Quote:
Originally Posted by Puxlut
The findings were: patulous anterior joint capsule that I suspect is secondary to capsular stripping from the scapular periosteum. This is a nonspecific finding but could account for the patients increased anterior translation on clinical exam. However the auxiliary recess is normally contoured with no evidence of tearing of the inferior glenohumeral ligament complex or HAGL lesion.
Normal glenoid labrum. No evidence of Hills Sachs lesion or bony Barnhart to confirm a previous anterior inferior location type injury.
Mild active supraspinatus and infraspinatus tendinopathy. No discreet rotator cuff tear.
So then I go in for my scheduled MRI in December the findings for that one was:
There is a cleft of contrast undercutting the glenoid insertion of the anterior band of the inferior glenohumeral ligament and the axillary capsule consistent with a GAGL injury. Posterior band of the inferior glenohumeral ligament is intact.
No labels tear is identified. No Hills Sachs and no bony Bankhart fracture.
Anterior cartilage is maintained.
Mild articular surface fraying of the supraspinatus tendon. Rotator cuff is otherwise intact.
When I went in to the sports med doctor in November he said based on the first MRI that the surgeon says he won't do surgery. He says I should try something different.. like water-jogging. It was all I could do to not punch him in the throat. My PT was surprised that they wouldn't do anything.
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Your MRI was an arthrogram, correct? There's zero reason why it wouldn't be, but I'm very surprised you don't have a labral tear, namely a SLAP lesion. The majority of dislocations have an associated SLAP lesion, and the fact that you've had 4 makes me wonder about the MRI. The radiologist hardly commented on it besides saying "no tear". The tear of the anterior capsule from the bone also suggests this.
The GAGL injury is the main ligament holding your shoulder in place in front has torn a piece of bone off of the "socket" of your shoulder joint and is no longer attached. This may be why your doctor has said that you're not a candidate for surgery. Many avulsion fractures (especially with this presumed chronic one) are inoperable.
Much of your pain will be from the tendinopathies of the two tendons. These will rehab well conservatively (there is no surgery for them).
The other good news is that you don't have a hills-sachs lesion, which is essentially wearing of part of the bone from dislocating it multiple times. It leads to further instability and a higher likelihood of dislocation.
It basically comes down to this:
-There are one or two things I think a surgeon can do (anterior capsule repair and ?GH ligament repair plus a debridement thrown in). I'm not at grounds to comment on you being a candidate or not, but you should probably see a surgeon for their opinion.
-You will need significant (proper) rehab including ++strengthening and manual therapy now. Significantly more if there's a surgery involved (that is a 9 month recovery).
Sports medicine doctors are gate keepers. They are meant to help triage patients to orthopaedic surgeons as needed. Your sports medicine doctor may certainly be right about the avulsion being inoperable, but given your MRI I would want the opinion of a surgeon. I also wonder about a labral tear.
So you have a few options. Your family doctor can put in a (generally slower) referral to a surgeon. You can get a second sports medicine doctor's opinion.
Or if you hurt your shoulder again you can play the system a bit.