Shoulder Injury - Need help with diagnosis Shoulder Injury - Need help with diagnosis

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Thread: Shoulder Injury - Need help with diagnosis

  1. #1
    Join Date
    Oct 2019
    Posts
    1

    Post Shoulder Injury - Need help with diagnosis

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    Help,

    My doctors aren't sure what my condition is.

    I weight about 165lb and I dead lift(405) and squat(345) which is a lot for a guy my size. I've been crushing my body and not resting properly over the past two years. 3 months ago I woke up in the middle of the night with what felt like a torn rotator cuff after a heavy deadlift day.

    The pain would subside during the day but would come back each night keeping me up for about 3 weeks.

    I slowly regained about 80% range of motion in my arm but I have accelerated muscle atrophy.

    I don't have any pain unless I'm lifting directly overhead. Very little strength in my injured side. Scapular winging and complete loss of serratus anterior ,infraspinatus and supraspinatus muscles.

    I'll be getting a EMG test to see if I have nerve damage.

    Should I be seeing a shoulder, neck, spinal specialist?

    shoulder MRI

    Evidence of prior acromioclavicular joint separation with acromioclavicular joint space widening and partial tear of the coracoclavicular ligaments as above.

    Mild rotator cuff tendinopathy with no high-grade or full-thickness tear.

    Mild disproportionate atrophy and diffuse intramuscular edema of supraspinatus and infraspinatus muscles, more than expected given degree of rotator cuff pathology, possibly related to denervation. No definite abnormality along the expected course of the suprascapular nerve. Consider brachial plexus MRI to evaluate for suprascapular nerve entrapment.

    Narrative MAGNETIC RESONANCE IMAGING OF THE RIGHT SHOULDER WITHOUT IV CONTRAST

    INDICATION: 31-year-old male with right shoulder pain and concern for AC separation.

    TECHNIQUE: Multiplanar, multisequence MR imaging of the right shoulder was performed on a 1.5 Tesla magnet without IV contrast.

    COMPARISON: Right shoulder radiograph 8/23/2019.

    FINDINGS: Alignment: Anatomical.

    Fluid: Subacromial/subdeltoid bursa: Physiological. Glenohumeral: Physiological. Long head of biceps brachii tendon: Physiological.

    Acromial arch: Shape: Curved. Subacromial spur: Absent. Lateral downsloping: Absent. Acromioclavicular joint: Widening of the acromioclavicular joint to 11 mm with tear and scarring of the inferior capsule. Partial tear of the coracohumeral clavicular ligaments with chronic tear of the trapezoid ligament with cortical remodeling and ossification of the trapezoid ridge of the distal clavicle. Partial tear of the conoid ligament.

    ROTATOR CUFF / TENDONS: Supraspinatus: Mild tendinosis with no high-grade or full-thickness tear. Infraspinatus: Mild tendinosis with tiny low-grade interstitial tear at the footprint of the conjoined tendon. No high-grade or full-thickness tear. Subscapularis: Mild tendinosis with no high-grade or full-thickness tear.

    Long head of biceps brachii tendon: Anchor: Intact. Horizontal portion: Intact. Vertical portion: Intact.

    GLENOHUMERAL JOINT: Labrum: Probable small recess undercutting the superior labrum without discrete tear. Glenohumeral ligaments: Intact. Glenohumeral cartilage: No high-grade defect.

    Bones: Otherwise intact. Muscles: Mild disproportionate atrophy of supraspinatus and infraspinatus muscles with diffuse intramuscular edema. Vessels: Intact. Nerves: No definite abnormality or abnormal signal intensity along the expected course of the suprascapular nerve.

    BRACHIAL PLEXUS MRI

    IMPRESSION: CERVICAL SPINE:

    Multilevel intervertebral disc disease, with moderate to severe right neuroforaminal stenosis at C2-3 and severe right neuroforaminal stenosis at C4-5.

    BRACHIAL PLEXUS NEUROGRAPHY:

    Slightly focal hyperintense signal of the right C5 and C6 joint/division and also of the right suprascapular nerve, possibly indicating neuropathy. There is no evidence of mass or external entrapment.

    Moderate edema pattern of the right supraspinatus and infraspinatus muscles with mild atrophy and fatty infiltration.

    Narrative MR NEUROGRAPHY OF THE BRACHIAL PLEXUS WITHOUT IV CONTRAST

    INDICATION: Plexopathy brachial, nontraumatic, no malignancy Assess suprascapular nerve entrapment, has atrophy of infraspinatus and supraspinatus

    TECHNIQUE: High resolution MRI of the cervical spine and brachial plexus, employing MR neurography techniques on a 3 Tesla system using multiplanar 3-D anatomical and fluid sensitive sequences without IV contrast.

    COMPARISON: Right shoulder MRI from 10/11/2019

    FINDINGS:

    CERVICAL SPINE: Intracranial and maxillofacial contents: Intact. Head and neck soft tissues: Intact. Prevertebral and paraspinous muscles: Intact. Lung apices: Intact.

    Craniocervical junction: Intact. Spinal cord: Intact.

    Bones: The vertebral heights are preserved. The marrow signal is unremarkable. Alignment: Anatomical.

    Atlanto-occipital: Intact. Atlanto-dental: Intact.

    Subaxial C-spine: C2-C3:

    Intervertebral disc: Right foraminal protrusion.

    Posterior Elements: Normal.

    Spinal canal: Patent.

    Neural foramina: Right: Moderate to severe narrowing. Left: Patent.

    C3-C4:

    Intervertebral disc: Normal.

    Posterior Elements: Normal.

    Spinal canal: Patent.

    Neural foramina: Right: Mild narrowing Left: Patent.

    C4-C5:

    Intervertebral disc: Disc bulge, asymmetric to the right.

    Posterior Elements: Mild uncovertebral protrusion.

    Spinal canal: Mild stenosis.

    Neural foramina: Right: Severe narrowing. Left: Mild narrowing.

    C5-C6:

    Intervertebral disc: Normal.

    Posterior Elements: Normal.

    Spinal canal: Patent.

    Neural foramina: Right: Patent. Left: Patent.

    C6-C7:

    Intervertebral disc: Normal.

    Posterior Elements: Normal.

    Spinal canal: Patent.

    Neural foramina: Right: Patent. Left: Patent.

    C7-T1:

    Intervertebral disc: Normal.

    Posterior Elements: Normal.

    Spinal canal: Patent.

    Neural foramina: Right: Patent. Left: Patent.

    BRACHIAL PLEXUS: Nerves: Spinal nerve roots: Intact bilaterally. Brachial plexus: Normal in course and signal intensity bilaterally. There is focal slightly asymmetrically hyperintense signal of the right suprascapular nerve just past its origin. There is no lesion or evidence of external entrapment.

    Thoracic Outlet: Cervical ribs: Absent. C7 transverse processes: Anatomical. Interscalene triangle: Patent. Costoclavicular space: Patent. Retropectoralis minor space: Patent.

    Muscles / Tendons: Scalenes: Intact. Other muscles: There is disproportionate mild atrophy, mild fat infiltration, and extensive intramuscular edema of the supraspinatus and infraspinatus muscles.

    Joints: Sternoclavicular joints: Normal. Acromioclavicular joints: Moderate left acromioclavicular joint arthrosis. Glenohumeral joints: Normal.

    Bones: Otherwise intact. Vessels: Intact. Masses: None. Other:

  2. #2
    Join Date
    Nov 2012
    Location
    Long Island, NY
    Posts
    959

    Default

    How would you describe the pain that you're having? (dull/achy, sharp, shooting, radiating, electric, numbing)

    Did you have a specific moment in time during the completion of the deadlift that you realized that you messed up your shoulder? Or was it a deduction you made after you woke up that night?

    How have you modified your training, or did you stop after the initial incident?

    Is the atrophy, strength, and ROM deficits getting worse, better, or staying the same?

    From the MRI and your clinical description, it seems there is a high likelihood that this is neurological in nature, possibly involving the long thoracic nerve and/or the suprascapular nerve. The long thoracic nerve supplies the serratus anterior (roots are C5, C6, and C7), and insults to it manifest as scapular winging and a decreased ability to raise your arm over your head. The serratus anterior works together with the upper and lower trap muscles to upwardly rotate the scapula as you raise your arm overhead. The suprascapular nerve is responsible for supplying the infra and supraspinatus. The primary function of these muscles is keeping the head of the humerus in the glenoid cavity (pull the shoulder into the socket) as you move your arm around (especially overhead).

    I think getting EMG testing is a great next step. Depending on how your clinical presentation has been progressing (atrophy, strength, ROM), seeing a specialist would not be a bad idea.

    I hope some of this helps man!

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