Dr. believes i have some muscular issues or possible shoulder issues due to a injury from a long time ago that ive ignored. She requested an mri....

Normal now for a insurance company to decline a mri but insist on therapy first...as a prerequisite for the mri?...they cant answer when i ask what am i having therapy on

most insurance requires an xray before an MRI.

Have your doc do an xray then use the code that says the xray shows something and he needs better detail to see what that something is.

ETA: surprised your doc doesn't know this

I should have added that, I had an xray done a few years ago, but it was inconclusive and at that point I got tired of going and paying...department had different insurance back then.

I'm trying to get those records from that dr to my new one. I also saw a chiropractor a few years ago and he felt it was more of a muscle issue as well. I would get stimulation treatments on the upper left part of my back and it would help for a few days, but it would then knot right back up like someone is just punching you right between your spine and shoulder blade

IME, PT is usually the first step when you've got something going on with ortho/muscular that isn't readily diagnosable.  I agree you'd think that getting a good picture would be primary to making a diagnosis or ruling it out.

Presumably they've got lots of statistics to deduce that the cost of an MRI coupled with the statistical results of a diagnosis vs. the percentage of cases that can get more benefit from the physical therapy PLUS the information learned by the physical therapist during that process, is better to start with the PT.  The PT will evaluate your range of motion, where the pain occurs during what motion, etc.  They also know that even with an MRI result you are probably going to start the healing process with PT anyway.

Surgery is so expensive now, and they can work miracles with it, but it isn't necessary for so many of our aches and pains. It is, and should be a last resort for so many of our ailments. Old injuries are the worst because your body (overcompensates) with other muscles getting everything out of balance.  I've had a bad back for years. After years of chiropractic care and stretching, the internet and I diagnosed my hip flexor problem from sitting with poor posture all day. Thought the problem was my hamstrings, but they are just the symptom because the hamstrings are lengthened due to poor posture and weak core.

Thats kinda of what my dr. thinks. I know when and how i hurt it and through description she thinks it might be a shoulder issue and my back is overcompensating causing pain in the muscles there. She did some range of motion and strength test and the left arm/shoulder was weaker

There are private, out of pocket MRI shops... sometimes they're even cheaper than a covered MRI's deductible.

I sure understand where you're coming from, though.  I was having recurring pains in my left shoulder (would bounce around back, side, front depending on activity), which was exacerbated when I tore the AC in my other shoulder and was forced to use the left more. My PT was helpful by having me do the same exercises on both sides, which help.  I complained (again) to the ortho when I went for follow-up after PT, and they took an x-ray and said impingement (they weren't wrong - it's getting pretty bad 4 years later) but I still don't feel like they gave me a diagnosis on the original complaint.  Guess I'm not being enough of a squeaky wheel.

ended up getting referred to a specialist. Dr. believes theres a good chance I have bursitis between my ribs and shoulder blade. Scheduled to get an injection and see if it makes the pain go away...that will kinda determine if its it or not....and then go from there

this right here...call around and get a cash price for at an image center.  use HSA dollars if you have an HSA.

In the mean time, look at this.  It literally saved me from surgery.

Shoulder hang

For my shoulder, after X-ray, they shot me with ‘cain followed by steroids.  The quick relief after the deadening pretty much diagnosed the problem area.

DC here.

MRI imaging is great, and someday I hope machines are really cheap...

For the time being it doesn't sound like you need an MRI ~not to put the burden on you, the patient, but I don't see a justification for the insurance co to pay for one in your description.

Find a DC who does specialized soft tissue work like Active Release Technique "ART".  I have fixed a lot of shoulders with ART and similar techniques/protocols.  Your brief description sounds like you have muscle/fascia adhesions interfering with normal shoulder and t-spine motion.

The video above that talks about hanging is worth a look.  I have been advocating passive hanging for about 10 years, it can do a lot to distract and therapeutically challenge the structures throughout the back and upper extremities. The biggest problem with it is that it just seems too easy/simple for people to take seriously, second biggest is that not everyone can do it.

Another update....went to a colleague Dr of the first for the injection. He seemed after poking and prodding and checking motion that he believed it was a muscular issue between the shoulder blade and spine. Like some of the muscle was damaged and twisted from the old injury ( he was indian so kinda hard to understand sometimes).

He took the lidocaine needle and prodded and moved it around in three close proximity areas. He gave me some exercises to do and wanted to see me again in a week. Said the goal is to get it stretched and blood flowing properly to the area again.

My biggest thing is i know the problem but whats the solution? This has been a problem for 10 years and my dumbass just realized its gotten to bad. I dont want to keep getting stuck with a needle.

Im in pretty good shape and exercise regularly. I actually do those hanging exercises. I appreciate the information guys.

You continue to sound like exactly the sort of patient who could respond dramatically to very specific/focused soft tissue work.

ART is far from the only system of treatment that works, but it has good marketing and penetration into chiropractic schools.  Graston or IASTM is also "modern" and very effective when properly coupled with evaluation of movement patterns.

I will warn you that a decent percentage of ART practitioners end up getting pretty full of themselves.  Not a trait I appreciate in a provider but when a lot of patients say "Wow, I can't believe you fixed that" it can happen.

I switched gps a little before the op...and actually got her to do blood work on me...because of family history and line of work. Between blood pressure and blood evaluation the dr said my heart was in pretty good shape.

I have been going to physical therapy and it does help, but the issue comes back after a few days. Im not sure what the long term holds

Eta lol between work and my 2 small kids id fail a stress test probably.

eta2 dr ordered an mri today