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RADIOGRAPHS: The patient has previously had MRI, radiographs and these are
available for my review. The radiographs from 2/8/2005 demonstrate no significant
evidence of glenohumeral arthrosis. There is a type I acromion without any significant
spurs. The AC joint is not prominent.
MRI from 2/15/2005 was also available for my review and there is a radiologist's report
along with it. I concur with the radiologist that there is no evidence of complete rotator
cuff tear. There is some question of rotator cuff tendinosis. There is some fluid around
the biceps tendon but to me not an unusual amount. There are very minimal
glenohumeral joint changes suggested by cysts in the humeral head.
IMPRESSION: Right shoulder rotator cuff tendinosis with secondary frozen shoulder.
RECOMMENDATIONS: The patient is advised that I think that her underlying
symptomatology is a rotator cuff tendonitis followed by a secondary frozen shoulder. I
think she needs a rotator cuff stretching and strengthening program with a therapist to
regain her motion. She may be a candidate for subacromial bursectomy if she does not
resolve her pain and possibly a candidate for arthroscopic capsular release if she does not
get back her motion but at this point I think the mainstay of her treatment is going to be
therapy. Because of the significant pain she is having I think a subacromial cortisone
injection is reasonable. Therefore after adequate prepping with alcohol injection of
lidocaine, Marcaine and Kenalog is made in the subacromial space with almost complete
relief of the patient's shoulder pain. She is given a referral for therapy and we have
selected a therapist for her in Menlo Park. I have asked her to go two to three times a
week for the next four to six weeks for working on range of motion and stretching. I
think she should take an anti-inflammatory and have transmitted Feldene 20 mg one p.o.
daily to her pharmacy and I would like her to take this on a regular basis. She may take
Extra Strength Tylenol in addition to this.
I would like her to recheck in six weeks' time for a recheck and I have asked her to follow
up with Dr. Andrew Haskell who might be more suitable for performing a subacromial
arthroscopic surgery if she does need this.