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|12/11/2012 9:52:56 AM -
I am posting these as a separate post so I will have the link for future reference. This will work better than having to keep posting this when needed. In this post I will not get into the reasons (or theories) why or what type of rehab will be done, or what will need to be done if the rehab doesn't work. All I will say for now is this is all from an accumulation of many things over the past 3 decades of training. Nothing here can really be "fixed", only managed. More on all this later. There were three MRI's taken; The lumbar spine, left hip and right shoulder.
A final reason I am posting these is so I can find them for comparison in the future. I have had several MRI's in the past but it's become a major pain tracking them down.
MRI OF THE LEFT HIP:
HISTORY: Left hip pain.
TECHNIQUE: Multiplanar and multisequence MRI imaging of the left hip was performed without IV or intraarticular gadolinium contrast.
Study is degraded by decreased signal-to-noise ratio on some of the sequences, especially the small
field-of-view fat-suppressed proton density sequences.
BONE MARROW: There is a moderate degree of likely reactive bone marrow edema seen on both sides of the joint involving the left hip superiorly. Visualized bone marrow signal intensities otherwise appear to
be maintained. There is no evidence for occult fracture or avascular necrosis. No suspicious focal bony lesions are seen.
HIP JOINT: There are moderate to severe degenerative changes noted to the left hip with marked loss of articular cartilage, predominantly superiorly. There is also moderate to severe osteophyte formation. There is also subchondral cystic change noted to the superior acetabulum. There is a trace joint effusion. No intraarticular loose bodies are seen.
On the large field-of-view images, there are also moderate degenerative changes to the right hip joint.
LABRUM: The superior labrum on the left appears diffusely degenerated/torn. There is also a small multiloculated cystic focus seen associated with the superior aspect of the superior labrum on the left, compatible with a small paralabral cyst. This measures approximately 8 x 5 x 6 mm in size.
On the large field-of-view images, there is also the suggestion for tearing of the right superior labrum with an adjacent paralabral cyst measuring approximately 10 x 6 mm in size.
BURSAE: No bursal fluid distentions are seen.
SCIATIC NERVE: No focal abnormalities are seen along the visualized course of the sciatic nerve.
MUSCLES/TENDONS: Visualized muscle signal intensities are maintained. Visualized tendons appear intact.
There are moderate to severe degenerative changes to the left hip along with trace hip joint effusion.
The left superior labrum is diffusely degenerated/torn and there is a small associated paralabral cyst.
On the large field-of-view coronal sequences, there is also evidence for moderate degenerative change to the
right hip as well as findings suggesting a tear of the right superior labrum with an adjacent paralabral cyst.
MRI OF THE LUMBAR SPINE WITHOUT CONTRAST:
HISTORY: Intervertebral disc displacement.
TECHNIQUE: Multiplanar multisequence MRI of the lumbar spine is submitted for review without the use of
The conus medullaris is of normal caliber and signal intensity.
The alignment of the lumbar spine is intact. Mild diffuse degenerative disc disease is identified with
desiccation and minimal narrowing of the disc spaces most apparent within the lower three lumbar levels.
Borderline congenital spinal canal stenosis is identified.
The height of the vertebral bodies is normal.
The marrow elements are unremarkable.
No paraspinal mass is identified.
L1-L2: The central canal and neural foramina are patent.
L2-L3: The central canal and neural foramina are patent.
L3-L4: Annular disc bulge is detected which flattens the thecal sac.
L4-L5: Annular disc bulge flattens the thecal sac.
L5-S1: No focal disc protrusion is identified. Shallow disc bulge flattens the thecal sac. Mild facet
arthropathy is identified. Moderate to severe bilateral foraminal stenosis is identified greater on the
1. Mild diffuse degenerative disc disease of the lumbar spine most apparent within the lower three
lumbar levels. Shallow disc bulges are identified at these levels which flatten the thecal sac.
2. Borderline congenital spinal canal stenosis.
3. Moderate to severe bilateral foraminal stenosis at L5-S1 greater on the left due to annular disc
bulge and facet arthropathy.
MRI OF THE RIGHT SHOULDER:
HISTORY: Right shoulder pain. Patient reports chronic shoulder pain for many years without known
TECHNIQUE: Multiplanar and multisequence MRI imaging of the right shoulder was performed without IV or
intra-articular gadolinium contrast.
ROTATOR CUFF: There is moderate to severe tendinosis of the supraspinatus tendon. There is also a small
partial-thickness bursal surface tear to the distal supraspinatus tendon anteriorly towards its
attachment on the greater tuberosity (refer for example to images 8 and 9 of the coronal sequences and
image 16 of the sagittal sequences and image 18 of the axial sequences). This appears to be high-grade
extending through greater than 50% of the tendon thickness. The tear measures approximately 5 x 5 mm in
size. There is no tendon retraction. The remainder of the rotator cuff appears intact and
unremarkable. Muscle mass and muscle signal intensities are maintained to the rotator cuff musculature.
BICEPS TENDON: The long head biceps tendon is intact, appropriately located and normal in appearance.
LABRUM: There is diffuse degeneration/tearing of the labrum, predominantly posteriorly and to a lesser
extent anteriorly and inferiorly. No paralabral cysts are seen.
ACROMIOCLAVICULAR JOINT REGION: There are moderate to severe degenerative changes to the AC joint. The AC joint
also appears to be widened measuring up to 1.3 cm. There is a small ossification seen adjacent to the
superior distal clavicle in the region of the AC joint capsular attachment. The capsular structures
have a somewhat attenuated appearance inferiorly and a somewhat thickened appearance superiorly. There
is no associated edema within the capsular structures or in the surrounding soft tissues. The
coracoclavicular ligament appears intact and unremarkable. Findings are suspicious for chronic
low-grade AC joint separation. No significant fluid is seen in the subacromial/subdeltoid bursa. The
acromiohumeral interval is maintained. There is a type II acromion.
GLENOHUMERAL JOINT: There are severe degenerative changes to the glenohumeral joint. There is
remodelling of both the humeral head as well as of the glenoid. There is marked loss of articular
cartilage on both sides of the joint. There is also extensive osteophyte formation on both sides of the
joint. There is a small joint effusion. No definite intra-articular loose bodies are seen.
BONE MARROW: There is a mild degree of likely reactive bone marrow edema to the humeral head.
OUTLET SPACES: No focal abnormalities are seen in the region of the spinoglenoid notch, suprascapular
notch or quadrilateral space.
Severe degenerative changes to the glenohumeral joint along with a small glenohumeral joint effusion as
Moderate to severe degenerative changes to the AC joint along with findings suggesting chronic low-grade AC joint
separation as above.
Small high-grade partial-thickness bursal surface tear of the supraspinatus tendon with superimposed
moderate tendinosis as above.
Now you can see why I stopped after these three.,
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