Sunday, August 18, 2019

Only One Painful Shoulder, But MRI For Both Shoulders Abnormal?

Neck/ nerves can cause shoulder pain
A patient recently came to our clinic complaining of right shoulder pain. She had just gone to see an orthopaedic surgeon who after a short chat suggested getting a MRI scan for both shoulders for comparison purposes. The surgeon did not even bother assessing her first before suggesting she go for the scans.

I was initially surprised that the surgeon suggested imaging both shoulders especially when there was no physical assessment done on her painful right shoulder or her neck. But what she told me subsequently surprised me further.

Both right and left shoulder MRI scans were abnormal! She had tears in both her right and left supraspinatus muscles (right side possibly from swimming and badminton)! There was no pain at all in her left shoulder.
See the position of Supraspinatus under the acromion
Then Gino told me an article he'd seen where researchers found abnormal MRI findings in both shoulders (Barreto et al, 2019).

These subjects had self reported pain in one shoulder only. They had no history of previous upper arm fractures, frozen shoulder, significant range of motion deficits, no repeated dislocations and no neck related pain.

MRI's were done on both shoulders and randomly interpreted by an orthopaedic surgeon and a radiologist specializing in musculoskeletal conditions.

The conclusion was that abnormal MRI findings were very common in both shoulders! Only full thickness tears in the supraspinatus tendon and shoulder osteoarthritis were higher by 10 percent. Otherwise many patients had similar abnormal tears/ injuries in both shoulders. Yes, even in the non painful shoulder.

Please bear this mind if your surgeon sends you for a MRI scan without even assessing you thoroughly. So many problems can be caused by this and a lack of understanding of context especially if no physical assessment is done.


Barretto RPG, Braman JP et al (2019). Bilateral Magnetic Resonance Imaging Findings In Individuals With Unilateral Shoulder Pain. J Sh Elbow Surg. S1058-2746(19)30234-4. DOI: 10.1016/j.jse.2019.04.001

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