This morning I had a Consultant’s appointment to get the result of my MRI and Arthrogram for my shoulder injury. Previously I’d been diagnosed with a PASTA lesion, which is a tear of the supraspinatus rotator cuff tendon, and the MRI was to look for a SLAP tear as well, which is where the cartilage cup inside the shoulder socket (the Labrum) which connects to the bicep tendon, comes away. Here are the findings:
- The PASTA lesion that he identified with an earlier ultra-sound didn’t show up on the MRI.
- I have a “not obvious” 1.5cm SLAP tear.
- Also there’s a small Inferior Glenohumeral Ligament (IGHL) tear.
The PASTA tear may or may not be there and the SLAP tear may not be as big as 1.5cm (which is small anyway) as he said that MRI’s are not great at showing up tears (missing maybe 40% of tears) and where they do, they tend to exaggerate. It seems there’s nothing that can be done about the IGHL tear.
At 39 I’m too old for a normal suture and anchor SLAP tear repair!
However the big news was that apparently at 39 the likelihood of success of normal SLAP tear repair (suture and anchor the labrum back into place) is not good, and so he would do a bicep tenodesis instead, which is where they simply cut the bicep tendon away from the Labrum and anchor it to the humerus (the upper arm bone) instead and bypass the shoulder altogether. That doesn’t sound like much fun!
But it gets worse as the bicep tenodesis has risks of life long shoulder stiffness, or frozen shoulder syndrome and that’s on top of the more obvious risks of infection, the operation simply failing or the tendon rupturing. Either way my Consultant reckons that recovering 75% pre-injury capacity from a bicep tenodesis would be a good result, and that’s after a year or 2 recovery period.
I’m able to do more and more things, e.g. push-ups and burpees
The issue is that I’ve been careful not to make my shoulder injury worse and through exercise and some home base physio, my shoulder has improved to the point that I’m 99% pain free. In fact this morning before my appointment, I actually couldn’t find any shoulder or arm movement that caused me any pain! Now it’s true that I’ve only been going to the gym say once a week, and only been doing a small subset of exercises, e.g. nothing overhead, but I have found that I’m able to do more and more things, e.g. I can now do push-ups where I couldn’t 4 months ago, and I can do burpees too where I couldn’t before. And a weekend full of martial arts recently didn’t give me too many problems.
So this leaves me with something of a dilemma. Do I elect not to have the surgery and keep up with my own recovery and stay 99% pain free through normal life, but maybe will never be able to do some exercises or workouts (no more butterfly pullups for example!)?
Or do I go for the surgery and get a proper repair done, albeit my bicep tendon now won’t be connected to the normal place, but after enduring a long recovery period, there’s still a significant risk that it’ll make the situation much worse than it is now?
I’m to get my butt back down the gym and see what my limits are
It’s a tough decision. Fortunately the delays of the NHS mean that I don’t have to decide today. The current plan is that I’ve booked in the for the surgery, but as there’s a 4-5 month waiting list anyway, I’m to get my butt back down the gym and see what my limits are, starting slowly and working up of course. I have 4 months then to decide if my current ability is sufficient for my needs for the rest of my life, and I suppose if it gets worse again later, I can always get the surgery then.
These things are sent to try us, as they say. But as my father pointed out when I told him: “At least you’re not coming back from Afghanistan with an arm or leg missing!”





What I discovered is that I could do narrow stance push ups without any significant pain, so narrow stance burpees are also in then, providing I don’t do them to excess I think. So the workout I did was this:
3 rounds of:
21-15-9 of:
AMRAP (As Many Rounds As Possible) in 10 minutes of:
3 x Tabata of:
Torn Rotator Cuff Workout 6
I have been to see a physiotherapist about my shoulder, but for some reason I always come away underwhelmed by them. They charge a fortune and I’m never convinced by the efficacy of what they do. But perhaps that’s just the one’s near me! I’m all for self learning and educating myself as to the problems, issues and treatments, as it makes me better able to understand and manage my own recovery, and I thank the stars for the internet, which enables this to happen so effortlessly in this day and age, particularly when it comes to accessing the best information from around the world.
Neither 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.
The 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.
The 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.


The above story happened to Salford/Manchester man Peter Flanagan who along with his son Neil and girlfriend were all arrested, this week learned that the police would not be pressing any charges against him despite the fact that he admitted stabbing and killing 27 year old John Bennell. We’ve all heard stories of people doing what Peter Flanagan did; remember Tony Martin, the Norfolk farmer who shot and killed 16 year old Fred Barras with a shotgun when Fred and his accomplice broke into his house? Martin was originally sentenced to 10 years in prison for murder, eventually serving 3 years inside after the conviction was reduced to manslaughter on appeal.
“I have today told the police of my decision that Peter Flanagan should not face any charges in connection with the death of John Bennell, an intruder who broke into his home in Salford on 22 June. John Bennell was stabbed in the chest by Mr Flanagan, and died from his injuries shortly afterwards.
Note point (4), somewhat counter-intuitively it’s actually ok to use excessive force, as long as you didn’t realise it was excessive at the time. Or put another way, if you genuinely believe you were using reasonable force, even if in hindsight you were mistaken and actually used excessive force, you can still successfully claim you acted in self defence. Think back to the shooting of Charles de Menezes, an innocent man who was shot 7 times in the head because the firearms officer believed he was a suicide bomber, a mistake that was only discovered later.
As it happens I think the force Peter used *was* reasonable, given that John Bennell (or one of his accomplices) was armed with a machete, and clearly the Chief Crown Prosecutor agrees. I would suggest that it was Tony Martin’s illegal shotgun, the traps he’d set in his house against burglars and the fact that he shot Fred Barras in the back as he was fleeing out the window, that probably sank his self defence claim! He clearly fails all of the above tests.


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