“Is orthopedic surgery needed?”
I recently had an MRI and the findings were as follows: There is moderate acromioclavicular joint arthrosis with inferior spurring, narrowing of the subacromial space, and mass effect on the subjacent supraspinatus region. The minimal fluid is seen in the subacromial/subdeltoid bursa. Coracoacromial and coracoclavicular ligaments are intact. There is some thickening of the coracoacromial ligament.
Signal alteration is seen in the supraspinatus tendon consistent with tendinosis. There is mild tendinosis near the infraspinatus insertion as well. The teres minor tendon is intact. there are findings of subscapularis tendinosis.
There is some thinking of the proximal vertical segment of the biceps tendon. The signal in the intracapsular component indicates tendinosis. The supraspinatus, infraspinatus, teres minor, and subscapularis muscles are preserved. The deltoid muscle is unremarkable. Glenohumeral articulation is maintained. There is a small glenohumeral joint effusion. There is a degenerative tearing of the superior labrum extending anteriorly. There are thickening and signal alterations along the axillary recess which may be a reflection of adhesive capsulitis. A small area of fibrocystic change is seen in the fumeral head at the superior aspect of the bicipital groove.
Acromioclavicular joint arthrosis with narrowing of subacromial space and mass effect on subjacent supraspinatus. Tendinosis involving supraspinatus, infraspinatus, subscapularis tendons.
Tendinosis and partial thinning of the biceps tendon. Degenerative labral tearing. Findings suggest adhesive capsulitis.
Signal alteration is seen in the supraspinatus tendon consistent with tendinosis. There is mild tendinosis near the infraspinatus insertion as well. The teres minor tendon is intact. there are findings of subscapularis tendinosis.
There is some thinking of the proximal vertical segment of the biceps tendon. The signal in the intracapsular component indicates tendinosis. The supraspinatus, infraspinatus, teres minor, and subscapularis muscles are preserved. The deltoid muscle is unremarkable. Glenohumeral articulation is maintained. There is a small glenohumeral joint effusion. There is a degenerative tearing of the superior labrum extending anteriorly. There are thickening and signal alterations along the axillary recess which may be a reflection of adhesive capsulitis. A small area of fibrocystic change is seen in the fumeral head at the superior aspect of the bicipital groove.
Acromioclavicular joint arthrosis with narrowing of subacromial space and mass effect on subjacent supraspinatus. Tendinosis involving supraspinatus, infraspinatus, subscapularis tendons.
Tendinosis and partial thinning of the biceps tendon. Degenerative labral tearing. Findings suggest adhesive capsulitis.
Male | 74 years old
Complaint duration: 3months
Medications: high blood pressor
Conditions: nothing major
4 Answers
OrthopaedicSurgeonOrthopaedicSurgeon
Hi there! The short answer is possibly. You may also do well with non-operative treatment with an injection and therapy. It would be a good idea to be seen for an office visit and evaluation.
First of all, an examination by your orthopedic doctor is also very important to determine the shoulder function and rotator cuff strength. Now, based on your MRI, considering age of 74 with hypertension, and no rotator cuff tear, degenerative labral tear and adhesive capsulitis, I would suggest physical therapy as a first line of treatment. After 6 weeks of PT, if it doesn't get better, you can try injection and another round of PT. Surgery is only indicated if these conservative treatment had been tried for more than 6 months and not getting better. Repeat MRI in 6 months.
Treatment would depend on the clinical symptoms but it generally starts with physical therapy and if not successful arthroscopic shoulder surgery would be offered if clinically indicated.
There are a number of degenerative changes consistent with age-related conditions in the shoulder. The MRI findings need to be correlated to symptoms to develop a treatment plan. In general, surgery is a last resort.
