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Old 11-13-2013, 05:12 AM   #1
Joe Bernard
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Shoulder MRI Arthrogram Results

I had an MRI arthrogram without contrast done this past Monday on my right shoulder and found out this:

Mild supraspinatus tendinosis and mild degenerative fraying of the superior labrum. There is also some very mild widening of the acromioclavicular joint.

Everything else was normal. I don't know why it was done without contrast but it found this damage. I've been looking this up and it seems like a Level 1 SLAP tear and the surgical procedure is debridement. Has anyone here gotten this done and how long was recovery before you were back to 100% with both everyday life and working out? Can physical therapy heal this or is surgery required? I can pretty much anything I want to, but benching and pressing leave me with tightness, and some slight pain if I do alot of pressing, and sleeping on my right shoulder can cause discomfort and some minor pain the following day. Also, when doing a Cuban press my shoulder hurts in the bottom portion of when you swing your arm from facing down to facing up.

It's not life-altering, but not being able to do benching or pressing movements sucks. I should add that I originally injured my shoulder last April doing either weighted dips or benching incorrectly, and my shoulder has never felt the same since. I've don't PT for two months two separate times since then and it has not improved my shoulder. I am seeing an orthopedic surgeon on Friday for his opinion but want to be armed with some knowledge beforehand. I've heard both good and bad from surgeries, and am kind of scared about what to do. On the one hand I want to be able to bench and press but on the other I've heard that your shoulder is never the same. Is PRP or Prolotherapy an option here? What would you do in my situation? Any advice is appreciated.

Last edited by Joe Bernard : 11-13-2013 at 05:23 AM.
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Old 11-13-2013, 08:41 AM   #2
Ari Sherwood
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Re: Shoulder MRI Arthrogram Results

I had a similar MRI finding as you - mild tendinopathy w/o tear in my supraspinatus, and some increased signal in the chondral-labral junction, which might indicate a small labral tear. Shoulder surgeon basically told me that if it was a tear, it was small, and I should rehab it until I plateau functionally and are unhappy. That was almost four years ago and I did not have surgery. Can't say that pressing and bench left me in pain for days, but I definitely get a bit of tightness and discomfort if I don't mobilize the shoulder and keep on my basic rehab/prehab stuff. And after high rep kipping pullup WOD's, it gets a little mad until I mobilize, stretch, etc.

Obviously every case is a bit different, but I would say if you can do most of what you want to do and are able to stay on top of the mobility and basic rehab exercises, you can avoid surgery for a long time. Just my $0.02.

Good luck!
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Old 11-13-2013, 10:05 AM   #3
Joe Bernard
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Re: Shoulder MRI Arthrogram Results

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Originally Posted by Ari Sherwood View Post
I had a similar MRI finding as you - mild tendinopathy w/o tear in my supraspinatus, and some increased signal in the chondral-labral junction, which might indicate a small labral tear. Shoulder surgeon basically told me that if it was a tear, it was small, and I should rehab it until I plateau functionally and are unhappy. That was almost four years ago and I did not have surgery. Can't say that pressing and bench left me in pain for days, but I definitely get a bit of tightness and discomfort if I don't mobilize the shoulder and keep on my basic rehab/prehab stuff. And after high rep kipping pullup WOD's, it gets a little mad until I mobilize, stretch, etc.

Obviously every case is a bit different, but I would say if you can do most of what you want to do and are able to stay on top of the mobility and basic rehab exercises, you can avoid surgery for a long time. Just my $0.02.

Good luck!
Well that's good to hear that you've been managing it. Do you ever bench or press with regularity? Do you get clicking in your shoulder at all? Where does the pain radiate from when you experience it? See I don't want to just manage it, I want to be back to 100%. I have clicking when I swing my arm and experience tightness and pain in the armpit area, between my shoulder and pec, when I do bench or press. The ortho did the O'Brien's test on me and it caused some pain, which is normally indicative of a tear. Did your doc do this to you?

After you got the diagnosis, did you take any time off working out, did you modify your training in any way, and any rehab exercises in particular that have had great results? Sorry for the barrage, I am just really concerned because this has been a problem for awhile and I would love to get it squared away. I've been relegated to doing just pushups for my pressing movement and it is killing me, I love lifting weights with a barbell, especially pressing. Have you tried using dumbbells at all or are you able to use a barbell well now?

Last edited by Joe Bernard : 11-13-2013 at 10:30 AM.
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Old 11-13-2013, 06:44 PM   #4
Ari Sherwood
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Re: Shoulder MRI Arthrogram Results

I bench maybe once every other week, though I had been benching at least once a week for while. I don't get any serious clicking. I get tightness and pain in the front of my delt and down into the bicep tendon, which occasionally I'll feel into my fingers, though not all the time. I don't get pain or tightness into my armpit.

I forget which test is O'Brien's, but I don't recall the doc noticing any remarkable findings on any of the physical tests - just minor twinges.

As for mobility and rehab exercises, I do lots of stuff from mobilitywod.com, like:
- barbell smashing the front of the delt into the pec while internally and externally rotating the arm
- barbell smashing the trap from on top and mobilizing the arm in full ROM
- banded bully stretches using a band tied to a pull up bar
- pec minor stretches using the band
- "sleeper" stretches
- scap push ups
- face pulls using bands
- also check out DC Shoulder Rehab on youtube for some more ideas
- smashing a lacrosse ball into the pec minor and front of delt
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Old 11-14-2013, 07:13 AM   #5
Joe Bernard
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Re: Shoulder MRI Arthrogram Results

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Originally Posted by Ari Sherwood View Post
I bench maybe once every other week, though I had been benching at least once a week for while. I don't get any serious clicking. I get tightness and pain in the front of my delt and down into the bicep tendon, which occasionally I'll feel into my fingers, though not all the time. I don't get pain or tightness into my armpit.

I forget which test is O'Brien's, but I don't recall the doc noticing any remarkable findings on any of the physical tests - just minor twinges.

As for mobility and rehab exercises, I do lots of stuff from mobilitywod.com, like:
- barbell smashing the front of the delt into the pec while internally and externally rotating the arm
- barbell smashing the trap from on top and mobilizing the arm in full ROM
- banded bully stretches using a band tied to a pull up bar
- pec minor stretches using the band
- "sleeper" stretches
- scap push ups
- face pulls using bands
- also check out DC Shoulder Rehab on youtube for some more ideas
- smashing a lacrosse ball into the pec minor and front of delt
Thanks for all the info, I'll definitely start doing the things you listed that I am not already doing. I tried the DC Shoulder Rehab but Cuban presses cause pain, specifically at the bottom portion of when you rotate your arm from facing down to facing up, does that cause a problem for you or no? Also, for face pulls, I've been doing them at the gym but how are you supposed to keep your scapula back and down when you have to pull the cable to your face? I noticed last night that I shrug my shoulders when doing them instead of keeping them retracted. Did you ever take time off of pressing movements or just limit the amount of times you did (and currently do) them?
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Old 11-14-2013, 08:32 AM   #6
Ari Sherwood
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Re: Shoulder MRI Arthrogram Results

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Originally Posted by Joe Bernard View Post
Thanks for all the info, I'll definitely start doing the things you listed that I am not already doing. I tried the DC Shoulder Rehab but Cuban presses cause pain, specifically at the bottom portion of when you rotate your arm from facing down to facing up, does that cause a problem for you or no? Also, for face pulls, I've been doing them at the gym but how are you supposed to keep your scapula back and down when you have to pull the cable to your face? I noticed last night that I shrug my shoulders when doing them instead of keeping them retracted. Did you ever take time off of pressing movements or just limit the amount of times you did (and currently do) them?
I do get a little tightness on the cuban press, but not significant pain, no. If it causes pain in the front of the shoulder or under the acromion, then do some barbell smashing while doing the internal/external rotation. Check out mobilitywod.com for a demo of that.

as for face pulls, etc. see this article:
http://www.t-nation.com/article/perf...and_shrugs&cr= {mostly WFS except for the bodybuilder images on the right}

I have taken some time off from pressing movements way back when, and that helped temporarily, though it always comes back a bit when I go back to pressing movements, so I have to stay on top of the mob. It is helpful to also manage the volume when you have a situation like this, but I have done Wendler cycles through it, though, so it is manageable.
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Old 11-14-2013, 10:01 AM   #7
Joe Bernard
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Re: Shoulder MRI Arthrogram Results

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Originally Posted by Ari Sherwood View Post
I do get a little tightness on the cuban press, but not significant pain, no. If it causes pain in the front of the shoulder or under the acromion, then do some barbell smashing while doing the internal/external rotation. Check out mobilitywod.com for a demo of that.

as for face pulls, etc. see this article:
http://www.t-nation.com/article/perf...and_shrugs&cr= {mostly WFS except for the bodybuilder images on the right}

I have taken some time off from pressing movements way back when, and that helped temporarily, though it always comes back a bit when I go back to pressing movements, so I have to stay on top of the mob. It is helpful to also manage the volume when you have a situation like this, but I have done Wendler cycles through it, though, so it is manageable.
I'll definitely check out mobility WOD when I get home tonight, that site is a wealth of info. I've seen that T-nation article but forgot about their clarification for face pulls at the end of that section, looks like I'm going to do more Ys, Ts, and Ls.

Question: it seems like no matter what you've done this thing always gives you problems and you have to modify your workouts some times, why not get a debridement? From what I've read, it only involves shaving the frayed/degenerative section of the labrum and the downtime is much less compared to when the surgeon has to put anchors in. You would be out of the game for like 2-3 months but then you could start back up again and get back to pressing and benching pain free. I see the surgeon tomorrow and I'm definitely going to grill him about this, but initially it seems like it has no downside, but I'm not sure.
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Old 11-14-2013, 10:41 AM   #8
Ari Sherwood
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Re: Shoulder MRI Arthrogram Results

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Originally Posted by Joe Bernard View Post
Question: it seems like no matter what you've done this thing always gives you problems and you have to modify your workouts some times, why not get a debridement? From what I've read, it only involves shaving the frayed/degenerative section of the labrum and the downtime is much less compared to when the surgeon has to put anchors in. You would be out of the game for like 2-3 months but then you could start back up again and get back to pressing and benching pain free. I see the surgeon tomorrow and I'm definitely going to grill him about this, but initially it seems like it has no downside, but I'm not sure.
It's never been suggested to me, and I don't know if it applies in my case, so I don't know much about it. But regardless, surgery always has risks and potential complications, no matter how seemingly simple. And it's not particularly debilitating for me - I'm still able to get through most WOD's and lifts without any real issues.
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Old 11-14-2013, 12:47 PM   #9
Joe Bernard
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Re: Shoulder MRI Arthrogram Results

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Originally Posted by Ari Sherwood View Post
It's never been suggested to me, and I don't know if it applies in my case, so I don't know much about it. But regardless, surgery always has risks and potential complications, no matter how seemingly simple. And it's not particularly debilitating for me - I'm still able to get through most WOD's and lifts without any real issues.
Oh ok. I've been talking to my cousin who has had shoulder surgery three times for dislocations and he said the same thing as you with regards to surgery and trying to avoid it, so hopefully the surgeon doesn't tell me I need it, I'll see. Thanks for your help, I appreciate it!
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Old 11-14-2013, 10:02 PM   #10
Ari Sherwood
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Re: Shoulder MRI Arthrogram Results

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Originally Posted by Joe Bernard View Post
Oh ok. I've been talking to my cousin who has had shoulder surgery three times for dislocations and he said the same thing as you with regards to surgery and trying to avoid it, so hopefully the surgeon doesn't tell me I need it, I'll see. Thanks for your help, I appreciate it!
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.
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