T Nation

Ortho Specialists: MRI Results

I recently had a MRI of my right shoulder due to shoulder pain for the last few years . I’ve received PT, ART, massage therapy and most recently chiropractic care for the pain. Most have helpled for the short term, but nothing has eliminated the pain or cured me completely. It was just recently that my shoulder has become even more painful and caused limited range of motion while interferring with workouts.

I haven’t been able to see a specialist regarding the results, but this is what the MRI says:

FINDINGS: There is no focal marrow replacement identified in the humeral head. There is a small cortical cyst formation along the posterior margin of the humeral head suggesting early degenerative changes. The biceps tendon is in appropriate position. No significant joint effusion is identified. There is no soft tissue mass identified. No displaced labral tear is identified. The supraspinatus tendon is intact. The subscapularis, teres minor and infraspinatus tendons are intact. There is no displaced labral tear identified.

There is no soft tissue identified. No localized muscle atrophy is identified. The rigth A/C joint is in anatomic alignment with hypertrophic changes without significant encroachment upon the supraspinatus.

IMPRESSION: 1. Intact rotator cuff without full thickness tear.
2. Small subcortical cyst formation is identified in the posterior margin of the humeral head suggesting early degenerative changes.

Okay, so what does this cyst mean and what can or should be done about it? Luckily, my rotator cuff is in good shape, but I’m concerned about the cyst and am not sure what I can do to eliminate the pain.

Anyone?

Nate,

I dictate those for a living.

It is not likely that the cyst is the cause of your pain.

One theory is that the cysts form from microtears in the rotator cuff and synovial fluid herniates into the humeral head.

Having rehabbed several injuries in the past year I’ve come to realize the difference finding a supurb PT makes–kinda like the difference between being trained by a local ACE trainer vs one of your favorite strength coaches. It does sound like you’ve been through the gamut, but if you have any doubt of the quality of the PT you saw you might see anther one (I found an excellent PT by getting a referral to a good orthopod and asking who they thought was the best PT).

You could get a second opinion on the MRI by taking it to another radiologist (doctors do make mistakes) but from the report, yours sounds very straightforward, so I do not think this is likely to be profitable.

Good luck and PM me if you have any other questions.

Scott

ScottL,

Thanks for the feedback. So this is not something that will require surgery? That was what I was worried about, as I want to avoid surgery at all costs.

However, I have no problem seeing a PT and having it thoroughly worked on. Good tip about asking the ortho who they think is the best PT to see for injuries. I think that is definitely key to finding someone good who will help.

Any other suggestions of what I should be doing or can do?

If you didn’t see a specialist, where did you get the MRI?

Can you describe the pain symptoms? Does it hurt only when lifting, or all the time?

I ask because I have a similar problem and I’m thinking about getting an MRI.

I’m currently being treated by a chiropractor who ordered the MRI for me. He received that diagnosis and said that my neck being out of alignment is contributing to my shoulder problem. But I wanted to know if there is more that could be done, or if he is only “speculating” that chiropractic treatment will cure me.

My pain is also related to biceps tendonitis, which I have been treated for in the past. Only recently has the pain gotten worse and more persistent. Prior to this, it would only hurt after benching, some biceps work and some shoulder work. It began hurting a few months ago almost daily. Putting my arm over my head hurt, and trying to throw a ball was impossible. I know that too much overhead work a few months ago is what aggravated my shoulder. So now it’s time for treatment. I’ve also eliminated overhead work. I have been able to bench without pain thanks to treatment and massages.

The pain always feels like it’s in the joint (unless it’s the biceps tendonitis acting up). It’s on and off now. Not as bad as it was.

Nate, spend a few bucks and get Horrigan’s “The 7 Minute Rotator Cuff Solution.” There’s more to it than just rotator cuff exercises. The book explains why certain exercises cause bicipital tendonitis. If you understand how you’re causing/aggravating the problem and which exercises are problematic, you can make adjustments in your training.

Let me give you an example. I’ll type directly from the book:


[center]Training Alert
Upright Rows
[/center]
"One exercise you should eliminate from your weight training program is the upright row. This exercise places the shoulder in internal rotation (palms facing backwards) as the arm is raised, a position that does not allow sufficient space for the greater tubercle to clear the acromion.

"Supposed “proper form” requires pulling the elbows as high as possible. This simply increases the degree of internal rotation and magnifies the danger of impingement.

"The onset of pain from upright rows often is not immediate, although it may be. Usually the inflmmation in the tendons and bursae increases with shoulder motion after the workout is over. Pain may develop hours or days later, making it difficult to associate the pain with a particular exercise. people with this inflammation usually feel pain during any stressful shoulder exercise – such as bench presses, incline presses, behind the neck presses, behind the neck pulldowns, pullovers, and military presses.

“Upright rows accelerate rotator cuff degeneration. If you do them, you risk developing chronic tendonitis or bursitis.”


Nate, I had the same problem; bicipital tendonitis. More than any other investment I’ve made in rehabbing my shoulder, this book taught me how to fix it.

I like the fact that there are lots of pictures and that it’s written for the layman.

One last quote about impingement:

“Impingment is exactly what it sounds like: one body structure repeatedly pressing – or impinging – on another. In the shoulder, the stage is set for impingement because the space between the top of the humerus and the bottom of the acomion (the “roof” of the shoulder) is not particularly big. Under certain circumstances, any of the structures running througnh that space – the supraspinatus tendon, the tendon of the long head of the biceps, and the shoulder bursa – can be impinged upon. When impingement happens, it usually occurs between the greater tubercle and either the acromion or one of the shoulder ligaments.”

It really takes seeing the pics in conjunction with the technospeak to get a handle on what’s going on. It all boils down to grip. I do a lot of neutral/mixed-grip work; T-bar rows with the triangular grip on the bar, semi-supinated pull-ups, DB bench presses with mixed grip. The book is full of advice on optimizing how exercises are done, so as to not aggravate your shoulders. There are only a few exercises you’re told to avoid.

Bottom line, I’m benching 100% pain free on my bench presses at high percentages of my 1RM.

Nate,

So this is not something that will require surgery? That was what I was worried about, as I want to avoid surgery at all costs.

Nothing to operate on, so you can relax.

Good tip about asking the ortho who they think is the best PT to see for injuries. I think that is definitely key to finding someone good who will help.

The better the orthopod is, the more likely the PT referral will be good. The orthopod I saw for whatever reason didn’t want to specify a particular PT,and I had to drag a recommendation out of him. Perhaps just ask which PT he/she would see.

The usual (you probably already know): make sure you do enough e.g. rowing to balance the pressing. If you stand with your arms relaxed at your sides which way are the palms facing? If the palms face backward or more backwards then straight towards your body and/or your shoulders are forward then you have imbalances which need to be corrected.

TT,

If you know of a source for that book let us know. It is out of print and when you first mentioned it used copies were going for over $50 on amazon. Then they were going for over $100 and now there are none at all–and a waiting list. I think you are personally responsible for a run on the book.

ScottL, the book is published by Health For Life, 800/874-5339, and sells for $19.95. ISBN 0-944831-25-7.

I’ll have to check to see if it’s still in print. I know about the > $100 price on Amazon. I had concluded that at that price, it was just a typo.

I’m searching the 'Net, too, to see if I can find another source.

[Edit Added]

Scott, I found a single source for the book if you can’t get it from the publisher. Unfortunately, the source is in the UK, and you’ll be paying a premium, especially with shipping.

http://213.253.134.41/tesco_a/display.asp?K=181095424774800&sf1=CAUTHOR&sf2=ctitle&sf3=imprint&st4=0944831257&sf4=vx_isbn&sf5=keyword&sort=%24RANK&sf_11=FORMAT_SIMPLE_CODE&m=1&dc=1

Really good advice to get a second opinion and also see a physio, I can’t stress enough how they have help me, and those I know in the past. An experienced one with the proper training will, 9 times out of 10 be able to pinpoint the route cause pretty quickly especially with the MRI results to had… I don’t know your financial situation/health cover etc, they can be expensive but can make all the difference. Postural imbalances, muscle imbalance and control and nerve related problems are all within their remit.

A good one will also make the treatment relevant for you as TT pointed out there are some movements which don’t suit all, the knuckles level lat raise for example. They will work you round this and offer alternatives.

If they do decide that they can help tho be ready for a frustrating time. As you know physio is something you do, not that is done to you. For example something like treatment for shoulder impingement just doesn’t involve 4 sets of rows three times a week or the like, it is a constant thing. At work, home as well as the gym, you could be there for weeks constantly trying to improve scap/ shoulder control etc. I was! I hated it but now bench and shoulder press again.

Sheeeeit! That all sounds really patronising, sorry if you already knew all that. Anyway, the very best of luck with it.

Woo Hoo! Thanks for all the wonderful info.

Terry, you’re the bomb! I definitely need to order that book.

A friend of mine is a PT, so I’m going to ask his professional opinion as well. He has shown me some exercises to do to help strengthen the area, but I’ll need to see what else I should do. And I’m waiting to talk to a specialist.

Looks like PT will be the course of action, and like what was mentioned, this is going to be a long process of rehab exercises and other changes. But if it works, I’m ready for whatever is needed to be done.

Nate and TT:

Shoulder pain injuries: rotator cuff muscles strengthening exercises compared?

www.sportsinjurybulletin.com/archive/shoulder-pain-injuries.html

Just printed this out for my use the other day. I haven’t had a chance to read it, but looks like it might be useful. It compares exercises and talks about which exercises activate which rotator cuff muscles.

Be careful with health for life…I ordered that book from them, they charged me, and I never received it. I called them several times but never got the situation resolved, never got the book, and eventually just got frustrated enough to forget about it since it was just $20 and I had too many other things going on in my life at the time to stress over it.