Bilateral shoulder pain for 18 months

Patient

Q: I'm a 36yr, healthy, fit male without any medical problems and no chronic meds. I've got bilat shoulder pain for the last 18 months that originally started on the right and then followed on the left 3 months later. I've had some impact injuries on the right but never hurt my L shoulder before. MRI Shows post labrum tear and extensive bone marrow edema of distal clavicle. I thought i might have irritated the cuff with some increased shoulder reps at gym, but after 4 months of rest and PT there is no improvement and bilat AC joint steroid injection did little. RA and hyperparathyroid has been ruled out. Full flex and abduction causes mild discomfort bilat, impingement tests are negative. Please help with diagnosis

Doctor

A:   In the view that you have been ruled out for RA and Hyperpatahyroidism, also you have history of injuries on your right shoulder, possibly overuse at gym with both shoulders, and the results of your MRI showed labrum tear, you may have besides the labrum tear a rotator cuff injury.The rotator cuff is a group of tendons that support the shoulder. These tendons can be injured during weight lifting, when playing sports with a lot of throwing, after repetitive use over a long time or suffer degenerative changes with the aging process. Typically, the pain worsens at night, with abduction over 90 degrees, it is a dull ache in the upper outer arm and shoulder, it results from mechanical compression of the rotator cuff tendon beneath the antero inferior portion of the acromion (one of the bones of the shoulder joint), causing changes in the distal part of the rotator cuff tendon, which is at risk due to poor blood supply. On the other hand, The shoulder joint is a ball and socket joint, extremely shallow, and thus inherently unstable, this means that the bones of the shoulder are not held in place adequately, and therefore extra support is needed. To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a that forms a cup for the end of the arm bone (humerus) to move within. The labrum circles the shallow shoulder socket (the glenoid) to make the socket deeper. This cuff of cartilage makes the shoulder joint much more stable, and allows for a very wide range of movements (in fact, the range of movements your shoulder can make far exceeds any other joint in the body). The labrum is made of a thick tissue that is susceptible to injury with trauma to the shoulder joint. When you sustain a shoulder injury, it is possible that you may have a labral tear. The labrum also becomes more brittle with age, and can fray and tear as part of the aging process. The treatment of a torn labrum depends on the type of tear that has occurred. Most labral tears do not require surgery; however, if as your case, you are having persistent symptoms, despite more conservative treatments, surgery may be necessary. It is very important to complete a intensive and comprehensive Rehabilitation program after the surgery to ensure that you strengthen and balance the muscles around the shoulder joint giving  stability, improve range of motion, prevent scarring as the ligaments heal and teach you which movements and / or activities you should avoid.

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