Partial Subscapularis Tear

[fatkillawhale]

I injured my left shoulder about 12 weeks ago while overhead pressing. I do believe this was partly an acute injury and partly the finishing touch to two decades of accumulated damage. My shoulder simply gave out halfway through one of my reps, and I dropped the weight. Since then I have stopped pressing and benching due to pain. I have tested pressing (the bar) and benching (50kg) several times since then, always with the kind of pain that makes me think I’m doing more harm than good. I have been squatting, deadlifting, and chinning without that kind of pain. My chiropractor suspected tendonitis, and after two months of no improvement I obtained an MRI. The findings are quoted in full:

“FINDINGS: There is mild supraspinatus tendinosis and peritendinitis without a discrete tear. The infraspinatus and teres minor tendons are intact. There is a focal interstitial tear within the distal subscapularis tendon at its insertion. No evidence of full-thickness rotator cuff tear. There is no denervation edema or atrophy of the rotator cuff muscles. There is no subacromial subdeltoid bursitis.
There is a curved undersurface of the acromion (type II). The acromioclavicular joint is preserved. There is no os acromiale.
The proximal long head of the biceps tendon is normal in signal, in caliber and in anatomic position. The intra-articular portion of the biceps tendon and biceps anchor are intact.
There is no Bankart lesion. There is no evidence of a focal detached labral tear within the limitations of this non arthrogram study. The articular cartilage of the humeral head and glenoid is preserved. There is no joint effusion.
There is no acute fracture or osteonecrosis. No mass or mass effect in the quadrilateral space. The deltoid muscle is preserved.”

Chiropractor referred me for PT. I am skeptical that PT will help heal a partial tear and have not schedule an appointment with them. The advice I have found on this board is to work through tendonitis but get surgery for a full tear.

In my case, I have a partial tear and tendonitis. What is the recommended course of action? I have not consulted with an orthopedic yet, though I plan to do so. If I continue to deadlift heavy and chin, will I make things better or worse? My concern is the tear.

BW: 190 lbs. Press: 65kg x 5. Bench: 90kg x 5. Deadlift: ~135kg x 5.

[Mark Rippetoe]

This is the only thing in the report of any concern:

There is a focal interstitial tear within the distal subscapularis tendon at its insertion

Dimensions of the tear?

[fatkillawhale]

No dimensions are given on the MRI report. I can ask the orthopedic when I see him in two and a half weeks.

[fatkillawhale]

Update: I met with an orthopedic, Dr. Anil Koganti, last week. Based upon his interpretation of the MRI along with his physical exam, he believes the subscapularis tear is a just a strain (good news). He says a strain can appear the same on the MRI, and I will experience similar weakness with internal rotation, strain or tear. However, he thinks I tore my labrum, or possibly have a “cyst” on the labrum (bad news). If torn, he called it a SLAP tear. I did not have the arthrogram MRI, so we are left with the previous report, “There is no evidence of a focal detached labral tear within the limitations of this non arthrogram study.”

In lieu of a second MRI, he advised me to continue with physical therapy and resume barbell lifts after four weeks of PT. If I still experience abnormal pain at that point, I can get a second MRI and a more definitive diagnosis. He and the PT said that many people live asymptomatic with a torn labrum.

I have been squatting and deadlifting heavy without issue. I would like to resume chins but have held off so far. What has been the experience and advice of this community regarding a torn labrum, presumably minor? I have not experienced “catching” or shoulder “instability.” I have no problem moving my arm overhead. At this point I'm inclined to resume pressing and benching conservatively, but I think I'll humor the PT for two more weeks.

To answer your previous question, I do not have dimensions of the subscapularis tear/strain.