Sunday, May 4, 2008

Lawn Mowers and a Painful Shoulder

There are few things in life I find more unappealing than mowing the lawn. Spending a few hours pushing this thing around, breathing in gas fumes, is my idea of hell:



I am always looking to for ways to justify my anti-lawnmower position, besides the obvious environmental justification. Recently, I ran across a case that helped me convince my wife that mowing can be hazardous to your health.

Thirty-four year old woman with severe right shoulder pain one week after trying to start a gas-powered lawn mower:




Sagittal T2 fatsat and T1-weighted images show patchy edema in the teres minor (yellow arrow), infraspinatus (red arrow) and posterior edge of supraspinatus (white arrow) muscles, representing a moderate strain of these muscles. She was yanking on the starter cord with all her might, when the cord abruptly froze, torquing her shoulder. She immediately felt a sharp pain, and sought medical attention.

Without this compelling clinical history, one might have to consider other diagnostic possibilities, including a myositis or a form of Parsonage-Turner syndrome (although the patchy involvement seen in this case would be atypical).

It was very helpful for the patient and her treating physician to have this information. There was no rotator cuff tear, and no intra-articular abnormality. Thus, one can tell the patient with a high degree of confidence that her symptoms will abate over a few weeks, with conservative therapy.

Some might call this study a waste of imaging dollars, since the patient will be better in 3-4 weeks, whether or not she had an MRI scan. I respectfully disagree with those individuals. I learned early in my training that one of the most valuable things a physician can provide for their patients is a diagnosis and prognosis. There are few things worse than being in pain, and not knowing why you are in pain.

If the pain is in your shoulder, or a shoulder of a loved one, you will tend to agree with me on this one.

1 comment:

Donald Ottens said...

What a wonderful site!!!!
And so funny!

As a radiologist I am asked to make a lecture for the rgeumatologistst in our area about the role of MRI in their field + early detection.
Your cases a very helpful in making the presentation.
Thanks a lot!!

Donald E. Ottens (MD PhD)
Bethesda Hoogeveen

PS any suggestions about MRI-material are most welcome!