My h (70M) saw an ortho doc yesterday who took an X-ray of his sore shoulder and said he has a type III acromion. Ordered PT and also told him he didn’t see a rotator cuff tear. My dear h is losing some hearing so I thought he must have misunderstood. Asked him how PT would fix a hooked acromion. I also thought that tendon tears don’t show up on X-ray, only MRI. Should he ask for MRI? Won’t PT potentially make the effects of an acromion impingement worse? He told me he forgot to tell doc that his one arm tingles all the time because he’s kind of used to it. What do you say?
Hi Jill,
Sorry to hear your husband is experiencing pain, though it seems like he’s getting some good care. Let’s unpack a few of your concerns.
The type III (hooked) acromion is probably not a big deal and, depending on your perspective, should be described differently to patients. For a long time the hooked shape was blamed for impingement and cuff tears, but that model has fallen out of favor. Acromion shape correlates poorly with symptoms, plenty of pain-free people have this finding on imaging, and the old logic of “the bone shape is grinding the tendon” doesn’t hold up well. So his doctor ordering PT instead of treating the acromion as the villain is up to date. You’re right that PT won’t “fix” the bone shape, but it doesn’t need to, because the anatomy usually isn’t what’s driving the pain. PT is unlikely to make it worse.
Regarding the X-ray, yep, you’re right that it doesn’t show tendon tears, only bone. So when the doctor said he didn’t see a cuff tear, they probably meant that nothing on X-ray suggested one indirectly, not that a tear was ruled out. An MRI is the test that actually images the tendons.
Whether your husband needs one depends on his physical exam and how he responds to PT. I suspect that’s what the doctor is doing, i.e. PT first to see what happens, but it’s a reasonable thing to ask about nonetheless.
Only thing that stands out to me is the arm that tingles all the time. He needs to tell the doctor that. I would want to better characterize it, because it might change my thinking about what’s going on here. It would be reasonable to have him, or both of you, call the office, or bring it up first thing at the next visit.
As always, we’re here to help if you need us.
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