MRI Help

[SwingNorthtoSouth]

I know we have some knowledgable experts on this board. My right shoulder acts up were I can not do a flat bench press and a couple of other excercises.This is what the MRI states. This was due to an accident that happened a long time ago.When doing some excercises in the past, I noticed that the right shoulder is not sysmetrical to the left?? Any Thoughts????

Hypertrophic changes and considerable pannus formation are identified of the acromioclavicular joint with a downward impingement identified on the supraspinatus. The supraspinatus tendon demostrates some increase signal densities near the area of insertion compatible with some tendinosis or tendinitis but no tear or retraction is seen. There is a small amount of joint fluid identified, but the labrum are intact anteriorly and posteriorly. The biceps tendon is unremarkable. There is some prominence of axillary recess with a small amount of fluid.
Impression:Acromioclavicular joint hypertrophy. Tendinosis and tendinitis.

[wolfman]

That is degenerative arthritis.

"characterized by the proliferation of the synovial lining forming excessive folds of inflamed tissue, termed pannus. Pannus formation is thought to be central to the process of joint destruction."

[SwingNorthtoSouth]

Thanks Wolf, but that is the end result. My left shoulder is fine. When I was riding a motorcycle in 1982, a woman came out of know-where from between two parked cars. I was going about 25 miles an hour. She deflected off the side of my engine, my right knee and my right shoulder/bicep area.

[rchang72]

The good news is that nothing on the MRI neccesitates surgery (e.g. tear of tendon or labrum). You would probably get help with physical therapy or perhaps even a cortisone injection. In the meantime, avoid the bench press. Most people let their elbows go below the plane of their chest, which puts a lot of strain on their rotator cuff tendons. If you want to work your pecs, flys would do a better job (full range of motion of the pectoralis) with less stress on your shoulder.

[Julian]

Thats an interesting MRI report. The term pannus is more commonly used with rheumatoid arthritis which I assume you dont have. The MRI often overcalls changes at the AC joint. Asymptomatic changes are common in this joint. Often it thickens and can press on supraspinatus (the top of the rotator cuff). It responds well to a file surgically!

Your report is encouraging as your cuff is intact and the lack of fluid around biceps is encouraging.

If 0 degrees is with your arm hanging at your side and 180 with your arm pointing straight up then

- pain 160 - 180 is likely from the ACJ and will respond to corticosteroid in the joint or excision of the distal end of clavicle surgically (assuming exercises etc fail)

- pain from 80 - 120 is likely due to the tendinitis so first rest, strengthen rest of cuff (subscap , teres minor, infraspinatus). If that fails subacromial corticosteroid then next option acromioplasty (thinning bone) - its at this stage one would co-plane the ACJ

Hopes this helps

Julian

[SwingNorthtoSouth]

Excellent Julian, that is exactly what I was looking for. Yeah the pain starts before my arm reaches parallel to the floor.

thank you