Thread by @hjluks

Interesting #Ortho tidbit. SHOULDER PAIN
You're over 40, you go to the doc because your #shoulder hurts. You did NOT have an injury. Many will be sent for an MRI.... 1/?

Bear in mind ... You have a very significant chance that a rotator cuff "abnormality" will be found. Those abnormalities will sound scary .... Partial rotator cuff tears, full rotator cuff tears, and labral tears. 2/?

These can be very alarming to many people... the word "tear" implies you're damaged and therefore something must be wrong -- and perhaps you're thinking it must be fixed. 3/?

But you didn't have an injury that you recall? What's going on? How did this happen? 4/?

Relax ... We are maturing :-) Our tendons age too. The vast majority of these findings are "normal" for your age and activity level. More important, many studies have shown that these "tears" are often not the source of your pain. Wait, what? 5/?

Consider this .. If we were to also #MRI your other shoulder, which does NOT bother you, there is a very significant chance that we will find the exact same issues. So, one shoulder hurts, but the MRI changes are the same ... it's confusing! It's confusing to us too. 6/?

If we MRI a professional baseball players shoulder who is pitching well and has NO shoulder pain we have a >75% chance of finding a labral tear and a rotator cuff abnormality. This should make you think. 7/?

Very few of us (after 40), will have a "NORMAL" MRI of our spine, neck, shoulder or knee. Same goes for many other joints too. 8/?

We treat patients, not their MRI results. Many/Most of these "age appropriate changes" to our body do not require #surgery. But you're in pain .. certainly something must be wrong. Especially with the shoulder, the night pain can be a huge quality of life issue. 9/?

Have faith .. The vast majority of you are going to get better over time... a timeframe you will routinely underestimate. It is not unusual for many #tendon related disorders to take a few months to feel completely better. 10/?

Physical therapy #PT , some activity modifications (overhead), and other pain relieving modalities are very successful at getting you through this without the need for surgery on your shoulder. 11/?

And keep in mind that you are not damaged... it will be really hard to make your "tear" worse. Many papers show that some of these partial "tears" actually heal over time... without surgery, stem cells, PRP, and so on. 12/ ?

You can lead a very active life with many rotator cuff and labral abnormalities. Again, you're not damaged.. recognizing this is a very important step in the overall recovery process. Fixating on your MRI findings can be harmful. 13/?

And if you go through the PT / recovery process and for some reason you do not respond ... go back to your shoulder doc to review other treatment recommendations. 14/14 . Thoughts on the thread? .. @theshoulderdoc @AndrewVCuff @ProfJillCook @JeremyLewisPT

Shoulder MRI findings in people WITHOUT shoulder pain
howardluksmd.com/shoulder-pain/…