MRI Results: Surgery, Rest, or Rehab? MRI Results: Surgery, Rest, or Rehab?

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Thread: MRI Results: Surgery, Rest, or Rehab?

  1. #1
    Join Date
    Dec 2020
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    5

    Default MRI Results: Surgery, Rest, or Rehab?

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    Quick backstory:

    Over the course of a couple of weeks in 4/2020, I developed that all-too-familiar rotator cuff pain in my shoulder while lifting weights. I lowered the weights, modified my workouts, and began doing traditional isolation rehab protocols. It was slowly getting better, but then I’d tweak it again. This happened several times over the Summer and into the Fall (two steps forward, one step back). After I tweaked it last, I started PT. It got better to the point where my PT told me I didn’t even need to come in anymore. I had also been lifting weights consistently since I was originally injured. Still not feeling super-confident in my shoulder, I had imaging done.

    Highlights from my arthrogram:

    1. “There is a large, very high grade partial-thickness tear of the supraspinatus and infraspinatus tendons. I do not see extravasation of contrast in the subacromial/subdeltoid bursa suggesting that there are a few intact fibers present”

    2. “Chronic Hills-Sachs defect of the posterior-superior numeral head. Probable old Reverse-Hills-Sachs defect of the numeral head”

    3. “Old Bony Bankart injury of the anterior-inferior glenoid. There is a bone defect of the glenoid in this region.”

    4. “Extensive chronic tear of the anterior-inferior labrum and adjacent ligament process. Degeneration and fraying of the remainder of the glenoid labrum”

    5. “Extensive synovitis and debris in glenohumeral joint”

    6. “Moderate glenohumeral osteoarthritis”

    The only symptoms I’ve been having over the past 8 months, which led me to get imaging done in the first place, is the rotator cuff, which was not caused by a specific trauma. The Hills-Sachs, the Bony Bankart, and the torn labrum are most likely from wrestling 15+ years ago. I never even knew I had those until I got the imaging for the rotator cuff.

    Cutting to the chase, I’m trying to figure out what to get surgically repaired, if anything. Since the labrum has never bothered me, I’m tempted to not have anything done to it. My only apprehension is the possibility that my rotator cuffs are shot due to the shoulder instability from the labral tear. I’d be heartbroken if I were to get the rotator cuff repaired, only to tear it again after the recovery. I’m also not sure whether or not a “large, very high grade” tear is something that I can nurse back to health with, say, PRP and several months of rest, or rehab and still be able to perform and compete athletically once I’m healed.

    Notes:
    - 40 year-old male
    - very physically active, inside and outside of the gym
    - told by a surgeon that I’ll eventually need a shoulder replacement, that I’m too young for one, and that I shouldn’t get any surgery now
    - told by another surgeon that I should have surgery now (rotator cuff & labrum repair, debridement)
    - told by an orthopedist that I should try PRP (that he specializes in/sells), along with a month in a sling

  2. #2
    Join Date
    Jul 2007
    Location
    North Texas
    Posts
    45,042

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    If I were you, I'd get this fixed before I got too much older. This is a pretty fucked-up shoulder, it's not going to heal, the surgery is no fun, and it will be far less fun the older you get.

  3. #3
    Join Date
    Dec 2020
    Posts
    5

    Default

    Quote Originally Posted by Mark Rippetoe View Post
    If I were you, I'd get this fixed before I got too much older. This is a pretty fucked-up shoulder, it's not going to heal, the surgery is no fun, and it will be far less fun the older you get.
    Thanks, Coach. Looks like I’m gonna have to bite-the-bullet.

    Seeing as you’re not a doctor and that anything you say or suggest should not be construed as medical advice [end disclaimer], would your post-surgery rehab protocol be a good bet for me, or does the labrum repair change things?

  4. #4
    Join Date
    Oct 2015
    Posts
    130

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    If you are active I would have surgery to fix what you can. It is not fun but neither is having a injured shoulder and outcomes generally are better in younger patients. Waiting makes successful repair less likely.

  5. #5
    Join Date
    Jul 2007
    Location
    North Texas
    Posts
    45,042

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    Quote Originally Posted by beek View Post
    Seeing as you’re not a doctor and that anything you say or suggest should not be construed as medical advice [end disclaimer], would your post-surgery rehab protocol be a good bet for me, or does the labrum repair change things?
    We'll have to see how the surgery goes.

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