Thursday, July 3, 2008

About My Shoulder .........(Part Deux)

I FINALLY got my MRI and arthrogram done today.

For those of you at home who haven't been following along, I've been dealing with shoulder problems for over 2 years now stemming from playing baseball.

Read this for the background story.

I first went to the orthopedic surgeon back in May. X-rays were taken and negative, and the MRI/arthrogram was the next step. I went ahead and scheduled one and showed up only to find they didn't do arthrograms there. Another month later and 2 more extremely annoying miscommunications and unexpected work commitments, and I was finally able to schedule the correct procedure at a place that did it on a day I didn't have to be on-call.

It started at 8am.
After some paperwork and stripping myself of anything metallic, I get taken into the X-ray room by a seemingly anorexic x-ray technician. (she was very nice and had a cute face, but looked like she weighed 90 pounds!)
Anyway, two initial exposures were taken while lying down and my shoulder in different positions. Once those looked good, the radiologist came in and introduced himself.
I gave him a brief history of why I was here and he gave me a rundown of what he was about to do. He also made me sign another waiver that if there was anything that went wrong, they weren't liable. Scared yet?? Nahhh......

So then I lay back down on the x-ray table and the tech puts this big wedge under me so I'm almost leaning on my right shoulder. They position my arm across my chest and then align the overhead imager over my shoulder. From this vantage point, I can see my reflection in the glass panel above, but more interestingly, if I look up behind me, I can see the monitor that the radiologist is looking at. I'm not sure of the technical term for it, but it looks essentially like a "live x-ray."

What he does next is a testament to the incredible medical advancements society has made in the new millenium...............
He tapes a paperclip to my shoulder.

Yes - a regular paperclip.
For a second, I'm a little puzzled, but when I glance up at the monitor it makes sense.

On the screen I can see the paperclip over the bones of my shoulder.
He adjusts it once more and I can see that the one end of the paperclip is perfectly aligned over a section of the space between my shoulder and the socket. He then uses a sharpie to mark that point so he knows where to inject.

He then swabs me with some iodine, etc. and gives me three shots of a numbing agent that I believe he said was primarily lidocaine. The shots didn't hurt that much - just like any other shot - an initial sharp prick then a slight burning sensation that only lasted a few seconds.

Next, he inserted what seemed like a very small cylinder about two inches or so in. He then attached one end of a clear tube to this cylinder and attached the other end of the tube to a big syringe filled with the contrast which was a barium sulfate solution. He then slowly injected about 10 ccs of the dye into the joint. It was during this point that I started to feel a little pressure in my shoulder, but after a few seconds, he pulled out the cynlinder and the arthrogram was complete.

After being led over to the MRI area and only waiting a few minutes, I was brought into the MRI room and once again checked for anything metallic on me. After assuring the nurse for the 10th time that I didn't have a pacemaker or work in a metal shop or have any shrapnel in me, she led me over to the machine. I had to lay down and shimmy up to get my shoulder into this support device that was supposed to keep it stable. She shoved some extra padding in the sides and top to help keep me from moving it at all. She also gave me a pillow, ear plugs and a wedge under my knees to take pressure off my back. Then, it was go time!

I'm not claustrophobic at all, but for anyone who is or may even think they might be, this next part might freak you out a bit.

The platform I was on slowly pulled me into the giant MRI cylinder headfirst. It was kind of like being loaded into a torpedo tube. The hole is only slightly larger than I am and both my sides were pressed up against the inside walls of the machine while the top was less than a foot in front of my face. At this point, I'm in up to my knees when I hear the girl start talking to me via speakers inside the tube. The rest of the procedure lasted about 25 minutes or so and was just me trying to stay perfectly still while all these bangs and buzzes and taps are going on around me. It went by relatively quickly and at one point I think I dozed off. I think I actually just fell asleep when she woke me up because it was finished. How rude!

So after changing, I asked the girl how I could get a copy of the films since my orthopedic doctor said I should. To my surprise, she told to wait a few minutes and they'd burn me a CD of the images. SWEET!!

Of course, I then went to work and popped it in and examined all these neat shots of the internal workings of my shoulder. Now, I'm definitely no expert in radiological diagnosis, but I do know that the bright white spots are the contrast dye, and if you see it anywhere else but in the space in the joint between the actual bones, then its gone into a void where there should be tendons or ligaments -- indicating that something has torn away.

When I started looking through the images, I started to get a little concerned.
I saw some noticeable white spots covering a larger area than I anticipated. Does this mean I tore my rotator cuff? Did I really do that much damage to myself over these years??

Instead of of speculating, I decided to ignore the shots with huge scary white patches and just picked the shots that showed the smaller, more likely areas of tears.
(If it turns out that the damage is more extensive than I originally thought, I'll post those images so you can see the extent of the tears)

Here's the first one:
The spot in red seems to stand out to me at not only a possible tear, but maybe bone degradation? I can't say for sure, but it does look abnormal.

This spot seems a little more prominent and likely to be a tear. You can see how it sticks out from the normal, round edge of the joint.

This is a top-down shot from above. Just like the previous one, the bright spot here just stands out as looking abnormal around the rounded edge of the joint.

So for any radiologists or orthopedic specialists who happen to stumble on my blog and see this, if you know how to read these, please drop me a comment with your input. I'd love to hear it.

For anyone else -- comments always welcomed!!

Otherwise, the next chapter to this story will hopefully come next week after my ortho doc gets to peep out these films. Then we'll know for sure.........


Rick said...

I am scheduled to have an arthogram on Tuesday. I have problems with both shoulders so my ortho has asked for both arms to be done. I called to schedule, but was told they would only do 1 shoulder per visit. I inquired as to why, and they reponded that I would not want to do both in one day as the procedure is "intense". So, I am a little nervous based on her comments, I am doing some research. It seems most of what I read is similar to your experience. A bee sting type pain from the local and some pressure or brief moderate pain related to the injection of the dye. Is there anything you would describe as "intense" you did not mention? Would you consider doing both shoulders as too much for 1 appointment?
I admit, the sight of needles makes me cringe, so I will be focusing my attention elsewhere.
How is your shoulder now? Did you have surgery?
Thanks for your input from a nevervously hesitant future arthogram patient.

garrettnicholson said...

Judging by the MRI of your shoulder it is safe to say it appears to be a Glenoid Labrum Tear. It is not as severe as a rotator cuff injury but can if severe enough can require surgery to anchor the labrum back to the shoulder joint. Sometimes simple physical therapy can help restrenghten the joint and aid in the labrum healing on its own. Always attempt other methods before electing surgical repairs as the shoulder surgery in some circumstances actually make the pain and discomfort worse than the injury itself. However, if it is severe enough then shoulder stability can be a major factor.

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