About the author:

Howard J. Luks, MD

Howard J. Luks, MD

A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr. Howard Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very "social" patient centric approach and believes that the more you understand about your issue, the more informed your decisions will be. Ultimately your treatments and his recommendations will be based on proper communications, proper understanding, and shared decision-making principles – all geared to improve your quality of life.

27 comments on “When Should We MRI Shoulder Injuries?

  • Dr. Luks,

    I am 29 years old and had major rotator cuff surgery 9 months ago. Around month 6 of recovery I was moving furniture and had a HUGE increase in pain and symptoms. I continued with my therapy for about two months but had no improvement in symptoms. My doctor ordered an MRI which came back negative. I requested a second opinion and that doctor ordered an MRA which also came back negative. This is great news for me except that I am still having terrible pain. Not just a little soreness or surgical pain but extremely bad pain that renders me inactive. I can’t lift weights, I can’t swim, I can’t do anything except very light rotator cuff exercises which are uncomfortable but bearable. I am a very active person and have played sports my entire life so I am familiar with shoulder tendonitis or tweaks that typically heal within 6 to 8 weeks. This is nothing like that. This pain is identical to the pain I was having before the surgery. My quality of life is very low because I am a very active person but I can’t do anything without pain. I don’t know what else to do. After reading some research it suggests that an MRI/MRA are not extremely sensitive to partial thickness cuff tears, especially retears. I guess my question is when should I or my surgeon consider a scope? What are the odds that both an MRI and an MRA from two different doctors are both negative? Thanks so much Dr. Luks.

    Adam

    • , I am having the same problem after surgery. I lifted up something heavy and felt like I tore a muscle or something in my arm. However, nothing is showing up in the test, what were your results?

    • On rare occasions it can tell us if a rotator cuff tear is acute (recent) or chronic (older). But in general, no … it can not give precise information regarding the age of a tear.

  • Does rotator cuff tears always show up on MRI scans? I had an MRI done, did physical therapy, iced my shoulder, and also took anti flam medication and muscle relaxers and nothing fixed it. I was a CNA and injured my shoulder on the job and my dr told me I that my MRI showed nothing… it’s a year and a half later with nothing getting better…..?

    • They usually do… Sometimes Radiologists may or may not mention the presence of rotator cuff tendinosis or tendinopathy–which is the most common cause of rotator cuff pain. In addition, some Orthopedists may say “nothing is wrong” to mean that you don’t have a tear… no necessarily focusing on the mention of tendinosis which again is a very common cause of shoulder pain.

  • So glad I looked this up! I’m currently seeing an Ortho and I’m also in PT. My Ortho and my therapist have told me I don’t need an MRI because they are both sure I have a tear. My Ortho says it is not significant enough for surgery and most tears can be treated with PT and injections as I also have some other issues with the same arm. I have a lot of friends in the medical field that keep telling me this just isn’t true I should insist on an MRI because my treatment plan may change after imaging. But it seems to me you have the same treatment philosophy. I just needed reassurance that my Dr was recommending the right treatment options and I’m not just suffering through this pain for no reason. I agree that it would seem quite redundant to have imaging taken if it will just confirm some thing he already knows, but when you have a village of medical professionals telling you other wise it makes you second guess your treatment plan.

    • Hi …
      Your doc is correct … after a certain age, degenerative rotator cuff disease- including the possibility of a small degenerative rotator cuff tear is the most common source of pain. If you have normal strength, then there is no need to rush into an MRI. Even if a small degenerative rotator cuff tear is identified the initial treatment is still PT. I hold off on an MRI until I see how my patients respond to PT. If you complete a course of PT and significant pain persists then an MRI can be performed.

    • hard to say … but it is possible. Burning pain is associated with inflammation and nerve pain— so a good examination can usually tell which one is bothering you.

  • Hello, Dr Luks,
    A month ago tomorrow, I fell flat out on a hard floor and dislocated my right shoulder. I spent a few hours in an ER. and they put it back in place. Since then, I went to 6 sessions of PT. I do exercises at home as well.
    I still have a lot of pain in the wee hours at night. There is improvement in my range of motion, maybe 25%.
    I feel I need an MRI to assess the damage of the tendons. Any arm movement to the side is still painful .
    I do not want surgery if I can avoid it. How many weeks of PT would I need to see bigger results?
    Is it a matter of time? And when is it too late to have surgery ?
    I’m a 73 year old female, in good shape otherwise. I still ran 9 short footraces in 2016. Never had any major illness. Is it possible to get 90% of range of motion back without surgery?
    Thank you for your reply !!

    • An MRI following a shoulder dislocation in a 73 year old is generally best down earlier rather than later…. that’s because many 60-80 year olds will tear off a large portion of the rotator cuff when the shoulder dislocates.
      Good Luck

    • A good exam by a shoulder doc can usually tell if you had a previous dislocation. The X-ray will also tell if you had a previous dislocation.

  • I was in a roll-over car accident in 2012 – I was not wearing a seat belt. At first my pain was thought to be from my neck, within months it was concluded my shoulder was also involved. 5 years and several X-rays and 2 MRIs later my diagnosis is still unsure. The pain gets much better if I don’t use my arm – usually during winter months. At todays app. I could not lift my arm to the side above my shoulder. Now they want to do another X-ray. I have a total of over 116 mSv of radiation over my life from thyroid cancer and CT scans among others. Is another X-ray necessary?

  • I don’t know what’s wrong with my arm it started about 2 months ago I was trying to pick up a door to move and something happened to my right arm, the next day my bicep was black and blue, and ever since that it hurts all the time I can’t pick anything up with my hand without pain going all the way up to my shoulder I can’t sleep for the pain I have to set up , when I try to raise my Are even with it bent it hurts terrible getting no better what should I do?

    • Time for a Sport Medicine Doc with a shoulder specialty to take a look and see what’s bothering you.

  • I just had my 3rd MRI/MRA on my left shoulder. Each has shown a torn rotator cuff in the same area. First also showed SLAP tear. I have had surgery on it twice in the last year. Is it possible the tendon is just can’t heal? I am in my early 40s and very active.

    • Yes… not all cuff tears heal. Some repairs fail due to biology, some fail due to early strengthening, some fail due to early return to full activities, some likely fail due to poor repair technique. As you can see there are many reasons why rotator cuff repairs fail to heal. Figuring out why is important. The results of revision rotator cuff surgery is much worse than the results of the first or the primary repair.

  • I’ve had shoulder pain for about 7-8 months now. Last trip to my VA dr I got a cortisone shot. Count tell any difference. The pain is when I raise my arm and starts just under 90 degrees all the way up to 180. The pain is also present below 90 degrees but only while reaching back. I have a follow up appointment in about a week. NSAIDs have also been inneffective. Does this sound more like a tear or an impingement?

    • Most shoulder surgeons have gotten away from the term impingement. We call this degenerative rotator cuff disease or rotator cuff tendinosis. As such the rotator cuff and surrounding bursa are usually the source of pain… but not because they are being impinged by a bone spur.

      A good exam and perhaps an US or MRI can help in determining the status of your rotator cuff. You can talk with your doc to see if they feel that physical therapy would be beneficial.

      Good Luck

  • About 20 years ago I was blindsided while refereeing a hockey game and hit the ice full force with my arms straight out in front of me. I finished the game but was hardly able to remove my clothing afterwards due to the pain in both shoulders. Long story short – I saw a doctor, completed a number of weeks of PT with no improvement, had an arthrogram, and saw an orthopedic surgeon who confirmed rotator cuff damage. He said he could only offer 50/50 chance of improvement through surgery since he couldn’t determine from the arthrogram whether the damage was repairable. Since he indicated no long term ill effects from not repairing it – as long as I continued to use the shoulders within my pain tolerance – I elected not to go ahead with surgery due to extensive travel required by my job which would limit PT in recovery.
    I’ve lived with various amounts of pain for 20+ years and limited my participation in sports. Two years ago I aggravated the shoulders (hedge trimming, raking leaves) and the pain has now increased to the point where it’s constant, acute and affects my ability to sleep, not to mention doing anything physical.
    My question is – given the length of time since the injury and my age (66) would surgery offer me a good chance to at least alleviate the pain if not restore some strength also ?
    Thank you.

  • why would a doctor order laserscopic surgery on a shoulder of a 16yr old instead of a MRI? she is a softball player and has been having issues with her shoulder for a while . she went through rehab and that did not fix anything. now the doctor says that they need to go in and see what is wrong because they don’t know. why not just do a MRI first?

    • Yours sounds like a reasonable plan … It’s often important to know why you are operating on a joint before you start the operation.

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