This is a diagram of a partial tear.
The doctor saw that problem in the exam, but also found another point of weakness/pain that the radiology report did not account for. This is a tear of the labrum. The labrum is cartilage. It's essentially the part of the shoulder that sticks to the glenoid, which is the socket part of the scapula. From the website: "The labrum turns the flat surface of the glenoid into a deeper socket that molds to fit the head of the humerus." The bicep connects to the labrum as well. Basically, the tearing I felt was the labrum separating from the bone.
This will show up only with a very specific MRI that the dr thought was unlikely to be approved by the insurance company.
Here's what a labral tear looks like.
Obviously the sensible thing would be to try the most conservative treatment first, even if the results were more likely to have unsatisfactory results. Physical therapy would at worst not make the problem worse, and might result in pain relief, strengthening of surrounding tissues, and healing.
So the sensible thing would be to do that and see if it gets me to a place that I can live with, and then consider surgery if it doesn't.
But, with my health care plan, this will cost me about $1000 out of pocket in co-pay fees for a 6 week course of treatment.
If I end up doing that, and then having surgery, I'll need another round of PT after the surgery to rehab the arm. That's a second $1000 of co-pay fees for PT.
The question now becomes whether to take the health-wise intelligent choice that is likely to cost me multiple thousands of dollars, or to jump directly into a surgical situation that, being surgery, comes complete with risks of infection, of worsening of symptoms, of scarring, and of nerve damage. This is not even counting the risks inherent in general anesthesia. But is cheaper.
Why is this even a question? Why does our health care system encourage jumping immediately to the more costly, more risky, solution?
And then there's another consideration - once I have the surgery, I'll be in a sling for a month or longer. How will I work? How will I write? I've spent time typing one-handed (minds out of gutter, folks, I had a broken arm). It is... suboptimal.
edit: further research shows this: "you will probably need to attend therapy sessions for one to two months, and you should expect full recovery to take up to four to six months."