Shoulder MRI Report: "Mild tendonosis of supraspinatus and infraspinatus."

[Raul_SJ]

Shoulder MRI Report: "Mild tendonosis of supraspinatus and infraspinatus."
Report says no indication of rotator cuff tear. Everything else normal according to MRI. X-ray report says no arthritis.

Doctor said to do stretching and come back and see him after 2 months. Said these types of issues resolve by themselves.
Very slight pain when serving.
Discomfort is mainly at night sleeping and when reaching behind back as follows. Do not have full range of motion behind back. Ouch!

 

[tennisenthusiast]

Do you have strength in your affected shoulder? I am also suffering from same symptoms and have been going to physical therapy and stretching at home since two months. Range of motion is slowly returning but strength is not.

 

[ollinger]

It appears you can still give the "I'm going to poach" signal

 

[megamind]

it appears you can still perform suresh's renowned backscratch drop volley

 

[Dartagnan64]

Well it's old age wear and tear rather than an acute injury. No different than most cases of achilles tendinitis and TE. Just affecting the rotator cuff tendons. Get a theraband and do external shoulder rotations with it.

 

[mad dog1]

Shoulder MRI Report: "Mild tendonosis of supraspinatus and infraspinatus."
Report says no indication of rotator cuff tear. Everything else normal according to MRI. X-ray report says no arthritis.

Doctor said to do stretching and come back and see him after 2 months. Said these types of issues resolve by themselves.
Very slight pain when serving.
Discomfort is mainly at night sleeping and when reaching behind back as follows. Do not have full range of motion behind back. Ouch!

If you have a pull up bar, grab the bar and hang from it to stretch the shoulder joint. If you can not hang for an extended period of time, you can use the pull down machine set at a lighter weight at the gym to accomplish a good stretch in your shoulder.

 

[Raul_SJ]

it appears you can still perform suresh's renowned backscratch drop volley

Do not yet have full range of motion to perform true back scratch volley. Only halfway.

 

[megamind]

Do not yet have full range of motion to perform true back scratch volley. Only halfway.

I will pray for ur ability to backscratch drop volley

 

[Raul_SJ]

If you have a pull up bar, grab the bar and hang from it to stretch the shoulder joint. If you can not hang for an extended period of time, you can use the pull down machine set at a lighter weight at the gym to accomplish a good stretch in your shoulder.

Have not tried that yet... Been dangling arm while holding a 10 pound weight. Feels better when I do it.
Maybe it is pretty equivalent to hanging from bar?

 

[jmnk]

Shoulder MRI Report: "Mild tendonosis of supraspinatus and infraspinatus."
Report says no indication of rotator cuff tear. Everything else normal according to MRI. X-ray report says no arthritis.

Doctor said to do stretching and come back and see him after 2 months. Said these types of issues resolve by themselves.
Very slight pain when serving.
Discomfort is mainly at night sleeping and when reaching behind back as follows. Do not have full range of motion behind back. Ouch!

I had about the same range of motion when suffering from 'frozen shoulder'. There's apparently no cure - just time. Mine lasted about 18-22 months, it is way better now, but it never got as flexible as the other shoulder.

 

[Raul_SJ]

Do you have strength in your affected shoulder? I am also suffering from same symptoms and have been going to physical therapy and stretching at home since two months. Range of motion is slowly returning but strength is not.

I was always able to lift things above my shoulder so don't think "strength" was ever really affected that much. The pain was mainly when reaching behind my back...
What is done at physical therapy?

 

[Raul_SJ]

I had about the same range of motion when suffering from 'frozen shoulder'. There's apparently no cure - just time. Mine lasted about 18-22 months, it is way better now, but it never got as flexible as the other shoulder.

Any known cause for the "frozen shoulder"?

 

[mad dog1]

Have not tried that yet... Been dangling arm while holding a 10 pound weight. Feels better when I do it.
Maybe it is pretty equivalent to hanging from bar?

Try hanging from the pull up bar or pull down machine. It gives the shoulder a better stretch. @R1FF told me about this. It’s worked wonders for my shoulder pain.

 

[tennisenthusiast]

I was always able to lift things above my shoulder so don't think "strength" was ever really affected that much. The pain was mainly when reaching behind my back...
What is done at physical therapy?

My PT does soft tissue manipulation thus improving my range of motion. I cringe for those however many minutes he works on my shoulder. I have tight/frozen shoulder. If you have complete strength and only inflammation then do shoulder stretches - you will get better soon with regular stretching.

 

[tennisenthusiast]

Oh yeah I also have difficulty reaching behind my back and pain at night. I am doing towel stretches regularly even at work and that is helping. Pull the towel up and hold as long as you can hold. Repeat.

 

[jmnk]

Any known cause for the "frozen shoulder"?

apparently age and overuse. seems about right in my case. Also some people are supposedly more likely to get it at some point.

 

[movdqa]

Do you have strength in your affected shoulder? I am also suffering from same symptoms and have been going to physical therapy and stretching at home since two months. Range of motion is slowly returning but strength is not.

One of my hitting partners had a fall and shoulder damage. A ligament or tendon was torn and he doesn't have the strength in that shoulder anymore. He waited too long so that they can't reattach it. So he learned to play lefty.

 

[Raul_SJ]

My PT does soft tissue manipulation thus improving my range of motion. I cringe for those however many minutes he works on my shoulder. I have tight/frozen shoulder. If you have complete strength and only inflammation then do shoulder stretches - you will get better soon with regular stretching.

MRI report indicates "tendonosis". Apparently there is an important distinction between tendon-itis and tendon-osis. Shoulder tendonitis indicates inflammation and can sometimes resolve in few weeks. But tendonosis typically takes longer -- tendonosis indicates that there is no inflammation; mainly degeneration.

Similarly, "Tennis Elbow", which was previously thought of as "itis" (inflammation) is now considered to be tendonosis.
Although there is still confusion as my Primary Doctor said, "MRI indicates you have mild inflammation", even though report does not mention inflammation.

 

[Dartagnan64]

MRI report indicates "tendonosis". Apparently there is an important distinction between tendon-itis and tendon-osis. Shoulder tendonitis indicates inflammation and can sometimes resolve in few weeks. But tendonosis typically takes longer -- tendonosis indicates that there is no inflammation; mainly degeneration.

Similarly, "Tennis Elbow", which was previously thought of as "itis" (inflammation) is now considered to be tendonosis.
Although there is still confusion as my Primary Doctor said, "MRI indicates you have mild inflammation", even though report does not mention inflammation.

Better to use the term "tendinopathy" as most cases show both degeneration and inflammation to varying degrees.

 

[R1FF]

apparently age and overuse. seems about right in my case. Also some people are supposedly more likely to get it at some point.

Actually it’s not from “over use” but atrophy followed by intense use.

If everyone did just 20 pullups a day, they’d likely never have ANY shoulder or back issues.

Heck, I think I read a statistic that said only 1 in 5 Americans can actually do a single pushup. Combine that with the resulting inflammation of the standard American food diet (80% carbohydrates) and it’s no wonder so many suffer pain.

I was one of em too. Now I play tennis 6 days/week. Never stretch. Never sore. No more pain or injuries.

 

[Crocodile]

Just do your rehab and with time you will come good, you just need to be persistent and see your Physio therapist weekly.
As far as time recovery can be anytime from 3 months to 2 years. It depends on how you use your arm.

 

[SystemicAnomaly]

Inflammation present? A tendinopathy designated at tendinitis (tendonitis) is supposed to indicate inflammation while tendonosis (tendinosis) is supposed to indicate a chronic overuse issue where inflammation is not present. But I do not know if this convention is strictly followed by those who use it. If inflammation present, some icing might help. With not inflammation, ice may or may not be useful. I have seen ice sometimes suggested for tendonosis conditions.

Issues with (lateral) abduction? ESR or ISR?

Are you still playing or are you resting the shoulder for while? Once you get back to play, apply some heat and do some light static stretches at home/work, 1/2 hour or more before heading over to the courts. At the courts, dynamic stretches only.

 

[SystemicAnomaly]

@Raul_SJ

Better to use the term "tendinopathy" as most cases show both degeneration and inflammation to varying degrees.

Interesting. Not heard the -opathy, -itis and -osis terms used consistently by doctors and other healthcare individuals. This could explain why that is the case.

 

[Raul_SJ]

Inflammation present? A tendinopathy designated at tendinitis (tendonitis) is supposed to indicate inflammation while tendonosis (tendinosis) is supposed to indicate a chronic overuse issue where inflammation is not present. But I do not know if this convention is strictly followed by those who use it. If inflammation present, some icing might help. With not inflammation, ice may or may not be useful. I have seen ice sometimes suggested for tendonosis conditions.

Issues with (lateral) abduction? ESR or ISR?

Are you still playing or are you resting the shoulder for while? Once you get back to play, apply some heat and do some light static stretches at home/work, 1/2 hour or more before heading over to the courts. At the courts, dynamic stretches only.

I feel tight pinching type pain at very end range of motion.
Left pic: Pain at 180 degrees flexion AND at the 50 degrees of extension. Particularly the latter.
Right pic: Pain at 180 degrees abduction and at the 50 degrees of adduction.

While playing tennis, not really any pain issue with FH and OneHandBH.

Mild pain when serving, think mainly when going from "Big L" position to contact; that is the point where rapid ISR occurs.

The pain is mainly when trying to reach behind the back as below. Ouch! Was not sure what bio-mechanical movement the below image is,, but apparently it is mainly ISR.

 

[SystemicAnomaly]

I feel tight pinching type pain at very end range of motion.
Left pic: Pain at 180 degrees flexion AND at the 50 degrees of extension. Particularly the latter.
Right pic: Pain at 180 degrees abduction and at the 50 degrees of adduction.

While playing tennis, not really any pain issue with FH and OneHandBH.

Mild pain when serving, think mainly when going from "Big L" position to contact; that is the point where rapid ISR occurs.

The pain is mainly when trying to reach behind the back as below. Ouch! Was not sure what bio-mechanical movement the below image is,, but apparently it is mainly ISR.

A bit confused by this. The test you show (2nd image above) appears to test ISR (and perhaps other shoulder function). However, the Infraspinatus is employed for ESR. Puzzling. It it possible that it has an effect on ISR? It is the Subscapularis that is the rotator muscle employed for ISR.

Along with the (lateral) deltoid, the Supraspinatus is utilized for shoulder abduction. I believe that the anterior deltoid is involved in shoulder flexion and posterior deltoid for extension. Not sure which rotator muscles might assist in flexion and extension.

@RogueFLIP or anyone else in the know... do you have a better understanding of all this?

 

[Raul_SJ]

A bit confused by this. The test you show (2nd image above) appears to test ISR (and perhaps other shoulder function). However, the Infraspinatus is employed for ESR. Puzzling. It it possible that it has an effect on ISR? It is the Subscapularis that is the rotator muscle employed for ISR.

Along with the (lateral) deltoid, the Supraspinatus is utilized for shoulder abduction. I believe that the anterior deltoid is involved in shoulder flexion and posterior deltoid for extension. Not sure which rotator muscles might assist in flexion and extension.

MRI report does not indicate any issue with subscapularis tendon.
Am able to externally rotate almost to 90 degrees; some pain at the end. Much more stiff and painful on inward rotation.

Full MRI Report:

Mild tendinosis of the supraspinatus and infraspinatus tendons, without high grade partial or full-thickness tear.
The subscapularis tendon, teres minor and long head biceps tendon are intact. Muscular bulk is maintained.

Labrum: There remains grossly intact.
Acromioclavicular joint: anatomic in alignment.
Subacromial and subdeltoid bursa: Normal.
Glenohumeral joint: No joint effusion or synovitis.
Soft tissues: Remaining visualized soft tissues are unremarkable.
Osseous structures: Normal.


Impression:
1) Mild superior rotator cuff tendinosis, without high grade partial or full-thickness tear.
2) Remaining rotator cuff, long head biceps tendon and labrum are intact.

 

[movdqa]

That sounds pretty good. So can a PT work on what seems to be a relatively minor issue?

 

[Raul_SJ]

 

[TimeToPlaySets]

Take 2 months off.
Focus on leg fitness. Lunges, squats.
Let your body rest and heal.

 

[RogueFLIP]

A bit confused by this. The test you show (2nd image above) appears to test ISR (and perhaps other shoulder function). However, the Infraspinatus is employed for ESR. Puzzling. It it possible that it has an effect on ISR? It is the Subscapularis that is the rotator muscle employed for ISR.

Along with the (lateral) deltoid, the Supraspinatus is utilized for shoulder abduction. I believe that the anterior deltoid is involved in shoulder flexion and posterior deltoid for extension. Not sure which rotator muscles might assist in flexion and extension.

@RogueFLIP or anyone else in the know... do you have a better understanding of all this?

You're getting confused because you're trying to separate each individual rotator cuff muscle into their specific action, where as in reality it's not like one shuts off and another one turns on as you go through motions of ESR and ISR.

Also remember that muscles can contract concentrically (shortening) & eccentrically (lengthening). So while yes, the main function of the infraspinatus is to concentrically contract during ESR, it will contract eccentrically during ISR. So yes it can be affected and affect ISR.

@RaulSJ

But my own hypothesis for Raul SJ issues is that it's more of a postural issue that is mainly contributing to the problem.

Judging from your pic, look at your left arm. It's internally rotated at the humerus bc your palm is facing the picture. If your right palm does the same resting at your side, well then your R humerus is also rotating inwards, which might be causing a minor impingement to the front of the shoulder. Normally when your arms are resting at your side, your thumbs should be pointing forward. That's the neutral position.

Second, the tops of your shoulder by your scapula look very rounded, like they're pitching forward; now it could just be the lighting and shadows.....but if I'm right, then this posture also will add to closing the joint space of the front of your shoulder....another minor factor to possible impingement.

Raul SJ, exaggerate some forward posture.....stand up, slouch head and shoulders forward, turn your arms inward so your palms face behind you and try to raise your arms to point to the ceiling. Notice the feel.

Now, stand up straight, nice and tall, arms with your thumbs facing forward and raise your arms to point to the ceiling. Notice this feel. Which one feels easier and more fluid?

So basically, if you've been in that forward rounded posture where everything is tight in the front of you (internal rotators), guess what has to work extra hard to compensate? The opposite (external rotators). So then you wonder why you've developed issues.

I've utterly oversimplified things mate.....

Something to consider......I'm off to bed.....

 

[Raul_SJ]

@RaulSJ

But my own hypothesis for Raul SJ issues is that it's more of a postural issue that is mainly contributing to the problem.

That was a random Google pic. Not me. Sorry for the confusion.
But my range of motion behind the back is about the same as that guy.
Will check if my posture is meeting the guidelines you've outlined.

 

[SystemicAnomaly]

You're getting confused because you're trying to separate each individual rotator cuff muscle into their specific action, where as in reality it's not like one shuts off and another one turns on as you go through motions of ESR and ISR.

Also remember that muscles can contract concentrically (shortening) & eccentrically (lengthening). So while yes, the main function of the infraspinatus is to concentrically contract during ESR, it will contract eccentrically during ISR. So yes it can be affected and affect ISR...

Thanks for the clarification, RF. I suspected that it might be some like this (esp the stuff in bold).

 

[RogueFLIP]

That was a random Google pic. Not me. Sorry for the confusion.
But my range of motion behind the back is about the same as that guy.
Will check if my posture is meeting the guidelines you've outlined.

Oops! Guess I should have clarified if that was you....

But again, what I wrote is still something to consider....

The MRI results don't tell the whole picture, there can be other factors contributing to your issue (posture just being one) that don't even have to involve the rotator cuff. Sometime where you have your pain isn't the actual CAUSE of why you're having the pain.

Good luck.

 

[Raul_SJ]

Oops! Guess I should have clarified if that was you....

But again, what I wrote is still something to consider....

The MRI results don't tell the whole picture, there can be other factors contributing to your issue (posture just being one) that don't even have to involve the rotator cuff. Sometime where you have your pain isn't the actual CAUSE of why you're having the pain.

Yes, MRI does not necessarily tell the story.
Apparently patients can have partial tears and be asymptomatic!! So as an example, a patient's MRI might show a partial tear but maybe his pain is due to posture issue and has nothing to do with the tear itself.

 

[tennishabit]

Shoulder MRI Report: "Mild tendonosis of supraspinatus and infraspinatus."
Report says no indication of rotator cuff tear. Everything else normal according to MRI. X-ray report says no arthritis.

Doctor said to do stretching and come back and see him after 2 months. Said these types of issues resolve by themselves.
Very slight pain when serving.
Discomfort is mainly at night sleeping and when reaching behind back as follows. Do not have full range of motion behind back. Ouch!

i started practicing serve recently after yrs of fh/bh only dosage daily as might be fun as well to play matches/comps........i could feel the tension on should straight away when trying to hit a big serve.

troubleshooting/probsolving mode again:
all pros using a lot of legs n torso forward/rotation, ie most 'cost effective/efficient' issue again, well they have to............i simply shifted shoulder away from rotation center/axle n increase the swing radius as much as possible, felt like a 'virtual rotation center' is somewhere under ground ~40-50cm:?)) then naturally i have to leg-push up/forward to accommodate the 'virtual extended' radius centered under ground. my shoulder's super-duper happy n won't feel a thing even serving all day..........lolololololol manohman..............saw some silly ytb vids dat saying arm serving only even serving on knees n i don't want to even try dat as it'll surely put huge burden on shoulder/elbow/wrist. why labor so much on arm/shoulder while u can use legs/torso to accomplish same thing:?)))..........anyway watava i do i try to shift as much wearing/tearing as possible away from any part of my body. let my outer soles of my shoes bear the wearing/tearing..................still i found my a few toe nails r growing at kinda tilted angle. lucky no pain though but still count a toll of my addiction..............

 

[RogueFLIP]

Yes, MRI does not necessarily tell the story.
Apparently patients can have partial tears and be asymptomatic!! So as an example, a patient's MRI might show a partial tear but maybe his pain is due to posture issue and has nothing to do with the tear itself.

Didn't watch the video, but not just partial tears. I've seen patients with far worse MRI results that have full ROM and function. The body can compensate in wonderful ways sometimes.

 

[Raul_SJ]

Didn't watch the video, but not just partial tears. I've seen patients with far worse MRI results that have full ROM and function. The body can compensate in wonderful ways sometimes.

Video is linked to a 30 second segment where the Doctor explains the problem of his patients demanding surgery when their MRI shows tear. He has to explain to them that the tears may not relate to their pain. I have also heard that some patients with knee articular cartilage loss (osteoarthritis) do not experience pain symptoms. Yes, I suppose the body can compensate in some areas such as the shoulder but I suspect patients with knee osteoarthritis will always have pain while running -- difficult for body to compensate on the knees. Those who say they experience little to no knee pain despite bad x-ray findings are likely sedentary.

 

[tennisenthusiast]

I am seeing improvement in range of motion but no improvement in strength. Could it be a tear though nurse practitioner said inflammation following x-ray? Have pain at night from the time I go to bed until my shoulder is warmed up the next day morning. Cannot lift more than 5 pounds with affected arm which is my non-dominant arm.

Can incomplete range of motion result in less strength?

 

[RogueFLIP]

Video is linked to a 30 second segment where the Doctor explains the problem of his patients demanding surgery when their MRI shows tear. He has to explain to them that the tears may not relate to their pain. I have also heard that some patients with knee articular cartilage loss (osteoarthritis) do not experience pain symptoms. Yes, I suppose the body can compensate in some areas such as the shoulder but I suspect patients with knee osteoarthritis will always have pain while running -- difficult for body to compensate on the knees. Those who say they experience little to no knee pain despite bad x-ray findings are likely sedentary.

Regarding OA of knees, not everyone who is asymptomatic will be sedentary.....quite the opposite actually IME.....ran into plenty of folks who were very active and pain free, but once they fell and got a XR, they were told they were "bone on bone" which surprised many including the MD as to their level of function despite such a harrowing XR/imaging.

I suspect that their previous movement lifestyle was a factor in staving off pain symptoms normally associated with OA.

And I've seen plenty of surgical candidates for TKR cancel their surgeries with the right mix of diet and various forms of bodywork & exercise/lifestyle changes. The OA and "bone on bone" diagnosis doesn't always have to lead to surgery to replace the knee.

 

[Raul_SJ]

Regarding OA of knees, not everyone who is asymptomatic will be sedentary.....quite the opposite actually IME.....ran into plenty of folks who were very active and pain free, but once they fell and got a XR, they were told they were "bone on bone" which surprised many including the MD as to their level of function despite such a harrowing XR/imaging.

I suspect that their previous movement lifestyle was a factor in staving off pain symptoms normally associated with OA.

And I've seen plenty of surgical candidates for TKR cancel their surgeries with the right mix of diet and various forms of bodywork & exercise/lifestyle changes. The OA and "bone on bone" diagnosis doesn't always have to lead to surgery to replace the knee.

The medical consensus is that long-distance running does not predispose to OA. But with existing OA, the patient is then advised to switch to low-impact activities such as biking and swimming. Even with a normal weight person and developed quad muscles and proper running form, there will still be ~4X the body weight on the knee joint and will exacerbate existing OA. It makes sense that running would worsen existing OA... Don't see how a person with even moderate OA would not notice the "bone on bone" pain and the inevitable associated stiffness and inflammation when running.

 

[Raul_SJ]

Do you have strength in your affected shoulder? I am also suffering from same symptoms and have been going to physical therapy and stretching at home since two months. Range of motion is slowly returning but strength is not.

Maybe try an injection to differentiate tear versus tendinitis.

UpToDate

www.uptodate.com

To differentiate rotator cuff tendinitis from tear, some health care providers may inject the shoulder joint with a local anesthetic. In people with tendinopathy, the anesthetic relieves pain, and muscle strength is usually normal. In people with a full thickness tear, the anesthetic relieves the pain, but muscle function does not improve.

In most cases, radiographs and other imaging tests are not needed to diagnose tendinopathy. However, if the person's symptoms do not improve after a course of conservative treatment, an imaging test (eg, radiograph, ultrasound, and/or magnetic resonance imaging [MRI]) may be recommended. Radiographs do not typically diagnose a rotator cuff tear but are useful for identifying alternative conditions such as calcific tendinopathy or joint wear from arthritis. Ultrasound or MRI can be used to confirm the rotator cuff diagnosis.

 

[Rafa.the.Magnificent]

Also on the subject of MRIs, they are not always foolproof. I had a shoulder problem for many, many months and my MRI/arthrogram showed no tears, but at arthroscopy they found a type II SLAP tear. Not suggesting any diagnosis at all, just making a point about imaging.