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Old 11-15-2013, 05:19 AM   #11
Joe Bernard
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Re: Shoulder MRI Arthrogram Results

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Originally Posted by Ari Sherwood View Post
No problem. I don't mean to say that surgery might not help you in your particular situation, it's just that I am not one to rush into surgery unless I know it's the only option, and I'd also rather not be in a sling and sleeping in a chair for a week or two and facing a 3-6 month rehab if I don't have to

BTW, I also forgot to mention that for the supraspinatus stuff, you can try doing eccentric rehab exercises. There's some research showing positive results with this technique on tendinopathies. Basically you do work on the eccentric phase of a lift and rest on the concentric phase. For example, do a shoulder press, but only work (resist the weight) on the way down, and then take your "good" arm and raise the weight back up to an extended press position so it's not working on the way up. Start light and work up gradually. I've had good luck with this technique as well during a flare up. You can also do this with push ups. Resist the movement on the way down, and then reset yourself in extended push up position without doing the actual push up.

Hope it helps.
Hah yea me too, I'd rather avoid surgery so I'll see what the doc says today. The downtime, even if it is shorter, would not be fun. Cannot imagine sleeping in a recliner.

Will do with the eccentric stuff, I've been doing it for my knee and it has been helping. Would it be worth it to do eccentric push-ups when I can do all types of full ones? Like I've been doing diamond, weighted, decline, medicine ball push-ups, etc.
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Old 11-18-2013, 05:34 AM   #12
Steven Wingo
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Re: Shoulder MRI Arthrogram Results

I had a left shoulder SLAP repair (type II lesion) 10 years ago and got a great result. Last week I had my right shoulder operated on--a type II SLAP repair and a subacromial decompression.

Let me know what your doctor says. I might be able to offer some helpful advice. Keep in mind your pain may be caused by something other than the SLAP tear. With my right shoulder the doc is pretty sure it is impingement causing the pain and we debated whether to even repair the SLAP lesion. He felt strongly the pain was caused by the impingement not by the SLAP tear--but there was no way to be 100% sure. In the end, we agreed it was probably best to repair the SLAP tear as well and be safe rather than sorry and have to go back under the knife a second time if fixing the impingement alone did not work. When he did the procedure he also found the SLAP tear was quite large, a little worse than expected based upon the MRI, so deciding to do the repair was probably the right decison.

Remember that MRIs give valuable info, but are far from perfect. In the end, you need an excellent surgeon because the final decision making on what to do is made during the procedure when they put the camera in your shoulder and get to actually see what is there. That is when they can best decide what is really problematic and the extent of repairs you should have.
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Old 11-19-2013, 05:11 AM   #13
Joe Bernard
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Re: Shoulder MRI Arthrogram Results

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Originally Posted by Steven Wingo View Post
I had a left shoulder SLAP repair (type II lesion) 10 years ago and got a great result. Last week I had my right shoulder operated on--a type II SLAP repair and a subacromial decompression.

Let me know what your doctor says. I might be able to offer some helpful advice. Keep in mind your pain may be caused by something other than the SLAP tear. With my right shoulder the doc is pretty sure it is impingement causing the pain and we debated whether to even repair the SLAP lesion. He felt strongly the pain was caused by the impingement not by the SLAP tear--but there was no way to be 100% sure. In the end, we agreed it was probably best to repair the SLAP tear as well and be safe rather than sorry and have to go back under the knife a second time if fixing the impingement alone did not work. When he did the procedure he also found the SLAP tear was quite large, a little worse than expected based upon the MRI, so deciding to do the repair was probably the right decison.

Remember that MRIs give valuable info, but are far from perfect. In the end, you need an excellent surgeon because the final decision making on what to do is made during the procedure when they put the camera in your shoulder and get to actually see what is there. That is when they can best decide what is really problematic and the extent of repairs you should have.
Hey Steve,

Thanks for providing your experience. How long will your rehab be for your right shoulder until you are able to workout again? Have you regained your strength fully in your left shoulder?

My MRI arthrogram reveal mild tendinosis of the supraspinatus and mild degenerative fraying of the superior labrum. The orthopedic surgeon told me that my problem is minor and surgery is not needed at all. He also said that most people who workout, especially those in there 40s and 50s, will have the same thing that I have. He said he had the same thing as well and did rehab stuff for 12 weeks and it never bothered him again. According to him, some people can have shoulder pain but nothing could be wrong with their shoulder! Weird. Also, the fact that I can do anything I want and just get tightness and discomfort with certain things is evident of the fact that surgery is not the right option.

Needless to say I was glad when I heard that as being out of the game for 6 months to 1 year would not have been good. He told me that I can do anything in the gym I want that doesn't cause pain because if I stop working out completely it can make it worse, plus hammer scapular retraction work while working on posture. Is that the basic protocol for this sort of issue?
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Old 11-19-2013, 08:22 PM   #14
Sean Rockett
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Re: Shoulder MRI Arthrogram Results

Excellent point about MRIs not being the gold standard, even with the highest resolution MRIs. They are not a dynamic test and the surgeon can only probe the tissue to see if there is truly a tear with arthroscopy. Also being able to see fresh signs of a tear vs old scarred tissue is valuable as well.
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Old 11-20-2013, 04:41 AM   #15
Steven Wingo
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Re: Shoulder MRI Arthrogram Results

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Originally Posted by Joe Bernard View Post
Hey Steve,

Thanks for providing your experience. How long will your rehab be for your right shoulder until you are able to workout again? Have you regained your strength fully in your left shoulder?

My MRI arthrogram reveal mild tendinosis of the supraspinatus and mild degenerative fraying of the superior labrum. The orthopedic surgeon told me that my problem is minor and surgery is not needed at all. He also said that most people who workout, especially those in there 40s and 50s, will have the same thing that I have. He said he had the same thing as well and did rehab stuff for 12 weeks and it never bothered him again. According to him, some people can have shoulder pain but nothing could be wrong with their shoulder! Weird. Also, the fact that I can do anything I want and just get tightness and discomfort with certain things is evident of the fact that surgery is not the right option.

Needless to say I was glad when I heard that as being out of the game for 6 months to 1 year would not have been good. He told me that I can do anything in the gym I want that doesn't cause pain because if I stop working out completely it can make it worse, plus hammer scapular retraction work while working on posture. Is that the basic protocol for this sort of issue?
My left shoulder SLAP repair from 10 years ago turned out great.

I am not quite one week out from my right shoulder surgery. The labral repair requires a long rehab--it will be at least 4 months before I'm allowed to hang from a pull up bar and that is if everything goes well. I will be able to start lower body stuff much sooner (I actually did 300 box step ups yesterday as my first post surgery workout). And I will be able to progress to some limited upper body work sooner than 4 months from now. It is the overhead stuff that has to wait.

Did the doctor mention whether you have impingement?

The tendonosis is often caused by impingement. Many of us, genetically, have an acromion bone which is more likely to cause impingement with overhead activity. When you get your arm in certain positions, the bone basically digs into one of the muscles and tendons of the rotator cuff (the supraspinatous I believe). So the rotator cuff there always gets inflamed and there are even little tears. That is what happened to me and over time it got so bad that therapy wouldn't fix it and surgery was required unless I wanted to just cease all overhead activity.

I agree with your doctor saying your labrum doesn't need repair. Lots of folks have labral tears and just live with them. I have probably had the one in my right shoulder for a long time. Its discovery was incidental when the MRI was done--my shoulder was not unstable so we didn't expect a labral tear. Also, I had had a cortisone injection under the acromion which gave me 100% relief for about a week and a half--if my labrum was the problem the cortisone injection should not have helped.

A big difference is that my tear was a type II tear and yours is a type I. Type I is fraying of the labrum. They really don't fix that or at least lean very heavily against it (unless maybe you are a profession baseball pitcher or QB). In a type II labral tear the labrum is actually pulled off the glenoid. Mine was large--from 10 o'clock to 1 o'clock. The doctor was still uncertain in my case whether to fix it. We both decided it was the safest thing since I am going to continue to do CrossFit and do lots of overhead stuff. (By the way my doc also CrossFits with me so he understands).

Have you discussed a cortisone injection with the doc?

They are not things you want to get frequently, only a few per your lifetime in any joint. However, they have their place and can be helpful. That is especially true if you then rest your shoulder and rehab it well.

Good luck I hope you can fix yours through rehab and other conservative care. It sounds like you have a good chance of doing so.
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Old 11-20-2013, 07:30 PM   #16
Joe Bernard
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Re: Shoulder MRI Arthrogram Results

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Originally Posted by Sean Rockett View Post
Excellent point about MRIs not being the gold standard, even with the highest resolution MRIs. They are not a dynamic test and the surgeon can only probe the tissue to see if there is truly a tear with arthroscopy. Also being able to see fresh signs of a tear vs old scarred tissue is valuable as well.
Well I definitely hope my MRI arthrogram got everything...

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Originally Posted by Steven Wingo View Post
My left shoulder SLAP repair from 10 years ago turned out great.

I am not quite one week out from my right shoulder surgery. The labral repair requires a long rehab--it will be at least 4 months before I'm allowed to hang from a pull up bar and that is if everything goes well. I will be able to start lower body stuff much sooner (I actually did 300 box step ups yesterday as my first post surgery workout). And I will be able to progress to some limited upper body work sooner than 4 months from now. It is the overhead stuff that has to wait.

Did the doctor mention whether you have impingement?

The tendonosis is often caused by impingement. Many of us, genetically, have an acromion bone which is more likely to cause impingement with overhead activity. When you get your arm in certain positions, the bone basically digs into one of the muscles and tendons of the rotator cuff (the supraspinatous I believe). So the rotator cuff there always gets inflamed and there are even little tears. That is what happened to me and over time it got so bad that therapy wouldn't fix it and surgery was required unless I wanted to just cease all overhead activity.

I agree with your doctor saying your labrum doesn't need repair. Lots of folks have labral tears and just live with them. I have probably had the one in my right shoulder for a long time. Its discovery was incidental when the MRI was done--my shoulder was not unstable so we didn't expect a labral tear. Also, I had had a cortisone injection under the acromion which gave me 100% relief for about a week and a half--if my labrum was the problem the cortisone injection should not have helped.

A big difference is that my tear was a type II tear and yours is a type I. Type I is fraying of the labrum. They really don't fix that or at least lean very heavily against it (unless maybe you are a profession baseball pitcher or QB). In a type II labral tear the labrum is actually pulled off the glenoid. Mine was large--from 10 o'clock to 1 o'clock. The doctor was still uncertain in my case whether to fix it. We both decided it was the safest thing since I am going to continue to do CrossFit and do lots of overhead stuff. (By the way my doc also CrossFits with me so he understands).

Have you discussed a cortisone injection with the doc?

They are not things you want to get frequently, only a few per your lifetime in any joint. However, they have their place and can be helpful. That is especially true if you then rest your shoulder and rehab it well.

Good luck I hope you can fix yours through rehab and other conservative care. It sounds like you have a good chance of doing so.
Good to hear your SLAP surgery went well, I've heard varying degrees of success with shoulder surgery. My cousin has had three and he has to live with some pain forever, not fun. The doctor did not mention if I had impingement or not. I meant to ask him what kind of acromion I have but forgot, I'll see if I can call his office tomorrow and ask if he could take a look at it for me.

I'm in agreement with my doc as well about avoiding surgery and he said the same thing regarding type I fraying of the labrum. It's annoying though because randomly I'll have discomfort in it and minor pain, but when I was working out this evening I felt fine. I really need to stretch and do the rehab exercises on a more consistent basis, then hopefully it will get better. I did not discuss a cortisone injection and I do not want to get one, it only makes the pain go away and doesn't heal it.

I don't get pain in my shoulder, rather it's where my pec and shoulder meet, the upper armpit area (but not in it). When I told him that and asked about prolotherapy he said he wouldn't do it to that region because a lot of nerves and veins run through there and it's not something you do to an area such as that. Did you have pain in your shoulder when it was bad or was it somewhere else?

I'm confused though on what to do regarding rehab. My doc said I can do anything I want in the gym and to avoid exercises that hurt, so I've been doing weighted chin/pull-ups, all types of rows, face pulls, deadlifts, some push-ups, and rehab exercises and avoiding benching and pressing. But then you said that after you get a cortisone injection you're supposed to rest your shoulder then do rehab. Since I'm not getting a cortisone shot, what's the protocol? Can I keep doing overhead work like chin/pull-ups if no pain is present? Did your doc ever mention this? It's cool that your doc does CF as well because he understands the demands that it can place on your shoulders. How's your shoulder feeling now? Did you start PT yet?
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Old 11-21-2013, 04:32 AM   #17
Steven Wingo
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Re: Shoulder MRI Arthrogram Results

In terms of what to do for rehab, it depends on what the problem is--but for many problems the prescribed stretching and strengthening exercises are going to be the same. So you can develop a program. What I would say is that "shoulder work" in the gym--pull ups, HSPU, and so on--are not rehab exercises. When you rehab you are going to be doing all kinds of stretching and really low weight work (light bands and dumbells--I'm talking starting at 1 pound each). You are targeting a bunch of tiny stabilizer muscles. You will not feel like you are working out, but the rehab can be very effective. You can look up therapy protocols on the internet and will find a lot through Google and YouTube.

While I agree with you that a cortisone injection doesn't heal the root cause, in some cases they can be very helpful. You often have two issues--the underlying problem is one and the inflammation and "angry tissue" is the other. The latter is caused by the former. It can be hard to get rid of the latter just with rest and even ice, anti-inflammatory meds, etc. A cortisone injection can often get rid of that quickly. Then you rest and focus on fixing the root cause through rehab. The other thing cortisone does is serve as a diagnostic tool. If the injection has no effect whatsoever, they know to look elsewhere--for example, in my case the doc did a cortisone shot below the acromion in the area which would be painful if impingement was the problem. It gave me 100% relief, although for a short time. That told him impingement was highly likely the cause of the pain. The cortisone injection was not done in a way that would have helped pain from a SLAP lesion in any way.

Did you doc x-ray your shoulder? And perform a physical exam asking you to do all kinds of arm movements and whether they cause pain? The main tool docs use to diagnose shoulder injuries is through their physical exam. They have all kinds of tests to look for impingement, SLAP tears, rotator cuff injuries, and so on. When certain tests come up positive, especially multiple tests for the same problem, they can then diagnose it. The x-ray, for impingement, is a confirming test--they look to see if the acromion has the "suspect" shape that they know is often associated with impingement. I'm guessing the doc performed these tests on you (I'm not sure how he could diagnose you without them) and just didn't find any consistent positive test.

I'd recommend you consider seeing a really good physiotherapist/physical therapist or a chiropractor also trained in orthopedics. They often can do a great job diagnosing and treating injuries that are a problem but non-surgical in nature. Remember that the vast majority of orthopedic docs are surgeons and specialize in surgery. There area of expertise is not really treating those who need conservative care--in fact they see those patients and send them on to physical therapists. You'd be surprised at how skilled some therapists become. Many of them can work wonders.

I am fortunately doing well so far. I'm able to get through the day without pain meds, but still take them at night. Since my surgery was just one week ago this morning, that is pretty good progress. My only therapy right now is doing very gentle passive range of motion exercises called pendulum exercises just to try to keep and gain a little range of motion. Mostly I just wear a big sling. I see the doc tomorrow and therapy is supposed to start next week.
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Old 11-21-2013, 09:36 AM   #18
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Re: Shoulder MRI Arthrogram Results

I should have phrased that question differently. What I meant was would continuing to do the exercises in the gym that I mentioned that don't cause pain (all pulling motions and pushups) be detrimental to my recovery? Should I stop working out and just do rehab? The surgeon, a doc, and a PT all said I can do things in the gym that don't cause pain and they want me to be active so the shoulder doesn't atrophy, but I want to make sure I'm not potentially doing more damage to it. I'm aware of the rehab stuff to do, I just need to be more consistent with it. I've been using 2.5lb weights from my weight vest and they are pretty challenging, it's quite humbling.

Good point about the cortisone shot. I guess my doc didn't talk about it because my pain was not terrible. How was the pain and ROM in your arm before getting surgery? I did have an xray done and the doc performed a physical exam and only the O'Brein's test brought some pain but it was not excruciating. I totally forgot to ask about the acromion, I'm going to call today to see if he can let me know over the phone.

I've been to so many docs and PTs over the past couple months for both my shoulder and knee that I'm sick of them and so is my Dad. The PT I had for my shoulder was not that good and I feel like I can do everything on my own that se had me do. Her office is right next to my apartment and there are other PTs there but I'd feel weird seeing someone else at the same time that she is working even if I do go again.

Good to hear that you are doing well. Are you sleeping in a recliner or a bed? My cousin said the worst part of recovery was trying to sleep.
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Old 11-21-2013, 01:01 PM   #19
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Re: Shoulder MRI Arthrogram Results

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I should have phrased that question differently. What I meant was would continuing to do the exercises in the gym that I mentioned that don't cause pain (all pulling motions and pushups) be detrimental to my recovery? Should I stop working out and just do rehab? The surgeon, a doc, and a PT all said I can do things in the gym that don't cause pain and they want me to be active so the shoulder doesn't atrophy, but I want to make sure I'm not potentially doing more damage to it. I'm aware of the rehab stuff to do, I just need to be more consistent with it. I've been using 2.5lb weights from my weight vest and they are pretty challenging, it's quite humbling.

Good point about the cortisone shot. I guess my doc didn't talk about it because my pain was not terrible. How was the pain and ROM in your arm before getting surgery? I did have an xray done and the doc performed a physical exam and only the O'Brein's test brought some pain but it was not excruciating. I totally forgot to ask about the acromion, I'm going to call today to see if he can let me know over the phone.

I've been to so many docs and PTs over the past couple months for both my shoulder and knee that I'm sick of them and so is my Dad. The PT I had for my shoulder was not that good and I feel like I can do everything on my own that se had me do. Her office is right next to my apartment and there are other PTs there but I'd feel weird seeing someone else at the same time that she is working even if I do go again.

Good to hear that you are doing well. Are you sleeping in a recliner or a bed? My cousin said the worst part of recovery was trying to sleep.
I have lots of medical knowledge, but don't have the level of expertise of the docs and physical therapists. I would suggest you follow their advice on what you can and can't do. They also have had the benefit of examining you. And their advice--"go ahead and do the things that don't hurt"--sounds consistent with what I have heard from many docs and therapists and chiropractors during my career as an attorney addressing medical issues (I have worked with hundreds of health care providers, taken many many depositions of them, and do more medical research than legal research). If it were me, and they told me to do what I can, then I would absolutely be in there working out. (Unfortunately I always push harder and, as you know, that is just the nature of many of us. Aches and pains are a part of athletics.)

In terms of how I was doing before surgery, the answer is really bad. It got to the point where the last month it was essentially like I was in surgical rehab already. I could not do anything overhead without serious pain, couldn't sleep at night, and experienced significant pain even with push ups and cleans. My pain now--just one week post surgery--is less than it was in the last month before surgery. I am fortunately able to sleep in bed at night--although in a sling--and haven't had to resort to a recliner.

Hit the rehab hard, do what the health care providers say you can do, and keep your spirits up. It sounds to me like they are confident you can get better without seriously invasive treatment.
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Old 11-21-2013, 01:52 PM   #20
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Re: Shoulder MRI Arthrogram Results

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I have lots of medical knowledge, but don't have the level of expertise of the docs and physical therapists. I would suggest you follow their advice on what you can and can't do. They also have had the benefit of examining you. And their advice--"go ahead and do the things that don't hurt"--sounds consistent with what I have heard from many docs and therapists and chiropractors during my career as an attorney addressing medical issues (I have worked with hundreds of health care providers, taken many many depositions of them, and do more medical research than legal research). If it were me, and they told me to do what I can, then I would absolutely be in there working out. (Unfortunately I always push harder and, as you know, that is just the nature of many of us. Aches and pains are a part of athletics.)

In terms of how I was doing before surgery, the answer is really bad. It got to the point where the last month it was essentially like I was in surgical rehab already. I could not do anything overhead without serious pain, couldn't sleep at night, and experienced significant pain even with push ups and cleans. My pain now--just one week post surgery--is less than it was in the last month before surgery. I am fortunately able to sleep in bed at night--although in a sling--and haven't had to resort to a recliner.

Hit the rehab hard, do what the health care providers say you can do, and keep your spirits up. It sounds to me like they are confident you can get better without seriously invasive treatment.
See that's the thing with me as well, I push too hard at times so that's why I was wondering about doing the non-painful things. It's reassuring to hear Thayer you heard the same thing as well, I'll continue to workout then and just hammer the rehab stuff.

Sorry to hear about your shoulder, sounds like it was really jacked up. Yea that's another reason why the surgeon didn't opt for surgery, referring to me being able to do anything I want with just discomfort and minor pain with a few things. I look for the quick fix too often and I realize that it took awhile to get to this point of injury and it'll take some time to get back to being healthy, so I just have to stick it out. It's crazy that you are in less pain now, I've heard how once the sedatives wear off that your shoulder hurts like heck right after surgery and for a couple weeks afterwards. At least you have less pain now, hopefully you recover quickly.

Everyone I've seen thinks that I'll be fine, so hopefully with dedicated rehab work I'll be back to normal in a couple months or so. Thanks for all your help, I really appreciate it!
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