 Poster: A snowHead
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I think I am being discriminated against because of my age. I am 73 and female and had a bad crash on my shoulder at Christmas. They did X-rays and said no AC displacement or fracture. I had no forward range of motion for a few days. It is still very weak, hurts and clicks. I am to start PT moth 11 th of January. I am American so of course my insurance stinks. They didn't do an MRI. I don't understand how I can have PT without one? How will they know what is going on in there? They told me I can ski but not fall.
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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Not a doctor, just a veteran of more rotator cuff tears than you can count on two sets of fingers and toes.
Biceps tear highly unlikely, my understanding of that injury is you'd be screaming in pain for a week. Sound like you had a subluxation so a tear of the subscapularis (front rotator cuff muscle) highly likely. Whilst an MRI might give you a bit more info, if your shoulder wasn't fully dislocated and the glenoid labrum is intact, which it might be, surgery isn't required. If it's clicky, the labrum may be slightly torn but no surgeon is going to operate at your age unless it's unstable (dislocating). I've had consultations with some of the best shoulder surgeons in the world, trust me they will tell you to leave it alone, surgery wise, unless it is dislocating. Doesn't sound like it's unstable, so physio it is. You can build the strength back up in a subscapularis pretty quickly if you're stubborn enough. The key is to exercise it to total fatigue level at least 3 times a day.
Last edited by Obviously A snowHead isn't a real person on Sun 7-01-24 23:34; edited 1 time in total
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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I'd definitely go with physio for a couple of months. Work hard, grit the teeth and push through as much pain as you can.
Clicky and clunky is the norm after a shoulder trauma. The joint seems to amplify everything
Basically echoing everything @Je suis un Skieur, said.
Your Physiotherapist should be able to determine what is damaged by a set of exercises/tests they will give you.
I did have X-rays and scans, but did need metalwork
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You need to Login to know who's really who.
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Just lie flat on your back and make snow angels. If it dislocates, your glenoid labrum's gone. 
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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Physios could often do a good job before MRIs were invented.
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You'll need to Register first of course.
You'll need to Register first of course.
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| Quote: |
Sound like you had a subluxation so a tear of the subscapularis (front rotator cuff muscle) highly likely.
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That's quite an assumption, off not very much info at all.
If you had a hard crash at Christmas your current symptoms are absolutely normal, and don't really tell us a whole lot. It could be something serious, or could just be bruising! But I would agree that biceps tear seems unlikely.
You got X rays which is the norm. MRI scan is not particularly useful in people your age. About 1/4 70 year olds will scan positive for some kind of rotator cuff tear, and of those over half are asymptomatic https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3768248/
So even if the scan did show a tear, doctors wouldn't know if it was new or actually problematic in itself.
Go see the physio. They will be able to help. If they believe you have a rotator cuff tear they may refer you for a scan.
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| boarder2020 wrote: |
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Sound like you had a subluxation so a tear of the subscapularis (front rotator cuff muscle) highly likely.
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That's quite an assumption, off not very much info at all. |
Er, no. Not an assumption at all. It's called experience. If you can't lift your arm out in front of you, your subscapularis has gone. How was it damaged? Well not through anything normal that's for sure. Did you have a dislocation? No. Did you have a heavy fall? Yes. But without a dislocation? Yes. Then you've most likely had a subluxation (which is a partial dislocation). Enough to tear the subscapularis muscle but not enough to fully dislocate. May or may not have torn and/or detached the glenoid labrum but probably has. Especially if it now clicks but didn't before. Will it matter? Depends on your rehab, age and future lifestyle.
I've had 34 full dislocations, probably 200+ subluxations and 3 full reconstructions of my shoulders. I've had a national deputy head of orthopedic surgery openly admit that my problems are above his skill level. He told a fellow patient that I know more about shoulders than he does; he was only half joking. He arranged an appointment with his boss, the national head of orthopaedics and fellow shoulder specialist and he dodged surgery on me too. I've had a teaching shoulder consultant ask permission to use my case notes in his lectures because in his 30 year career, he'd never seen anyone heal a completely torn supraspinatus tendon through physio alone before. It was a self-imposed physio regime that forced scar tissue to function as fibrous tissue.
Come back with your assumption accusations when you have the same level of experience.
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| boarder2020 wrote: |
| If you had a hard crash at Christmas your current symptoms are absolutely normal, and don't really tell us a whole lot. |
BS, losing range of motion is not at all normal.
| boarder2020 wrote: |
| It could be something serious, or could just be bruising! |
More BS. Bruising causes soreness, it does not restrict range of motion.
| boarder2020 wrote: |
So even if the scan did show a tear, doctors wouldn't know if it was new or actually problematic in itself.
Go see the physio. They will be able to help. If they believe you have a rotator cuff tear they may refer you for a scan. |
Is that the same scan that you've just said is pointless?
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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Come back with your assumption accusations when you have the same level of experience.
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I actually wrote my PhD in this area so it's one of the few (possibly only!) areas I'd consider myself a relative expert 
The problem with lived experiences is that they give us a certain bias, "when I had the same symptoms it was x, so therefore you must have x too".
One of the thing that separates the experts/professionals, is that online they are very hesitant to and cautious to diagnose anything. They will tell you what it "could be". They will almost certainly never say you have x,y,z. It's too easy, and not at all helpful, to make a false diagnosis with basically no real info.
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If you can't lift your arm out in front of you, your subscapularis has gone.
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I guess I should tell the researchers working on physical tests to identify subscap tears they can abandon the research and just see if the person can lift their arm out in front of them. If only it was that easy!
Subscapularis is more involved with adduction of the arm than flexion. There are certainly people who have subscap tears and can flex their shoulder. So no, that's not enough to diagnoses a subscap tear. In fact there are actual subscap diagnostic tests (belly press test, bear hug test etc.), which is how we would try to diagnose without MRI, rather than looking at shoulder flexion. As you can see these tests don't use shoulder flexion at all.
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More BS. Bruising causes soreness, it does not restrict range of motion.
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Taken straight from the most basic medical textbook:
"Intramuscular Bruises — Some trauma can cause an area of blood to collect inside a muscle, which may interfere with a muscle's function and restrict your ability to move."
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BS, losing range of motion is not at all normal.
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See above.
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Is that the same scan that you've just said is pointless?
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The whole point of a scan is to diagnose and dictate treatment. As the study showed it's common for people at that age to have rotator cuff tears, which are mostly asymptomatic. So even a positive MRI at this stage is fairly inconclusive, and risks a false positive, as well as being financially costly.
A good physio will make an assessment using the kind of physical tests mentioned above. If they think there is a tear you can then use the MRI to confirm their diagnosis. You remove the false positive risk, as if there is a tear you know it's likely not asymptomatic.
Am I saying the OP definitely didn't have subluxation and tear supraspinatus? Absolutely not. But based on the evidence you absolutely can not say they have with any confidence at all. It's not helpful. Let her trained medical professionals with access to all the info diagnose her.
Full disclosure: I've never dislocated my shoulder, so what do I know, my experience is zero. Feel free to discard all the above 
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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| Je suis un Skieur wrote: |
Not a doctor, just a veteran of more rotator cuff tears than you can count on two sets of fingers and toes.
Biceps tear highly unlikely, my understanding of that injury is you'd be screaming in pain for a week. Sound like you had a subluxation so a tear of the subscapularis (front rotator cuff muscle) highly likely. Whilst an MRI might give you a bit more info, if your shoulder wasn't fully dislocated and the glenoid labrum is intact, which it might be, surgery isn't required. If it's clicky, the labrum may be slightly torn but no surgeon is going to operate at your age unless it's unstable (dislocating). I've had consultations with some of the best shoulder surgeons in the world, trust me they will tell you to leave it alone, surgery wise, unless it is dislocating. Doesn't sound like it's unstable, so physio it is. You can build the strength back up in a subscapularis pretty quickly if you're stubborn enough. The key is to exercise it to total fatigue level at least 3 times a day. |
This age thing is just plain wrong. My buddy who is about 80 had an old ski injury come back to bite him this summer when he was painting his deck and he just had rotator cuff surgery His cuff wasn't unstable.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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I had a very bad fall ...or at least I think I did ...I have no memories of the following 20 minutes when I skied down the slope ...no real problems and I was checked out at the hospital at Cavalese but one of the consequences was a rotator cuff tear ..it took ages to get better and the only exercise that I was told to do was with a 1or 2 kilo weight to lift it forwards straight and level then sideways the same but try raising higher as time went on
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My partner had an ultrasound recently for imaging his shoulder. Prescribed by a sports med physician. Is that an option?
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