What is the diagnosis and treatment plan for a patient with mild rotator cuff tendinopathy and minimal articular surface fraying?

Understanding Your MRI Results

Your MRI shows very mild wear and tear on your rotator cuff tendons with minimal surface fraying—this is not a tear, and the good news is that all major structures in your shoulder are intact. 1

What the MRI Found

Rotator Cuff Status:

• Your rotator cuff tendons (the muscles that move your shoulder) show only "minimal articular surface fraying" of two tendons (supraspinatus and infraspinatus) 1
• This means there's some roughening on the inner surface of these tendons, but no actual tear 1
• The term "tendinopathy" refers to mild degeneration or inflammation in the tendon—think of it like minor wear on the tendon surface rather than a rip 1
• Your other rotator cuff muscles (teres minor and subscapularis) are completely normal 1
• The muscle bulk and quality are normal, which is important for healing 1

Everything Else Looks Good:

• The labrum (cartilage rim around your shoulder socket) is intact 1
• Your biceps tendon is normal 1
• No inflammation in the bursa (fluid-filled cushion) 1
• Mild arthritis in your AC joint (top of shoulder), but nothing causing problems 1
• No bone damage from your motorcycle accident 1

What This Means

The MR arthrogram was the right test to order because it's the most accurate way to detect partial-thickness tears on the inner surface of tendons 1. Your results show you're in the early stages of tendon degeneration—common after trauma—but you haven't progressed to an actual tear 1.

Treatment Plan

Conservative (Non-Surgical) Treatment is Strongly Recommended:

Since you have no actual tear and only minimal fraying, surgery is not indicated 1. Here's your treatment approach:

1. Physical Therapy (First-Line Treatment):

• Resistance exercise is the primary recommended intervention for rotator cuff tendinopathy 2
• Focus on strengthening exercises to improve shoulder mechanics and reduce pain 2
• Expect 8-12 weeks of structured therapy 2

2. Anti-Inflammatory Medication:

• Consider celecoxib (Celebrex) or other NSAIDs for pain relief 3
• These medications not only reduce pain but may help prevent progression of tendon degeneration 3
• Use as directed by your physician, typically for 2-4 weeks initially 3

3. Activity Modification:

• Avoid overhead activities and heavy lifting temporarily 4
• Gradually return to normal activities as pain improves 2

4. Follow-Up:

• Reassess in 6-8 weeks to monitor symptom improvement 4
• If symptoms persist despite 3-4 months of conservative treatment, consider repeat imaging 1

Important Points

Why No Surgery?

• You have no full-thickness tear, which is the main indication for surgical repair 1
• Minimal fraying typically responds well to physical therapy 2
• Ten percent of rotator cuff tears are completely asymptomatic, meaning structural changes don't always correlate with symptoms 1

Prognosis:

• With appropriate treatment, most patients with mild tendinopathy improve significantly 2
• Your normal muscle bulk is a positive prognostic factor 1
• The recurrence of pain after your accident suggests inflammation rather than progressive structural damage 4

Red Flags to Watch For:

• Sudden increase in pain or weakness (could indicate tear progression) 1
• Inability to lift your arm 1
• Night pain that doesn't improve with treatment 4

If any of these occur, contact your physician for reassessment 1.