I Have Some Answers on my Shoulder
Thursday, July 10, 2014
Probably better than I expected, but not great nonetheless.
When I dislocated my right shoulder in January in a cycling crash on Black Ice, things started out fine for several weeks. I was going to Physio, and while swelling in the shoulder was going down things were improving rapidly, however six weeks out things started going downhill (fast) and ten weeks out I decided I needed to get more answers.
Emails back and forth with my wife's Uncle Jack (a Sports Medicine specialist) going over symptoms suggested two tears, one in the supraspinatus tendon and one in the Labrum, but until I was able to get in to see him for a physical exam at the end of May we couldn't progress any further. The physical exam gave essentially the same suspected diagnosis as the email conversation, with a request for two diagnostic imaging procedures (an MR Arthrogram and an Ultrasound) to see what's actually going on.
The MR Arthrogram (an MRI with a Gadolinium contrast agent injected directly into the joint) was last Monday. It was a supremely weird feeling having a needle directly in the joint, but the rest of it was fairly straight forward - lie still with my body in a great big washing machine. Today I met back with Jack to get the results.
First, my supraspinatus tendon is not torn. It has a fair amount of scarring yes, but it's not torn; if it had been it likely would have meant surgery. It is expected that this will heal on its own and/or with physio. The MRI also showed that the muscles of the rotator cuff were all in good shape and exactly where they should be, as is the biceps and the biceps tendon.
Second, I have a fair amount of scar tissue in the area of the acromioclavicular joint. I had to Google that - it's where the shoulder blade and collarbone meet. The scar tissue in this area prevented me from putting my arm behind my back, reaching backwards, and severely limited my range of motion. This scar tissue has gone down significantly since May, and things are much better, but my right shoulder is still significantly worse than my left. It is expected that this will heal on its own and/or with physio.
Third, I have a small Hill Sachs lesion on my humerus head. This is not unexpected - many (if not most) shoulder dislocations have this type of injury, essentially a groove in the bone that comes from dragging it across other bones as it gets pulled out. This injury is minor, and doesn't need any intervention.
Fourth, I have an anterior glenoid labrum separation. This is the big one, and most likely does mean surgery. It's at this point that Bruce (SPEEDYDOG) would put in a cool picture, but I'm feeling kind of lazy. Basically, the shoulder joint consists of two parts, a ball and a socket. The ball is the humerus head (where I've got the Hill Sachs lesion), while the socket comes in two pieces: the glenoid process which is bone and makes up only a small part of the socket, and the glenoid labrum which is a cartilage ring and makes up most of the socket. The biceps tendon attaches to the labrum (not to the bone) and when my shoulder was dislocated, the biceps tendon was jerked hard and violently pulled the labrum off the bone.
The next step? Meeting with a surgeon to get a plan in place.