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Doctor Chip
Doctor Chip, Board Certified Physician
Category: Medical
Satisfied Customers: 22285
Experience:  20 yrs practice, surgery, general medicine, addiction medicine, pain
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I fell on my shoulder 10 days ago, and have severe pain in

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I fell on my shoulder 10 days ago, and have severe pain in my shoulder blade and rib cage at the back, below the shoulder blade. The muscles between the shoulder and elbow are sore, especially at the back. I have limited movement in my arm, due to pain just below the shoulder, when I move my arm out, sideways, from my body, or upwards. I can lift it only if I support it with my other arm (hand), and then only less than half way up. X-rays of shoulder and arm showed no broken bones there.
Submitted: 3 years ago.
Category: Medical
Expert:  Doctor Chip replied 3 years ago.

You need an MRI of the shoulder to see if you have a rotator cuff tear or perhaps a tear of the glenoid labrum--the cartilage that forms part of the socket section of the shoulder joint. Depending on the results you will either need to see a physiatrist--a physical medicine specialist--for definitive therapy or you may need to see an orthopedic surgeon.

Customer: replied 3 years ago.
If it is a rotator cuff tear, why is there no pain in the shoulder socket area itself? It,s not sore to the touch at all. I don't want to waste an MRI. My doctor gave me a requisition form for an ultrasound on the shoulder, but it seems odd that there's no pain there - again, I don't want to waste the test. Could broken ribs account for the limited arm movement?
Expert:  Doctor Chip replied 3 years ago.
X-rays would have shown any fractures, and an ultrasound would be of limited benefit. If you only had a partial tear then physical therapy would be in order, but if it were a complete tear, the surgery would probably be necessary and the sooner the better. With your limited range of motion and no fractures, a rotator cuff or a labral injury is the most likely diagnosis here.
Customer: replied 3 years ago.
I didn't have my ribs x-rayed, so can't rule out fractures there. That is where it hurts, especially to sneeze. My should blade at the back is sore, and seems to me to protrude outward. It doesn't add up for me. What is a labral injury?
Expert:  Doctor Chip replied 3 years ago.
Well the shoulder x-ray would at least have shown the area of the ribs near the shoulder and of course you could have fractured ribs but that shouldn't prevent you from fully moving the shoulder. The fact that you have to support the arm to lift it implies a rotator cuff tear. As I said, the shoulder is a ball and socket joint and the labrum is a piece of cartilage that forms part of the socket. It can be torn in an injury like this and that can also limit the range of motion. All I'm saying here is that there is more to the shoulder than just the bones and an MRI will show all the soft tissue. You seem to have a serious injury and without a fracture than leaves the soft tissue as the cause of the symptoms.
Customer: replied 3 years ago.

I didn't have my ribs x-rayed, so can't rule out fractures there. That is where it hurts, especially to sneeze. My should blade at the back is sore, and seems to me to protrude outward. It doesn't add up for me. What is a labral injury?

 

 

I can't understand your reasoning. When I try to move my arm, the pain is not in my shoulder, but about 2 inches below the shoulder, at the back (shoulder blade area, and down my arm towards the elbow. The shoulder is not sore!

Expert:  Doctor Chip replied 3 years ago.
The shoulder x-ray would have included your shoulder blade if there were a fracture there. The rotator cuff includes all the muscles that surround the shoulder. You could just move to the physical therapy but if you are still concerned about the ribs you could ask for x-rays of those. I already explained what a labral injury is.
Customer: replied 3 years ago.
I am not satisfied with this answer. It seems to me that any MRI of the shoulder will only confirm my suspicion that the muscles/tendons involved in my injury are not in the rotator cuff area at all. I know where the pain is, and it's not there, as I already explained. I'm sorry, but it just does not compute!
Expert:  Doctor Chip replied 3 years ago.
I'm trying my best to help you here, but except for muscle, tendons, and bones, there isn't anything else that comprises the shoulder. What more can I tell you about this that would satisfy you?
Customer: replied 3 years ago.
My point is not what comprises the shoulder, but that the pain is not in the shoulder/rotator cuff area at all, so what is the point in doing an MRI there? Unless the test includes all the area down my arm to the elbow, and in my back (lower shoulder blade and below) then it will reveal nothing.
Expert:  Doctor Chip replied 3 years ago.
There is another possibility here--that being that you injured a disk in the neck with radiation of pain into that area, and an MRI of the neck might be in order. BotXXXXX XXXXXne here--the MRI isn't essential, but you do need appropriate physical therapy to hasten recovery from this injury.
Customer: replied 3 years ago.
I've been to physiotherapy before, and I'm sure I can just as easily torture myself without bankrupting myself. Thanks for your time. I will cancel my ultrasound appointment, and save the Healthcare system money as well. I know after all these years that God created the body to heal itself - and I will heal. If you like, you can e-mail me in a few weeks to see how I'm doing.
Expert:  Doctor Chip replied 3 years ago.
So long as you keep doing things that extend the range of motion of the shoulder so it won't get frozen that may work. You can come back here and let me know how you're doing at any time.
Doctor Chip, Board Certified Physician
Category: Medical
Satisfied Customers: 22285
Experience: 20 yrs practice, surgery, general medicine, addiction medicine, pain
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