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Dr. Chip
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 31196
Experience:  Over 20 yrs of Family Practice
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I had a fall and got an MRI the impressions were Full Thickness

Customer Question

I had a fall and got an MRI the impressions were Full Thickness Tear Distal Insertion of the Supreaspinatus Tendon and Associated Muscle Atrophy. Subscapularis Tendinois. Large Shoulder Joint Effusion. Bony Hypertropy of the AC Joint, TYPE II acromial configuration and laterally downsloping acromion.

I had a few PT sessions but they make my shoulder, arm and forearm hurt more. I have appt. with the orthopedict doctor tomorrow but wanted someone to explain the impressions in English ahead of my apt Thank you so much.
Submitted: 4 years ago.
Category: Health
Expert:  Dr. Chip replied 4 years ago.
Hi. Before I answer, how long after the fall was the MRI done and did you have any problems with the shoulder before the accident?
Customer: replied 4 years ago.

the accident was on 5/23/13 and MRI was done on 6/22/13. My orthopedic doctor said to go for PT right away so I would not lose ROM. But I asked her after two weeks of PT if it would be possible to get an MRI because the PT sessions were causing too much pain and no improvement in my ROM. Before this fall I have never had any problems with my right shoulder.

Expert:  Dr. Chip replied 4 years ago.
OK. I needed to know that since some of the report may indicate things that were there before the accident. The bony hypertrophy of the AC joint means that there is some extra bone growth of the acromioclavicular joint--the area where your collar bone attaches to the forward part of your shoulder blade. That takes more than a month to develop, so that was there before the accident. The supraspinatus muscle and tendon are part of the rotator cuff of the shoulder and a full thickness tear of the tendon means that it tore completely thorough and the muscle has wasted away a bit from inactivity. The subcapsularis is another muscle and tendon part of the rotator cuff and you have inflammation and swelling of that. Joint effusion means fluid in the joint. The description of the acromion is just a normal variant of part of the shoulder blade that you were born with. Usually one treats these tears for about six months with conservative therapy as in physical therapy and cortisone injections, but if that is unsuccessful in relieving the pain and the movement restriction of the shoulder, then arthroscopic surgery is needed to attempt to reattach the tendon and to free up the other tendons that may have become somewhat stuck in their tendon sheaths
Customer: replied 4 years ago.

Ok. but I am a little confused with your response because my original orthopedic doctor saw the MRI results and said "I need to refer you to another orthopedic doctor that specializes in shoulder surgery" right away after seeing the results. Her specialty is hands. So why if the concervative way to go is the best course of action based on these impressions, would she tell me to see "a surgeon who specializes in shoulder surgery". She could have easily said "you need 6 months of PT therapy and cortisone shots". Now I am wondering that if this doctor tomorrow tells me I need surgery to correct the problem, he'd be rushing things and not taking the conservative approach. Very confused.

Expert:  Dr. Chip replied 4 years ago.
OK. Let's put it this way. There is no harm done in taking some time to see if conservative therapy will improve the shoulder function. It's always best to try to avoid surgery if possible. The orthopedic surgeon just said she wanted you to see a shoulder specialist but she didn't say you needed surgery right away. She just wanted a more specialized surgeon to evaluate your case. Since I can't examine you, I can't be certain what the new surgeon will tell you tomorrow. He may decide that in your particular case there is no need for conservative therapy. Please let me know what he does say.
Customer: replied 4 years ago.

last reply (I promise). Are there cases with these impressions that need surgery? It sounds based on what you just said and based on my own research online that surgery is not the solution. The only reason I initiated the question to begin with is that I had a sharp stabbing pain that was made worse with PT and maybe I need to tell this doctor tomorrow that surgery is not the answer if the suggests that for me.

Expert:  Dr. Chip replied 4 years ago.
No problem with the questions. It's not that surgery would not be appropriate for your condition, it's just that in many cases, conservative therapy, given time, makes surgery unnecessary. I think you need to see a physiatrist--a physical medicine and rehabilitation MD specialist--for a more comprehensive and customized therapy program first. I'm not trying to preempt whatever the surgeon tomorrow suggests but I'm obligated to give you my views here. And, of course, with any type of surgery, you have the right and the obligation to ask for a second opinion if you feel the need to do so.
Customer: replied 4 years ago.
Relist: Incomplete answer.
basically I was left with more questions than anwers. Basically I am more confused than I was before.
Expert:  Dr. Chip replied 4 years ago.
Sorry if you're confused but please reconsider the poor rating because I spent a good deal of time telling you what your MRI report meant which was your original question. I only elaborated on the treatment to give you more information. Can you at least tell me what is still confusing you so maybe I can clear that up?
Customer: replied 4 years ago.

my issue is with the surgery. The moment you indicated that this type of impressions (injury) gets resolved with 6 months of PT and cortisone shots you sent me into a tailspin of doubt. I had already made arrangements for someone to come and take care of my kids and household for when my surgery was schedule and now I find out that I may not need surgery. I don't trust my previous orthopedic doctor for telling me this and for referring me to someone else when there was not need to. I am upset about that but it's not your fault per se, it's just that I now don't know what to do or who to believe.

Expert:  Dr. Chip replied 4 years ago.
OK--stay with me please for as long as it takes. Are you saying that the second surgeon has already scheduled your surgery before actually seeing you? Or is it that the first surgeon said you needed the surgery, and, if so, can you tell me exactly what she said?
Customer: replied 4 years ago.

the first orthopedic (did not know she was a surgeon to me she was just an orthopedic doctor) saw me examined me and told me to go to PT. I did that for 2 weeks and I went back to her and I asked if it I could have an MRI. She told insurance co.s don't want to pay for MRI without iniciating PT first. But she authorized it and I got an MRI on 6/22. When I went back to see her, she gave a whole of 5 minutes and immediately said I may need surgery but she did not specialize in shoulders. She referred me to a shoulder surgeon. So I got from that, that there was a need for surgery. She treats all kinds of people with orthopedic problems (broken bones, hand, arm injury, carpel tunnel), but she does not operate on shoulders. You understand my confusion. She did not even give a chance to ask her what the impressions meant, enter YOU..

Expert:  Dr. Chip replied 4 years ago.
I see. So basically she gave you the idea that you'd have to have surgery? But were you told expressly that the surgeon tomorrow would be recommending surgery?
Customer: replied 4 years ago.

No she did not tell me the surgeon tomorrow was going to say I have to have surgery. But she did say that based on my MRI report I would need surgery and that she does not specializies in shoulder surgery. I even kept asking her if my type of tear could heal on its own and she said no. (keep in mind she took 5 mins to diagnose this). I much rather not have surgery that would send my world upside down by not being able to use my right arm for a while. If it's true what you say, I'll take that, but now I don't know whether I NEED it or if a "surgeon" would just go ahead do it because they don't have time to really examine it. On the other hand if I need surgery I would not want to wait 6 months to deal with it.

Expert:  Dr. Chip replied 4 years ago.
Well, hopefully the surgeon tomorrow will do a thorough exam and give you a truly informed opinion. It is true that a full thickness tear will not heal--will not, say, reattach itself--but as I have said, conservative therapy often restores the movement of the shoulder and the pain diminishes in time. Sorry to have confused you--I certainly didn't mean to--but we'll just have to see what the surgeon says and I'd be very interested in hearing from you about that. I've given you the facts here, and I'm sorry if those upset you, but I did my best to give you a comprehensive answer. So--and this is entirely up to you--I would appreciate your reversing your poor service rating and rate this answer positively. Thanks.
Customer: replied 4 years ago.

I am sorry I lead you to believe I was unhappy with your efforts. It's not that. It's just that I was not sure at the end if you were an orthopedic doctor and maybe I had doubts about your determination, but I think you are right, I need a second opinion. I will let you know what happens after my appt. tomorrow. Thank you.

Expert:  Dr. Chip replied 4 years ago.
My pleasure, and just to let you know I was board certified in general and trauma surgery so I do have some knowledge of orthopedics. Looking forward to hearing from you again soon.