Sports Medicine/Shoulder Pain

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Question
QUESTION: The following are the results from a shoulder MRI because of a lot of shoulder pain.

RIGHT SHOULDER IMPRESSION:

1. Low grade intrasubstance tearing to include a delaminating type tear at and adjacentto the footprint of the posterior fibers of supraspinatus tendon/anterior fibers of the infraspinatustendon on a background of mild tendinosis. No full thickness rotator cuff tears.

2. Small subacromial/subdeltoid bursal fluid can be seen bursitis; correlate clinically.

3. Altered signal and irregularity of the superior labrum probably representing tearing (age indeterminate) without extension into the longhead of the biceps tendon.


I'm going to a DR. in 3 weeks, but would like an idea of what this is saying. 1. Am I reading this right in that its SUGGESTING I have 3 separate tears? 2. If this MRI Report is correct, are these results something that can cause a lot of pain? 3. Would this be considered an injury that usually requires surgery?

Thank You.

ANSWER: Hello John,

Because the issue with your shoulder is fairly complex, I need to ask you some questions, relative to the shoulder, in order to give you a quantitative answer.

Firstly, how old are you?
Secondly, how have you hurt your arm in the past?
Thirdly, is this your dominant side, in other words, is most of your activity on your right side?

It is very important to have the history of injury in order to answer your questions.
Thank you, and I will look forward to your reply.

Dr. Patricia Arthur

---------- FOLLOW-UP ----------

QUESTION: I had a cervical fusion c5/c6 2.5yrs and I went to physical therapy post surgery and developed severe shoulder pain especially the front of the shoulder. This is going 2.5yrs since I actually first hurt my shoulder and I'm guessing that more damage maybe has been done waiting so long. I'm 43yrs old and this is my dominant side and now the pain is pretty brutal and I've developed atrophy of shoulder and atrophy of the infraspinatus muscles. The reason its taking so long is because my neck was a workers comp injury and they have given me fits about the shoulder, so they haven't done anything for me and I'm fighting that still.

Answer
Hello John!

Thank you for answering my questions.It has definately put information in perspectve, if I am reading it correctly.To summarize, you hurt your neck on the job, and at the time you did not report the shoulder pain?  So, 2.5 years ago, they  performed a cervical fusion on C5/C6. From your letter, I am understanding that you were prescribed physical therapy as a post-surgical Rehab plan?

If your shoulder was not hurt in the neck injury, then it was damaged in  PT while trying to develop your neck muscles from the surgery?  If that is the case, then you have a legal right to contact an impartial Orthopedic Surgeon to assess the damage in the right shoulder.

My feeling is that if the shoulder was not involved in the original neck injury, but the surgery might have damged some of the large nerves which innervate the shoulder, arm, hand complex.  When physical therapy was ordered, the shoulder was showing some signs of a problem post-surgically, and PT strarted doing active, load-bearing exercises with the right shoulder?  Conversely, the surgery was a success, but the Rehab was too aggressive on the shoulder.

As for the questions you asked relevant to the report, I will try to answer them in the order you presented them;

1)  The tears mentioned here sound like stress tears, and the rotater cuff has remained intact without tearing completely;
2)  Anytime there is damage to interstitial (muscle, ligament, tendons or nerves) tissue in the body, there will be an irritation to the bursa sacs around and within the joint involved, causing an inflammation (swelling) in the immediate area.  This is the reason for the pain and lack of motion in the joint.
3)   Again, I believe there is a  stress tear with the large biceps tendon which attaches to the shoulder, but is not affecting the complete tendon.

You asked about the tears, and from what I'm reading, there doesn't seem to be a surgical necessity to anything other than the reattachment of the biceps
tendon.......depending solely on the length of the tear from the labrum.  So, to answer about the tears, there is one possible surgical tear, and the rest are
fragmented tears due to possible PT overload.  Your question about pain is right on, and the atrophy is caused by the nerve(s) not properly innervating the muscle structures properly, or not at all.

There will be a lot of work for you to do, and as I said, a consultation with another Orthopedic Surgeon (not in the same office), would be a major benefit for you.  Additionally, a good attorney would help you with the W/C problem, but be very careful whom you choose.

I'm hoping to have covered all your questions, and you can find some answers which are desperatly needed at this point.  Best of luck to you, and if you have time, would you share with me what they decide to do to help this situation?  Thank you.

Dr. Patricia Arthur

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Dr. Patricia B. Arthur, DC, MRC, CST

Expertise

As a 30-year practicing Chiropractic Physician, my specialty was Sports Medicine. For 8 years I had the distinct pleasure of working with the USOC, and traveled the world to care for the athletes in the Pre-Olympic venues for the Summer Games. When I wasn't traveling, I had a private practice, and a hospital practice, in Kamuela, Hawai'i. Questions I couldn't answer usually dealt with pharmeceuticals. This was not my expertise, but the simple questions pertaining to familiar drugs I was able to digress, or refer to someone that was knowledgable in that field. Most Sports Medicine field injuries were familiar to me, but I always aired on the side of caution. In my office practice, I would tend to see more patients with the weekend injuries who would try to self-treat, only making the injury worse than it should have been! Nevertheless, I never took anything for granted, and so it was my conservative approach to the "cause-and-effect" mechanisms that were vitally important to the healing process.

Experience

Following my competitive nature, I knew Sports Medicine would always be a part of my life. After graduation from Palmer University in Iowa, the old adage taught at the school dealt only with the spinal column......anything connected to the spine was outside our scope of practice. To me, this was too simplistic, because the complex body also had arms and legs! From this point, I developed specific technigues which would encorporate the body as a whole rather than haphazard segments. There is nothing traumatic that happens to a single ligament, tendon or joint that doesn't effect a secondary, or possibly a tertiary element in that area. In order for that space to heal, all the factors must be addressed. Volunteering my time teaching referrees, coaches, and interested parents about the realities of probable sports injuries was worth a thousand words!j

Organizations
American Chiropractic Association; Local Emergency Response Committee; Hazardous Materials Response Team; Urban Search and Rescue Team - Operations and Planning; Federal Corps of Engineers Committee; Earthquake Advisory Board; Big Island Wildfire Committee

Publications
Papers published focusing on the importance of proper care of sports injuries; Authored medical columns for the syndicated magazine "The People's Doctor "; Published papers in professional journals on Head Injuries in Sports; Published papers on Drug Abuse in Sports.

Education/Credentials
Robert Packer Hospital - Certified Surgical Technician - CST; Palmer University - Doctor of Chiropractic - D.C.; Wright State University - Masters in Counseling/Psychology; Wright State University - Masters In Couseling of the Severely Disabled.

Awards and Honors
Selected US Olympic Physician -1988; Graduated Wright State University with a 3.75 GPA; Graduated Palmer University with a 3.5 GPA; Faculty Appointment - Palmer University Post Graduate Education; Faculty Appointment- Hawai'i/Kapiolani Community College - Skills Team Tester;

Past/Present Clients
Cincinnati Bengals Football Team pre-season training; Summer Olympic Athletes worldwide; Kona Ironman Triathletes - Finish - line physician

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