Cuff Tendinopathy Tear?

Discussion in 'Health & Fitness' started by tennisenthusiast, Jul 5, 2011.

  1. tennisenthusiast

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    My ortho wrote script to get an MRI today and on it was written as "dx cuff tendinopathy tear"

    What does it mean? My shoulder pops everytime consistently when I do an external rotation and when I told him over the phone he told me to ignore that if there was no pain. But I was adamant and took appt; when I went today and when I was able to show him that my shoulder popped consistently he was surprised to see how consistent the pop was and reffered me to an MRI

    This was my third followup visit.

    In my first visit, pop was there but not so consistently but off late it is just so conspicuous. I am surprised why do they simply ignore symptoms in people who are not over 40 and just disregard the symptoms.

    Is this tear reversible or am I done with tennis forever? I went to conservative therapy for 10 weeks with no considerable improvement.

    I asked doctors explicitly whether I could play or not during my initial visits and they said it should not be a problem. But I am now repenting thinking I shouldnt have played.

    I have no pain but just the pop. When I did some research, an article said that a tear can still have pop with no pain.
     
    #1
  2. ollinger

    ollinger Legend

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    Too soon for despair. A friend of mine had a rotator cuff tear repaired in his 50s, plays tennis today. Not likely you did further damage by playing.
     
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  3. tennisenthusiast

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    What do you mean by repaired? Do I have to have a surgery to get it repaired? Please tell me no.
     
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  4. ollinger

    ollinger Legend

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    You haven't even had the MRI yet. If there is a non-trivial tear, surgery will be recommended. If you have surgery, you'll wear a sling for several months and not play tennis for at least 6-9 months.
     
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  5. Limpinhitter

    Limpinhitter Legend

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    Does your ortho specialize in sports medicine? If not, IMO, you should see one who does. In the mean time, the MRI will show what damage you have. From there, you can chose a course of action. It could range from surgical repair to a torn rotator cuff tendon or labrum, to merely doing exercises to stabilize your shoulder joint. In any event, you can definitely pay tennis again. Indeed, you may find out that you do not need to stop at all.
     
    Last edited: Jul 6, 2011
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  6. tennisenthusiast

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    I am claustrophobic. Will I have problems with MRI? For shoulder MRIs, do I have to go through whole body MRI?
     
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  7. ollinger

    ollinger Legend

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    About 30% of MRI exams are aborted due to anxiety. A mild sedative (valium, xanax, klonopin, whatever) is a good idea an hour before, close your eyes before they slide you in and don't open them until they slide you out; lively sexual fantasy during that time is essential.
     
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  8. tennisenthusiast

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    Yes, my ortho specializes in sports medicine. I hope I can play tennis again...!
     
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  9. pdx_tennisplayer

    pdx_tennisplayer New User

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    The MRI I had wasn't so bad, it was a T3 machine (very good) with open front/back end but you are enclosed and cannot move. I found the biggest issue with the MRI was the sheer volume of noise. It basically sounds like you are next to a Diesel truck even with headphones and my music blaring in my ears! It lasted about 25 min with 5 stints of 5-6 min each. Tell them you want headphones and to turn it up!!
     
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  10. tennisenthusiast

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    Went for MRI today and had no problems at all. It had enough room; only thing was the blaring noise. I am anxiously waiting for the results.
     
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  11. larry10s

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    ask the doc for a copy of the report
    give us the report not what the doc tells you
     
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  12. Tennis_Monk

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    I am assuming that this would be after sanitizing the report to remove any personally identifiable information unless the OP doesnt mind.
     
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  13. larry10s

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    of course you can stay anonymous:)
    its just having the medical description and not the "laymens" version would be more precise
     
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  14. tennisenthusiast

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    Got call from my doctor. This is what I heard from him.

    1. Your rotator cuff looks good but there is an inflammation in your AC joint.

    2. Tiny labral defect in cartilage? That is what I heard but maybe it does not make sense. He said that this is not of a major concern.

    He said that he can give cortisone injection at the top of the shoulder for AC inflammation.

    Should I go for injection or not? Any experiences that you can share? I completely understand that it boils down to my choice and individual case symptoms but any experiences with cortisone injection?
     
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  15. tennisenthusiast

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    sorry that was a layman report. I did request the report, so, will be updating this thread as soon as I get it.
     
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  16. i_heart_ib

    i_heart_ib Rookie

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    From what I've heard, it's best to avoid the cortisone injection. Often time, it's more of a temporary relief and not the best option, as sometimes the pain comes right back after a month or so.

    Again, this is just from what I've heard from others, so don't put too much weight on this. However, I believe that it's best if you can avoid it if possible.
     
    #16
  17. charliefedererer

    charliefedererer Legend

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    Your MRI showed AC joint inflammation.

    But you have no pain.

    So what is the cortisone supposed to do? How will it help you?

    Does your orthopod now think that the clicking in your shoulder is at the AC joint, because of a low grade AC joint separation? If so, I would think the cortisone would delay the healing process.

    [​IMG]

    "AC joint injuries are graded from 1-6 using the Rockwood scale which classifies injuries in relation to the extent of ligament damage and the space between the acromion and clavicle, as shown in the pictures opposite.

    Grade 1 is a simple sprain to the AC joint, grade 2 involves rupture of the AC ligament and grade 3 rupture of both AC and CC ligaments which often results in a superior displacement. From this point onwards the scale and grade of injury depends on the degree of displacement of the clavicle."
    -http://www.sportsinjuryclinic.net/cybertherapist/front/shoulder/acjoint.htm

    If he thinks that the clicking is due to an AC joint separation, do you need a 2-3 week period of taping to "immobilize the joint" to let healing occur?

    If he thinks that the clicking is due to the AC joint, does he think a rehab program similar to the following is appropriate after a period of healing?

    Rehabilitation of AC Joint Injuries http://www.sportsinjuryclinic.net/cybertherapist/front/shoulder/acjoint/ac-rehabilitation.php



    I would think you would want to know the answers to all these questions put to your orthopod.
     
    #17
  18. tennisenthusiast

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    Hi All,

    Here is the MRI report. Please please share your comments. Please!

    ---- begin -----

    MR examination of the right shoulder performed usinga local coil. transverse, oblique

    coronal, and oblique sagittal short TR/TE and fast spin-echo images were obtained. no

    prior right shoulder MR is available for comparison.

    RESULT:

    there is a type I acromion without subacromial spur. the acromioclavicular joint appears

    normal. there is focal edema in the distal aspect of the right clavicle. the coracoacromial

    ligament appears normal. there is no subacromial-subdeltoid bursitis.

    the muscles of the rotator cuff have normal bulk. the rotator cuff tendons are intact

    without evidence of tendinopathy or tear.

    on this non-arthographic exacmination, the long head of biceps appears normal. there is

    a focal linear labral defect at the 2 o' clock glenoid position containing a small amount of

    fluid. a physiologic amount of fluid is present in the glenohumeral joint. there is a normal

    marrow signal intensity within the bones of shoulder girdle.

    IMPRESSION:
    1. mild distal right clavicular osteolysis ;likely secondary to repetitive trauma.
    2. normal rotator cuff.
    3. tiny linear labral defect at the 2 o' clock position of the right glenoid, likely a sublabral

    foramen, a normal anatomic variant. if there is clinical concern for a labral tear, MR

    arthrogram of the shoulder would likely be diagnostic.

    --------- end -----
     
    #18
  19. charliefedererer

    charliefedererer Legend

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    The official MRI shows a "normal" AC joint, although the focal edema is indicative of inflammation there.


    MRI's often show evidence of minor old changes that don't have much clinical significance. That is why the MRI is only one part of making a diagnosis, with clinical correlation from the history and physical exam all needed to come to a worthwhile conclusion.

    Nevertheless, overall it sounds like pretty good news that there are no major problems on this MRI report.
     
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  20. tennisenthusiast

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    right now there are no words to express my frustration with myself, my diagnosis and symptoms.

    why wasn't AC joint inflammation diagnosed the first time when I visited the doctor? as a layman i knew something was wrong but all my symptoms were disregarded and was prescribed therapy for rotator cuff when in reality everything was fine with cuff.

    i visited two different doctors not once but twice which is four visits in total. attended 10 therapy sessions to alleviate wrong problem.

    enough of my gripe. does anyone think that the pop is due to labrum issue? do you think i need to go for another MRI with contrast?
     
    #20
  21. larry10s

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    IMPRESSION:
    1. mild distal right clavicular osteolysis ;likely secondary to repetitive trauma.
    2. normal rotator cuff.
    3. tiny linear labral defect at the 2 o' clock position of the right glenoid, likely a sublabral

    foramen, a normal anatomic variant. if there is clinical concern for a labral tear, MR

    arthrogram of the shoulder would likely be diagnostic.
    ok lets see what the big picture is
    1. see the link yes cortisone shot is an option
    http://shoulderpaininfo.com/shoulderACOsteolysis.html
    bad news can take a long time to recover
    2.YEAHHHHHHHHHH:)
    all of the common bad things that can go wrong with your shoulder youdont have:)

    3. labral tear
    clinically significant???????

    im not sure that one you need to talk to your doctor about


    on another note
    your frustration of why it took so long to come up with a diagnosis
    is that sometimes things are not black and white
    you try to treat /exclude common things first

    common things present themselves uncommonly before uncommon things
    physical therapy. nsaids.ice etc is conservative therapy and always appropiate
    imho
    when you dont improve its time to do more
    just my 2 cents
     
    #21
  22. tennisenthusiast

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    Almost one and a half years into this shoulder popping...still no luck. I do have pain in the shoulder near AC joint and back of rear of my shoulder.

    I suspect that something is going on with my AC joint because I see no improvement ever since I stopped playing tennis last spring. I also suspect that I might have SLAP tear.

    I am going to ask my ortho to refer me to an arthogram MRI.
     
    #22
  23. charliefedererer

    charliefedererer Legend

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    I'm sorry to hear you are still having problems.

    Hopefully that orthopod will get to the bottom of things, and you can finally make some progress.
     
    #23
  24. tennisenthusiast

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    charliefedererer - the thing i am frustrated about is why is it taking so long to diagnose accurately. initially i might
    have only had inflammation and i seriously suspect that the inflammation progressed into tear due to repetitive strain.
     
    #24
  25. charliefedererer

    charliefedererer Legend

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    You very well may be right.

    Microscopic tears would not have shown up on your MRI.

    But over time the very tiny tears could have coalesced into a more major tear.

    The arthrogram MRI may be the way to go to get an accurate diagnosis of what you currently have. But seeing your shoulder specialist and getting his advise on the next test or what else to do would seem to be the next appropriate step.
     
    #25
  26. tennisenthusiast

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    insurance denied my doctor's request for an arthogram. wht can i do now?
     
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  27. charliefedererer

    charliefedererer Legend

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    Don't take "no" for an answer.

    It will take time, but call the insurer and get someone to review the request.

    Be persistent. Ask for a supervisor. If no help, ask for the supervisor's supervisor.

    Talk with your doctor's office. Ask them if they have advice on how to get your request reviewed.
     
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  28. tennisenthusiast

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    Yesterday after several unsuccessful attempts of insurance precerts, I accepted my defeat and had my cortisone shot yesterday near AC joint :(

    I am not sure whether cortisone will help or not but being optimistic. This pain has been there for almost 2 years and nothing has helped - conservative treatment, waiting out, staying away from tennis, strengthening - you name it and I did them all to no avail.

    Any suggestions?
     
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  29. tennisenthusiast

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    Did the cortisone shot mask my pain? I have not tried overhead motion but pain seems to have subsided for now.
     
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  30. tennisenthusiast

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    Pain returned this year. Don't know whether it was resistance band strengthening that caused it or me starting tennis again outdoors.

    Went to get a second opinion with an ortho and he gave me four options:

    1. Don't play and live pain free.
    2. Play and bear pain.
    3. Get an injection.
    4. Get surgery and we will trim collar bone.

    He said that based on my history and records and physical exam cartilage between A and C is damaged. It cannot be reversed.

    Will cortisone injection weaken my shoulder? It is already weak. I do not know what to do. I have been having this problem since 2011. Even hearing that I won't be able to play tennis pain free is making me shiver. What should I do? He said physical therapy is not going to help, bluntly. :(

    SOS
     
    #30
  31. Chas Tennis

    Chas Tennis Hall of Fame

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    Sorry to hear that you have had this injury and the worries about it for so long.

    Sorry also, no good advice here, other than some things for you to research.

    The Acromioclavicular joint is the lesser known joint at the shoulder.
    http://en.wikipedia.org/wiki/Acromioclavicular_joint

    The article says that it is often injured by impacts, very common in impact sports. Did you have any known trauma? Also, overhead sports and arthritis affects the AC joint. Serious arthritis?
    http://www.sportsmed.org/uploadedFiles/Content/Patient/Sports_Tips/ST AC Joint Injuries 08.pdf

    Video on the joint. Find other videos to check the information.
    http://www.youtube.com/watch?v=oJz76hYa4jI

    The joint has ligaments around it and some cartilage between the bones. It looks very small. The video shows that it also has some ligaments attached away from the joint that might be important for how the joint aligns. Have they said anything about your scapular alignment in PT?

    Did you ever get that arthogram MRI? If not, was the last MRI the one in 2011?

    To check and better understand your injury you might search all the terms mentioned and conditions in your MRI report and see which are located near your pain. Does the pain location make sense with the motion problems that you have?

    In other words, in your opinion, does everything point to the Acromioclavicular joint as the main injury?

    Does the Acromioclavicular joint have two kinds of cartilage? A question to research is whether the Acromioclavicular joint has two types of cartilage as some other joints do. For example, the knee joint consists of articular cartilage on the ends of the bones and the meniscus cartilage in the joint. The link on the meniscus says that the AC joint also has one cartilage ("disk", in video?) of similar cartilage tissue to the meniscus. If the Acromioclavicular joint has two types of cartilage you might discuss that issue with your Dr. Particularly, what is/might be the condition of each cartilage? How would the surgery - that would "trim" the collar bone - affect the remaining cartilage(s)?

    Search: Acromioclavicular joint cartilages pictures

    There are pictures, probably in cases of severe arthritis, where the entire end of the collar bone has been removed. If that is what is proposed in the surgery research the procedure and the stability of the shoulder afterwards.

    AC Joint Injury & Treatment
    http://www.hopkinsortho.org/ac_joint.html

    http://gamradtortho.com/conditionsShoulderAcromioclavicularJointOsteoarthritis.php
     
    Last edited: Sep 19, 2013
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  32. tennisenthusiast

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    I got Arthogram MRI last week and the results came back negative for a labrum tear and AC joint tear.

    My symptoms and frustration are persisting. Ortho suggested I go for another shot of Cortizone. What should I do? What should I do? I repeat, what should I do?

    I am quite positive there is something going on with my shoulder but what is it? If MRI with contrast came back negative, what can I think of that?

    I am only 32 and I have no problem stopping tennis but how can I fix my shoulder problem? Is surgery my only option?

    Any pointers?
     
    #32
  33. red rook

    red rook Rookie

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    It could be worse. My arthrogram mri this month showed slap tear.
     
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  34. springfieldalum

    springfieldalum New User

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    Are the orthopedics you have seen shoulder specialists? What racquet were you using and strings were you using when this started? I can't tell you that a cortisone injection would help, but unless you have had several/many, I doubt having one or two is going to cause permanent harm. Do you ice your shoulder, use heat, or have you taken any ibuprofen to see if that helps? I would make sure you do some light strengthening and range of motion exercises consistently. Just my 2 cents from someone who has had a serious shoulder issue, took about 2 years to fully heal, and who has a strange acromion and marked cartilage narrowing.
     
    #34
  35. springfieldalum

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    http://orthopedics.about.com/od/shoulderconditions/qt/Distal-Clavicle-Osteolysis.htm

    This explains your probable situation and why you have pain. It's pretty good and maybe better than how your dr. has described it to you. I would read the article in full.

    It states:

    Distal clavicle osteolysis initially shows up as an area of poor bone density or bone lacking appropriate mineralization, which can look like the bone loss of osteoporosis, a condition where more bone is absorbed by the body than created.
     
    #35
  36. Chas Tennis

    Chas Tennis Hall of Fame

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    Are you still playing?

    Could you list a chronology of your injury from the beginning with the recovery periods. Not many details - the main thing would be to see how many long recovery periods you have had. List all periods of 1 month or longer since you got the injury.
     
    #36
  37. tennisenthusiast

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    I stopped playing intense (intense according to my recreational standards) tennis one and a half years ago.

    I am going to list the periods shortly sometime today. Thanks for any pointers.
     
    #37
  38. tennisenthusiast

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    And, also I would say I am playing tennis once a month or twice at the max (not often than that)
     
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  39. tennisenthusiast

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    Also, this thread's title is a misnomer. I started it based on what my ortho thought. My rotator cuff is ABSOLUTELY fine.
     
    #39
  40. tennisenthusiast

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    Thanks springfieldalum - that sounds just about right.
     
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  41. tennisenthusiast

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    From an article on ESPN Cricket:

    Cortisone injections are useful for chronic problems among cricketers, but only up to a point. Repeated use of the treatment can result in a lessening of its effectiveness, while also taking a toll on the joint itself - something Pietersen's former Hampshire team-mate Shane Warne experienced when having his overworked spinning finger repeatedly jabbed early in his career before finally resorting to surgery in 1996.

    http://www.espncricinfo.com/the-ashes-2013-14/content/story/687219.html (5th paragraph from the end)

    How effective are these cortizone shots if taken once or twice? If it did not help first time, will it help next time?
     
    #41
  42. Chas Tennis

    Chas Tennis Hall of Fame

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    Reports on Cortisione

    Search of NCBI for free full reports on Cortisone. 17,000 finds, have to refine the search.
    http://www.ncbi.nlm.nih.gov/pmc/?term=cortisone

    Bookmark this NCBI site as the name for it is an acronym that is not obvious.
     
    #42
  43. RogueFLIP

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    It also states that it can be confirmed by MRI, which the OP has had two....which I would think would mention this diagnosis.

    Sorry to hear that you've had this frustrating issue for more than 2 years. Always sad to hear a fellow player not being able to do what we all love.

    Obviously at this point being a chronic condition, you have to consider that your symptomatic area at the AC joint is not the origin of your pain. There may be a structural imbalance somewhere else in your body and/or significant soft tissue restrictions that continuing to put pressure on your AC joint under duress.

    Think of it like a rope: whereas you can tug on one end of the rope, but you feel the tug at the other end. If all you're doing is looking at the end where you feel the tug, you could be missing a whole lot.

    Chronic issues you always have to look at the whole picture, not just symptomatic regions.

    What's the thoracic spine look like?
    How does the scapula(s) move?
    What's the neck look like?
    Soft tissue mobility of the region compared to the other side?
    What's going on at the pelvis?

    Any and all plus more can easily affect your symptomatic areas. Your body has had plenty of time to develop compensations to avoid pain.

    Everything is all connected.
     
    #43
  44. tennisenthusiast

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    I have a tender spot in the left side of my thoracic spine between my left shoulder blade and spine. This has also turned into chronic condition because none of the chiro visits or physio visits helped. However, the doc says that it is not related to my AC joint issue.

    There is definitely some kind of tension in the neck. As a matter of fact, I got spasm last week and it lasted for couple of days just because I turned my neck fast while on bed.

    I don't know how to approach this problem.
     
    #44
  45. Chas Tennis

    Chas Tennis Hall of Fame

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    Video on pinched nerve and shoulder pain.

    I don't know much about pinched nerves.

    My son would get some tingling in his arm-hand sometimes after he would work out and build up a bit. He did some shoulder alignment exercises and said that the issue did not occur.

    The spine and other well-know nerve pinch spots usually cause pain, numbness, tingling, other?, in certain locations. There are body maps relating the location of the nerve pinch and the symptoms.

    http://www.videojug.com/film/how-to-treat-a-pinched-nerve-in-shoulder
     
    Last edited: Nov 13, 2013
    #45
  46. RogueFLIP

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    http://mfrtherapists.com/

    Suggest you get in touch with a therapist near your area. Contact them, explain your situation and let them explain how they be able to address your issues.

    If what they say resonates with you, make an appointment to get some treatment.

    Not saying MFR will "cure" you, I'm just letting you become aware of it.

    Good luck.
     
    #46
  47. tennisenthusiast

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    Are these therapists covered by insurance? Do I need a doctor's prescription to see them?
     
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  48. RogueFLIP

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    As far as prescriptions goes, it depends. If you see a massage therapist who does MFR, no you won't need one.

    If you see a physical/occupational therapist who does MFR, you might need one depending on what state you live in and their direct access laws.

    The insurance, well, also depends. I don't know too many MFR therapists that accept insurance, a lot work on a fee-for-service basis. If you have out of network benefits, you might be able to submit receipts for reimbursement.

    Some MFR therapists may accept insurance directly.

    Your best bet is to contact the therapist directly. Good luck.
     
    #48
  49. tennisenthusiast

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    Finding a physical therapist who is also an MFR specialist would be great but that is not the case it seems where I live. And, an exclusive MFR therapist's fee-for-service is way too expensive for me....cannot afford it.
     
    #49
  50. RogueFLIP

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    800
    http://myofascialrelease.com/resources/mfr-talk.aspx

    You can subscribe to the chat, it's an email chat about MFR. You could ask if there's any advanced therapists near you. Unsubscribe after you've gotten the information you want.

    Suggest if you do subscribe to use a secondary email as its an email chat with many different conversations going on at once; so you can easily receive hundreds of emails in one day.

    You can read of course the other conversations, just be warned that some contain some pretty esoteric topics.

    Give it a day or two for people to respond to you.

    The other list is for MFR therapists that pay to be on that list, by no means is it a list of ALL MFR therapists.

    I hear ya, yes it's not cheap. But again, I'm just trying to let you be aware of the system. Perhaps if you got in touch with someone and got more information, you could make a more informed decision regarding your next step and your financial situation.

    Good luck.
     
    #50

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