05/08/2026
This is a 42 year old man who was involved in a motor vehicle accident eight months ago. Since then, he’s had persistent pain over his right shoulder that radiates down into his right hand.
He’d already had multiple scans of his shoulder, but nothing had identified the cause.
So we performed a wide field of view MRI, imaging from the neck all the way down to the fingers. Here’s what we found.
On the contrast images, you can see this bright white area here. That’s enhancement, which is consistent with granulation tissue, part of the body’s healing response. In this case, it appears to be related to tearing of the muscles that attach to the ribs. Ongoing healing in this area may explain the persistent pain he’s experiencing over the right shoulder.
We also identified a second finding. On his cervical spine MRI, this bright white area within the disc represents an annular tear, also known as an annular fissure.
When the outer layer of the disc is torn, inflammatory chemicals from inside the disc can leak into the tear, irritating nearby pain sensitive structures and, in some cases, adjacent nerve roots. That may account for the symptoms radiating into his right hand.
So instead of one problem, we identified two separate pathologies, both of which correlate with different aspects of his presentation.
Having a more complete picture means his treating physician can now consider targeted management options, which may include further rehabilitation, image guided therapies such as PRP where appropriate, or continued conservative treatment depending on his clinical assessment.
This case is a great reminder that sometimes the answer isn’t found by looking at one structure in isolation, it’s found by imaging the whole pathway of a patient’s symptoms.
See you on the next one! 👋