Q. Can I try physiotherapy for my shoulder pain?

Hello,

Welcome to icliniq.com.

I have seen the attached report (attachment removed to protect patient identity). The MRI film is more helpful than a report on its own.

• You reported a fall from the bike a few months ago, but you describe little as to what happened immediately after the injury. I need the following details:

1. Did the shoulder dislocate? Did you have any x-rays?
2. What was the period of rest? Was a sling needed?
3. What was your range of movements then? How does it compare with movements now?
4. Do you have pain at rest or with certain movements?
5. What physiotherapy have you had? What was the physiotherapist's impression?

• Going by the MRI report, which I must say is very ordinary, there is a tear in your rotator cuff, especially the supraspinatus muscle. But, there is no mention of the size of the tear, in addition, a slap tear is present, but I am not sure without seeing the films.

• Please upload the films, and answer the above questions for me to help you better.

Revert with more information to a fitness expert online --> https://www.icliniq.com/ask-a-doctor-online/fitness-expert

Hello,

Welcome back to icliniq.com.

• I have seen your MRI films (attachment removed to protect patient identity) myself, and I feel that you have a small articular surface tear of the supraspinatus tension and not a full thickness tear as reported.

• The implication of this is that you need an arthroscopic assessment and if need be, debridement or repair of the tear of the shoulder if the pain and feeling of weakness do not settle in three months from injury.

• You also need to send me the x-rays of your left shoulder to assess the cyst reported in the x-ray. If this is a fracture instead of a cyst, then we may have to reassess the situation.

• Keep the arm in the sling and do pendulum exercises only. Avoid anti-gravity exercise of the arm that you move the arm in front of your body unprotected.

Revert with more information to a fitness expert online --> https://www.icliniq.com/ask-a-doctor-online/fitness-expert

Hello,

Welcome back to icliniq.com.

• The new MRI (attachment removed to protect patient identity) showed a slight displacement of the bone at the site of the cyst. I will request you to arrange for an x-ray of the shoulder. Get a Grashey AP (anteroposterior) and Y view of the shoulder.

• This is to see any displacement of the fragments. Ideally, the x-ray is the first investigation done before an MRI, as these small diagnostic dilemmas are more easy to address. Please update the x-ray. Thanks.

Revert with more information to a fitness expert online --> https://www.icliniq.com/ask-a-doctor-online/fitness-expert

Hi,

Welcome back to icliniq.com.

I have seen the attached x-ray (attachment removed to protect patient identity).

• As I had suspected, there is a fracture of the greater tuberosity and that has been the source of your symptoms as the fracture has dislodged from its place, and I feel that you are better off having it fixed surgically.

• What a shame that an MRI was asked before a plain x-ray, otherwise the fracture would have been picked up earlier and treatment would be to immobilize the shoulder and not have physiotherapy till the fracture heals.

• Note that now the fracture is unlikely to heal as it is out of place.

For more information consult a fitness expert online --> https://www.icliniq.com/ask-a-doctor-online/fitness-expert

Hello,

Welcome back to icliniq.com.

• The fragment is small and may not hold a screw, I feel that a simple figure of eight with an orthocord around a distal screw should be enough for the repair of the rotator cuff.

• You will need to keep your arm in a sling for three weeks till the fixation is sound. Pendulum exercise is allowed during this period. No active or overhead movements are allowed till six weeks.

• At three months, start resistive and strengthening exercises with full strength.

For further queries consult a fitness expert online --> https://www.icliniq.com/ask-a-doctor-online/fitness-expert

Hello,

Welcome back to icliniq.com.

• I think when you talk about biodegradable screws, it will require you to have a larger fragment, in your case, no such thing is needed. Only a small area needs freshening up and then the metal screw can be placed distally with a figure of eight suture in the rotator cuff.

• You will need a diagnostic arthroscopy, this is to confirm the MRI findings followed by an open procedure with a small 5 cm incision.

For more information consult a fitness expert online --> https://www.icliniq.com/ask-a-doctor-online/fitness-expert

Hi,

Welcome to icliniq.com.

• The screws can be removed after the fracture has healed. It usually takes 4 to 6 months.

For further queries consult a fitness expert online --> https://www.icliniq.com/ask-a-doctor-online/fitness-expert

Hi,

Welcome back to icliniq.com.

• The screw need not be removed as it should not cause problems, but if you do so wish the screw can be removed by a small open procedure.

• More important than x-rays, clinical healing will be taken into account while progress will be monitored, an x-ray will show healing but the fragment is small. The lack of clinical symptoms and satisfactory progress at three months will be our guide to healing.

For further queries consult a fitness expert online --> https://www.icliniq.com/ask-a-doctor-online/fitness-expert

Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Dr. Atul Prakash

Experience: 33 + Yrs

Orthopedician And Traumatology

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