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I have two questions.
First it is about my left shoulder which I went through two surgeries recently. I am trying to figure out why did my surgeon leave 1 cm extend out of my humeral shaft when he did the bicep tenodesis.
I'm typing down what the mri impression said.
1. Full thickness tear along the leading edge of the supraspinatus tendon. There is also high-grade partial tearing of the distal subscapularis and infraspinatus tendinopathy.
2. Postsurgical changes compatible with interval acromioplasty, rotator cuff tear repair and biceps tenodesis (MRI appearance of proud screw of uncertain clinical significance) as detailed above.

Biceps Tendon: Post surgical changes of biceps tenodesis are seen. Tenodesis screw along the humeral shaft extends approximately 1 cm proud of the anterior humeral cortex.

OK, I do not quite understand what it means. I had the same procedure on my right shoulder and the screw was normally into the humeral and I have no problem with my right bicep since 2009. Unfortunately with my left shoulder, it is still bothering me, still weak, still feel heaviness, tired easily and just some throbbing pain on and off. I also have trouble with swelling mostly in the front area. My back where the shoulder blade area is feeling tenderness when touched. I saw my surgeon's partner and he recommended a third surgery but wants to cut off my bicep tendon. I worked very hard to get my bicep back to normal since 4 months and still attend therapy. I am not planning on having third surgery without diagnosis. I need to know what is wrong with my shoulder first. Why would he want to cut off my bicep? What is the purpose of leaving a screw 1 cm extend of my humeral? Now I have to continue physical therapy for the next 6 weeks. In a few weeks, he wants me to go to Physical Medicine and Rehab to find out the problem I have with my shoulder.

Second question.
This one is about my neck. I had MRI last October and the impression showed mulitlevel degenerative disc disease in the setting of borderline intrinsically narrowed central canal causes no more than mild central canal or neuroformanal stenosis. What does this mean? One of the doctors gave me the paper, he wrote Report of her C-Spine MRI identified no signficant neuroforaminal stenosis.
I'm a little confused here. Two doctors said differently to me. My orthopedic doctor said I have tightness in my neck. The other doctor wrote no significant neuroforaminal stenosis. Can you clear this up for me?


Category: Orthopedic Surgeon

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Category: Spine Surgeon
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Hello. Thank you for posting your query at
I will reply to both your questions.
First question :
Your shoulder MRI is showing tear towards the insertion site of suprspinatus tendon.
Other tendons of subscapularis & infraspinatus has age related degenerative changes as well as there is incomplete tear in them.
Second Question-
In your spine there are holes from which our nerves passes to different parts of body to supply them with power or to receive sensations.These hoes are known as neural foramen.
In your MRI there is mild compression of central canal or central part of spinal cord as well as only mild compression over nerves at foramen level.These changes & mild pain at neck or spasm at neck produced by them can be relieved by exercises of neck muscle(easily explained to you by your physio).Different opinion by different doctors is due to there mild or early appearance. This.This is observer bias.You should not worry about this.
Hope this will help you.
Feel free to discuss further,
With best wishes.

Patient replied :

Hello again,
Thank you for responding to my two questions. I understand that I have a tear which is new after my second surgery unfortunately. I just don't understand why I have another tear and I believe this tear is what is causing pain and hurting when I do something with my arm like stretching some elastic or holding a baby in my arm. It hurts in a minute and I have to shift over to my right arm. Sometimes I wonder if this tear will ever heal on it own.
My main concern is the bicep itself. I wonder is it normal that the surgeron leaves one cm extend of humeral when my surgeron did the bicep tenodesis? Is this normal? In my opinion I don't think it is. Those people who studies the MRI of my shoulder and bicep were not sure about that part. It is really hard to understand what's going on with my bicep. They said that the screw is 1 cm extend out of my humeral and my suprasinatus is very anterior. This surgeron told me that these people really don't know about this. I'm just wondering if this procedure like MRI result said tenodiesis screw along the humeral shaft extends 1 cm proud of the anterior humeral cortex is that normal? I do understand that with my right bicep I had that done with a different surgeon. The screw is perfectly inserted and I have no problem since 2009.

Extending of humerus screw 1 cm beyond the humerus is not s normal one.A large screw always irritate the muscles iinfront of them.
The tear in supraspinatus is full thickness tear & is cause of your pain.It should be repaired ,but in revision surgery it may be difficult.This tear will not heal by its own.
Feel free to discuss further,

Patient replied :

to info

I had an x-ray shoulder. Can you explained what the finding means?
It says There is degenerative hypertrophic spurring within the distal clavicle with slight widening of the acromioclavicular joint. The visualized left lung and ribs are unremarkable. There is a rounded lucent lesion with rim sclerosis eccentric within the proximal humerus shaft which may reflect a fibrous cortical defect.

It looks to be a different question.
There is a small beak of bone at joint between a romain process and clavicle bone found at shoulder area. In your humerus bone there is a small soft tissue defect which is filled by fibrous ups of soft tissue. Generally this is harmless until unless found in large area. No treatment is needed for this.
Hope this helps, please feel free to get back.

Patient replied :

It is the same shoulder problem I have had for a while. Another question here, my humerus is still hurting me. Can three anchors and a screw for bicep being stalled all at the same time ruin my bone? Will they heal up? I had them since 6 months ago.

The anchors & screw are the tested devices .They are structured & used in the way that they do not harm the bone.You should not worry in this regard.
With best wishes.

Dr. Mukesh Tiwari
Category: Spine Surgeon
Fellowship - Khandaka Hospital, Jaipur
Residency - MS, Rabindranath Tagore Medical College, Udaipur, 2000
Medical School, Internship - MBBS, SMS Medical College, Jaipur, 1995
Dr. Mukesh Tiwari and 4 other Medical Specialists are ready to help you

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