question: Pain in Left Shoulder during arm movements G. Venkadachalam, M/49 yrs, 70 Kgs, 170 cm Some time in Nov 2010, The pain used to occasionally appear in a small portion of lower arm near the wrist. Also I felt pain in my upper arm sometimes. It was mild. I could not associate this with any of my arm movements or postures and I did not seek any medical advice. Later (January – February 2011) the pain started to appear more frequently and by February this year, it was almost continuous and even it had extended to my right shoulder. Even getting up from bed was difficult for me for three days. But by the time I could consult an Orthopaedic surgeon, the pain from my right shoulder had completely subsided. Neck X-ray was done. It was diagnosed as Spondylitis and I was advised physiotherapy. February – August 2011 I continued Physiotherapy – 3 or 4 days in a week. IFT, Heating Pad, Vibrator applications to my left upper arm and shoulder followed by muscle stretching exercises. All pains associated with my neck movements gone. But the pain in my shoulder continued to trouble me with certain movements of my arm. Moments causing pain (e.g) When I try to reach the back seat of car from the driver seat. When I wear belt through the loops of the trouser Trying to keep my office bag in the car (in the passenger’s seat) extending my left arm. Taking my arm to my shoulder level (Elbow at right angle) and try to move the arm backwards Take any weight and try to move it backwards (using left arm) Changing gear from 1st to 2nd Wearing /Pulling up the Sorts etc. This pain is almost gone when I press and hold by two fingers to immobile a small area front of my left upper shoulder closure to rotator cuff and move my left arm like in the above cases. MRI was then suggested by the physiotherapist. The MRI report is given below. G. Venkadachalam, M/49 yrs, 70 Kgs, 170 cm Clinical Findings: date: 31.08.2011 C/o Pain in left shoulder joint. MRI STUDY OF LEFT SHOULDER JOINT MRI study of the left shoulder joint was performed using T1W and T2W sequences in multiple planes OBSERVATIONS: There is intrasubstance hyperintense signal seen in the supraspinatus tendon (anteriorly) on PD fatsat images, which is iso to hypointense on T1W images. It reveals associated mild thickening – represents its Tendinosis. Subtle fluid is seen in the subdeltoid region. Rest rotator cuff tendons are well demonstrated on coronal T1/T2 weighted images. Acromio-clavicular joint appears normal. Acromion is Type-II/III. The articular margins are intact. The glenoid Iabrum is normal. Major neurovascular bundles are normal. No evidence of joint effusion. Impresson: MR scan reveals: Intrasubstance altered signal in the supraspinatus tendon (anteriorly) with associated mild thickening of it-represents its Tendinosis. Subtle fluid is seen in the subdeltoid region Please advice whether surgery is compulsory. What are the risks if I delay it as long as possible