Joe A Shaw PA-C - 10/4/2010

Question
wrote you in June... this is sort of a follow up question but could not figure out how to do it that way. After months of advising my primary that the shoulder is interfering with life, he ordered an MRI.
MRI report of my left shoulder says I have a small partial tear of the bursal surface of the supraspinatus tendon near the humeral attachment. There is a downsloping type 1 acromion which contacts the outer border of the supraspinatus consistent with bony impingement. There is a deformity of the anterior labrum consistent with a small tear.

Would any of the above indicated problems cause pain near the top inside portion (near spine) of the scapula that shoots up behind the left ear? It is very sensitive to the touch, and there is frequent and fairly consistent pain not touched by anti inflammatories. I am assuming that this is the origin since on occasion it does not throb, if i touch that segment of the scapula it shoots the pain up the same path to behind the ear.

I landed on the outside of my arm causing direct blow to the left upper arm / shoulder. Heard a crack and felt a strong burning sensation between the AC joint and neck followed by extreme ache and difficulty moving arm. MRI (which my primary physician just recently ordered after 6 mo of letting him know it interferes with sleep, work, etc in spite of plain x-rays showing nothing) showed the above issue but the it did not cover the part (inside top portion of the scapula) that seems to be what shoots pain up behind the left ear.

Do you have any directions that would help me talk to my doctor better if the initial MRI results do not explain the additional symptoms? (Initially the AC joint area was extremely sensitive to the touch also. Now it just aches, sometimes into the collar bone and shoulder movement sounds like bones are colliding with each other and causes increased pain.)
My primary ordered the MRI. I have been referred to an ortho now. Nervous about them saying surgery and it not being what will really take away the pain i am having (happened to my right side). Doctors are always reminding me that i am a female and should take up things like crocheting or reading as if my being a girl means i should not be athletic. They dont understand that I NEED to be able to work out and work out a lot and work out hard.
Do you have any advice on how to communicate with the ortho when I go? Verbal communication for me is not good. If the symptoms dont match the MRI results then surgery would not really solve the problem correct? Thanks for your time...i really appreciate it.  

Answer
Vic,
The ortho will probably want to scope and repair your tear..which after 6 mos still having some symptoms I would tend to agree..but it wouldn't hurt to try 1-2 cortisone injections and PT first.
Now the parascapular symptoms you are having I guess is from the tucked shoulder fall you had and it "jammed" your scapula/adjacent muscles and nerves..these scapula injuries are typically frustrating to ortho's b/c surgery of bones and joints is what they do...these scaplar injuries are hard to figure out but I would try trigger point injections and Lidoderm patches where the specific pain is,,you also may want to see a physiatrist..they specialize in muscle,nerve injuries and are not surgeons. It is possible to get an MRI of the scapula area which may detect a tear in that area, if you were a big time QB they would go to great lengths to find the cause :)but again most orthos will do 20 shoulder scopes to 1-2 scapular inuries..
good luck