Q: I’ve developed some issues with my right shoulder due mostly to pitching in baseball. I’ve had an MRI done recently and I’ve been working with an ART specialist as well. So here’s the email I just received from my chiropractor:

I just got your MRI results in, it shows tendonitis of the supraspinatus tendon and a small “hot spot” on the anterior/superior aspect of the glenoid labrum, which might represent a small tear. The radiologist has recommended an arthrogram, which is an MRI with contrast injected directly into the joint capsule instead of intravenously.

You have two options: We could try some more ART and more laser treatments. If your pain decreased after one treatment, than I think it would definitely help. Option two is referral to an orthopedist. He would in turn probably refer you for 4-6 weeks of physical therapy. In any event, the possibility of a major labral tear is slim as a large tear should have been visible on the MRI.

Based on the MRI results what do you recommend as far as the options he layed out for me? The ART has helped some but it is still very painful to throw hard. I have no clue what to do and I’m afraid of getting in over my head with medical bills and still having a hurt shoulder.

A: Congratulations! You have the same MRI that every pitcher I’ve ever seen has ever had!

I can pretty much tell you that your labrum is frayed regardless of whether or not you get the MRI. According to the research, the main difference between those in pain and those not in pain is internal rotation ROM.

Get the PT – and bring this list with you:

1. Scapular stability
2. Thoracic spine range of motion
3. Glenohumeral (ball-and-socket joint) range of motion
4. Overall soft tissue quality (especially posterior capsule)
5. Rotator cuff strength
6. Cervical spine function
7. Mobility of the opposite hip
8. Mobility of the opposite ankle.
9. Core stability/force transfer
10. Breathing patterns

Tell them that you want to address each of these 10 factors (in this order) in your rehab.

In particular, tell them to check internal rotation ROM, and even print this out for them, if need be: https://www.jaaos.org/cgi/content/full/14/5/265/JA0008404FIG9

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