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Dr. Chip
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 32662
Experience:  Over 20 yrs of Family Practice
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Could you please help me understand my MRI of left shoulder,

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Could you please help me understand my MRI of left shoulder, I have been diagnosed with frozen shoulder by my ortho. surgeon, however my physio believes it is impingment:
small area of increased signal involving supraspinatus tendon at junction of two thirds and the posterior third. Linear area of high signal extending from busal surface down to greater tuberosity. Increased signal in overlying bursa. Findings consistent with focal bursal surface tear extending down to bony insertion.The linear fluid filled signal is approx. 1mm in depth on safittal imaging. Focal partial tear of infraspinatus in its junction of anterior two thirds and posterior third from bursal surface down to bony insertion measuring approx 1mm. All other rotator cuff tendon appear normal in position and appearance. AC joint shows some minor hypertrophic change, no significant joint effusion.
Hi--one question. The term frozen shoulder really only refers to limited range of motion of the shoulder. Is that the only diagnosis the orthopedic surgeon offered?
Customer: replied 4 years ago.

Yes the orthopedic surgeon indicated I had a frozen shoulder, as when I attempted to raise my elbow away from my side, my shoulder blade would move with the joint. However, although I have limited movement in my shoulder I believe it is more to do with the pain I feel rather than unable to move due to stiffness. Most pain is felt when I raise my arm to the side above my shoulder, or I reach behind my back (eg. reaching behind the to get something out behind the passenger seat in the car if I am driving), or when I place my hand across my chest onto the opposite shoulder. I am able to raise my arm above my head, although some pain is felt.

OK and we can continue after this if you'd like. Nothing in the MRI report shows anything that would actually cause a frozen shoulder and it sounds as though you don't have one anyway. That would take a total through and through tear of more than one of the rotator cuff tendons or perhaps a severe labral tear--a tear of the cartilage in the socket part of the ball and socket joint of your shoulder. You have some partial tears and there's the tear of the bursal sac around the joint. That said, there's really no mention of tendinosis and possible impingement syndrome but that could well occur given time. If you've had intensive physical therapy and, perhaps, cortisone injections and there's been no improvement, then in my opinion you'll need arthroscopic surgery to attempt to repair the tears of the tendons and the bursa
Customer: replied 4 years ago.

I have had one cortisone injection into the glenohumeral joint which gave some relief of the aching pain down the arm, but this returned 1 week later (but not quite as severe). I have also been undergoing physiotherapy. I understand the partial tear of the supraspinatus tendon is only very small, but could you explain what is going on with the bursal tear. The surgeon did not mention this to me, would it cause the pain in my arm?

You basically have a chronic bursitis at this point and that could be a major part of your pain and it may be that the bursal sac will need to be surgically drained and some of it resected.
Customer: replied 4 years ago.

Could you please elaborate on the bursal tear, is it significant enough to require surgery as the surgeon never mentioned this after reviewing the MRI

It may not be since it can be improved with physical therapy, another cortisone injection and antiinflammatories. If all that doesn't help signifcantly then you'd need the surgery to explore the entire shoulder since MRI's can sometimes not indicate how bad the internal problem may be. At least get back with the surgeon and ask him to expand on his diagnosis and what he thinks may be necessary
Customer: replied 4 years ago.

thank you for your advice

My pleasure but please let me know how it goes and remember to rate my service to you
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