At least thats what my Hopkins orthopedic guy thinks. Nothing on x-ray, nothing on MRI really either, but I have all of the signs/symptoms of a tear somewhere in there.
SH*T!
Shot me up with some cortisone as a temporary measure yesterday. Working already.
Gonna need this fixed asap or lose my IMUSA entry fee!
He said it could be done through a scope as opposed to really invasive shoulder surgery with likely return to some sort of activity after 2 weeks. Anyone with contrary experience?
You probably have what is called shoulder impingement syndrome, a step less than a rotator cuff tear. Your MRI should not be normal though although, in my experience, the abnormality is so slight that radiologists frequently call it normal. If your MRI is truly normal and you are getting relief with the steroid injection you should not need surgery. Despite the “slight” abnormality seen on MRI with this disorder the pain and dysfunction can be awful.
I dealt with a lot of this in my practice but I tended to see the worst of the worst (I was a chronic pain specialist). In my experience, steroid injections never worked and surgery was necessary. Also, in the experience of the surgeon I used, when surgery was necessary, scoping was much less effective than open shoulder surgery. If the diagnosis is correct (it is easy to make on MRI, combined with physical exam if one knows what to look for) we saw essentially 100% success with surgery.
The key to getting better is correct diagnosis. If this responds to steroids I question the need for surgery, at least right now, unless it keeps coming back. If it doesn’t I would ask exactly what he is going to operate on in view of the “normal” MRI?
Thanks Frank. Good info. Great response. I’ve had this since 2002. It started with my last Ironman training regimen. Pain is chronic. I sleep prone on my stomach, cannot put right arm over my head due to pain. Swimming motion cause pain when lifing arm.
Doc said if steroid helped and remained pain free after 6 weeks or more I would probably not need surgery but he was skeptical due to my physical evaluation and history. He’s also an ironman athlete and knows what I’m about to go through. I trust the guy but your questions are valid and very real. He fixed up my foot last year just fine.
Thanks Frank. Good info. Great response. I’ve had this since 2002. It started with my last Ironman training regimen. Pain is chronic. I sleep prone on my stomach, cannot put right arm over my head due to pain. Swimming motion cause pain when lifing arm.
Doc said if steroid helped and remained pain free after 6 weeks or more I would probably not need surgery but he was skeptical due to my physical evaluation and history. He’s also an ironman athlete and knows what I’m about to go through. I trust the guy but your questions are valid and very real. He fixed up my foot last year just fine.
Sounds like shoulder impingement to me but there has to be an abnormality on MRI to confirm the diagnosis and you should get complete (I mean complete) temporary relief with an injection of local anesthetic into the subacromial bursa. (at least that is how I confirmed it) If the diagnosis can be confirmed then you will almost certainly need surgery. If not, it is something else (there are alternative diagnoses) and shoulder surgery will be a waste of time.
Well I can tell you this much Frank, 24 hours later and I have complete 100% relief from pain throughout my entire range of motion. Other than residual pain from the injection, the joint pain is gone. First time in 3 years.
I’m starting to get a little confused now though - are you saying that relief from pain must be accompained by a positive MRI diagnosis to indicate surgery?
I feel your pain. I have had both conditions. 2.5 years ago I tore (heard it) my left rotator cuff. I managed to hold off surgery until after a OD race that I had already paid for. Surgeon agreed that it would not get much worse. I ended up having the repairs done through a scope by a highly skilled surgeon. I will not lie to you … the post surgery pain is a level of suffering like nothing else (even with oxycontin & oxycodin) . Partial recovery was 3-4 months with PT. I really improved once I was able to swim again. Full recovery was closer to 12 months. Now that shoulder is great but have had some recent impingement problems with my right one. For me it is likely due to muscle imbalance from years of swimming. Get with a good PT to set up exercise program and stick with it. Surgery should be the last resort.
Good Luck,
I had an impingement. The two keys to getting better are:
Go see a good PT.
And have your swim stroke analyzed. The poor strength and flexibility turned into a bigger problem because my timing was off in my stroke. I was in too much of a catch-up stroke, with my recovering hand entering the water too close to when I began to pull. This meant I was trying to reach into the water while still fully on my other side. (think standing with your right shoulder to the wall and trying to touch the wall above your head with your left hand vs. standing chest to the wall and trying to touch the wall with your left hand – you will feel the pinch). I also tended to enter to close to the centerline of my body (think entering at 11:30/12:30 instead of 10/2) which made this even worse. I am not saying that these are your exact problems, just trying to give some examples of things that might aggravate it.
But you NEED to develop flexibility and strength in the joint.
Friction massage will also help to alleviate the pain.
Also, get a good swim coach. Make sure you swim smooth with a high elbow and good body rotation.
Well I can tell you this much Frank, 24 hours later and I have complete 100% relief from pain throughout my entire range of motion. Other than residual pain from the injection, the joint pain is gone. First time in 3 years.
I’m starting to get a little confused now though - are you saying that relief from pain must be accompained by a positive MRI diagnosis to indicate surgery?
If you get complete relief of pain with a steroid injection I would not get surgery right now. I can tell you I never saw such in my population. I could get complete relief with the local anesthetic combined with steroid (that way I knew I got it where it needed to be) but it would last 2 hours and afterwards the patient would be worse because they would be moving their upper extremity because it didn’t hurt.
So, unless the pain returns when you resume normal activity I see no need for surgery, even if you need an injection like this once or twice a year when things flair up.
How old are you? If you are 20 surgery now might be indicated as someday you will progress to needing it but if you are 60 I would wait. Discuss it with your doctor. He seems to be on top of things.
Thanks again Frank. I turn 40 in November.
Thanks again Frank. I turn 40 in November.
Your first mid life crisis! Surgery or not?
Thanks again Frank. I turn 40 in November.
I might add that in view of your response to the injection I would pursue some of the other advice with PT and perhaps stroke analysis to see if it can be addressed non surgically. At least, surgery can be delayed.