Minor Rotator cuff Tear, Frozen Shoulder

[gk10002000]

61, male.  non smoke, almost non drinker.  Sedentary engineer in good physical shape.  but apparently and noticeable 30 years of same same mouse clicking and same position at desk led to symptoms of partial frozen right shoulder. And recently MRI shows minor tear of supra something or other.  fine.  Starting routine physical therapy.  But throughout the process pretty pissed off I Never saw a doctor.

 

    I had my annual physical exam and only saw the Licensed practioner.   She ordered the routine blood work, took pulse blood pressure etc.  She ordered an MRI for my shoulder.  MRI radiologist one paragraph report showed nominal older age stuff along with minor tear.  So just went to the orthopedic doctor.  A fine place but never saw a Doctor.  I brought the MIR images and all I saw was a PA Physician Assistant.  He did not even look at the MRI images.  They took several x-rays.  They did not even look at the x-rays.  Gave me a cortisone shot, scheduled me for the physical therapy stuff.  Now this is all stuff I as an engineer can learn from the internet.  I probably agree with the moderate treatment at first and the judgement of the PA.    But my point is I never saw a doctor after all these visits.   I did not see my supposed primary physician during my annual physical.   I did not see the orthopedic doctor.   I have very inexpensive medical insurance through my large employer (Northrop Grumman.. $85/month.).  But so far I am not getting much out of the insurance except the free physical.  I had to pay for the MRI 200 bucks because the insurance won't pay for an MRI without first having an xray or doing therapy, which to me is stupid because I would expect a diagnostic image before forcing motion.  To move things along I paid up front.

 

    How much would routine treatment and exam for stuff like this cost in Thailand?  I was prepared to leave the USA and at least partially retire, but I delayed my decision pending the results of my shoulder stuff here, in case surgery was needed/  It looks like surgery won't be needed.   I would prefer to be in the Pattaya area versus Bangkok, just because I have spent enough times in big cities here in the USA.  Anybody have any experience with shoulder rotator cuff type things, a hospital or clinic recommendation?  I would plan to get BUPA or some equivalent medical, perhaps even Cigna Global as I don't want to be without major medical in case something severe happens.  Then hold on a few more years until I hit 65 and can get USA medicare for anything major

 

Thanks in advance,

 

Greg K

[tifino]

that x-ray would be a waste of time and money. 

It's also waste of time on money with an MRI, for what little help it provides.

 

The best detail was to have an Ultrasound of the spot, and in hindsight one should take along a VHStape/blank cdrom to record a full video of the action when rotating the area.

p,s. I had a near-total tear of the Supraspinatus ligament. Local Dr referred to it simply as an ACjoint problem, until the video was viewed.

 

Cortisone only of use during the inital couple of weeks after the actual incident; after which it becomes referred to as 'an old injury'

 

Get the fix done asap (in my case it took 37months before I finally got 'repaired', as up until then... 'I was imagining it all' according to a Psych )

Asap, so as to reduce the chance of the tear growing further - as, for example; 37 months wait results in 2.2 cm of outer Clavicle being removed - and that really messes with the resultant geometry of the whole shoulder

 

 

been there done that...  I'm 58 now, still in pain for 23 years (injury '95) since that 37 month-delayed treatment in '98

[Airalee]

I had Dr Chanakarn in Chiang Mai operate on a frozen shoulder in Chiang Mai for about US$3000 all in (including a night in the hospital) about 4 years ago.  A few months of PT afterwards (very affordable in CM). All done at Rajavej Hospital.  Dr Chanakarn is the sports medicine dr/orthopedist for the Thai national team (or was at the time...not sure if he still is). Many expats have used his services for anything from knee replacement surgery etc.  I now live in BKK but if I need anything in the future, I wouldn’t hesitate to fly back to CM to avail myself of his services.

 

https://chanakarn.com/

[gk10002000]

6 hours ago, tifino said:

that x-ray would be a waste of time and money. 

It's also waste of time on money with an MRI, for what little help it provides.

 

The best detail was to have an Ultrasound of the spot, and in hindsight one should take along a VHStape/blank cdrom to record a full video of the action when rotating the area.

p,s. I had a near-total tear of the Supraspinatus ligament. Local Dr referred to it simply as an ACjoint problem, until the video was viewed.

 

Cortisone only of use during the inital couple of weeks after the actual incident; after which it becomes referred to as 'an old injury'

 

Get the fix done asap (in my case it took 37months before I finally got 'repaired', as up until then... 'I was imagining it all' according to a Psych )

Asap, so as to reduce the chance of the tear growing further - as, for example; 37 months wait results in 2.2 cm of outer Clavicle being removed - and that really messes with the resultant geometry of the whole shoulder

 

 

been there done that...  I'm 58 now, still in pain for 23 years (injury '95) since that 37 month-delayed treatment in '98

thanks.  I want it fixed up ASAP.  I don't like the risk of waiting and doing more damage.  But the medical system here pretty much won't allow me to do that within the medical plan.  It has not gotten better every day, so I don't see it getting better with any therapy that the PA and practioners drones think will happen.  I am trying to get through to the doctor for a more thorough look see and filed my complaint with their health advocate today.  Will see what shakes out in the next week or so.  Failing that, I really was open to retiring from work this month, and I would have no problem paying a few grand in Thailand for the arthroscopic suturing and follow up.  After Oct 1 I won't have any Obamacare penalties or need for it so I can even get Thai or Cigna global insurance and just move on with things

[gk10002000]

7 hours ago, tifino said:

that x-ray would be a waste of time and money. 

It's also waste of time on money with an MRI, for what little help it provides.

 

The best detail was to have an Ultrasound of the spot, and in hindsight one should take along a VHStape/blank cdrom to record a full video of the action when rotating the area.

p,s. I had a near-total tear of the Supraspinatus ligament. Local Dr referred to it simply as an ACjoint problem, until the video was viewed.

 

Cortisone only of use during the inital couple of weeks after the actual incident; after which it becomes referred to as 'an old injury'

 

Get the fix done asap (in my case it took 37months before I finally got 'repaired', as up until then... 'I was imagining it all' according to a Psych )

Asap, so as to reduce the chance of the tear growing further - as, for example; 37 months wait results in 2.2 cm of outer Clavicle being removed - and that really messes with the resultant geometry of the whole shoulder

 

 

been there done that...  I'm 58 now, still in pain for 23 years (injury '95) since that 37 month-delayed treatment in '98

at least the MRI showed the tear, although nobody but the radiologist looked at it and nobody quantified the size of the tear and the Exam and the movement of my arm when pain started pretty much confirms things.  Now it is just a matter of degrees.

[tifino]

1 hour ago, gk10002000 said:

thanks.  I want it fixed up ASAP.  I don't like the risk of waiting and doing more damage.  But the medical system here pretty much won't allow me to do that within the medical plan.  It has not gotten better every day, so I don't see it getting better with any therapy that the PA and practioners drones think will happen.  I am trying to get through to the doctor for a more thorough look see and filed my complaint with their health advocate today.  Will see what shakes out in the next week or so.  Failing that, I really was open to retiring from work this month, and I would have no problem paying a few grand in Thailand for the arthroscopic suturing and follow up.  After Oct 1 I won't have any Obamacare penalties or need for it so I can even get Thai or Cigna global insurance and just move on with things

 

good luck with this all... I know what you have been going through. 

 I lasted another 5 years, post-op; before forced out of the (military) workforce.

Compromised muscular skeletal plays havoc putting a rifle butt to a bung shoulder; nor dig trenches; nor easily running away from incoming bullets

[tifino]

1 hour ago, gk10002000 said:

at least the MRI showed the tear, although nobody but the radiologist looked at it and nobody quantified the size of the tear and the Exam and the movement of my arm when pain started pretty much confirms things.  Now it is just a matter of degrees.

yeah! just don't give up and let them win.

I use the relative scale of comparing cross-sectionals... if I scaled up compared to, say fingers on a hand - I had one&half fingers out of four, cross section of ligament left.   OCOO

 

If they operate; be prepared for some (possible) nerve damage... something like a single line of numbness down the arm at the connected muscle -  shoulders are one each of a body's (pain referral points) 

 

All depends on what scale of Incision they create...Arthroscopic not so bad; but a 9cm one is not good at all ? 

 

 

 

[dddave]

Not the same issue but the cost comparison probably close.

Walked into Bangkok Christian Hosp, Bangkok. A very decent hospital though not with the 5 star amenities of the top tier facilities.

I wanted  Cortisone shots in my arthritic knees and within 30 minutes of arrival was seeing an English speaking Orthopedist.  I had my own X-rays from a recent trip to the VA hospital in the US so saved money there.  The total cost of the visit, including consultation with the Orthopedist and the cortisone shots was B2500, about $75.  X-rays would have been about B1000 additional.  MRI's usually run to between B10,000-15000.

[Sheryl]

Actually the treatment you describe is standard and you will have trouble getting a doctor in Thailand to do otherwise assuming the diagnosis is correct and no undetected factors at play.

 

The best shoulder specialist in Thailand is in Bangkok. Nothing remotely as skilled  in Pattaya.

 

https://www.bangkokpattayahospital.com/en/doctor-profile?v_id=173&depid=22

 

A consultation with him, given that you already have an MRI (be sure to bring the CD with you and also Xray if any were done)  will cost around 2000 baht. If medication is suggested (likely an NSAID, that's about the only thing that might be) do nto buy at hospital pharmacy as there is considerable mark up, get at a pharmacy.

 

Treatment costs will depend on what treatment .Physical therapy is in fact the usual approach and can take months to see results. There is a physical therapist in Pattaya who could provide this based on Dr. specifications or yo ucan learn to do the exercsies on your own.

 

It is only when physical therapy does not yield results after say 6 months that surgery would be indicated for a frozen shoulder (and a minor tear would nto usually need surgery).  That will vary in cost depending on where you have it done and also what procedure (sometimes they just put the shoulder through full range of motion under general anesthesia to break up adhesions; that is less expensive than arthroscopy).  At a top private hospital I would guess anywhere from 4-7,000 USD. Much less at a government hospital but long waits and lots of red tape and

 

 

[gk10002000]

13 hours ago, tifino said:

 

good luck with this all... I know what you have been going through. 

 I lasted another 5 years, post-op; before forced out of the (military) workforce.

Compromised muscular skeletal plays havoc putting a rifle butt to a bung shoulder; nor dig trenches; nor easily running away from incoming bullets

I was ex air force but I flew a desk.  hats off to you and your real service

[tifino]

9 minutes ago, gk10002000 said:

I was ex air force but I flew a desk.  hats off to you and your real service

same as, and to you too...

I actually flew a screwdriver and a PC7  (Adcola soldering station) a techo' , but no matter which Service; we all had to be able to shoot eh!

[rumak]

On 9/11/2018 at 11:19 PM, Airalee said:

I had Dr Chanakarn in Chiang Mai operate on a frozen shoulder in Chiang Mai for about US$3000 all in (including a night in the hospital) about 4 years ago.  A few months of PT afterwards (very affordable in CM). All done at Rajavej Hospital.  Dr Chanakarn is the sports medicine dr/orthopedist for the Thai national team (or was at the time...not sure if he still is). Many expats have used his services for anything from knee replacement surgery etc.  I now live in BKK but if I need anything in the future, I wouldn’t hesitate to fly back to CM to avail myself of his services.

 

https://chanakarn.com/

had my frozen shoulder fixed by "shoulder manipulation" by Dr Suthee in CM.....very famous but now retired.   Most

sites do NOT recommend this method,  but he did it and i am fixed.   NOW,  if i had a problem I also would go to see Dr. Chanakarn.   He would be my first choice here in CM   

Edited September 13, 2018 by rumak

[gk10002000]

I have a combination of partial frozen shoulder and after two sessions movement and mobility are much better.  But I am still concerned about the tear and when and if I am making it worse by constantly stretching the tendon.  I will definitely avoid any strenuous lifting and will continue with some therapy for a while.  FYI, I saw the bill for the terapist.  The USA firms seem to by default submit a claim to the insurance for 4 times the Medicare rate!  Then the insurance company knocks that down to what they are contractually allowed to charge.  So my therapy was $271, then knocked down to $43.  It is not clear yet if I will bet billed that $43 or if that is totally covered by my insurer.  It looks like I have to pay that until my deductible is reached.  But just an interesting factoid on how these medical centers try to bill.  The off the street rate if I had no insurance would be $85. 

[RAZZELL]

On 9/12/2018 at 2:14 PM, Sheryl said:

Actually the treatment you describe is standard and you will have trouble getting a doctor in Thailand to do otherwise assuming the diagnosis is correct and no undetected factors at play.

 

The best shoulder specialist in Thailand is in Bangkok. Nothing remotely as skilled  in Pattaya.

 

https://www.bangkokpattayahospital.com/en/doctor-profile?v_id=173&depid=22

 

A consultation with him, given that you already have an MRI (be sure to bring the CD with you and also Xray if any were done)  will cost around 2000 baht. If medication is suggested (likely an NSAID, that's about the only thing that might be) do nto buy at hospital pharmacy as there is considerable mark up, get at a pharmacy.

 

Treatment costs will depend on what treatment .Physical therapy is in fact the usual approach and can take months to see results. There is a physical therapist in Pattaya who could provide this based on Dr. specifications or yo ucan learn to do the exercsies on your own.

 

It is only when physical therapy does not yield results after say 6 months that surgery would be indicated for a frozen shoulder (and a minor tear would nto usually need surgery).  That will vary in cost depending on where you have it done and also what procedure (sometimes they just put the shoulder through full range of motion under general anesthesia to break up adhesions; that is less expensive than arthroscopy).  At a top private hospital I would guess anywhere from 4-7,000 USD. Much less at a government hospital but long waits and lots of red tape and

 

 

I was just about to post something concerning my shoulder...but it seems I can piggyback this thread.

 

I "think" I have a rotator cuff tear.

 

Trouble with movement, pains down the arm, wake up in the night from the pain etc

 

What are the benefits of a cortisone injection? I think my injury happened about 6 weeks ago...but didn't get the symptoms until a few weeks after.

 

Any recommendations for somewhere to go in Bangkok which won't cost an arm and a leg?

 

I have read this thread:

 

https://www.thaivisa.com/forum/topic/1041600-damaged-rotator-cuff-treatment-besides-surgery/?page=2

 

RAZZ

 

 

 

Edited September 22, 2018 by RAZZELL

[Sheryl]

There are a potential didadvantages to cortisone injection (weakening of tendon etc) though it can help relieve inflammation. If however thete is an ongoing cause of the inflammation thst is not addressed (e.g. nerve compression) such reluef will be temporary. The pros and cons of steroid use have to be assessed on an individual basis taking into account cause of the pain etc.

There is no substitute for seeing a good shoulder specialist. Do not see only a regular ortho.

Dr. Mason at Bumrungrad is tops and well worth the money and consultation only will only be around 2000 baht. If MRI is needed you can save money on that by having it done at an imaging center.
www.mrithailand.com

One important caveat: the type of pain you describe could also be from the cervical spine. So unless you are sure it is the shoulder maybe hold off on MRI until you have seen doctor. Shoulder is more likely to be the culprit if you have trouble raising your arm up to comb your hair or reaching your arm to your back and pain when raising and lowering the arm. While cervical spine is more likely the cause if the pain is not so much related to lifting/lowering arm but worsened by leaning the head back (like when getting a shampoo at a shop) and turning the head certain ways.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[gk10002000]

42 minutes ago, RAZZELL said:

I was just about to post something concerning my shoulder...but it seems I can piggyback this thread.

 

I "think" I have a rotator cuff tear.

 

Trouble with movement, pains down the arm, wake up in the night from the pain etc

 

What are the benefits of a cortisone injection? I think my injury happened about 6 weeks ago...but didn't get the symptoms until a few weeks after.

 

Any recommendations for somewhere to go in Bangkok which won't cost an arm and a leg?

 

I have read this thread:

 

https://www.thaivisa.com/forum/topic/1041600-damaged-rotator-cuff-treatment-besides-surgery/?page=2

 

RAZZ

 

 

The cortisone shot seems to be useful about 50% of the time.  It can reduce inflammation and swelling.  My shot did not seem to do much.  In fact the needle was put into the shoulder socket and that by itself causes trauma and the guy warned me it might seem worse for up to one week.  It does not seem to do any harm so from my recent experience I have no issue with it.  You really need to get an MRI done.  They are cheap.  30 USD for images here in the USA, 200 USD for the images and a radiologist report.  Take it from me that I am amazed at how frozen my shoulder got from years and years of constant mouse and computer work.  I mean when I am doing software testing, I literally don't move for hours.   I had not realized how limited my motion had gotten. My left arm free wheels like a windmill.  My right arm, I can barely reach back and scratch my butt, can barely reach across my chest to wash under my other armpit.  Take some time to read about mobility and try the range and reach exercises. 

 

[RAZZELL]

Will keep you updated...

 

 

[BestB]

MRI -15000 baht, surgery 380000 baht , physio 1200 per visit for about 3 months at least.

This is Bangkok hospital prices for keyhole surgery , no visible scars at all.

 

public hospital 120000 baht and you have a massive scar across the shoulder. 

 

Docs claim 90-95% full recovery , in my case lost about 30% movement in my hand.

 

would I have the surgery if I could turn back the clock? No.

 

medicate it and look after it. 

 

 

[RAZZELL]

Yes, there is no way I will have surgery.

 

Read too many horror stories.

 

RAZZ