This topic contains 7 replies, has 2 voices, and was last updated by 
Brandon Cohen DC, CSCS October 15, 2018 at 3:11 pm.
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Brandon Cohen DC, CSCS
Patient’s MR and report came back yesterday. What is that white spot on the head of the humerus? I tried to find it on the internets, but my search was lacking. No comment in the report. Under bones it says, “No worrisome lesion.”
Brandon Cohen DC, CSCS
I’ll color it in a little. 54 y/o male professional musician (stand up base) positions required to play do not aggravate pain.
History of Present Illness: Location: superior, anterior shoulder, and lateral left arm.
quality: stabbing
Intensity: 7/10
Provocative: abduction, sleeping on that shoulder
Palliative: resting it in neutral
Numbness in the left thumb and web.
Worse first thing in the morning. Present for the past 18 months, worse after the last 6 weeks.
Keith Puri, DC
That looks similar to a hills sachs deformity? Were there any findings in the labrum? To me “no worrisome lesion” under the bone heading sounds like there is something present. However, it’s just not worth reporting. Possibly a normal variant?
Brandon Cohen DC, CSCS
Thanks Keith.
Here’s the rest of the report: This is the conclusion, but the actual report has minimal detail.
CONCLUSION: 1. Moderate acromioclavicular osteoarthritis. Mild outlet narrowing. 2. Moderate supraspinatus tendinosis. No full thickness tear. Remainder of cuff intact. 3. Mild osteoarthritis of the glenohumeral joint. 4. Small focal posterior chondrolabral tear at the 9:00 position.
Logan Scharf
To my knowledge, this can be arthritic erosion enhanced by contrast. Here is an image of such.
Carl Nottoli, DC
Have you done resisted testing of the rotator cuff? The bone lesion may be a result of all the other pathology and getting slammed around in the joint.
What is the exact location of the numbness? Is it on the palmar side at all?
Brandon Cohen DC, CSCS
Thank you Logan and Carl.
I have a call into the radiologist, and waiting for a response.
Numbness is only in the dorsal surface of the hand. He also has a cervical disc issue that I have treated previously. I dropped his insurance, and he stopped coming in. Shoulder became a priority, and the neck is on the list of things to continue to work on, but is not his immediate priority.
Assuming there is nothing ominous about the imaging, it doesn’t appear to me to be a surgical thing, and we have had good improvement in range, but pain persists. Its becoming more and more of a load management case for the shoulder.
Brandon Cohen DC, CSCS
I spoke with a different radiologist than the one who read it (due to vacations), and he explained that it is a subchondral cyst, and that many of the radiologists don’t mention it because the orthos don’t find it valuable information. He also he added a couple more pieces of degeneration that weren’t on the existing report, so in the addendum, there should be 7 findings pointing to his degenerated shoulder instead of 4.
I don’t read shoulder films very well, so I’m working on getting that better. I will say 90% of the time when I call the radiologists and get to speak with them (getting a hold of them can be a bit of a pain) they are helpful and more than willing to make changes, or at least discuss with me what the findings are. Also, 80% of the time there are parts on the images that they mention as relevant that didn’t make it into the report. I imagine talking over a case is a welcome reprieve from staring at the computer all day.
At first, I was super nervous about calling them, and would practice several times what I might say, but most of the time they are more than friendly. So, if you have questions or concerns, give your friendly neighborhood radiologist a call.
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