Diagnosis

My blog is turning into a journal of medical horrors. But that's the only really interesting thing going on right now, so here we go.

Yesterday, I went in for the MR-Arthrogram. It wasn't as bad as I made it sound in my previous post. It was worse.

The first worse part? The cost. My Orthopaedic Surgeon's office estimated that it would cost about $600 or $700. They were wrong. The estimated portion of the procedure not covered by my insurance is just under $1150. *ouch!* Right in the wallet! But what can I do? I need to be able to sleep through the night again. I need to be able to get life back to normal again.

The other worse part? It was surprisingly painful. Again, if you're squeamish, you might not want to read on.

After arriving at the Imaging Center and filling out a bunch of paperwork, they had me change into scrub pants and a gown and I was asked to lay down on a table with a fluoroscope. A fluoroscope is basically a lower-dose x-ray machine that provides live images. The radiologist came in to fill my shoulder joint with contrast medium. The local anesthetic was a piece of cake--a little pinch and a little stinging for a few seconds. No big deal. But the other needle? *ouch*

In order to place the needle in the proper position, the radiologist has to push the needle in until it hits the bone, then pull it back a little bit. When that needle hit the bone, it HURT. Instant tears springing into my eyes, and a big wince. Yeah. It was bad. Then I felt strange pressure/pain as he injected a LOT of fluid into my shoulder joint. That fluid has nowhere to go, so it slightly expands the entire joint, and yes, that is a painful process. Worse than I thought it was going to be. *ouch again* When the contrast medium was in, he quickly pulled the large needle out, which was just as painful as when the needle hit the bone, but because he did it quickly, the pain was over before it really registered, thank goodness. And with that, the hard part of the procedure was done.

The radiologist then proceeded to position my arm in different positions and told the radiology tech to take different pictures (basically screen captures from the fluoroscope) of my shoulder joint. That was kind of fun to see. I watched the bones in my shoulder moving about as the radiologist positioned my shoulder.

The next hour was spent in a "high field open MRI" machine. They took several pictures of my shoulder. The MRI made a lot of loud buzzing and banging sounds as it made high-resolution images of the inside of my shoulder. The time to take each picture ranged from 4 1/2 to 15 minutes.

My shoulder remained VERY sore for the rest of the day, and I ended up taking Lortab last night so I could sleep. Fortunately, I'm feeling a lot better this morning. It feels as if a lot of the fluid in my shoulder has been absorbed and a lot of the pain I was feeling yesterday is gone. Because of the Lortab, I think I slept better last night than I have since July. That was nice too.

The result of all of this?

Labral tear extending from the posterior superior labrum posteriorly just past 3 oclock

Now I have a diagnosis.

This particular tear is called a SLAP tear. This web page explains all about it. The most interesting bit to me was the part about causes:

The cause of a SLAP tear can generally be divided into acute traumatic events or chronic repetitive injuries that lead to failure. An example of an acute traumatic event would be a fall onto an outstretched arm, which may result in SLAP lesion secondary to abnormal contact between the humeral head and the superior labrum/biceps anchor. One of the most chronic repetitive injuries that leads to a SLAP tear is overhead throwing. Overhead athletes, especially baseball pitchers, place huge amounts of stress on the shoulder with every throw. The position of external rotation just before ball release can overstress the attachment of the biceps tendon and can lead to a SLAP tear.

Although my shoulder was sore from playing racquetball left-handed, racquetball is not an overhead motion. However, my natural reaction to being pulled backward off of the raft was to extend my arm to stop myself from falling. My right hand was busy with a paddle. My left hand took the brunt of it, and the result was the tear that I'm dealing with. I am 100% certain that this tear happened that day on the river. I felt the pop. I felt the sickening clicking in my joint immediately after. This diagnosis confirms what I had already thought.

The next step comes tomorrow. I am meeting with my Orthopaedic Surgeon to determine the severity of the tear and to decide on a course of treatment. From everything that I've read, this is going to mean surgical repair followed by a bunch of physical therapy. Wonderful.

The nice thing about this diagnosis, though, is that certainty that my shoulder was injured on the river trip. Because of this, I emailed my bishop yesterday and started the process of filing a claim with the church's supplemental insurance program. Costs not covered by my insurance (which will be significant--I chose the high deductible insurance plan this year, not anticipating a shoulder injury) will hopefully be covered by this supplemental insurance.

The other nice thing is simply that there IS a diagnosis. I don't have to continue wondering what's going on in there. With a diagnosis, the surgeon can recommend a definitive treatment plan and give me a prognosis for future recovery. There can be a light at the end of this tunnel of sleep deprivation, even if that light may be a few more months down the road.