Down below is the diagnosis and following is the story.
Diagnosis: Rotator Cuff Tendons: There is a shallow linear intrasubstance tear of the supraspinatus myotendinous junction
posteriorly. The remainder of the rotator cuff is intact. There is an intramuscular tear and strain of the posterior
supraspinatus fibers with mild edema within the teres minor muscle belly suggesting a mild strain or intramuscular tear.
There is no atrophy.
Labrum and Capsule: There is a large labral tear extending from the 11:00 position of the posterior superior labrum
through the superior and anterior labrum to the 7:00 position of the inferior labrum sparing the posterior inferior labrum.
There is an associated there is mild irregular tearing of the superior glenohumeral ligament as well as the superior portion
of the middle glenohumeral ligament. There is irregular tearing involving the anterior band of the inferior glenohumeral
ligament.
Long Head of the Biceps Tendon: There is a split tear at the attachment of the biceps tendon to the biceps tendon anchor.
Acromioclavicular Joint and Acromion: There has been previous distal clavicular resection. No subacromial bone
formation.
Cartilage and Bone: There is deep partial-thickness chondrosis of the central glenoid. Joint alignment is normal. No
fracture or osseous lesion is seen.
Other Intra-Articular: No joint effusion or body.
Extra-Articular and Localizer Images: No subacromial-subdeltoid bursitis.
Patient had a history of left shoulder impingement and prior arthroscopic surgery, followed by a second surgery for Adhesive capsulitis in 2009. She recovered fully and had been completely pain free with normal function for years.
In January of this year, she slipped on ice at work (sanitation job) while taking out the trash and fell directly onto her left shoulder. She had immediate pain and went to urgent care the same day.
Since then, she’s had severe pain, very limited range of motion, and can’t sleep due to the pain. She can barely move her arm. She’s done physical therapy and had an injection with no relief.
She saw an orthopedic doctor, and a workers’ comp case manager was in the room during the appointment. One of the first things he asked was if she had diabetes (she does), then after a brief exam he said it was frozen shoulder. He didn’t mention the MRI findings unless asked.
When asked about the MRI, he said the shoulder “doesn’t even look that bad” and wanted to focus only on frozen shoulder. He also said the tears were probably already there due to age (50+) and diabetes, describing them as wear and tear, and said only the frozen shoulder was related to the fall.
What’s confusing is that she was completely pain free before the fall and now is in severe pain with major limitations.
To me, it felt like the doctor was leaning toward the workers’ comp side and downplaying the injury, but I’m not sure if that’s just how these cases usually go.
She will be seeking an opinion from the doctor that did both shoulder surgeries in 2009.
Does she have to let workers comp case manager into the room during that appointment???
Does it affect the case if she doesn’t let them in???
Do the tears on MRI seem like they could have come from the fall???