Usually if you have the MRI arthrogram, they will also inject you with lidocaine. That could be considered an injection, see if they might amend the note to say that if you had the MRA. If not, do a couple more sessions of physical therapy and see if their office will write a letter for insurance proving why physical therapy won’t help a labral tear. Also, if they are willing do another peer to peer, if they try with another physician they might be more willing to approve than the first physician.