Shoulder Pain for over 4 years in both shoulders

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Hello everyone,

This is my first post on this forum.  Unfortunately, like all of you, I have found myself in a position of having shoulder pain for far too long.  I am going to post a brief history here so I don't bore everyone.

Right shoulder- 3-4 dislocations that happened between 2005-2006.  Never got surgery (wish I did?).  Rehabbed it through weight lifting.  Hasn't dislocated in 10-11 years but still feeling unstable in certain positions and doesn't feel like a normal shoulder in terms of stability

Left shoulder- had pain in the front of the shoulder for 10-11 years while weight lifting in certain exercises and positions but ignored it (ARRG! stupid me). Fast forward to 2013, had surgery, had a biceps tenodesis due to a subscapularis tear and biceps pulley lesion.  My shoulder has never been the same and I have not been able to lift since then, I lost a lot of muscle mass.

Here are the latest results of my MRI I had around 2 months ago.  What do you guys think?  Surgery?  I have gone to PT without any results, I am doing pilates now hoping it helps.  I have full strength in both my shoulders so I don't know what is causing this.  I should mention I also have chronic Lyme disease, not sure if that's making it worse.

EXAM: MR LEFT SHOULDER WITHOUT CONTRAST

HISTORY: Shoulder pain and limited range of motion.

TECHNIQUE: Multiplanar T1, T2 fat sat, PD, and PD fat sat sequences of the shoulder were acquired on a 1.5T magnet without the in travenous administration of contrast,

COMPARISON

FINDINGS:

Rotator cuff. Thickening Compatible tendinosis of the distal supraspinatus, Intact infraspinatus and teres minor, Subscapularis intact. No rotator cuff atrophy.

Biceps: There is been prior biceps tenodesis,

Labrum. There is blunting of the superior and posterior labrum. No displaced tear or paralabral cyst.

Ligaments. Intact inferior glenohumeral ligaments,

Joint space and cartilage. No joint effusion or cartilage defect. Trace fluid in the subacromial subdeltoid bursa.

Muscle and soft tissue. The deltoid muscle appears normal in signal. The spinoglenoid and suprascapular notch regions are unremarkable,

Bone marrow: Mild acromioclavicular joint capsular hypertrophy. Type II acromion. No os acromiale. No Hill-Sachs or Bankart fracture

IMPRESSION:

Mild tendinosis of the distal supraspinatus. No rotator cuff tear.

Biceps tenodesis.

Blunting of the superior and posterior labrum, likely postoperative.

Mild subacronial subdeltoid bursitis

EXAM: MR RIGHT SHOULDER WITHOUT CONTRAST

HISTORY: Shoulder pain and limited range of motion.

TECHNIQUE: Multiplanar T1, T2 fat sat, PD, and PD fat sat sequences of the shoulder were acquired on a 1.5T magnet without the intravenous administration of contrast.

COMPARISON: NOe.

FINDINGS:

Rotator cuff: There is tendinosis of the distal supraspinatus. There is a focal interstitial tear of the anterior insertion of the Supraspinatus. Intact infraspinatus, teres minor, subscapularis. No muscle atrophy.

Biceps. The extra articular biceps tendon is seated in the bicipital groove. There is mild biceps tenosynovitis. The intra-articular Course of the biceps tendon is intact. The biceps pulley is intact. The biceps labral complex is intact.

Labrum: Blunting and degeneration of the superior and anterior labrum. No para labral cyst.

Ligaments: Intact inferior glenohumeral ligaments,

Joint space and cartilage. No effusion. No full-thickness cartilage defect. No significant bursitis.

Muscle and soft tissue: The deltoid muscle appears normal in signal. The spinoglenoid and suprascapular notch regions are unremarkable,

Bone marrow. Mild acromioclavicular joint hypertrophy, Type II acromion. No os acromiale. No Hill-Sachs or Bankart fracture,

IMPRESSION:

Tendinosis with low-grade interstitial tear of the anterior insertion of the supraspinatus tendon

Mild biceps tenosynowitis,

Bunting and degeneration of the superior and anterior labrum

Thanks all

Dave

0 likes, 5 replies

5 Replies

  • Posted

    Dang, you're a mess.  You can't really "rehab" a dislocated shoulder through weight lifting.  But it depends on what you did.  If you didn't give the shoulder proper rest and immobilization in the acute phase of injury after proper setting of the shoulder in it's socket, like what most sites of orthopedists recommend, it's likely you altered your anatomy permanently.  They really need to do a better job of stressing the importance of resting an acute injury in my opinion.  The athlete's mindset is different than those who are inactive, "pain is gain".  I really think doctors don't understand this, I really don't.  They seem to pay it lip service.  And yes, surgery MIGHT have been the better option.  Multiple dislocations sounds like your glenohumeral joint is matted in scar tissue.

    But something else kind of doesn't jive.  All these symptoms persist years later and yet you still don't lift?  Finding that tear and all those symptoms of inflammation suggest you are still engaged in some physical activity.    The report also says you don't have muscle atrophy confirming this.

  • Posted

    Hey droopy- not to sound rude, the "you're a mess" comment isn't needed- we all know we have issues that's why we're here wink. Let's leave the negative stuff out the door please.  Are you a physical therapist or work in orthopedics that you know this? I've seen multiple surgeons and they've all said they don't recommend surgery on my shoulder that dislocated they it's stable and the X-ray showed how to sitting in the socket properly.  Yes there probably is a lot of scar tissue.  I can't lift all these years later which sucks.  I am thinking it's something systemic. 

    I agree surgery MAY have been the better option, it's never a guarantee. The report doesn't show any labrum tears which is odd after multiple dislocations?

    The inflammation doesn't not suggest physical activity, that's local inflammation which you're referring to I think.  This is something systemic.  Perhaps I didn't mention it which is my fault but I am in treatment for Lyme Disease for the last three years. 

    • Posted

      Hi Dave, Are you currently seeing a physical therapist?
    • Posted

      Hi henpen,

      I was for a long time, over several years did not do much, several different physical therapists, chiropractors, massage etc didn't help. 

  • Posted

    It is what it is.  Believe me, I intimately know the frustration of chronic conditions.  "Feelings", safe spaces, and being "sensitive" most likely aren't going to help you understand where you stand.  In my opinion, they cloud the judgement needed to handle these types of problems.  I'd say weigh your emotions after you know what the problem is.  And to answer your snide question, no I am not in orthopedics nor in physical therapy.  What I am is someone who was stupid enough to separate my shoulder (not dislocate) and failed to either seek treatment or most importantly, immobilize and put it in a position for an adequate amount of time to achieve some degree of proper healing.  Granted I was a minor when this occurred, but it was a dumb decision nonetheless. 

    In your case, it sounds like surgery and/or rest would have been the better option the first time around.  Not repeated dislocation as I'm sure you agree.  And I hope you are aware that scarred up ligaments do NOT heal to their former strength.  I read somewhere that a rule of thumb is the best you can hope for is 70%.  So, if we're doing back of the envelope calculations here, a full tear will only get 70% strength back.  A partial tear at say 50% torn will restore to approximately 85% preinjured strength, IF it heals.  But these are just guesses on my part.  I have to believe there is better science out there that's more accurate than my fly-by estimations.

    Lyme's disease can be pretty nasty.  And I assume that is what you were referring to when calling it systemic.  Some websites say one of the things chronic Lyme's disease can cause is joint problems because they speculate the immune system remains hyperactive trying to fend off the bacterial infection.  So I guess that makes Lyme's disease a global disease that can manifest via other symptoms in local regions such as joints.  And seeing as how scar tissue is already more vulnerable to autoimmune attack, I'd imagine combined with a hyperactive immune system would make that tissue even more susceptible.

    These are questions for your doctors in my opinion.  You should be able to research it yourself online as well.  And I assume you've already seen an PCP/internist.  It sounds like your questions could be answered by an infectious disease specialist or a rheumatologist.  Your attending physician might be able to consult for you if you simply ask.  Maybe not, they may refer you for another visit with them instead, or not refer you at all.  Never know until you ask.

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