reading the established chart/notes. Things have taken a considerable turn for the better, with returning to regular PT's work and exercises.

In relation to the injury, I'm not sure of my hand position during the front type raise. Internal or external shoulder rotation? As this was a stupid move, I wasn't thinking.
All of those "does it hurt when" tests I can do, but sometimes they cause irritation later on in the day.

I decided to not get the injection, with the therapy seemingly going in the right direction and a considerable pain decrease. The pain flare up was really due to the other therapist's exercises/not following what was working. The ortho follow up had the doctor impressed with an increased range of motion ( him moving my hand at sides, internally rotated, raising arm out to sides, like a pinky up lateral raise).
Ortho thought there was some atrophy in the injured shoulder (lateral part). There is less of a line or crease where the ball of the shouler meets the upper outside arm, but not that much of a difference from the uninjured side. I asked the PT , he said everyone isn't always perfectly symetrical. He then observed the small difference, and asked me to thumbs up, arms straight in a diagonal (about 45 degrees from front) raise against him and found strength was o.k.

Continue with PT is the plan for now. Man, it's been a long time since I've been able to do an "un-injured" workout routine. Reading the forum and what routines everyone is currently doing is definitely frustrating.