Possible Shoulder Impingement

About 4 months ago I got a pain in my shoulder. I can’t pinpoint how it happened or what triggered it, other than a possible fall on ice over Christmas that may have twinged something. I was getting pain in my left shoulder anytime I did any overhead work (military press / dumbell incline press) or raising my arm out to the side laterally. I went to see a physio who has been taking me through some exercises and strengthening exercises, but it’s still only 40% back to where it was before this shoulder pain. My physio did think it may be a labrum tear.

My physio referred me for a MRI scan, but in the meantime he’s been taking me through internal and external rotations with arm out to the side and up at 90 degrees, which have helped. But I do notice a lot of clicking in my shoulder when my arm is up at 90 degrees and I’m using a dumbell and internally rotating. I also notice pain whenever I hold the door open for someone after passing through it.

Anyway I had a MRI scan last week on my shoulder and this was the report that came back. I’m waiting for my physio to come back to me with the findings. Can anyone make sense of it or offer any guidance who have had similar experiences?

Many thanks

Mike

It looks like good news, right? The 4 muscles of your rotator cuff are intact, your bicep is moving like it’s supposed to, and the bursa in front of your shoulder is small, or not inflamed.

But your Subscapularis, one of your internal shoulder rotators is irritated or inflamed or something. Maybe this is causing your shoulder clicking and pain?

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Seems as though they found spurs (osteophytosis), which do not necessarily mean that surgery is warranted. You may just have some irritation of the subscapularis. Have you heard of ART (active release technique)? There may be a practitioner near you, and it involves pressure on the muscle while taking the muscle through its range of motion, for 5-6 reps. Not comfortable, but very effective. I am not a practitioner of this, and haven’t done the formal course, but have used some form in practicing as a physical therapist assistant. Usually with the anterior delt/proximal biceps region. I would not be surprised that you got major relief with one single treatment. It is that good. Let me know if you want any further info. All the best.

100% agreement

OPs findings are the same as the MRI findings would be on most other asymptomatic, active individuals. In fact, there’s a very high chance OP has the same findings asymptomatically on the unaffected shoulder.

Generally, these findings should be considered “normal anatomical variation” like a birthmark, rather than pathological

Thanks for the replies so far.

So I’ve heard back from the Orthopaedic radiologist. Good news is there’s no muscle or labrum tear.

He advised me that the gap in the shoulder joint between bone and muscle has shortened / reduced, there is a lack of fluid from what I gather? Resulting in muscle or bone pressing on my nerve.

He recommends a injection to separate the joint (not steroids). It’s a saline that widens the joint. I believe the medical term for the procedure is hydrodilation.

In the meantime I’ve been continuing at the gym and have found some progress with the exercises I’ve been doing, which includes cable external shoulder rotations, Cuban dumbell rotation and straight bar hanging. I’m also noticing less pain when doing shoulder press, however when I look in the mirror, my shoulders do not look symmetrical, the affected shoulder looks like it’s slightly depressed.

I’m also nothing slight pain down the side of my bicep (outter arm) when performing dumbell side lateral raises, when the dumbells are at about 80 degrees. I’m also noticing a clicking noise in my shoulder when doing dumbell front raises also at around 80 degrees. Also get slight discomfort on the front of my shoulder when doing internal cable rotation.

So question is do I continue with the physiotherapy and rehab shoulder exercises or go with the prognosis from the radiologist and have the hydrodilation?

Physiotherapy + progressive exercise first

At the population level, interventions to increase the size of the subacromial space (such as hydrodilation) don’t provide massive benefits over placebo (fake intervention), or exercise. As such, start with exercise management first, as this is generally cheaper, and will equip you to manage your shoulder pain more independently in the future, should your pain recur. If exercise management fails, then consider medical intervention