Rotator Cuff MRI Shoulder Scan & Arthrogram (MRA)

A little while ago I posted about my torn rotator cuff (PASTA lesion), well this week I went to hospital for a shoulder scan, looking for a SLAP Lesion Tear. Just to be clear about the differences here, the terms mean:

  • PASTA Tear - Partial Articular Sided Tendon Avulsions, which in terms you and I can understand, means that you’ve partially torn one of the 4 rotator cuff muscles. In my case I’ve partially torn my supraspinatus.
  • SLAP Tear – Superior Labral tear from Anterior to Posterior, which means that you’ve torn the labrum away from the bone, which is the cartilage lining on the inside of your shoulder socket.

shoulder-arthrogram-mra-slap-tearNeither of these is a good thing to have! Diagnosing the PASTA tear was relatively easily and completely painlessly done via an ultrasound. The SLAP diagnosis was done with an MRA though, which is not so pleasant. MRA stands for Magnetic Resonance Arthrogram (sometimes Magnetic Resonance Angiogram) or more succinctly can be described as MRI + contrast dye.

shoulder-arthrogram-mra-slap-tear-injection-x-rayThe basic process is, before you get the MRI scan (Magnetic Resonance Imaging) you first have a contrast die injected into your shoulder. Unlike an Angiogram where die is injected into your blood stream, for a SLAP scan the die is injected directly into your shoulder. This is NOT NICE! The procedure was done whilst under an x-ray machine and takes several minutes during which the needle is constantly in your shoulder. The dye is injected directly into the labral area as shown on the x-ray.

shoulder-arthrogram-mra-slap-tear-mri-scan-contrast-dyeThe reason for this is the doctor needs to make sure the needle is exactly in the right place in your shoulder joint so that the labrum shows up properly in the MRI scan. So after an initial local anaesthetic, he sticks the big needle and, takes an x-ray, adjusts it, takes an x-ray etc etc until it’s right. Then he injects the contrast dye, which is another unpleasant experience I could do without repeating. But it’s worth it in the end, as the MRI scan shows up the labrum very clearly.  Note that this isn’t my picture, it’s just one I found on the net, I have yet to see my own scan images.

mri-scanner-cutawayI was also a bit nervous of the MRI scan itself, as you never know really how you’re going to react to the claustrophobic environment that an MRI machine puts you in, especially as I’d never been head first into an MRI scanner before. Apparently they reckon that 10% of the population is so claustrophobic that they can’t have a tradition MRI scan (there are new walk in MRI scanners now that aim to solve this problem).

photo-of-mri-machine-cutawayThe other fear factor often cited is the noise, but personally I think it’s just the whole unknown thing, so I did some research into how MRI machines work and found it quite hard to find pictures of their innards. This one on the right shows the inside of an MRI scanner face on. Click to enlarge it to get a better view.

In the end though I was fine with the MRI scan. Sure I can see how people would get upset by it, but it’s completely safe and ultimately it was simply loud and boring. It’s amazing how many itches and twitches you find the moment someone says to you: “Please lie as still as possible!”.

{ 68 comments… add one }

  • Sue 4 August 2011, 11:59 pm

    My MRI’s and MRA’s have all involved a head cage (yuck), and lucky me (not), with my first MRA I had a negative reaction to the contrast upon injection. Glad you had a basically decent experience Colin.

  • Colin McNulty 5 August 2011, 6:19 am

    Hi Sue, sorry to hear that. Was that an angiogram, where they inject the contrast into your blood stream? What’s the issue with a head cage, isn’t that just to keep your head still?

    It certainly didn’t feel like a basically decent experience, definitely the worst day of my year so far, but thank you for reminding me that the next person always has a worse story and that in the whole scheme of things, I’m generally lucky to only have what I have.

  • Sue 5 August 2011, 2:52 pm

    Hi Colin,

    Re using the words basically decent, I was trying to be positive. :) I’m an MRI/MRA veteran and can appreciate what’s involved physically and psychologically. It’s definitely not my most fun thing to do either, to put it mildly.

    Yes, the head gear is to immobilize, but when you already know you have a brain tumor and then they snap the cage over your head (very close quarters) and you’re transported deep into the bowels of the MRI machine for your 65 min MRI…well, you can imagine the things going through you mind. Unfortunately they don’t use the open MRI’s for heads because of quality of results needed for the head. My first MRI was almost 11 years ago (10 yrs and 11 mos, a time in my life I will never forget). I had a meningioma, usually benign, but with brain tumors, benign doesn’t necessarily mean you’re home free. The position of the tumor determines whether it can be removed. A week later came my first MRA to map the veins in my head (yes, gadolinium contrast injected into the bloodstream) for the purpose of determining whether the tumor was operable. Very scary stuff. Mine was able to be removed, thank goodness, because I happened to be in the 30% of the population who is congenitally missing the left branch of the major vein the drains blood from the head, and where my tumor was located. If I’d been in the other 70 % the tumor would have been inoperable until it grew to a much larger size and hopefully would have cut off blood flow to that left branch of the vein. My gadolinium reaction was tightening of the chest. I have to use a different contrast dye now and have to have a doctor present for the procedure in case of another contrast reaction. I feel very lucky; lucky the elderly lady hit my car at a red light which led to finding the tumor before it caused permanent damage (the tumor was not related to the auto accident), lucky I was in the 30% without the vein, lucky it was a benign tumor…

    There you have it, the tip of the iceberg of my brain tumor experience. My way of handling things is to do whatever it is you have to do and then get on with things. It’s working for me so far. :)

    Sue

  • Colin McNulty 5 August 2011, 3:09 pm

    Hi Sue, it’s ok, i did understand that you were being positive, I was accepting that in the general scheme of things, you were right to be.

    I was aware of some of your story, which you’ve told me before, but not that level of detail. It’s weird to think of yourself as lucky in that situation, but I guess from a certain point of view, you are! Lucky indeed.

  • julie 22 October 2011, 1:31 pm

    Hi my experience of an mri scan was fine. although i am scared of closed in places. but inside there was air running through. and you could see the staff and talk to them. all good, don’t be afraid.

  • kim 10 November 2011, 12:31 pm

    Hi Julie, great wee comment. I have been referred for an MRI for Rotator Cuff problem. I have no problems at all with pain, needles etc. The closed in space thing is a different matter. When my times comes I am going to remember your comment and hopefully “I won’t be afraid” thanks :-) Kim

  • stacey 5 March 2012, 7:12 pm

    Sorry to hear about what you have had to go through Sue, good to hear you are doing good though. I went through watching my 4 yr old brother and Mom go through brain cancer. They were able to remove my brothers tumor, and did radiation and chemo. He is now 17 and it has never come back and he is doing good, other then afew health problems from the treatments. I unfortunately lost my mother to it after a 2 year fight.
    On the MRI and MRA subject, I have to go for a MRA on my shoulder because the surgeon thinks I might have a SLAP tear. I also have a partial thickness tear on the supraspinatus. I have had MRI’S before, and I am fine with them, but my question is, how bad does the injection into the labrum hurt? Like on a scale from 1-10, 10 being the worst? lol. Did you have surgery on it? I read it takes awhile for it to heal after surgery too. I had a caudle epidural before, because I have back problems also, and it was the worst pain I have ever had! Probably a 9 or 10 out of 10. I’m just wondering what I’m in for. Lol Thank you very much :)

  • Colin McNulty 5 March 2012, 7:45 pm

    Hi Stacey, I’m sorry for your loss.

    It sounds like you were in the same situation as me. The injection for the Arthrogram doesn’t really hurt as you get a local anaesthetic first, so you’ll be please to know I’d rate it a 1 out of 10 on the pain front.

    However there were a few things that are worth mentioning: when the needle punches through the cartilage to get into the right place, there was a noticeable jolt which was quite disconcerting. To be fair, the Consultant did warn me about this first. Then when he injections the contrast dye, there’s a lot of fluid going into a place where fluid doesn’t normally go. Again no real pain, just “very uncomfortable” is the best way I can describe it.

    The whole process takes a few minutes, during which you have this big needle stuck in your shoulder and of course you aren’t allowed to move. If you’re like me and someone says: “Don’t wiggle your toes for 5 minutes.” all I can think about is wiggling my toes! I also don’t really like needles (who does?) so it took some will power to force myself to relax and be calm and patiently wait for the process to be over. I looked the other way from my shoulder for the whole time.

    In summary then it’s not a pleasant procedure, but it’s far from painful and quite manageable and all over in a few minutes. You’ll do fine I’m sure. Do post back how here how it went! :)

    Oh and I cancelled my op a few days before it was due, see here for why:

    http://www.colinmcnulty.com/blog/2011/12/05/ive-cancelled-my-shoulder-op/

  • stacey 6 March 2012, 6:13 pm

    Thank you very much for that link. I will definitely put some thought into that if they want to do the surgery. I have to have the MRI first to make sure that’s what it is. The only problem is that this has been going on for about 3 yrs. It gets better, well, about 75% better ( I’ve been told it is a permanent injury, and it will never be 100%), and then I injure it again, and I’m back to not being able to move my arm out from my side. I will be going back to the surgeon after the MRI, and will definitely be asking a lot of questions! He told me yesterday that if it is a SLAP tear, physio won’t help it, only doing the op will. But I think I will really start working on it, and see how much I can do myself.
    Once again, thank you very much for the “food for thought”, I have a lot of thinking and researching to do if they want to do the surgery. I will post again after I have the arthrogram and get the results from it. And thank you for putting my mind at ease about the injection, sounds a lot like the caudle epidural I had, it was mostly uncomfortable, there was a lot of pressure from the fluid going in. I think I will have my hubby there to hold my hand if I can. He was there for the epidural and seen the size of the needle, and was shocked that I didn’t cry. Lol

  • stacey 3 April 2012, 5:02 am

    Hey Colin,just wanted to let you know that I had that arthrogram today, and it wasn’t that bad. Like you said, its mosly uncomfortable. The injection site it a little sore still, but the “fullness” feeling has pretty much gone away. They told me to keep moving my arm around so the fluid will work its way out quicker. I will let you know what the results are when I find out. I think I see the surgeon on April 23rd. I see my doc on wed. For something else, but I don’t think she will have the results by then. We will see. Lol

  • stacey 5 April 2012, 4:42 pm

    Well, my doc’s nurse just called and told me it isn’t a SLAP tear. I guess that’s good, but I guess that means I have to live in pain. Lol. My doc said to still see the surgeon and see what he says.
    I will let you know what he says when I see him in a couple weeks :)

  • Colette 6 April 2012, 7:47 pm

    Hi Stacey,

    I have just stumbled across your blog and thought i would share my shoulder story. I had the ink injected into my shoulder (i was stoked to have the anaesthetic before hand as it was the first time i could go and play some volleyball without pain before it wore off!).

    I had a car accident and injured my shoulder. I did my rehab for 1 year (doing my exercises thoroughly as I am an athlete). Nothing helped (seeing serveral physios). Finally i found a good physio (i suggest looking until you find a good one, get 2nd, 3rd opinions!). I got the injection in the shoulder and this showed ‘some discolouration’ but nothing certain. My surgeon said that the scans can overplay or underplay injuries so said he would have to go into my shoulder to have a look at what’s going on (because i had been doing my rehab well and not seeing any results).

    I had split my supraspinatus in two and needed a capsular shift as the whole joint was very loose (remember that this did not show at all from the scan so i wasted a year doing re-hab that would not fix the prob). The surgery was horrible and rehab following surgery is a long and painful process but WORTH IT!! I am now pain free and can play sport again. It will never be a perfect shoulder but so much better post surgery.

    So, moral of the story. Get second opinions, third opinions! If you do your re-hab exercises hard for a month or 2 and see no progress then i would be asking my surgeon/physio why and getting them to look inside your shoulder with a camera!

    I hope this helps. Go hard with your exercises. SO important!

    Good luck

  • Colin McNulty 8 April 2012, 9:18 am

    Stacey, I’m really pleased that no SLAP tear showed up for you, and that the arthrogram wasn’t a bad experience for you.

    Thanks for sharing Collete, you’re right that often 2nd and 3rd opinions can be very important.

  • Tracey 27 April 2012, 12:46 am

    I had a MRI arthrogram also on Monday. Now it’s Thursday and my shoulder still has
    a achy-sore feeling it didn’t have before…..is it possible for the gadolinium to irritate the shoulder some how?

  • Tracey 27 April 2012, 12:48 am

    Ps it showed I have a slap tear and because I’m 45 ( and very active )!they still want to attach the bicep to a new location…. Apparently old people don’t heal as well. :(

  • Colin McNulty 27 April 2012, 8:44 am

    Hi Tracey, I don’t recall having an issue after the MRI so can’t comment on that, sorry.

    They said the same thing to me, calling it a Biceps Tenodesis. At the last minute, I decided not to have the operation and definitely made the right decision. See these 2 posts for my updates. The first one details what they wanted to do, including a graphic of the torn labrum that shows the biceps tendon:

    http://www.colinmcnulty.com/blog/2011/10/03/mri-results-slap-tear-shoulder-labrum/

    The second one is where I’ve made the decision not to have it done and includes a video of a biceps tenodesis keyhole surgery:

    http://www.colinmcnulty.com/blog/2011/12/05/ive-cancelled-my-shoulder-op/

    It’s a tough decision Tracey, I know what you’re going through and don’t envy you the choice. It definitely depends on how bad your SLAP tear is I think. For me, I’ve managed to get to being pain free 99% of the time, and sporting wise, am probably at 90% of what I was, so I’m very happy with that. All through careful self rehabilitation.

  • Dave 27 April 2012, 2:59 pm

    I am an MRI tech.
    An MRI with intraarticular (into-the-joint) contrast injection is not called an MRA- MRA is a MR angiogram, a dynamic study where the IV-contrast injection is imaged as it moves though the larger blood vessels, resulting in pictures of the blood vessels.

    MR arthrograms (what you had) are imaging studies done after the radiologist has injected contrast directly into the joint space, and the condition of the joint’s inner surfaces and possible leaks (damage) can be seen with an MRI. This is most often done if you are suspected of having a ligament or tendon tear, or have reinjured it after a repair.

    Thirdly, there is a possibility that one could get an MRI with IV contrast just to identify scar tissue. In this case a scan before the injection is done, then the dye is injected in an IV and allowed to spread though the tissues; newer scar tissue, which has really good blood supply, will appear dark pre-contrast and lighter post contrast. This is the most common use of MRI IV contrast, but rarely used for joint imaging.

    Let me know if you have technical questions.

  • Colin McNulty 27 April 2012, 3:13 pm

    Thanks for the comment Dave. So what you’re saying is that a shoulder MRI with Arthrogram, should not be called an MRA. Thanks for clearing that up.

  • Ardith 1 May 2012, 10:49 pm

    Oh….my….gosh! I was not prepared for this today. When the nurse told me last week they were scheduling an MRI and an MRA I asked what an MRA was and she said, “Oh, it’s just when they insert dye to get a better image.” I have had many MRI’s with contrast and thought that is what I was having. When I arrived today, I asked what the MRA was and they had the doctor come out and specifically explain the procedure. I asked three different people if it hurt worse than a cortisone shot and they all said no. I was stoked. But….when he first started it became quickly apparent they lied because the Lidocaine alone was like a horrid bee sting and then things went down hill from there. Although the needle was in the joint the dye wouldn’t enter. 30 min later, four times the amount of Lidocaine, me in tears and horrific pain at that point he got it. He then began apologizing over and over and over saying that rarely happens. I could not believe no sedative was given…nothing. I almost threw up from the pain and it took three hours before I could move my arm. I have no clue what the results will be, if I ever have to have this again I will ask for some type of sedative first.

  • Dave 2 May 2012, 4:28 am

    I am sorry about the unexpected complications.

    Sometimes the needle just can’t deliver the dye- the needle tip might be in tissue, the space it has found might be very small, or least likely a defect in the equipment.

    Once they start however the radiology staff want to make sure all the pain you paid will pay off. The radiology department will probably make a report for both parts of the test- the injection part and the MR arthrogram.

    Anyway, I suspect you might just have a tough shoulder to inject into, that could be true next time too, should you need the test again.

    If you do ever have the test again, bring the reports and images from this experience. Ask to talk to the tech or the lead tech in “fluoroscopy” (where they put in the dye in you) and warn them about your struggle- they most likely will inform the Radiologist (xray doctor) and he can arrange for pain management before the test…this above all else would help get you though it.

    I hope your results are good!

  • Colin McNulty 2 May 2012, 7:26 am

    Ardith, that sounds like a horrible experience, but well done on getting through it. Dave once again is the experienced voice with some excellent tips, thanks Dave.

    How does that saying go: “What doesn’t kill us, makes us stronger.”? Yes pain meds for next time sounds like a good idea, but take solace in the fact that you did come through the procedure without quitting. That shows good grit and determination on your part, which are excellent character traits to have. You’re stronger than perhaps you realised, and that may well come in handy later if you have an op and need a period of physio. Well done you!

  • Dave 2 May 2012, 8:21 am

    You were very supportive of Ardeth. She toughed out a long ordeal to get healthier

    I will make a suggestion to some radiology vendors, that there might be some value to a stereoscopic injection system, where the radiologist (or surgeron in surgery) can take two exposures with each needle movement, one for the aspect of the radiologist’s left eye, and one for her right eye, and feed the two images into a Viewmaster type of eyepiece, to better judge depth of a needle.

    Ardeth, swelling will go down and over the next few days the fluids injected will be absorbed and excreted; the only problem that you should watch for is reddening or heat in the area- attempting more than one injection kind of increases the chance of an infection starting, but it is still very very rare this happens. If it does just see any doctor and tell them you had a MRA.

  • stacey 3 May 2012, 6:07 pm

    Tracey- I had mine done about a month ago, and it is still tender where the needle went in.
    Ardith- that sounds like an aweful experience! I was lucky, mine worked the 1st time they put it in. But I will say good for you for not giving up on it :)
    Update with my case- seen the surgeon, no surgery for me, he told me to go back to physio, for ultrasounds and strengthening (which I have been doing), but I’m suppost to go back and see him in 3 months. My physio therapist wants me to go to a arm and upper body specialist for a second opinion. I told him that my arms fall asleep when I have them away from my body. He is starting to think that all of this is being caused by TOS

  • stacey 3 May 2012, 6:16 pm

    Sorry, pressed send by accident. Lol. Anyways TOS, ( thoratic outlet syndrome). Which, from what I read, is when the blood vessels and/nerves are being pinched that supply blood flow to the arms. This can be caused from tightness in the muscles or could be from and extra rib. The symptoms are neck, shoulder and chest pain, numbness and weakness in arms and handshich, I have all those. The physio therapist said that I have better range of motion, better posture, and that both of my shoulders are stronger. So next step, see my family doc, and have a x-ray and see what’s going on in my neck. Soooo frustrating!! Lol

  • Tracey 4 May 2012, 4:53 am

    I want to know what exercises you did to improve your shoulder? I feel alot better and my surgery not until may 25… Thinking maybe I could avoid such drastic surgery ( as I’m over 40 they want to move where my muscle inserts).
    Thanks
    Tracey

  • Colin McNulty 4 May 2012, 9:57 am

    Brian Schiff Rotator Cuff ExercisesHi Tracey, the exercises I follow are from a very experienced physiotherapist who is an expert in shoulder rehabilitation called Brian Schiff. Here’s the link:

    Shoulder Rotator Cuff Rehabilitation Exercises

    I used his very comprehensive material in 2 ways: first to get a really good sense of just how good/bad my shoulder really was, including where I was strong and where I was weak; and secondly to strengthen and rehabilitate the shoulder. This I combined with sensible work in the gym, focusing on what I could do, and not on what I couldn’t.

    If I ever meet Brian in real life, he’ll find me a very grateful man! I just wish I’d been following his program before I hurt my shoulder, as I have little doubt that prevention being better than cure, I either wouldn’t have suffered the tears I did, or that they would have been less severe. Especially when you consider that the cost of his program is less than the price of a single PT session (and I’ve spent £hundreds on those!), it becomes a no brainer really.

  • Dave 7 May 2012, 8:18 pm

    Tingling in the fingers and over 40? Have you had an MRI of the c-spine?

  • Dave 7 May 2012, 8:24 pm

  • Christopher 29 May 2012, 5:10 pm

    Colin,

    Was wondering if you can help me? I am currently enrolled in my first video production class and one of my first assignments is to make a short film about sports injuries. I think it would be an added touch to incorporate a detailed look into the human body. One of the area’s I will be pin-pointing, is a torn rotator cuff. Torn cuff’s seem to be a common injury in sports. I have also been told that a arthogram would be the best to view and understand what exactly the injury looks like….so to speak.

    Would it be possible to obtain a copy of your procedure? I’m only assuming that when a procedure like this is done, they give you a copy on disk than can be editable? Or maybe you can point me in the right direction?

    Any help would be greatly appreciated. Thanks for your time…
    Christopher

  • Colin McNulty 30 May 2012, 9:30 am

    Hi Christopher. Sadly not, I have no copy. Dave might be able to help you though, he’s an MRI Technician… Dave?

  • Dave 30 May 2012, 11:57 am

    There are three ways to get a copy of an MRI

    First is on Film (hardcopy) and this way would be most useful for film.
    Second is a CD made with proprietary software included, but I understand that they are hard to transfer digitally from disc to other formats. The software allows them to be viewed on PC or MAC
    Thirdly there is the Dicom system, which is the standard origin form the image took, and can be more readilly be transfered between medical storage and viewing devices- usually not PCs

    I would like to say this- in is professionally appropriate and legally too, is to be sure when published that personal identifiers be obscured from view, even if they are your own or if you have the permission of the patient (HIPPA regulations).

    I personally think the best way to see the tear would be as a surgical training film or photo, because the tendon itself isn’t clearly visible on most MRI or MRA. On MRA’s of the shoulder, the lesion shows up where tissue has torn away rather than the tendon itself. Microscopic demonstrations are also interesting, where the actual fiberous connective tissue damage is seen. There are MRA images that are exception and pronounced but they are rare.

  • Felicity 31 May 2012, 6:47 am

    Hey There! I’m from Australia and had a MRI with dye yesterday! :) I just want everyone to know it didn’t hurt much AT ALL!! I have had a crook shoulder for 3 years which I injured while swimming in a deep river with a massive current. I got a cramp in my shoulder while I was swimming a long way from shore and I HAD to keep swimming else I’d end up at sea! :) I was in SO much pain that night – suffering from impingement. It SUXED!!!!! (Need I add, this was on my birthday too! :( ) Anyway, I’ve had physio, a cortisone shot (that helped TEMPORARILY til I re-injured the blasted thing!! as I am super active! :) ) had an Ultra sound – and no tears showed up. So I went to a BRILLIANT Ortheopaedic specialist and he required a MRI with dye.

    I didn’t want to think about it cos I’m a big wuss with needles, so I just ‘assumed’ that it would just go on the vein and I could handle that! I went to the centre and the same guy who gave me my Cortisone shot six months previously attended to me! That was good as he knew I was a bit ofa nervous Nellie! :) They did an ultra sound – then the Radiographer said I’m going to get the Dr and he is going to give you a needle. I was like “Ah, OK…. ” Cos I only thought it was gonna be in the vein…. THEN they told me to lie on my side and be still and ‘it was going to be similar to your Cortisone shot” – I was actually strangely calm!!! As is was then I realised that I was having an interjoint shot!! But honestly, hand on heart, IT DID NOT HURT!!!!! :) :) :) I didn’t even FEEL the needle stick into me! The thing I felt after a few seconds was pressure from the dye going in and pressure of something (the needle) just gliding around inside my shoulder to get the right spot. BUT NO PAIN!!!!! The radiographer was with the DR the whole time guiding the injection by ultra sound. The Dr was a lovely, warm man and constantly reassured me there was no need to worry! And he was right!! :) It really, really DOES not hurt!!
    Today my shoulder is a wee bit tender, but no more tender than it’s usually been! :) I can’t WAIT to see my Ortheopaedic guy to work out HOW to fix it so I can get back to being pain-free!! :) SO my two cents is, the little bit of yuk is worth it in the long run! :) (The worst bit for me though was LYING STILL for 45 mins in that MRI machine!!! I NEVER do ‘still’ and as I live way out in the middle of woop-woop I’m NOT a fan of closed spaces AT ALL! :)
    I will stop waffling on. I know I can talk the leg off a chair sometimes! :)

  • Dave 4 June 2012, 6:10 pm

    Sounds like a great experience for you, other than the MRI- which by far was the most important part of the test.
    I have been an MR tech for many years, and MR of either the neck or the shoulder seems to make people the most claustrophobic. It is the lying flat on the back in the magnet, rather than just being in the magnet, that produces the most anxiety.
    I have scanned Heads on people, and they do fine even with their heads taped or strapped or stuffed in a cage coil, but had a claustro reaction when the cervical spine study was started without the tape etc. I am convinced it’s the idea that they are offering their neck- the defense mechanism inside fires off and here we go!

    One problem with a shoulder is that it rests on the moving, breathing, heart throbbing ribcage. As people breathe, their hearts beat, and they squirm (even slightly), there are resulting blurs in the image called motion artifacts. The blurs are worse when there are bright parts of the image next to dark parts, and also when the shoulder joint moves into different positions during each scan-which makes it look like double exposures.

    Some Radiologists scan alot for the Shoulder MRarthrogram. Not only that, they do something called T-1 fat-saturation, a time-consuming scan which makes everything but the dye show up dark. This is what shows the rotator cuff best. Some radiologists scan more than the T-1 FS’s that are more of an MRI rather than an arthrogram study. That can extend the scanning. Some radiologists also add ABER views, where the arm is placed above the head and more scanning is done to demonstrate the arm joint in a different position.

    This next part you might want to share with your techs there in Australia:

    First, no matter what you scan, you should ALWAYS place the thin wedged sponges (or pads) half under the patient, half under the elbow. On every scan, but especially under C-spine, L-spine and shoulder studies. It stills the arms and supports the back. After 15 min it works better than a pain killer for comfort.

    I once, about twenty years ago, had a shoulder patient who could not tolerate being on their back due to other injuries. I was immediately doubtful that we could get through the entire test, or even a part of it.
    I was used to accommodating my patients in creative ways, so I told him I was willing to scan him tilted onto his shoulder with support underneath him. Instead of being blurry, the images were pristine! Rolling him to where his shoulder blade was on the table suppressed the shoulder moving as he breathed, his heart beat, or if he figgitted while in the scanner.
    I have tiltted every shoulder since, and have introduced this method wherever I travelled.
    I let people sleep, scratch their nose etc without worry. The anxiety they felt when flat would be considerably aleviated in most people when tilted.
    I was stunned to see a demonstration of this technique on Youtube.

    http://www.youtube.com/watch?v=-LujduSjUlE

    I am still waiting for that check from Siemens!

  • Lee Watson 11 July 2012, 8:24 am

    I’m so glad I’ve found this blog about other peoples experiences with an MRI Shoulder Arthrogram. I have had 2, with differing experiences. Now before you read on, let me just tell you this. There are details that may put you off, but do not worry and providing you are in competent hands, the first time is not that bad.

    Firstly, the background stuff. I’m a veteran martial artist with 20 years of experience in Traditional and Goshin Ju-jitsu, Ninjitsu, Judo, Karate and Boxing (so yes I can hand pain!). I twice suffered a partial dislocation (seperation away from the joint, not out of) from students who incorrectly were performing shoulder throws, basically the students had grabbed my wrist and yanked my arm out of the socket! For a while I was fine until I was at a seminar and during the afternoon warm-up when I was performing stretches I felt basically a tear in my shoulder, this sent the entire shoulder structure into a spasm and it ‘froze’ where it was, which was up in the air at the time (bit like an orangutang does! ha ha). Being the usual stubborn martial artist and wanting to continue, one of the other instructors saw what had happened and recommend I not continue. Anyway, it was tender for a few days and the pain subsided mostly. My job at the time was in a Leisure Centre, setting up equipement, doing activities with customers and such. I noticed quite quickly that any action that involved swinging overhead, throwing, or lifting above my head was generating a ‘shearing’ pain in my shoulder, this would subside quickly usually. It continued for a few weeks so I decided to visit my doctor to which he sent me to see a consultant (I got my first appointment after 9 months!). I got the usual ‘go to Physio’, which by the way was the biggest waste of time ever! I had very well developed muscle structure and it wasn’t until after 6 weeks of travelling 20 miles that they (the physio) realised that it wasn’t going to be off benefit to me at all as the exercising I already did in Martial Arts was what they were doing! So, back to the consultant, send you for an x-ray, try these tablets so on and so on. Nothing was improving it and the pain was getting slowly worse. Eventually I had enough, I asked the consultant why he was beating around the bush, his answer ‘it’s self-inflicted, you’re in a high risk group if we do anything’. I explained that at this point because I was on 60mg of Co-codamol a day to counter the pain, I couldn’t sleep properly, I was nursing my and I couldn’t work because of both the pain and mediciations were knocking me silly. He refused to take it any further (not the best thing to say to a ‘wounded tiger’ lol). I went straight to my GP, explained I wasn’t happy with his explanation and I wanted a 2nd opinion. So…round 2 of exactly the same with someone else! By now it was 2 and a half years after the inital injury, I had massive joint instability and the weight of my arm on the muscles was stretching and lengthening them, worsening the instability. So we get throught more X-rays and finally the 1st MRI Arthrogram. It’s pretty relaxing, anaesthetic worked brill and I could feel the fluid going in the joint sac. The MRI was awesome, Trance music relaxed me, got thru it all with no ill effect other than a bit of tenderness and dull aching for 6 hours.

    A week later went back for the results, ‘It’s not showing anything is wrong with your shoulder’. At that point I was weary and furious! I explained in no uncertain terms that there was something seriously wrong, the pain wasn’t in my head, etc, etc. He said came with the excuse of me at a high risk of tearing again if they could fix it, I said wanted to work again at some point, blah, blah. So eventually, he folded. ‘We’ll do an arthroscopy and see if anything else shows’. SCORE 1-0 to me.

    3 months later, now 3 years after the original doc’s appointment’, I get into Burnley General in Lancs at 7 in the morning, staff make me feel comfortable ‘but you can’t eat or drink’ they explain. Hours tick by, I’m getting to know the other ‘inmates’ we’re sipping water cause we’re dying of thirst’, 1 person goes in, then another, it get’s to 6pm! I get wheeled into pre-op, chatting up the nurse (as you do) ‘count to ten’ and zzzz’s I’m out. 3 hours later I’m brought back round, shoulder heavily strapped and restrained, after 30 minutes one of the surgeons mumbles something then walks off, and I fall in and out of blissful painless sleep (it was more due to the ‘nerve-block’ than anything!). Following morning as the block wore off, I became all too aware of a building, raging pain at around 9am, the block wearing off, when the nurse came I tried to get info on what they found, she knew nothing, and I was eventually realeased in the early evening still not knowing what was found with some instructions to see the specialist in 2 weeks. That was when I found out with gleeful delight what an own goal had been scored by not just 1, but 2 specialist consultants. COMPLETE LABRUM DETACHMENT (Bankart Tear). Score 2-0 to me and 1 hell of a red-faced consultant when I lambasted him and told him square that if they hadn’t beaten around the bush, they would have listened and had this sorted with-in 6 months, not 3 years!

    So, all is good, recovery doing fine until, 6 months after the op, a stronger happier Birthday Boy out round town on his birthday with his mates and pretty well lubricated is in the local night-spot. Bit of an arguement by one of my mate with another bloke, kept out of it myself and such. Anyways later that night, the guy grabbed my right arm and pulled it sharply backwards, what happened, immediate excrucitating pain, legs went, me on floor, mate jumping on horrified guy getting slapped! Following day, just thought probably a tight muscle, nothing to worry about. A few months pass on to New Years Eve 2010, the very cold winter we had here in the UK. I had been asleep for a few hours when I was woken by my shoulder going into a huge spasm again, mainly cause of the temperature, everytime I shivered I hurt, badly! Got into the specialists as soon as I could, said another MRI and he put me on the tablets and then some! Took a few weeks, got the appointment, but as I was travelling to the hospital, remembering what was involved last time, I realise with horror what I was going to experience. Now the arthroscopy on a healthy joint isn’t that bad, but my labrum had been pinned back to my arm, so that was going to be an issue. I get into the room, and immediately inform the doctor about my concerns, ‘I’ll up the dosage abit then’…..then, picture this, imagine films you’ve seen where they get the guy bound with rope to four horses and they get the horse to pull and you’ll get what sort of pain I was in….I was gripping the table the moment he started injecting the fluid in, every single millimetre of the stuff was expanding the socket which was full of scar tissue and a pinned in labrum!! Everytime he touched the plunger I got worse, and worse, had I been a hold of a persons arm, I would have crushed it to dust! Oh they asked if I was okay, I said no, did they do anything, of course they did…..carried on!!! It was the worst pain describable! I’ve had numerous injurys, hyper-extensions and such, but nothing got remotely close to this, how I didn’t pass out on the table I don’t know. Eventually he finished, I said ‘Thanks’ (lol), got helped into the changing room and promptly my legs gave way! Yes it was that bad and sorry ladies, I’ve found what real pain really is! Ha ha. Had the second op, doing well till last month and popped the other pin now so more than likely going for another!

    Thanks for reading, know this was an essay. Initally tho, most arthrograms are relatively easy to cope with, a little weird, but nothing to worry about. If nothing shows up tho, be persistant, do not just take it and leave it. It is your doctors and consultants responsibility to absolutely rule out as much as possible, you know your body far better than any doctor or other person ever will. The reason the tear never showed up in the first place is due to the position of the arm and shoulder, this ‘pressed’ the labrum onto the bone, so obviously the tear would have never shown using this method!

    Stay well, Lee.

  • Malcolm 3 November 2012, 2:23 am

    I am a 61 yr old male who had an MRI arthrogram of the shoulder to check for labral and cuff tears.The procedure itself was surprisingly painless? I believe this was because of the skill of the radiologist.Did not feel the local anesthetic.Also did not feel administration of dye injection prior to MRI. On a scale of 1-10 I rated it a 1 for pain.Had a previous MRI at Veterans Hospital which showed a full thickness partial width tear of the infraspinatus muscle which was 4 cm from where it should be. The report also said had possible SLAP tear of Labram.My surgeon did not agree with these findings so sent me for MRI Arthrogram.will find out results next week

  • Barbara 12 January 2013, 9:33 pm

    I had an MRI Arthrogram yesterday. My first comment will be – be sure of the facility and previous patient comments before having it done anywhere. After reading all of the above comments and how people commented it wasn’t that bad, my experience was to the contrary.
    I have never had a problem enduring needles, MRI’s or even nerve tests (where they put the needle directly into the nerve to see if it is working). After having Rorator Cuff surgery about five years ago, I have had to learn to live with constant pain in the shoulder and arm and after doing some over shoulder reaching recently started to have severe pain. Dr. recommended the MRI Arthrogram to see what was going on.
    I was told it would be uncomfortable but not bad. The first shot to deaden the area was fine, needle prick. Then the needle to put in the dye began. I didn’t feel the needle going in but the pain once he was in was the worse I have ever felt. It felt as though he was scrapping my bone, awful. Since he went out of the room everytime to look and see if the dye was in the correct place, I got a little breather from the pain, but he did this seven times!!! On his last dye injection, I was ready to say for the first time in my life – enough is enough – I can’t take it any longer with tears rolling down my cheek. I read where others were given more deadening fluid if it was bad. I was not offered this even though I obviously was in severe pain each time he went in and seemed to hit the bone.
    Then the actual MRI commenced. Every other time I have had one, they stop from time to time to let me relax or move slightly as a break from holding still. This time however I was told to lie still for a total of 1/2 hour!!!! Try that sometime not being in an MRI!!! Then again, more of the MRI was done again for 1/2 hour. Then the Tech. had the nerve to be disgussed with me because on the last test I had a muscle spasm and he had to do one test again……..like I could control the muscle spasm!!!
    Today, I can barely move my arm/shoulder – and having to take pain meds which I hate doing.
    I would rather have two more natural child births than go through this again. NEVER again regardless of reason! So as I said, be sure you check out facility before you go!!!!

  • Eddie Smith 18 February 2013, 6:33 pm

    Hi Colin,

    After reading your information at the top of this page I am very interested to hear what steps that were taken to treat the two tears? The reason I ask is because I have just been referred for an arthrogram of my right shoulder. Both of the tears you mention were brought up during my clinic appointment earlier today. I injured my shoulder around 8 months ago and it just hasn’t been right since. The physio I have been seeing thinks it is impingement of one of the tendons, this was also brought up at the clinic today. However, the doctor said we should proceed with the arthrogram to fully assess the area and to rule out any tears.

    Thanks

    Eddie Smith

  • Bonnie 19 February 2013, 8:15 pm

    I just had my first arthogram and MRI of my shoulder this morning. I was a nervous wreck after reading this board yesterday as to what to expect. I am 50 yr old female. I decided to take .25 mg of xanax before it all began. It all went fine. The numbing agent did not burn going in and I never felt the needle insertion or contrast at all. CT went fine. I waited a few minutes before I went into MRI room. I asked for an eye mask and they gave me earplugs which worked great! My feet did not go into the tube and that really helped with not feeling trapped. I could see a bit out of eye mask at the corners and that was fine. I was afraid I would need to scratch or sneeze or go to the bathroom but none of that occured. Staying still was not as bad as I thought it would be. The technician gave me ten seconds or so between 6 minute scans to relax a bit. You are allowed to breath normally and wiggle your toes. She came in the last ten minutes to my arm over my head and I worried it would be too painful but all the pillows helped to be comfortable. I know every experience is different – but for those of you about to go through this know that this person had a good experience. I am having an abdominal hysterectomy next month and know this was tons easier.

  • Colin McNulty 23 February 2013, 10:57 am

    Hi Eddie, I cancelled my sholder a few days before I was due to have it.

    I followed many of the exercises in this program I got off the internet:

    http://www.colinmcnulty.com/blog/2011/08/04/my-rotator-cuff-mri-shoulder-scan-and-arthrogram-mra/#comment-13039

    Took it easy, didn’t do anything that hurt, and slowly, over about 6 months got most of my ROM and strength back. A year later I can do 95% of everything I could do before.

  • Dave 24 February 2013, 12:43 am

    Bonnie
    Hi, I’m an MR tech, have been since 1984. I think you were well handled and it warms the cockles of my shoulders to hear you had a good experience.

    Colin
    How does your doc feel about your alternative method with your shoulder? Does he think you should have done it? Does he think you might have a derangement that might have just reduced its inflamation from non-use?
    Dave

  • Paul 27 February 2013, 1:59 pm

    Had violent spasms during my third MRI for shoulder issues, I had to hold down my right pec muscle with my left hand. I’m sure it caused more damage to an already iffy right pec major transfer. Another MRI was done,it went great and the tech told me incorrect settings on the machine can cause spasms, anyone else have this problem?

  • Colin McNulty 27 February 2013, 8:48 pm

    Hi Dave, I’ll admit I haven’t been back to the Doctor’s about my shoulder, but it rarely causes me any concerns any more and I can do 95% of everything I could before the injury, so I’d call that a success. Besides, I have new issues to worry about; I’m currently waiting for a hernia repair surgery!

  • Dr. Peter Nefcy 1 March 2013, 9:40 pm

    It was sad to hear of all the pain and problems patients have undergone having MR imaging with arthrography. I have performed more than 14,000 MR and CT arthrograms in the last 10 years , and have nearly perfected the proper technique. Here are some helpful hints: (1) An MR before and after an arthrogram is really required to adequately evaluate the shoulder. MR without arthrogram or with indirect arthrogam has too many miss diagnoses, both positive and negative. And skipping the pre-arthrogram MR also is not recommended. Anything less benefits the hospital or diagnostic center or doctor financially, and does not help you as much, while costing you the about same amount of money. (2) Only have an arthrogram with a physician who has performed 1000 or more of these proceedures in the past year. A resident in training is not good for you, and a physician who tells you that they have years of experience may have done one a month for the past few years. (3) Only have an MR study with arthrogram at a site where the same physician performs the arthrogram and interprets the MR images. Many sites and hospitals pay an inexperienced physician to perform the arthrogram, and send the images out of state or out of the country for interpretation. Your study may end up so far away that you will have no legal recourse if incorrectly interpreted. Information important to you is lost this way. Again, this is usually bad for you, and good for them. Finally, ask questions. I usually can promise a patient that the shoulder arthrogram will take less than 30 seconds, and will hurt about the same as a flu shot. And many patients have temporary improvement of their symptoms with the proper administration of injectable medicine during arthrography. Good luck!

  • Sam 3 March 2013, 4:30 pm

    Hi Colin, I have an MRI Arthrogram tomorrow for my left shoulder injury. Been having impingment feelings for years and mostly gone away after some physio sessions and standard rotator cuff excercises. This time the pain wont go away with secondary pain around traps, orthopaedic specialist says that he is concerned hence tomorrows arthrogram.
    Really need to get back into gym asap and was hoping you could give me some advice on upper body muscle groups that I can continue to train, biceps, triceps, is chest a no go??
    Also, interested in the ultimate rotator cuff excercises by Brian Schiff and any other advice you can give me for rehab and weight training. Will update on diagnosis after tomorrows arthrogram.

  • justsomeguy 28 June 2013, 10:52 pm

    I’ve had a couple of shoulder arthrograms. The injections were almost painless. Be aware starting 6-10 hours after and continuing for 48-72 hours after the procedure your shoulder will lose 50-75% of its strength. Mine first arthrogram was 3 months post surgery – so my shoulder was already quite weak – I couldn’t move my arm AT ALL for a couple of days. No one told me about this and as you can imagine it was pretty scary (Thanks Kaiser- Permanente !). Having it done again in a couple of weeks – 16 months past what seems to be a botched rotator cuff repair and tenodesis. Yes, after 14.5 months of saying “it doesn’t feel right” and doctors telling me to “give it some time”.
    I have talked to dozens of people who had rotator cuff surgery (the sling is a great conversation starter). 50% – Great, no issues, wish I had done it sooner. 20 % had to have it redone. 30% – not great, but they are living with it.

  • PJ 1 July 2013, 10:58 pm

    Oh, geez, wish I hadn’t read this blog..I had two shoulders surgeries in 2007 , one for impingement and the other for rotator cuff repair, that I experience while doing therapy from my impingement surgery. I have two anchors in my right shoulder . I later ripped my rotator cuff and have a large rip (three years ago) that the doctor had a hard time reding from an MRI on my shoulder because of the two anchors..He said the kind used on my surgeries were an old type BUT I was about to undergo back surgery so he put off doing the repair of the shoulder and I was to return after back surgery, but one back surgery turned into three back surgeries and a hip surgery for me and right before I go see the shoulder doctor again, I fall and hit my bad shoulder on a wooden bench and man does it hurt …So I go back to th doctor and he orders another MRI (although he knows I have those anchors and they can’t get good pics) They called me this morning to tell me that the pics were of poor quality and I would need a CT with contrast…then they call back to tell me I am having an Arthrogram and will have to have it at the main hospital because their other locations don’t do the arthrograms…What I didn’t tell you is I also have trouble with being in the MRI’s although I have had many many many, and I was hoping for a CT machine instead of the MRI machine…I swear I am staying still but they always say ” you need to lie still” and the minute the mri starts going I begin to feel twitches..this last mri the minute they put me all the way in I felt my chest get tight and was thinking I would have to be pulled back out… Giving me valium does nothing to help me, nor taking any pain medications…my shoulder though is hurting so bad and has hurt for so long that I am losing use of it…I am 58 years old but I am not an OLD woman and I am afraid they may not decide to fix my shoulder at all because I have had sugery before which I think is crazy..surely ther is something they can do, therapy and pain injections are no help either…So now I have read all the scary stories just before I go..I was wondering though, do they do the arthrogram in a CT machine or an MRI machine..I sure hope it is a CT machine..

  • Pj 2 July 2013, 7:03 pm

    Justsomeguy: yes I know the feeling, my rotator cuff tear was because after my impingement surgery I kept telling than that something felt stuck. But the therapist and the doctor kept saying , “No, you just got to work harder and it will feel better, give it some time.” So the therapist works me harder and one day RIP^^^^^^ and it took another three or four months to convince the doctor that something had happened…Then an mri finally showed the tear and I went back for repair of the rotator cuff with the same doctor….Then another big RIP^^^^ worth than ever when I returned to work…but I had to go to another doctor who referred me to a specialist and the first thing he tells me is that the doctor who done my surgery should never have used those old type of anchors?????? because I needed back surgery also, I was made to wait and now two years later and another fall, my shoulder is worse than ever….they may not repair it at this point because although I am only 58, it looks like my shoulder keeps tearing, when in reality I just never got the kind of care I should have. I now may have a torn labrum also :-(. Going now for a shoulder arthrogram.

  • Dave Zinzow 3 July 2013, 1:46 am

    Hi it’s me, Dave the old MRI tech.
    Nothing shows how much you are in the hands of the system.
    First, CT and MRI aren’t always interchangeable, in some cases. MRI-arthrograms even more so. In MR arthrograms the scanner uses a few MR tricks to get the image. One is fat saturation, which makes everything dark except the fluid injected into the joint. When “fat sat” is used it is vulnerable to the presence of metal- which knocks out the image at that particular area. There are things a tech can do to reduce that, but few techs nowadays bother to learn them- upping the bandwidth etc- but usually the tech is in the habit of blaming the machine and not making the effort to master it. RSVP me for tech details.
    Secondly, the shoulder rests on the ribcage, attached with hinges to the sternum at the throat, and the rest of its support is from muscles and tendons. When people breathe, the shoulder moves, differently in all people. People rock when they breathe, if only slightly- the head usually goes up and down and the lower chest rocks upward and downward. Flat on your back, the unsupported shoulder dances along with the rest of your body.
    Also, because of repeated “insults” to all the tissues surrounding the joint with histories of swelling and swelling and surgery and swelling etc, position of the arm/neck/head, coupled with the fact that an injection has been made, you are in flare up, and you never ever have to “hold” your shoulder completely still, and because the arthrogram scans are so sensitive to motions anyway (and sometimes very long) you might seem powerless; I believe it is the duty of the tech to master these limitations. The best way is in this video:

    http://www.youtube.com/watch?v=-LujduSjUlE
    I think sometimes I invented this way, but anyway along with antifidget techniques I have had tremendous success with this.
    (show this to your orthopedic doc immediately if the tech who did the test is disinterested).
    Thirdly, CT scanners are x-ray machines that make images that are x-rays in cross-section. This is not the best choice in your case, because the metal in your shoulder can be a problem for what they want to see on the MR. It does make the CT and x-ray portion of the test billable when the MR is bad. Also, you have had tons of x-ray in your life, and the younger you are the more susceptible to radiation you are. This area is right around the thyroid and it is bad to get too much in that area. Many doctors will perform the test but it is often best to redo the MR arthrogram with the metal suppression, skipping fat sat, skipping gradient echo scans, and for God’s sake taking a relaxant like valium (ask your doc) can help so much even if you don’t have claustrophobia. Most of all, be sure the tech knows to tilt you as in the above video.
    This is all I got! Best of luck

  • Pj 6 July 2013, 1:50 am

    Dave, thanks for your reply, No I have never been positioned like that at all, and I noticed the mri machine in the video had lots of room inside, the last MRI they put me in had the lowest magnetism a MRI can have and let me tell you I felt like I was being hugged by the machine it was so small ??? Anyway. I will mention it to the tech about the positioning when I go which is next week, the latest I was told is that I am having an arthrogram and I am having a CT with contrast ??? I was told I was going to be receiving two different types of dye ?? I just had an MRI (not positioned well) and it had poor pics and thus they are ordering this..They know I have already a large rotator tear again, but are looking for further damage and then deciding whether I am fixable or not…I am 58 years old , I hope they can do something. I already have thyroid problems (all out of whack, hypothyroid) so thank you for mentioning that to me also, as I will be sure to ask the doctor about it. I sure hope then the CT scanner can get some pictures then and this is not more of the same stuff I have been put thru many times already. I have had a hip arthrogram as I also have a torn hip labrum also ,so I am figuring it must be pretty much the same….Again thank you so much for your help!

  • Dave 6 July 2013, 3:21 am

    You are welcome.
    The two different kinds of dye are xray dye to see on the xray, and MR dye highly diluted. If they are injecting both it sounds like they are going to do the MRI again.
    On the positioning- many radiologists want to see the rotator cuff in a stretched-out position, so they insist the hand be rotated “externally” (supinated) so the thumb is pointing outward.

    Determining at what point to do a CT to replace the MR is all up to how the two docs involved have decided. It may be the case that the CT would be done in addition to the MRI. Such determinations are not universal.

    If done on a 16- or 4-slice CT your dose will be less. If done on a machine that is equiped with the newer dose-reduction feature.

    To what degree your are affected by the radiation have a lot to do with your age and how many times you have been irradiated, how you are shaped, how well trained the CT tech is, how healthy you are. All hard to determine.

    As you know, each case can get complicated when past surgeries have failed. Doctors will do their best, and will use all they can to create a solution to these novel conditions.

    Being a tech, it such conditions I can only follow directions of my radiologist as far as adaption and alteration of what I do. I provided the youtube link to give your MR tech an expanded knowledge. Rolling a person onto the shoulder blade not only stills the shoulder for imaging; it can reduce claustrophobic feelings by lessening the positional anxieties produced just by the fact that you are lying on your back. There have been patients that have told me it feels better too; however, it can be harder to rotate the thumb outward. If you are 57 and the machine is “hugging” you this might help. I have yet to have a patient that couldn’t rotate.

  • PJ 6 July 2013, 1:14 pm

    Thanks for the information, Dave. I am scheduled for the tests for a couple hours, so maybe they will do both , as for repeated surgeries I know a doctor thinks there is no sense in fixing me because of fear of tearing again, however in my case it wasn’t exactly like that, I can honestly say my first surgery for inpingement was somehow not quite done right and I ripped in therapy because something was stuck from the surgery.. It sure is hard as a patient to get help when one as been done unjust by a doctor. I have no bad feelings toward him now, I just need for my new doctor to understand the difference. I have been in many many Mri machines and the one I was just in, that they said was their lowest magnet rating was tiny, it was hot my body size. I intend to talk to the tech doing my test next week about the positioning , I agree it would help not to lay on my back (which has lots of hardware and it is very uncomfortable for me to lay for long periods). I will have trouble stretching my arm out for the pictures , so I am not looking forward to that, this past MRI they didn’t ask me to stretch out my arm, in fact they hugged me up tight. It does concern me about the radiation from the CT, as you are right I have had many xrays, and CTs on my neck and shoulder. I have advanced degenerative disk disease with bilateral narrowing and loss of lordiac curve in my neck as well…as you can tell I am an orthodpedic nightmare. Your help has been greatly appreciated, and I will take the video to the tech and see if they are receptive to it..Thank you so much!

  • Courtney 9 July 2013, 11:50 pm

    After reading this I was a little worried becuse I have already had one surgery back in 06′. Just wanted to ease some peoples minds that it was completley painless for me even though they had to pull the needle back out a few times and put a new one in becuse of all the old scar tissue and my shoulder being so tight.. The inital injection for lidocaine (SP?) felt like a very small prick. Less pain that getting blood drawn or a flu shot, and after that I didn’t feel a thing. I actually was still waiting for them to start putting the needle in for the dye when they told me it was all done. My arm is a little sore now, but really not as bad as I expected at all.

  • PJ 12 July 2013, 11:08 pm

    Well I had mine done yesterday, I have also had previous surgeries and they also had trouble getting through scar tissue..The initial injection I guess of Lidocaine did feel like a little bee sting but the injection of dye got pretty uncomfortable, I had it done at a teaching hospital and I am sure that the doctor doing mine was just learning because as I lay there I could hear another person telling him what to do and what not to do. (like NO, move a little , tht is bone there, etc..)..my procedure took about an hour and a half , and today my arm has been aching all day, shoulder is still as painful as ever, but not any more so than before the procedure.. They did not do an MRI with my Arthrogrm, then they did a Cat Scan and I am very worried because the darn Cat Scan only lasted 3 minutes…how in the world could they possibly have got good pictures of my shoulder…I am so frustrated with the whole ordeal..the doctors orders was for them to do a cat scan with contast but they decided not to because they had already injected dye into my shoulder with the Arthrogram, however I have two metal anchors in my shoulder and the doctor knew there would be trouble getting the pictures..I had received two phone calls prior to my apt to make sure I was able to take the dye and never had had an allergic reaction to it BECAUSE they would be giving me two types (but then they didn’t) Probably they were running behind on time and afterall , “Who Cares”, it isn’t their shoulder!!! .I am so tired of the repeat trips back, why of why doesn’t anyone ever stop and listen to their patients ???

  • Dave 16 July 2013, 7:28 pm

    Hi PJ, Dave again.
    First of all, when they are injecting contrast for this test (MR arthrogram) they DO use two dyes mixed together- they use an iodine based dye to enable the radiologist to see the contrast mixture under x-ray, and a very diluted gadolinium based dye for the MRI itself. Often a steroid can be included, too.

    The rad is trying to get the contrast into the joint space, fill it up and see if it leaks; the rotator cuff is a part of that container she is trying to fill. If it leaks generally that means the rotator cuff has torn.

    Things get complicated in many ways as the shoulder has had surgery or has been repeatedly injured. Both histories cause scar tissue and funny shaped terrain inside, and that not only makes it harder to diagnose, it makes it harder to find an easy place to inject and a tougher decision about just what test the radiologist would do.

    It sounds like someone was training when you were having your injection. I have seen experienced radiologist pull out their hair in handfuls with difficult injections such as yours, and even when experienced, a radiologist or (rad assistant, sort of a P.A. in radiology) would seek assistance from a radiologist with more skill to coach them. I cannot say what they could have done to get the dye in, but I admire that neither you nor they quit.

    Either they got in and thought the MRI would be of less use, or they felt too much dye had gotten into the surrounding tissue for the MRI to be of use, or they never got the dye into the joint.

    I think the CT was going to be helpful to see the anchor, to verify it was in place, and maybe even show whether the cuff segment had detached.

    A CT machine is an x-ray machine; x-ray dye (iodine) shows up well. It does NOT scan the same way an MRI machine does- it’s like apples and postage stamps. A modern CT scanner can scan your entire chest in between heartbeats. Where it would have taken a half hour or more in 1985, it can take seconds to do a shoulder CT now. But it is an x-ray exam, with the limits that has for showing some things; it is harder to see certain lesions in CT that can be shown in MR and vice versa.

    I wonder if the radiologist decided to do the CT and not the MR because the dye injection attempts had failed. That way the radiologist has a record of the misplaced dyes and also a study of the shoulder.

    The stiffness should be watched. The injections are like artificial inflammations, and as the fluid is absorbed by the surrounding tissues the sensation of stiffness should go away. There can be an irritation that lasts longer due to the “insult” to the tissues, which are already scarred and damaged in the past- if so see your MD. Especially watch for reddening and heat and fever; if this happens it is important you seek medical care immediately to make sure you did not get any bacteria in there.

    On their attitudes I am helpless to explain. Customer service and empathy seem to take a back seat in these situations and with some people, especially in facilities where people are full of emotional scar tissue. I am sorry. Make sure your doctor knows how you felt.

  • PJ 16 July 2013, 8:31 pm

    Thanks Dave, I am still waiting for the results :-( … They done a CT , instead of the MRI because that is the way the doctor ordered it ??, but it was suppose to be according to the girl who gave me my original apt and orders, a CT with contrast??? and they didn’t do it with contrast?? I did just come from the Arthrogram though. That is the second dye she was talking about , she told me that I would receive the dye from the arthrogram and then dye from the contrast they were going to use with the CT.. What you say makes total sense to me, I was all prepared to give them the position you told me about for better MRI pictures of my shoulder but didn’t get the chance to have another MRI ?? Even if the guy doing my procedure was new, he was professional, and I know everybody has to learn, but with me being so complicated I just wished for someone more experienced.. They didn’t seem to say they couldn’t get the dye in, I even once or twice heard “the trainer” say “there you go , get that picture, good, good” Well now I sit and wait and wonder, hoping to hear something soon. My doctor is a pretty busy man , as he is a head doctor for the College Basketball teams, as well as having a busy sports athletic medical office…just hope I don’t continue to slip thru the cracks…Thank you so much for all your help, it has been of great help! I learned a lot from you!

  • Dave Zinzow 16 July 2013, 10:43 pm

    Glad I could provide insight

    The Contrast for the CT was in your injection, sometimes specified as an intra-articular (“in the joint”) injection

    I don’t think they gave you MRI dye.

    I am sorry the doc injecting was not successful. They are like the rest of us- some are god, some are great. Somedays you read the book, somedays you write the book; somedays you eat the bear, well, you know.

    If you talk to the doc please have a discussion with him about getting the right testing and especially the right testers.

    I hope you heal up.

  • pj 16 July 2013, 11:30 pm

    Thanks again, Dave. Just wanted to tell you I received a call from the doctor’s office and it appears they do see a large full tear and something about something being pulled. But I had to tell you that they told me that the radiologist said he didn’t see anything…, but the doctor in reviewing the tests himself said he seen a large full tear , they told me that they had the radiologist look at it again and he then also confirmed what the doctor saw ?? I don’t know who is telling it like it really is , but I know something is really messed up in this shoulder of mine, and I wouldn’t be surprised if the labrum is torn also. I have a torn labrum in my hip and I know what it feels like, I have had a torn rotator before and I know what it feels like, this shoulder is worse than both…..Anyway, hopefully now I can get on the road to recovery.. Thanks again for your help!

  • Johnny 23 July 2013, 7:32 pm

    Colin, I have been reading the stories about the MR anthrograms and wanted to tell my story. On January 23, 2013 I went for surgery on my right shoulder. Once the surgeon was in, he found a tear of the biceps anchor that extended posteriorly to the 9 o’clock position. to attach this back he used a Smith & Nephew double loaded 2-7 anchor placed at the 12 o’clock position on the glenoid and the root of the biceps was repaired to the glenoid superiorly. A second anchor was then placed at the 10 o’clock position posteriorly to secure the posterior extension of the labral tear. Also, while in, an extensive bursectomy was performed due to subacromial bursitis. When surgery was scheduled, he actually thought he was going in to do a slight repair on the rotator cuff. 3 hours later, I came out of surgery. It has been 6 months since surgery and I am having pain issues again in the same area of the shoulder. I am scheduled for an MR arthrogram soon to find out what is going on in the shoulder area. I went religiously to therapy sessions for the four months post op and was completely released back to work. Now, 2 months back into the grind, problems are starting all over. I have started having problems lifting my arm out in front of my body with the palm facing down. No problems lifting the arm with palm facing up. Another issue I am having is reaching towards my back pocket with that arm. After therapy sessions, this seemed to be a non issue, but it has come back again. Was wondering your thoughts on my dilemma…

    Thanks
    Johnny

  • Murdoch 30 July 2013, 5:11 am

    Colin,
    Thanks for providing all the info on your rotator cuff experience and the forum. I would just offer some words of warning to anyone reading this that is about to have the arthrogram procedure. I think that people tend to post more regarding bad experiences they’ve had with something than when something went well. I read most of the posts here just prior to driving to my arthrogram appointment. By that point I was sure I was in for the most excruciating experience of my life. I hate needles, and everything about the procedure and other folks experiences with it made me sure I was in for a hellish experience.
    This was not the case. The Dr. numbed my injection site so effectively that I only felt the first little pinch (no bee stings) then he was quiet for a while, I thought he was getting everything ready when he said “OK, I’m taking the needle out, we are all finished”. It was less than 30 seconds to -1 minute of him injecting the dye and I didn’t feel a thing. Then about 20 minutes in the MR tube and I was on my way.
    So, there you go. One very positive experience.
    Not sure of the outcome yet. My shoulder feels better 5 hours after the procedure, but is slowly starting to ache again, likely the lidocaine is starting to wear off.
    Anyway, I’m glad I had it done, hopefully it will shed some light on what’s going on with my shoulder.

  • Dave 2 August 2013, 5:53 pm

    Great to hear it went so well.
    Skills sets can vary, and working with injured parts is tricky. But one of the trickiest tasks for a radiologist (who mostly just look at images all day) is to inject into joints, be it arthrograms (shoulder, wrist, knee) and facet spinal injections are the toughest. Because as with many things, somedays you eat the bear, somedays the bear eats you.

  • Dee 9 November 2013, 12:20 am

    I brought my teenage daughter in for an MRI with dye injection. The doctor administering the dyecouldn’t seemto find the right place to put the needle and insert the dye. My daughter was on the table in agony and my heart was breaking for her. The doctor actually pulled the needle out and reinserted it. After what felt like forever, she finally said she couldn’tcontinue to tryas my daughter was moving around too much. The brought her in for the MRI without the contrast and now I worry that all of this was for nothing if her orthocan’t see anything in the images.

  • Jrc 19 December 2013, 4:53 am

    I am reading through these, and now I am nauseous :(. I have a MRI + Arthrogram scan scheduled tomorrow. And I plan to travel right next day. Do you recommend taking medicine before going in ?? Or the local anesthetic is supposed to do the trick for duration of MRI ? It maybe too late to ask these questions now :(. I see some really horrible experiences here, and I hope my nerves settle down by tomorrow (cant read anymore of what ppl experiences !)

  • jrc 19 December 2013, 2:26 pm

    dee and murdoch..wanted toknow where you were located. but i do not think my comments will get posted soon enough..i am glad for good experience of one.. and sorry Dee. I hope the results were helpful and daughter didnt have to go through hell again..

  • Dee 19 December 2013, 4:39 pm

    We’re in VA. Thankfully, the small amount of dye was enough for them to see. There was no tears and was diagnosed with rotator cuff tendonitis, so she’s been continuing with physical therapy. She is still stiff, but finally pain free after 5 months. She’s been having dry needling therapy and it’s worked wonders for her. Good luck to you!

  • Jrc 20 December 2013, 1:24 am

    Glad to hear that Dee. Hope there is complete recovery. I just had my MRI + Arthrogram few hour ago. The pain has not yet set in (anesthetic is still working). The facility used a CT scan to look at the joint first, found the best spot and then administered the anesthetic and the dye. The CT scan lasted 5-7 mins and the injection took 1 minute. I told the technician about some comments here which mention 20-30 mins of needle into the joint/ associated discomfort etc. He said most facilities use fluoroscopy which can take little longer to locate the exact spot. since they use a CT scanner to scan the joint, it gives them far clearer picture and makes their job easy. Maybe someone more knowledgeable (and unbiased) can shed light over this whole CT scan vs Fluroscopy thing to administer the dye. It maybe worthwhile to check which technique your MRI facility uses.

    After the dye insertion the MRI took about 30-40 mins, the technician did stop it couple of times to tell me I was not keeping my hand still (they gave headphones for the noise, into which the technician could talk to you). So in all a decent experience. Now the only bad part is, they saw a stress fracture and called up my doc as I left the facility. Now doc says I may have to keep travel plans on ice!

  • Just G 25 March 2014, 5:45 pm

    Good afternoon all! I have an MR arthrogram scheduled in a week’s time. I have been obsessed with finding information. Seems as though the more dramatic I find, I keep on looking. Admittedly, when I started reading this blog, I thought I should stop seeking information. I’m glad I continued – maybe over time the procedure has been refined and less pain is experienced. In any event, I have so appreciated everyone’s contributions – I took something from each post.

    The doctor is unsure of a diagnosis at this point – I started out with right shoulder pain which is accompanied by feelings of tearing. Reaching and lifting (a gallon of milk from the fridge, for example) is painful, but so is reaching for the radio in the car. My left shoulder now feels similar, but the doctor opines that it is from overutilization in order to favor my right. I am not buying it. In both instances, the paid radiates down my arm to the elbow and, sometimes, the hand. Doing a push-up would be torture. I had one event several years ago that may have caused the pain on the right, but really no explanation for the left. PT did not work. In fact, it seems to have made things worse – although, that may just be from movement.

    So, it’s off for my MRA next week. I am at the point where I hope they find something. Something that they have a treatment for.

    I wish all of you well.

  • Stacy 14 July 2014, 10:55 pm

    I did not have a problem with any of the injections, well, the freezing or numbing shots did feel like little bee stings, but no pain with the main injection. My issue was an unbearable pain once in the MRI machine, both with my arm on my side with support, and very bad with the arm above my head. I see the Dr. tomorrow. I have constant unbearable pain. Pills help, but I am not into drugs.

  • Angela Todd 22 November 2014, 4:54 am

    I am about 75% better following therapy, three X-rays (included one arthrogram), and an MRI. I heard everything from osteopenia, two mildly frayed tendons, a touch of arthritis, a totally frozen shoulder, and later on, scar tissue in my scapula, as well. After one failed therapy session from people who didn’t even know what was wrong with me, I had the second set of X-rays and the MRI. After expanding the shoulder with saline, followed by a cortisone shot, I had immediate relief, which allowed me to do weeks of therapy with a different therapy group. I was told that I had scar tissue in the scapula, meaning the scapula area. That, I was told, after I had been re-assured that all scar tissue was gone. Then, I was told that only the scar tissue in the shoulder area was gone. Then, I also heard that my problem was, “tight muscles.” I have reached a plateau, where the last major obstacle to overcome is to scratch the center of my back. Also, when I lie on my back, with both arms, straight, elbow also straight, the good arm flops down flat on the floor or bed. The affected arm only drops to within about four inches of the floor or bed. Then, it pivots inward, as if it is on a hinge. Also, when my hands are cupped behind my head, also while lying down on a bed or floor, the good arm falls back flat. The affected arm’s elbow only drops to within about four inches from touching the floor or bed. Also, if put pressure on the affected arm to force (gently) the arm all the way back and down, the chest rises. If my shoulder is free of scar tissue, is the problem, as “they” say…MORE scar tissue in the area of the scapula? BTW, I’ve seen that word spelled, “scapula” and, “scapulae.” Which one is really correct? Others tell me that my whole problem is tight muscles. So, if you stretch the muscles out, and that WAS the problem, why do muscles immediately shrink back into their former position almost immediately. I believe that there is more of a problem than tight muscles. Also, I have been told that scar tissue doesn’t show up on X-rays. Others also have conflicting answers as to whether scar tissue shows up on an MRI. I had asked to see my images…so someone could show me the scar tissue. No one showed me anything except after the arthrogram, but not the scapula images. So, even though I continue to do my exercises at home, I am still confused as to what all problems still remain. At first, I could not sleep, and almost every position hurt. Long story. Now, although I continue to exercise at home, and I can do most things again, I still cannot do everything. I’d appreciate some answers, especially the tight muscles vs. scar tissue problems. Which do I have? And does scar tissue show up on imagery? I would think it would. Sincerely, Angela Todd.

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