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Thread: Should I get an MRI?

  1. #1
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    Default Should I get an MRI?

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    50 years old, 200lbs, fairly experienced lifter.

    I’m sure there’s some of you out there that may have dealt with this. On Wednesday (5 days ago) I was benching and my right shoulder felt like someone hit me and the bar dropped. Turns out I tore or strained my right pec and/or tendon on my humerus. the bruise is as expected but horrific looking. (FYI. My bench was programmed at 232.5x5x3)

    I have a bit of mistrust for doctors and didn’t get it looked at until Sunday. I had two different sports medicine orthopedists look at it. The first is a friend of my neighbor. His opinion is that i probably tore the tendon off. And I would need an MRI and most likely surgery that he has done a thousand times and would do.

    The second orthopedist is a personal friend. I coincidentally was over his house last night and he could see my bruise because it extends well below a short sleeve shirt. His opinion was that I need neither an mri nor surgery. It will heal on its own. If I needed the muscle for a high level sport, he’d personally fix it but his opinion was that I’d get back 97% functionality anyway.

    Id appreciate opinions about rehabbing and about the course of action. I would rather rehab it myself than pay a thousand bucks for an mri and more for surgery. I’ve done a couple days of Starr rehab but the first doctor yesterday made me question my approach.

    The he pain is not severe but it is sore.

    Thanks

    Mike

  2. #2
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    Quote Originally Posted by DaddyMantz View Post
    50 years old, 200lbs, fairly experienced lifter.

    I’m sure there’s some of you out there that may have dealt with this. On Wednesday (5 days ago) I was benching and my right shoulder felt like someone hit me and the bar dropped. Turns out I tore or strained my right pec and/or tendon on my humerus. the bruise is as expected but horrific looking. (FYI. My bench was programmed at 232.5x5x3)

    I have a bit of mistrust for doctors and didn’t get it looked at until Sunday. I had two different sports medicine orthopedists look at it. The first is a friend of my neighbor. His opinion is that i probably tore the tendon off. And I would need an MRI and most likely surgery that he has done a thousand times and would do.

    The second orthopedist is a personal friend. I coincidentally was over his house last night and he could see my bruise because it extends well below a short sleeve shirt. His opinion was that I need neither an mri nor surgery. It will heal on its own. If I needed the muscle for a high level sport, he’d personally fix it but his opinion was that I’d get back 97% functionality anyway.

    Id appreciate opinions about rehabbing and about the course of action. I would rather rehab it myself than pay a thousand bucks for an mri and more for surgery. I’ve done a couple days of Starr rehab but the first doctor yesterday made me question my approach.

    The he pain is not severe but it is sore.

    Thanks

    Mike
    I am qualified to give an opinion. But not saying if you have any particular diagnosis. Only how to approach problem.

    The two doctors are suggesting different diagnoses, one requiring (generally) no surgery....and the other requiring.

    You can believe either one and proceed. Typically a biceps tear is far more common and you could play the odds game. But why do that if you are in doubt and you lift and wish to continue? Pectoralis tears happen during BP.

    So....mri will easily distinguish between two processes and perhaps catch other stuff along with it that both doctors miss by examining acute injury and you could easily have multiple injuries and chronic issues.

    I would vigorously dispute your 1k patient pay. Don’t know where you are and in this forum could easily be on Medicare. Outpatient mri centers must accept MCare payment rates.....FAR below 1k...

    If not Medicare and you have big deductible,call the facility and ask for cash price. 500 tops in big city.

    Look for facility with high power magnet....ie 3tesla. You can accept 1.5Tforyour purposes. Ask if musculoskeletal trained or experienced radiologist supervising and reading.

    Make certain that your MD writes that likely biceps tear but possible pectoralis tear. Why?......because some deviation from standard shoulder protocol may be necessary and not standard, at least in most facilities.

    Good luck.....are you worth 500$, given the very different consequences of the two possible injuries?

    PS.....amazingly if it were your dog at vetyou would pay at least 1k for care of nothing burger concern, gladly. But I’ve been around a long time and people just hate to pay for their own care. But don’t fret....it will someday all be FREE.

  3. #3
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    I'd say the likely choices are between a very distal pec belly rupture and a pec tendon avulsion off the humerus. This really doesn't sound like a bicep tendon. The first is not usually repaired, the second needs to be repaired immediately. So I'd recommend a formal evaluation with an orthopod TODAY, which should involve an MRI.

  4. #4
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    My sincere thanks for the reply. Both physicians agree with you that the bicep is not involved. I will do my best to get an MRI today.

  5. #5
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    I'll add my two cents:

    Get the damn MRI.

  6. #6
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    Quote Originally Posted by Jonathon Sullivan View Post
    I'll add my two cents:

    Get the damn MRI.
    I respond like I have a little lawyer on my shoulder.....and you guys just get to blurt it out. WTF?

    Thought it would be nice to lay out some of the arguments and help optimize the experience....with some inside baseball.

    the reality is that without some specific input , a MRI facility will not always fulfill the necessary views and sequences to adequately depict a distal pectoralis tear if RX=shoulder pain. INsertion is at or little below the biceps sheath and need expanded views to assess the pec Major for it's clavicular and medial sternal insertions as well as humeral insertion.

    Basically, need to look at the axilla and chest wall in a way that standard shoulder protocols can be deficient. Input for actual surgical planning important.

    Most pec tears partial and a number of pec tears included medial and superior elements. Some experience very helpful.

    Pectoralis Tear - Radsource

    Long head biceps tendon tears are straightforward.

    The financial arguments: exasperating. Biggest risk...get sent to hospital for test.

    Best part of this response.....no charge.

  7. #7
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    Thank you Keith for taking so much time to answer my question and thank you Sully for your reply. I am a big fan of your book and YouTube channel and I enjoyed you on the barbell logic podcast. Keith your link and info is very helpful.

    I obtained a prescription and booked an mri but the best I could do was 7am tomorrow. To give more information, the first doctor palpated the tendon below my delt and his opinion was that it was most likely torn off the bone. I wrote it down and he was talking about the Sternal head of the pec major. My pectoral muscle is swollen and could be the muscle “bunching up” or could be fluid. Immediately after the injury, the area of my arm where my deltoid and bicep come together right next to the pec was bulging out. I assume that’s where the pec inserts into the humerus.

    Thank you and I’ll post the results of the MRI

  8. #8
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    Right, you can't just go in and say "MRI my shoulder." You have to go see the sports med guy/orthopedist and get a Rx for the study based on a careful exam and differential in the clinic, not your buddy's living room or whatever.

    Two different orthopedists saw the OP and they couldn't agree on the Dx or Px. " "you'll get 97% function back" sounds like some serious "there, there" hand-waving-out-my-ass-reassuring-bullshit-now-go-away.

    Time for some imaging. See the doc, get the Rx for the study, get it done, move on from there.

  9. #9
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    Quote Originally Posted by Jonathon Sullivan View Post
    Right, you can't just go in and say "MRI my shoulder." You have to go see the sports med guy/orthopedist and get a Rx for the study based on a careful exam and differential in the clinic, not your buddy's living room or whatever.

    Two different orthopedists saw the OP and they couldn't agree on the Dx or Px. " "you'll get 97% function back" sounds like some serious "there, there" hand-waving-out-my-ass-reassuring-bullshit-now-go-away.

    Time for some imaging. See the doc, get the Rx for the study, get it done, move on from there.
    Orthopedists will occasionally get that way....

  10. #10
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    Quote Originally Posted by Jonathon Sullivan View Post
    Right, you can't just go in and say "MRI my shoulder." You have to go see the sports med guy/orthopedist and get a Rx for the study based on a careful exam and differential in the clinic, not your buddy's living room or whatever.

    Two different orthopedists saw the OP and they couldn't agree on the Dx or Px. " "you'll get 97% function back" sounds like some serious "there, there" hand-waving-out-my-ass-reassuring-bullshit-now-go-away.

    Time for some imaging. See the doc, get the Rx for the study, get it done, move on from there.
    Thank you for the advice and I'll let you know about the MRI as soon as I can. I can't do those regular MRI's so I'm going to do an open one. I know they suck but it's better than not getting one right? You couldn't pay me to get in that tube of death. The surgeon who prescribed the MRI told me there's no other option to diagnose this so I have to suck it up.

    I feel the need to clarify my experience with the two physicians. Ortho #1 (Surgery) and Ortho #2 (no Surgery. no MRI) did the exact same living room exam. Both were probably exactly what they would have done had I been in their office. (Except for the prostate exam. Not sure why that was necessary but let's just move on...)

    Ortho #1 - You may have pulled a small pec muscle which requires no surgery but you almost definitely ripped the muscle off the tendon. We need an MRI and then we will do surgery. (That was paraphrasing)

    Ortho #2 - "Trust me. You do not need an MRI. You do not need surgery. I know Ortho #1 and he has a large practice because he does a lot of surgery. I don't need the money and trust me. You DO NOT NEED AN MRI OR SURGERY." This guy then proceeded to cook burgers on his grill in the backyard. Between the two surgeons, I get a much better feel from Ortho #2. Ortho #2 is very good friends with my best friend and my best friend trusts him completely as a stand-up guy. I do not believe his dismissal of surgery was a go-away sort of thing. (If Ortho #2 had recommended MRI and possible surgery, then I wouldn't have even posted on this forum.)

    As a further twist, one of my neighbors stopped me at my driveway this morning and got out of his car to tell me that I should be careful not to trust Ortho#1 because he is a surgery first type of physician who is trying to make a lot of money with a big practice. He and Ortho#1 go to the same ritzy country club and Ortho#1 repaired this guy's shoulder. I did not even know the guy knew about my injury but he felt strongly enough about this to seek me out and tell me that.

    I don't know if this info changes anything for anyone but I am damn sure going to get the MRI read by Ortho#2.

    As always, thanks for the advice.

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