Dear shoulder ortho - How do I fix this?

FINDINGS:

The acromioclavicular joint demonstrates a mildly degenerated appearance with a trace

effusion/synovitis of the joint. There is a type II acromion with mild lateral downsloping. There is

trace nonpathologic appearing fluid in the subacromial subdeltoid bursa. There appears to be a

ganglion cyst in the subcoracoid region at the level of the rotator interval on series 6 image 12-13

measuring 1.1 x 0.7 cm.

There is tendinosis of the supraspinatus tendon with a small area of intermediate grade partial

thickness bursal and interstitial tearing as seen on series 8 image 8-9 and series 6 image 4. There

is also low-grade interstitial tearing of the anterior insertional fibers of the infraspinatus on series 6

image 4. Is no high-grade or full-thickness tear seen. The AP dimension of the supraspinatus

tendon tear is 7 mm. AP dimension of the infraspinatus tendon tear is 8 mm. Subscapularis tendon

and teres minor tendons are normal. Rotator cuff muscles appear normal.

Diminutive and degenerated appearance of the superior and posterior superior labrum with

suspicion of a subtle degenerative tear of the posterior superior labrum and a tiny cyst on series 6

image 15 and series 9 image 7-8.

Biceps tendon is normal.

There is no substantial cartilage loss.

No acute or destructive osseous process seen. Benign bone marrow is present. Cystlike reactive

changes along the greater tuberosity on coronal images 14 noted.

Soft tissues are normal. There is no mass, fluid collection, or adenopathy seen. No joint effusion,

synovitis, or intra-articular body.

IMPRESSION:

1. Supraspinatus and infraspinatus tendinosis with low to intermediate grade bursal and interstitial

tearing of the supraspinatus and low-grade interstitial tearing of the infraspinatus tendon as further

detailed above. No high-grade or full-thickness rotator cuff tearing is seen.

2. Mildly degenerated acromioclavicular joint.

3. Ganglion cyst in the rotator interval region, of indeterminate clinical significance, measuring 1.1cm.

4. Mildly degenerated acromioclavicular joint.

5. Degenerated and likely subtly torn posterior superior labrum.

What did your orthopedist say?

FrankPS wrote:

What did your orthopedist say?

Hi FrankPS, I don't have one :) In this scenario I am hoping you/the internet will be my ortho.  Cheers

You didn't say your age or what your symptoms are but that's a pretty good MRI really.  Not a surgical candidate at this point, so that's good. 

You should do well with lots of scapular stability exercises and fine tune your rotator cuff strengthening in overhead and functional climbing patterns.

Tendinosis can do well with progressive loading programs, some IASTM work can help (The Wave Tool is one option  www.wavetoolstherapy.com ) , deep trigger point and muscle work, and/or trigger point dry needling.

Just to restate:  I would stay with conservative treatment options and would not see a surgeon with that MRI.

As far as my credentials:  I've been an outpatient orthopedic PT for 31 years and have treated hundreds and hundreds of shoulders over the years. ( www.frontrangeclimbingpt.com )

Good luck!

Jeff, many thanks!  I think when I saw the MRI report my initial concerns were related to the tears.  I do have a wave tool, so can have my wife dig in and will seek out some PT for the rest.

Cheers!

Smaller tears (as per your MRI) can heal well without surgery.  Full thickness tears generally don't do well with just conservative measures.

Go with what Jeff said, but line up a good physical Therapist who can give you exercises that will strengthen what needs to be strengthens without making it worse. That said, my rotator cuff shoulder pain got so bad that after years of extreme climbing pain, where even classics were starting to no be any fun, I finally went in. What I learned is that they were torn to shit -the infraspinatus, supraspinatus, Labrum, etc etc and that I should have gone in much much sooner:-) I had 5 tendons repaired in my left shoulder and 4 in my right. Took well over a year off, but glad I did. Now I only have mild pain, but still do the PT exercises. 

I've gotten steroid injections a couple of times since then which was encouraged by my surgeon who noted: "feel free to come in every 6 months or so for a steroid shot", doesn't seem to help much. Sounds like you are starting to get Bursitus as well. 

What Jeff said is pretty spot on.  I am an NP and used to work in Ortho. Without knowing symptoms/age/history just based on the reading this would be a conservative treatment plan. PT/ strengthening exercises and not a bad idea to see Ortho if for anything just continuity in care if things go awry down the line. 

I’m going to go ahead and second what Jeff said. I’m an Ortho Sports surgeon, specializing in shoulders, hips, and knees. In general partial tears get better with PT and full thickness tears do better with surgery. Would definitely lean towards PT and away from some of the more unproven and expensive injections.