To Scan or Not to Scan, that is the question :)

[Catrin]

We have so many talented women here, some of which have a lot of medical knowledge at your disposal. I know what my doctor is going to ask me Friday and I want to have decided before then.

I don't know exactly what the shoulder x-rays showed, I will find that out Friday, but his assistant indicated that there was something in the position of my shoulder bones makes it clear that something mechanical is going on - whether tendinitis, a rotator cuff problem, or a frozen shoulder will need to be determined. For some things surgery wouldn't be considered, for other things that is possible. Whatever it is, it's been there for YEARS and is quite entrenched. The older I get the more difficult it will be to deal with and frankly I want to be one of those old women that people consider nuts because of all of the physical activities I enjoy. For that I've got to be able to move my arm and build strength in it.

Right now I am leaning toward holding off on an expensive CT scan until I've had a month of intentional physical therapy to see if the shoulder will respond at all. The cost of the PT will count against my deductible, so this approach will decrease the CT cost by at ~30%. Is a CT scan better than an MRI for shoulder issues? Are the PT approaches for shoulder issues really different between different problems so if I hold off on the scan can they make things worse by using the "wrong" treatment? Am I overthinking all of this? Shall I put pure 100% cacoa in my coffee with cream? Any comments would be appreciated as I consider the best approach.

[e3rdpower]

Definitely put the cacao in your coffee and cream. Mocha FTW!!

As far as the shoulder, I think a trial course of a month with a SKILLED PT would be very worthwhile. It's just like any profession, there are good and bad. I would ask your physician specifically which therapist they send their shoulder patients to (not just which facility, but which therapist) and also ask around local athletes for recommendations. Many therapists specialize just as orthopedic surgeons do, so if you have a local PT who specializes in shoulder disorders that would be ideal. Shoulder issues can be quite tricky, but can respond well to therapy. Holding off on a scan prior to starting PT should not be detrimental. A skilled therapist will be able to do testing to have an idea of what is going on. Granted, they do not have MRI vision but can tell quite a bit. Many shoulder issues can be helped with scapular mobility/stability as needed. They will be able to assess that in your evaluation. I would also ask the therapist their opinion after they've completed your evaluation as far as what is going on and if they feel that improvement is possible.

As far as CT vs MRI, in this region most MD's will order MRI's for the shoulder. I'm not well versed enough in the radiology to say if one is better than the other, but MRI is definitely more common here.

Good luck with it!

[Kiwi Stoker]

I was having problems with movement in my shoulder a couple of years after having a plate etc inserted to rebuild the joint. Tried to have a MRI but of course the metal obsurced the image. Ended up having an ultrasound and that showed a partially torn shoulder. So no a CT scan might not be needed.

[Catrin]

I've read that MRIs apparently show more soft tissue than a CT scan does, so if that is the case it does seem the better choice if it should be necessary. I decided to return to the awesome PT I saw for my hamstring and quad tear in my first year of riding. His office is FAR out of my way, but he typically is able to get results and people out of PT quicker than usual. He has multiple certifications, including McKenzie, so he has a large toolbox and lots of experience from which to draw. If anyone can get that shoulder to respond though PT alone it will be him.

[OakLeaf]

I'd just caution that shoulders are very complex and no matter how good your PT is, if he specializes in the spine, he might not be the best for you right at the moment. You speak so highly of him that hopefully he will know and admit when he's out of his depth - which is the problem I had this summer - and refer you to a shoulder specialist.

I was going to stay out of this discussion since everyone already knows what my opinion is - but can I say I'm glad that you made the decision you did? I really think that with neuromusculoskeletal issues, imaging, especially static imaging, is way more likely to come up with red herrings (like the neck DJD that we both have) and, worse, incidental findings on other body systems, than it is to nail down the actual source of your symptoms.

[Catrin]

Good words Oakleaf. The only PTs I've found who specialize in shoulders aren't in my network Bill doesn't really specialize in the spine but he has a broad range of expertise, keeps up on research, and if he has a client that he needs to do extra research on he does so. He did wonders on my hamstring and quad injury - while that is far from the shoulders I hope he can help on this as well. I suppose I should call the original place that my dr. referred me to to see if they actually DO have a shoulder specialist. I've just had mixed results from that facility in the past which doesn't help my confidence going there.

I hear you about red herrings - I remember the whiplash injury when my doctor focused far too much on the bone spur and bulging disk in my neck when it turned out to be the whiplash itself that was causing all of the problems.

I am noticing more pain in that shoulder...unsure if there is actually more there OR if I've given myself permission to admit that it exists. I do tend to ignore pain whenever possible and it's been like this for years... I am also concerned that the wrong PT will flare up my whiplash injury while trying to treat my shoulder.