Undiagnosed Shoulder Re-Injury (To MRI, or not to MRI…)

[AikiPapi]

Hello, Will and Friends –

I’m realizing that my previous threads re: rotator cuff repair and subsequent adhesive capsulitis mid-2023 have run their course and my latest shoulder mishap merits its own summary, if not advice.

Despite the residual stiffness and pain from the above situations, I’ve been able to push the Bench and Press to PR weights since regaining enough ROM to effectively train them. A bench volume workout (5x5) two weeks ago however resulted in me waking up about 4 hours later with the same left shoulder on fire (no pain anywhere near that intensity during or immediately after lifting). Interestingly, this was with a weight I had gotten not too long ago done for 3x5 and I don’t have any reason to believe there had been a significant breakdown in form since as I’m pretty conscious of things like elbow position given the now chronic lower-level pain that is a constant reminder. I was able to beat the pain back enough over the next couple of days with NSAIDS and ice to get my volume press workout in (which actually went well), but skipped the intensity bench work thinking that I would lay off the bench until I could try transitioning to CGBP for volume work the following week.

Unfortunately, the pretty intense anterolateral shoulder pain re-surfaced (again, a few hours after the presses) so I hit it hard with naproxen and ice for about 5 days (to little avail) and went back to see the ortho. The pain is often alternating between throbbing and searing (along with some new clicking and grinding) just beyond the end of the acromion and is reminiscent of the unusual tightness I was feeling a few weeks after the RC (supraspinatus) repair, once out of the sling and before the shoulder completely froze. It is however unlike the feel of the original injury (sub-acromial impingement, partial supraspinatus tear, etc.) which more so radiated a dull ache down the upper arm.

Along with a negative x-ray, provocative tests that confirmed no loss of RC strength lead to the ortho’s conclusion that it was very unlikely anything (RC, labrum, etc.) was completely torn. With no real diagnosis, the Rx was for a longer term NSAID (celecoxib) and PT for a few weeks before considering if an MRI was worthwhile, but I got an MRI order up front in case I decided to go that route anyway. I have no intention of going to the local strip mall PT clinic and am considering the appropriate therapy for a potential partial tear, tendinitis, tendinosis, etc. to be slow heavy benching and pressing, per my review of guidance seen here in these situations.

So this leaves me hoping the pain will subside to the point where it feels at least reasonable to try benching and pressing, but I am losing patience and second-guessing this approach and interpretation of my related readings in the forums here. (Note: I have been continuing with slow weighted chins, along with my squatting and deadlifting, as they don’t seem to make things worse).

I suppose my question at this point is whether my current approach and more patience makes sense, or if I should bite the bullet cost-wise and get the MRI so as to know for sure what’s going on. And if so, whether I should insist that it be done with contrast as, while all my previous shoulder MRIs were done without, I have also read here and elsewhere that the contrast can be important in visualizing certain, possibly relevant details (labrum, etc.).

As always, I can’t thank you guys enough for taking the time to read this and advise (if at all possible). It’s all very frustrating, but if I’ve used up my freebies as an individual or for any one specific body part, I can certainly understand that as well.

[Mark Rippetoe]

You don't want to know for sure what's going on?

[AikiPapi]

I would like to, sure - my hesitation was only that there is obviously some cost involved (although not insurmountable) and I am lead to believe that the findings would be inconsequential. By this I mean that I have essentially been assured it is not a full tear, and the course of treatment/rehab would be the same regardless.

Do you think I’m putting too much faith in the (non-)diagnosis and perhaps there may be something to learn from the scan as to how the injury was caused or could be avoided in the future?

Am I answering my own question???

[Griffin727]

Get the MRI, it's data. The issue is finding someone who can read them well. I have found the surgeon does a better job then the radiologist.

[AikiPapi]

Get the MRI, it's data.

Absolutely - and few relish new data more than me! The only question is whether it's useful data or just an expensive way to satisfy a curiosity, as I've been led to believe.

I suppose if I feel little difference after the weekend (~2 weeks since this started and beginning NSAIDS), I'll get the MRI early next week. I would think that'd be enough time to expect some significant reduction in inflammation and the ability to begin pressing again to rehab, no?


Thanks for your time and perspective, guys...

[Griffin727]

Get an MRI to see if any major tearing or histological issues with the pathology. Then rehab using a light press and work your way up. If this doesn't work then you may have get scooped. Do all you can do before surgery. Surgery isn't the end of the world but is very costly and time consuming. You don't want to cut on somthing that can be rehabed.

[AikiPapi]

Sprung for the MRI. No full-thickness tears but as usual, it's interesting to see what's going on in there. General theme is a good bit of tendinosis and subacromial impingement of the supraspinatus against a seemingly newly developing bone spur, causing a painful cyst to form. At the risk of taking up more than my fair share of space on the Injuries board here, I'll share the details in a dedicated post in the hopes of confirming that my intended path forward makes some sense.

Thanks again for the time and encouragement here.

[Mark Rippetoe]

Look up the "Mumford Procedure."

[AikiPapi]

Thanks, Rip -

I'm mostly aware, and I brought up that possibility in the context of my other (right) shoulder that feels as though it's starting down the road of chronic impingement, etc., but we did not circle back to it for the (left) shoulder in question here. I will follow up and seek to understand why that may or may not be a good option here...

[Griffin727]

Oh man with just a bone spur and no major tearing that needs repair you will get a subacormal decompression and be back fast. A mumford is just were they shave down the distal end of the collar bone. Subacormal decompression is the acromion being shaved. You need around 1cm of room in subacormal space. Get the surgery, that bone spur will rip a hole in the bursal surface of the tendon if not. Of course talk to a good orthopedic first.