Ahhh…summertime. Warm weather means outdoor sports, vacations, exercise and …shoulder injuries? That’s right, shoulder injuries. Many classic outdoor activities during the summer months are “overhand/overhead” ones like baseball, softball, tennis, swimming volleyball or even painting, roofing and yard work.
While all these activities use different muscles, they all involve repetitive use of the shoulder that can lead to potential shoulder instability (when the shoulder joint is loose and slides around too much in the socket). This repetitive motion can cause the shoulder ligaments to loosen and in some cases, slip out and dislocate or lead to arthritis. Frequent use of the shoulder can also cause severe problems with the rotator cuff.
The rotator cuff is the name for four distinct muscles and their tendons that surround the shoulder, that provide strength and stability during motion. Some of the most common shoulder conditions to the rotator cuff that can occur in the warmer months include impingement syndrome, bursitis, tendinitis and tendon ruptures or tears. All of these can vary in severity and if ignored, can aggravate the shoulder even further. One of the top injuries that we see at Shields MRI during the summer season is rotator cuff tears. So how do you know if you have a rotator cuff tear and if you need an MRI?
First thing is first –any concerns, sharp pains or prolonged discomfort is a reason to visit your doctor; and a doctor that specializes in orthopedics is one that can help address concerns with your shoulder and rotator cuff.
Dr. Mayo Noerdlinger, an Orthopaedic surgeon at Atlantic Orthopaedics and Sports Medicine in Portsmouth, New Hampshire, advises on why MRI may be recommended for a rotator cuff tear. “To simplify matters, rotator cuff tears do not heal; they can retract, leading to muscle atrophy and eventually cause arthritis in the shoulder. For these reasons, I tend to order MRIs to evaluate the rotator cuff when someone presents with ongoing shoulder pain and weakness.”
MRI is particularly beneficial for internal organs, muscles, connective tissue and the central nervous system and uses cross-sectional imaging to create extremely clear and detailed picture, allowing your physician to make an earlier and accurate diagnosis. In the instance of a rotator cuff injury, your doctor may recommend an MRI not only to diagnosis a tear, but rather, to exclude the possibility of one.
Not all shoulder pain and injury to the rotator cuff is cause for an MRI. Dr. Noerdlinger explains, “Only three things will limit external rotation: arthritis, a posteriorly dislocated shoulder and frozen shoulder. Both arthritis and a posteriorly dislocated shoulder can be diagnosed on plain x-ray. The best way to evaluate for a frozen shoulder is to assess the external rotation of a patient's glenohumeral joint. A frozen shoulder is the presumed diagnosis in the setting of normal X-rays and limited external rotation."
Dr. Noerdlinger describes a very simplified method he uses when he is considering an MRI for a patient complaining of pain and discomfort in their shoulder. “Pain and weakness with good passive range of motion, consider a MRI to rule out a rotator cuff tear. Pain and weakness with poor passive range of motion (especially external rotation), consider a glenohumeral cortisone injection and physical therapy to treat the frozen shoulder.”
If your doctor does recommend an MRI for your shoulder, there are two potential types of MRI procedures that can be used to diagnose a rotator cuff tear: A routine shoulder MRI, which takes about 25 minutes of actual scan time, and shoulder MR arthrogram, which involves an X-ray procedure during which contrast is injected directly into the shoulder joint space followed by an MRI. An MR arthrogram is more specific for shoulder joint injuries, but is also more involved and requires the patient to be at the facility for about two hours. Your doctor can help determine which scan is the right one for your injury. Example images of shoulder injuries for both types of MRI scans are shown below.
Shields MRI, chief technologist, Aaron Easton says, “ As with any injury, it is critical that the patient is comfortable and relaxed during their MRI. Not only does this create a better imaging experience, but it ensures that the patient is still to obtain the best images possible. An important thing to remember when imaging the shoulder is that MRI is very sensitive to motion; the challenge with the shoulder is its very close proximity to the lungs. Breathing calm and relaxed and avoiding heavy breathing, coughing and clearing of the throat during the imaging sequences will all help to ensure image quality. At Shields MRI, our staff will use cushions and padding to support our patients’ arms and legs as a way to make them as comfortable as possible and make it easier to remain still throughout the exam.”
If you are experiencing any pain that is consistent with the descriptions in this article, you may want to consider a visit to your doctor, who may recommend therapy, rehabilitation or an MRI. The biggest lesson is to listen to your body and your doctor. And if we see you at Shields MRI, we’ll do everything we can to get you back on the playing field without further pain or injury.
We found that one of the top items on shields.com that people are looking for information on is an MR arthrogram. Since so many people are interested in this topic, we thought we should provide some additional information.
What is an MR arthrogram?
An MRI arthorgram is an imaging study conducted to diagnose an issue within a joint. The exam is done in two parts and usually with the aid of a contrast agent called gadolinium that will help to highlight the visualization of joint structures and improve the MRI evaluation.
An arthrogram is used to:
How do I prepare for the exam?
- Identify the presence of abnormal growths or cysts.
- For diagnosis of complete rotator cuff tears, adhesive capsulitis, tear of the rotator interval, disorders of the biceps tendon and impingemetn syndrome.
Prior to your appointment, a Shields representative will contact you to review your medical history and answer any questions that you may have. If you suffer from claustrophobia or anxiety, you may want to request a wide, open-bore MRI or ask your physician about being sedated prior to the scheduled examination.
Patients are asked to withhold fluids two hours prior to arrival. You should wear comfortable clothing and remove any metal including jewelry, under wire bras and hair pins.
If you have had previous imaging studies such as MRI, CT or X-rays that were done at another facility other than Shields, please bring the films and reports with you to your appointment.
How long is the exam?
The length of the test may vary based on several factors, but is usually one to two hours. A team of Shields specialists are available to answer any questions throughout the exam.
During the exam – what should I expect?
The first part of the exam is completed with the assistance of an x-ray machine called a C-arm. The procedure begins with the application of a local anesthetic to the joint area being scanned. A radiologist then injects the area with a small amount of the contrast agent (gadolinium) under the guidance of x-ray. The patient is then sent to the MR room for the imaging portion of the scan.
The second part of the exam is the MRI scan. Shields MRI systems uses a combination of a powerful magnet, radio signals and sophisticated computer software technology to create amazingly clear, detailed images of the inside the body. There is no radiation with MRI and the machine does not touch you at any time. At Shields, patients may relax and listen to their choice of XM satellite radio music while the images are being taken.
After the exam – what should I expect?
After the exam is complete, you may resume regular activities and normal diet (provided you have not been sedated). Some patients may experience swelling and discomfort around the joint where injected. You may apply ice to the joint to reduce swelling if it is bothersome. These symptoms usually disappear after 48 hours. Contact your doctor if they persist after two days.
When will I receive my results?
Following the test, the images will be reviewed and prepared for interpretation by the radiologist. The results are then sent to your referring physician who will be responsible for discussing the results with you.
How much will an MR arthrogram cost?
The price of the test is depending on location and your insurance coverage. Keep in mind that this test is two parts- the x-ray/injection and the MRI. If you are price shopping, be sure to ask for the TOTAL price of the test including both parts.
At Shields, the total price is estimated to be between $880 - $1,083, depending on your insurance & location. On average, non-partnering hospitals are abour 60% higher in price than Shields services. For an exact price for your arthrogram at Sheilds, please contact our Patient Financial Services team at: 877-712-3075. These representatives are dedicated to providing pricing information to our patients, a service few other healthcare providers offer. Shields is proud to be a leader in healthcare pricing transparency.
Where can I get an MR arthrogram in Massachusetts?
Shields offers MR arthrograms at 10 of our 25 MRI locations incuding: Shields MRI Framingham, Shields MRI Weymouth, HealthAlliance Hospital in Leominster, UMass Memorial MRI & Imaging Center, Marlborough Hospital, Baystate Franklin MRI Center, Wing Memorial Hospital, Shields MRI at Lowell General Hospital, St. Luke's Hospital and Winchester Hospital-Shields MRI at Unicorn Park.