Does anyone have a knowledge of reading MRI's? Torn rotator cuff, insight needed

[brollickby06]

I will post a more detailed thread soon, but I am wondering if anyone here has any idea on reading MRI's. I have been having pains in my shoulder for about 2 months. Since I don't have insurance, I waited a while before going to get an MRI. In early December, I finally decided that enough is enough. I got Xrays of both shoulders and an MRI of my right shoulder.
The radiologist's report said I have AC separation of both shoulders, bursitis, and rotator cuff impingement. Then under associated findings, it suggests that there is a tear of the rotator cuff muscle.
The AC separation is mild, but the torn rotator cuff is what really worries me.

I realized that I shouldn't put a price on my health, so I saw an Orthopedic last week...worst experience of my life.
The man did not give a damn about my situation. All he did was read my report and reiterate what it said. He did a few tests on me, and told me my rotator cuff seems imflamed. He prescribed my naproxen as an anti-inflammatory and told me to get physical therapy.
I asked him how bad the RC tear is. He told me "you're too young to have a serious RC tear, just rest it." I told him I have been having pain for 2 months and have the MRI images on disc. I asked him to please take a look at them. He goes to anohter room for 5mins, comes back and says he can't see it very well and wants to take another Xray. So I pay even more money to have another set of xrays done. He tells me it seems like I have AC separation. Thanks..I already knew that!
Then he tells me to take naproxen 500mg 2x per day for a month and come back. Then if I still have pain, he will do another MRI.

I am furious he didnt take any time to view the MRI I paid so much money to have done. I am 23 and don't have insurance. I paid a fortune out of pocket for this...
All I wanted to know was, is my supraspinatus tear on the tendon or on the muscle itself?

I know if the tendon is torn badly, surgery should be considered. But if it is a tear more on the muscle, then therapy should suffice.

Anyway, I uploaded my Xray and MRI images onto photobucket. If anyone has some knowledge of how to read them, I'd greatly appreciate it. If my tendon is torn, I will probably see anohter orthopedic and possibly discuss surgery/other options.

link to XRAY and MRI images:
http://s862.photobucket.com/home/adnanmri/allalbums

[braindx]

I'll relook at them.

From what I saw earlier when you and I talked it looked like the tear was very close if not on the tendon.

I rechecked just now, and it does kind of look like it could be more muscular than tendinous. Basically, it's kinda borderline. It looks like the fibers got separated from the tendinous structure that exudes from the humeral head.

Take the naproxen and also supplement with fish oil. Self massage to the area to help move the swelling away would be good as well. Light and non-painful movement too.

[low blow]

From experience, research a specialist before you see them. Theres plenty of information on the web about a person and who they're linked with for surgery (sports teams, which hospitals etc..etc..).

[NIguy]

I'll relook at them.

From what I saw earlier when you and I talked it looked like the tear was very close if not on the tendon.

I rechecked just now, and it does kind of look like it could be more muscular than tendinous. Basically, it's kinda borderline. It looks like the fibers got separated from the tendinous structure that exudes from the humeral head.

Take the naproxen and also supplement with fish oil. Self massage to the area to help move the swelling away would be good as well. Light and non-painful movement too.

...dont suppose you could show us what you were looking for on the MRI.

[braindx]

Part 1:

http://s862.photobucket.com/albums/a...&current=1.jpg
http://s862.photobucket.com/albums/a...&current=2.jpg

Part 2:
http://s862.photobucket.com/albums/a...&current=2.jpg

------------------------------

Part 3 -- You can see the disruption to the supraspinatus the best. Posting these in sequence and annotating here.

http://i862.photobucket.com/albums/a...%20part3/4.jpg

So we are starting at the posterior portion of the shoulder and moving forward in slices.

The humeral head is the darkened circular object near the top of the photo 4. The very dark area to the upwards-right is the infraspinatus. Swelling as indicated by the white space. The supraspinatus is the muscle through the middle of the white space.

http://i862.photobucket.com/albums/a...%20part3/5.jpg

We can see there's more significant swelling. Near the humeral head there's some disruption of the supraspinatus tendon as it's less dark where it connects to the humeral head. See how there's a divot in the muscle as you move from right to left? That's the tear. There's more tear from the top than from the bottom.

http://i862.photobucket.com/albums/a...%20part3/6.jpg

You can see the disruption of the supraspinatus continues with the divot. Although there's a bit less tearing as evidenced that the tendon is a bit darker.

http://i862.photobucket.com/albums/a...%20part3/7.jpg

The supraspinatus is a bit less torn. We can start to see the AC joint disruption as the swelling is poking up into the space between the acromion and clavicle.

http://i862.photobucket.com/albums/a...%20part3/8.jpg

Less swelling & less disruption than the previous. Still significant though.

http://i862.photobucket.com/albums/a...%20part3/9.jpg

This part of the tendon seems to be intact as it's a straight line across. Still swelling as evidenced by the white above and below.

------------------------------

Part 4 is similar to part 3 except you can see everything a little better because it's lighter. Take a look given what you know.

http://i862.photobucket.com/albums/a...%20part4/4.jpg
http://i862.photobucket.com/albums/a...%20part4/5.jpg
http://i862.photobucket.com/albums/a...%20part4/6.jpg
http://i862.photobucket.com/albums/a...%20part4/7.jpg
http://i862.photobucket.com/albums/a...%20part4/8.jpg

If picture 7 caught your eye that's probably the best view of the AC joint separation we have seen yet.

------------------------------

Part 5: this sequence looks from the top and goes down into the shoulder.

http://i862.photobucket.com/albums/a...part%205/3.jpg
http://i862.photobucket.com/albums/a...part%205/4.jpg
http://i862.photobucket.com/albums/a...part%205/5.jpg
http://i862.photobucket.com/albums/a...part%205/6.jpg
http://i862.photobucket.com/albums/a...part%205/7.jpg
http://i862.photobucket.com/albums/a...part%205/8.jpg
http://i862.photobucket.com/albums/a...part%205/9.jpg

So if you looked at all of them in a row you can see that as you go deeper the humeral head is surrounding by white which is the swelling.

The last photo in particular shows that the AC joint is separated. I think this it the best picture from what I recall looking at all of the slides. You can even see some of the disruption to the supraspinatus as well. Top part of the "4 point star" is the AC joint separation, bottom part is the tear.

------------------------------

Part 6 & 7:

See if you can see everything yourself.

http://s862.photobucket.com/home/adnanmri/allalbums

------------------------------

Hope that helps OP (and everyone else who wants to learn). If ever you want me to take this out for privacy let me know.

[braindx]

Oh yeah, the doc you went to sucks.

You may want to get another opinion if you don't trust mine (which you shouldn't trust mine really... even though I'm sure I'm correct).

[NIguy]

Part 1:

http://s862.photobucket.com/albums/a...&current=1.jpg
http://s862.photobucket.com/albums/a...&current=2.jpg

Part 2:
http://s862.photobucket.com/albums/a...&current=2.jpg

------------------------------

Part 3 -- You can see the disruption to the supraspinatus the best. Posting these in sequence and annotating here.

http://i862.photobucket.com/albums/a...%20part3/4.jpg

So we are starting at the posterior portion of the shoulder and moving forward in slices.

The humeral head is the darkened circular object near the top of the photo 4. The very dark area to the upwards-right is the infraspinatus. Swelling as indicated by the white space. The supraspinatus is the muscle through the middle of the white space.

http://i862.photobucket.com/albums/a...%20part3/5.jpg

We can see there's more significant swelling. Near the humeral head there's some disruption of the supraspinatus tendon as it's less dark where it connects to the humeral head. See how there's a divot in the muscle as you move from right to left? That's the tear. There's more tear from the top than from the bottom.

http://i862.photobucket.com/albums/a...%20part3/6.jpg

You can see the disruption of the supraspinatus continues with the divot. Although there's a bit less tearing as evidenced that the tendon is a bit darker.

http://i862.photobucket.com/albums/a...%20part3/7.jpg

The supraspinatus is a bit less torn. We can start to see the AC joint disruption as the swelling is poking up into the space between the acromion and clavicle.

http://i862.photobucket.com/albums/a...%20part3/8.jpg

Less swelling & less disruption than the previous. Still significant though.

http://i862.photobucket.com/albums/a...%20part3/9.jpg

This part of the tendon seems to be intact as it's a straight line across. Still swelling as evidenced by the white above and below.

------------------------------

Part 4 is similar to part 3 except you can see everything a little better because it's lighter. Take a look given what you know.

http://i862.photobucket.com/albums/a...%20part4/4.jpg
http://i862.photobucket.com/albums/a...%20part4/5.jpg
http://i862.photobucket.com/albums/a...%20part4/6.jpg
http://i862.photobucket.com/albums/a...%20part4/7.jpg
http://i862.photobucket.com/albums/a...%20part4/8.jpg

If picture 7 caught your eye that's probably the best view of the AC joint separation we have seen yet.

------------------------------

Part 5: this sequence looks from the top and goes down into the shoulder.

http://i862.photobucket.com/albums/a...part%205/3.jpg
http://i862.photobucket.com/albums/a...part%205/4.jpg
http://i862.photobucket.com/albums/a...part%205/5.jpg
http://i862.photobucket.com/albums/a...part%205/6.jpg
http://i862.photobucket.com/albums/a...part%205/7.jpg
http://i862.photobucket.com/albums/a...part%205/8.jpg
http://i862.photobucket.com/albums/a...part%205/9.jpg

So if you looked at all of them in a row you can see that as you go deeper the humeral head is surrounding by white which is the swelling.

The last photo in particular shows that the AC joint is separated. I think this it the best picture from what I recall looking at all of the slides. You can even see some of the disruption to the supraspinatus as well. Top part of the "4 point star" is the AC joint separation, bottom part is the tear.

------------------------------

Part 6 & 7:

See if you can see everything yourself.

http://s862.photobucket.com/home/adnanmri/allalbums

------------------------------

Hope that helps OP (and everyone else who wants to learn). If ever you want me to take this out for privacy let me know.

That was alot of work. Really appreciated. Gonna spend some time going over this as it is useful knowledge.

Thanks alot.

[braindx]

That was alot of work. Really appreciated. Gonna spend some time going over this as it is useful knowledge.

Thanks alot.

Yeah no prob. Reading MRIs is kinda fun for me. If you're interested in anatomy you can see a lot of different stuff, and it's pretty interesting how everyone is different.

[imdunn]

What great information here! I'm going to have to spend a few hours looking at these MRI pictures and comparing them to the ones on the disc I just got tonight. I know my results should be back within 24-48 hours, but I'm one of those people that get into looking at the MRI's and trying to figure out what I see or don't see.

My shoulder popped on Friday out of the blue, and I got a nice goose-egg bruise to go along with it. Doctor rushed me in to see a specialist on Tuesday afternoon - my regular doctor thought maybe a cyst burst or a tear, specialist seems to think it's a torn tendon. Not exactly thrilled by the prospect, but even if it were to require surgery, it couldn't possibly be as bad as laminectomy/fusion at L5 S1 I had in October!

[booniebearsmom]

Hi all. I found this from researching what a torn rotator cuff looks like on a MRI. I had one today. I'm trying to figure out what my MRI is showing. A little history (if you don't mind reading)...I have a congenital deformity in my neck (extra half of vertebrae, some fusing going on....really hurts all the time!) that I was born with. There is nothing they can do for it. The neurosurgeon advised not to have surgery on it unless my spinal cord was being compromised. Luckily I'm not there...and hopefully never will be!

My shoulder has been hurting on and off for a pretty long time. I have no idea when I injured it. I have a lot of swelling most of the time in the area between my neck and shoulder. Not sure what you would call that area. And I'm sure it's from my neck deformities. But when my shoulder hurts....it's not the same pain. And it will hurt in my shoulder (sometimes feels like it's really deep and then sometimes it seems like it's on the outside of it). And sometimes it will hurt down the outside of my arm down to my pinkie finger. I also noticed recently since my pain has been getting worse that I have muscle atrophy. I admit...I started freaking out when I felt how the muscle is just withering away on my left elbow/arm compared to my right arm/good arm. My pain doc confirmed that I do in fact have muscle atrophy.

I saw a surgeon in 2009 for my shoulder. I had MRIs done before I went to see him. I had a 75% tear in my rotator cuff. He tried PT on me and also gave me 2 different sets of cortisone shots. I almost passed out after the second visit while waiting for the elevator to go the parking garage. Everything just made it worse. I also have fibromyalgia, a herniated disc, degenerative disc disease, some arthritis...and I'm constantly in pain. It never ends. Even epidural shots, etc. for my back just make things worse. He then decided that he wanted to do surgery on my shoulder. I was okay with that UNTIL he told me that I had to completely stop my pain medication for 6-8 WEEKS before he would do it. I said hell no! (Excuse my language. I was on vicodin 3/day for my pain. A while ago I decided (not my pain doc – she actually said I shouldn’t…???) that I didn't want to keep taking all of that every day. God only knows what it's done/is doing to my liver and I didn’t want to get addicted to it. I’ve been taking it for over 5 years and I have never tried to get more than I should. It doesn’t give me a “high”…it takes the edge off the pain so I can have some sort of quality of life. So now I take mostly ultram (3 doses of 100 mg/day) and a vicodin whenever it gets really bad.) It doesn’t always helps but I’m determined to not rely on vicodin. I went back to my pain doc but I guess they just didn't care or didn't hear me or something when I told them this. I don't know...? They are really good about everything. I guess they thought it was my decision....? I told her my shoulder has REALLY been bothering me and I reminded her that the surgeon wanted me off my pain meds for 6-8 weeks. She didn’t understand why I would have to do that…so she referred me to another surgeon. Why didn’t she do this way back in 2009?
I went to see a different surgeon this morning. He looked at my old MRIs and then took x-rays and then said he wanted me to get a new MRI…which I did this afternoon. When he was moving my arm around and having me push/pull etc., he said that he thought my pain was from my neck issue. He said that the pain going down my arm and into my elbow and pinkie finger has nothing to do with my rotator cuff. (Not what I have been reading when I research it…but what do I know???) It was hurting when he was doing this in different areas. I’m having a nerve conduction test done in two days. I think that my nerve is being pinched…it seems like you can actually feel it on my elbow. Sometimes it feels like I’ve hit my funny bone and it never stops hurting.

I’m sorry I’ve written a book here. I have my MRI images that I can post a link to (old and new to compare). I’m also impatient and want to know what this new MRI says. If anyone can shed some light I would be very grateful! I tried to compare my images with the ones posted on here….but I’m not sure if I’m seeing what I think I’m seeing.