Hello,
I fell and tore up myself up pretty bad in Feb 2014. According to the Ortho I have impingement and three partial thickness tears (all but teres minor) along with AC synovitis, spurs and abnormal fluid (inflammation?).

I have been reading up on these issues but am getting so confused. There seems to be a lot of overlap and conflicting information. I know that this forum is full of compassionate and well educated people. Any information/clarification would be a blessing. There are so many frustrations and no clear answers.

Can anyone please give me a basic symptomology difference?
What causes the problems/hurt where? I have limited movement, pain, weakness, and numbness in various areas. I just don't understand what's happening.
For example: when I cant raise my arm thumb up in front of me... is that impingement or a tear causing the problem? I can't do a lift off/belly lift test? Tear or impingement? Popping in the joint with ROM exercises: synovitis perhaps?
Why does my armpit itch all of the time? I believe there is nerve involvement but the Doc just shook his head and said to change my deodorant.

To some people it may sound silly to want to know these things, but I am just trying to get a handle on what is ruining my life. Knowing may reduce the anxiety these last 5 months has burned into my existence.

Thanks for reading my ravings,
Blessing and a complete recovery to all.
Daesin

daesin,
I will not speak to the nerve issues. However, rotator cuff tears, even if partial, can cause quite a lot of pain and functional disability. Usually the ortho can determine which tendons are torn by the MRI as well as clinical tests, but even then, there is no certainty until they actually go in and look.
Spurs can cause the cuff to tear, as well as overuse (normal aging process), wear and tear or an accident. The AC joint can also become arthritic and painful with age.
Most people who have spurs can have them smoothed down, and then the cuff may be repaired, or often times just a debridement may be enough to restore painfree movement. If the tears are less than 50%, they might not need repair. A lot depends on your age and the condition of the rotator cuff muscles. Also, the fluid indicates that there are tears.
Your confusion is understandable, and you are not alone! There is quite a bit of differing opinions on how to treat shoulder problems, and sometimes no easy fixes. You may want to get another opinion, and seeing a shoulder specialist, who only treats shoulders, is always a good idea. Some are better than others in providing a clear explanation of the disease process.

Talon, thank you for your time. I have a shoulder specialist now, but he isn't very open to communication or questions. He tends to be rather brusque and condescending. Surgeon issue? This is the 2nd ortho who would prefer that I just stay quiet. I have questions and need to know what is happening in *MY* body. Our visits are rushed and the nurses never know when they call back. So its nice to have some insight. I appreciate your time.
Thanks again,
Good luck to you.
Daesin

Daesin, what is your doc's plan?
As you might guess from my history, i have been around the block with shoulder problems. I finally ended up with one of the top shoulder docs, who writes the books and complex problems and teaches extensively in the US and europe. HE was stumped by what happened to me.
He has a very good website on a multitude of shoulder issues. I do believe, and understand, that they do not have the time to fully explain all the concepts, possibilities and probabilities. But you are entitled to a diagnosis and clear understanding of what they believe is the problem. So, my doc refers patients to his website for fuller understanding. It is one of the best i have seen
Also it is a good idea to get all the visit notes and surgical notes, if you have surgery.

OH wow Talon, the dos plan...well that's a story in itself....grab a warm beverage and get comfy (if possible).

I fell on ice this Feb, PCP checked my wrist as it was bleeding swollen and really painful. They did document other injuries (whole left side bruised and battered) but the wrist was the only thing bleeding. They said sprained with no fracture go back to work. I went back to PCP after a few weeks as my shoulder didn't move right and the wrist was the worst sprain I ever had. My pcp was out so they gave me sub. This Doc initially accused me of wanting pain meds and faking an injury. After an exam and hearing all the crackling and screaming he sent me to an ortho. Got ortho to run a MRI. He told me it was tendonitis and sent me to PT. Its now 3 months in and I am still working full time with no anti-inflammatories or pain meds). PT encouraged me to read my mri report. At next ortho apt I had obtained my MRI report (showing three partial tears, AC synovitis spurs and abnormal fluid) and asked him if there was a difference in tendonitis and tears. He got really upset and fired me as a patient as I "was not cooperating by healing." So I had to find a shoulder specialist on my own.

At almost four months I saw shoulder specialist. He is trying to get the dx codes straight and answer the DOL questions but is very grumpy and hates the paperwork I guess. Communication is not his strength. But he did finally take me off work and put me on meds: to which I had an allergic reaction. Last visit he told me that his only option was surgery, but he didn't recommend it as he didn't think it would help. No further explanation given. But if I didn't agree to the surgery then he would close my case on our next appt.

I am currently waiting for the insurance (Dept Labor) and the doc to agree on a dx code so that they can send me to a physiatrist (sp?) to check for possible cervical nerve involvement. Meanwhile I am circling the airport with no Doc to help, no meds and now PT has me as plateaued which means they cant justify services. They are afraid to get aggressive as I present as more than just tendonitis. They are great and have kept me from freezing my shoulder but are as frustrated as I am. I still don't have AROM or PROM without considerable pain. I cry every day.

I do finally (as of late June) have a case manager who is trying to help but experiencing great resistance from the Docs and DOL. Currently they only agree on shoulder tendonitis and left wrist sprain NOS as accepted DX. Oh yes, The insurance examiner asked me a few weeks ago what treatment I had received for a radial distal fracture. News to me, oh the joys of my life. By now the waters are so muddy that no one is willing to help. I notice that Drs are unwilling to refute another drs decisions no matter how idiotic they are. I will probably have to drive far out of this network, maybe to Indianapolis for treatment which is four hours away. Living in a rural area has challenges.

I am a Postmaster at a small office and handled hundreds of pounds of mail each day until early may. Short of being pregnant I never have experienced medical issues of any note. I am only 42 and thankful that my kids are all grown and out of the house. My husband has been very supportive but faces his own challenges (multiple myeloma copd myasthenia gravis etc etc etc).

Obviously I am scared and frustrated. I am now seeing a therapist due to anxiety, for which I am hopeful....with all this said I am blessed! I am still standing, my kids are healthy and my honey loves me. So I might feel pain and not have great movement or strength in my left side but I DO have a great life. I just really really want to get back to it.
Daesin

Wow, i am so sorry to read all of this. The workers comp makes these already difficult problems even worse. I do understand your frustration and hope you find the help you need.

That said, i went through a horrific experience myself. I was struck by a horse, thrown several feet, and landed on my elbow. All the force went to the shoulder causing severe damage to the rotator cuff, labrum and humeral head. The first doc ignored the injury, and i was labeled a middle aged woman with a sore shoulder. One doc tried to convince me that accident had absolutely nothing to do with my shoulder problem, nothing at all.

It is way too long a story to relate, but i ended up losing most function of the shoulder and have chronic pain. I am now considering a pain pump. I applied for disability and received my award letter 4 months later - no exam, no initial denial, only one question asked. As one friend said, knowing almost everyone is denied the first time around, you must be really messed up. I am also going to a therapist almost weekly to deal with the many losses this has entailed - my job and profession, my lifelong interests, ability to do the things i enjoyed, etc.

You may be able to overcome this without surgery. Surgery is not always the best answer and some people continue to have problems. My husband injured his shoulder twice, has a full tear, but worked through it in his own. I think most of the people who know me would never have shoulder surgery knowing what i endured.

I did have to travel several hundred miles for treatment, twice. The prosthesis i have now will not last - i will be lucky to get 5 or so years. Who know what will happen then. I can use my arm just from the elbow to hand for short periods of time, but have to keep the upper part close to my side.

Daesin,
Educating yourself is the best thing you can do in order to make a reasoned decision. Unfortunately, even being fully prepared is not enough as there really is no way to be certain based on scans and clinical tests. When I had my fifth surgery, the surgeon was prepared to do a cuff repair plus total shoulder, a reverse replacement or a fusion of the joint. He did not know which of the three he would do. As it turned out, he did a total shoulder without a cuff repair, and that was not even on the list ( which was on the overhead screen in the OR). Sadly, it was the wrong decision and it failed almost immediately. And there are not many surgeons more knowledgeable than him!