Ongoing serious pain influencing daily life, sleep etc. Most people with ongoing pain will usually try the conservative interventions before considering surgery. Moderate subacromial/sub deltoid bursitis. Usually getting a second opinion is not a bad option if you are not confident that the first opinion is going to lead to the best outcome for you, but I expect that may well be impossible while you are still on deployment? This may not give immediate relief, but hopefully will show some benefit within 6 weeks. Dr. Mike. What we often don't see is the subsequent shoulder surgery and months of rehabilitation (sometimes in the off-season) to repair the damaged structures. Pain is really consistent and moderate with moments of severe. It sounds like you are not following your surgeons instructions! I don't lay on the side of the hurt arm as I don't think it will be good for it. Taking on certain pain, loss of motion and lengthy recovery scares me given my mostly normal function. The orthopedic said that after 6 weeks of PT if there is pain then we looka possible surgery, is there something else that I should do or look at? I have a second opinion on Monday. Hope that helps. is PT a good options. From my experience, orthopedic surgeons are not usually eager to perform surgery for something like this unless they think there is a good chance of a favorable outcome. The postoperative recovery period following a surgical rotator cuff repair will take months and involve a specific program of range of motion and strengthening exercises that your surgeon will prescribe, often in conjunction with a physical therapist who will teach you exercises and monitor your progression. Here is some general information that may be useful. As far as general information goes, it is also worthwhile noting that chronic pain and inflammation at a joint can lead to secondary changes (weakening muscles, changes in the way the body processes pain etc.) That was July of 2011. As defense lawyers are quick to point out, rotator cuff tendons, just like lots of our other joints and tendons, tend to degenerate as we age. Instead specific movements are required, these shouldn't cause pain while performing the exercise. dr mike,a i got an mri shoulder pain, the surgen said it was adhesive capsulitis and with about 6 weeks of pt it would be fine, but the mri report also said there was a tear, the doctor said the report was wrong, needless to say i got a second opinion, the next doctor ordered a new mri and he suggest surgery , i am at a loss, should i get a 3rd opinion just to be sure? Unfortunately I can't give you specific advice over the internet, without conducting a physical examination etc. [1] Quite often, the tear occurs in the tendon or as an avulsion from the greater tuberosity. Full thickness tears of the rotator cuff are described as small, medium, large or massive (Figures 7, 8, 9 and 10). The supraspinatus tendon was assessed at its insertion by moving the transducer anteriorly, where the bony landmarks were the greater tuberosity laterally and the junction of the tendon footprint and articular cartilage of the humerus medially, 2 mm posterior to the long head of biceps. I'll go check out some of your Lenses. Pain is moderate. The radiomics model of no tears or tears achieved a high overall accuracy of 93.6%, sensitivity of 91.6%, and specificity of 95.2% for supraspinatus tendon tears. Massive. Dr. Mike great info here thanks. 6 months ago a different ortho diagnosed the problem as frozen shoulder and gave me a cortizone shot followed by physio therapy for few weeks. Your physical therapist should be able to help you improve the strength and functioning of your rotator cuff muscles. The process of recovery is different depending on a number of factors including the cause, severity and location of the tear, the biomechanics of the affected shoulder, the age of the individual just to name a few. Couldn't even lay down. The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint. It is common for patients with known rotator cuff disease to have acute pain and weakness following a minor injury. I experienced a fall on August 31, 2012. Anyone want to shed a little light for a vet? You have asked for information about potential options. What I think is more common, is two doctors not taking the time to explain something in normal everyday language and ensuring their patients have understood whatever it is they are trying to say (so lots of people feel like they are being told different things)! A rotator cuff tear can extend or get larger over time. Good luck! Had mild discomfort in shoulder for a few weeks in August. So don't give up on your ambition to participate in exercise. What ever recommendation you received, you are looking up more information on line. The pain is manageable if you stay on top of it with pain medication. I have a feeling this is going to be a long recovery! That being said, a surgeon's own experiences, skills and abilities (as well as risk tolerance) may factor into their decision as to whether a surgical repair (and the nature of the repair) is something they will advise. However, there are certainly injuries and structures other than rotator cuff tears that can cause some of the symptoms Tim described above. Had periods of pain go from the back of my shoulder down my arm like before. I appreciate your thoughts on this matter. It can be difficult to find good information on the web for specific rehabilitation following surgery. My question to you is why can they not try and repair the rotator cuff using a graft of somesort. Since most rotator cuff tendons are about as wide as three of your fingers, a small tear would be one the size of your fingernail or smaller (less than one centimeter of tendon torn) (Figure 7). Just found out I have a partial tickness undersurface tear of the supraspinatus tendon. The four muscles supraspinatus, infraspinatus, subscapularis and teres minor originate from the scapula (shoulder blade). 2. Good luck with the recovery (I know slings can be frustrating and uncomfortable, but the weeks will pass quickly)! sorry for the double posting, first time user. I have had this problem with my shoulder/arm for about 6 months maybe. I slept in a recliner for about 2 1/2 months following surgery (I don't think I slept at all before surgery :) ). I decided to go to the local army medical hospital. If the pain has been present for only a couple of months (or less) and there were minimal risk of worsening the condition with delay, then often a trial of conservative management (e.g. The recovery after surgical tendon repairs often takes longer than recovering from broken bones. It was sometime in the early months of 2011 that I was sent off to have an MRI done. But shoulder exercises from now until I die. As another rule of thumb, if you are getting mixed opinions from non-specialist doctors, it is often a good idea to refer you to a specialist (who will have most likely have seen your condition ever other day and have plenty of experience treating it). Twelve patients in Group 1 received an intra-substance injection into rupture area of supraspinatus tendon with Diprospan 1 cc (betamethasone disodium phosphate 2 mg and betamethasone dipropionate 5 mg) and . The supraspinatus tendon runs from the muscle body through quite a narrow gap under the acromion. Surgery for a minor partial thickness tear will often involve a simple debridement of the tear. Even though surgery repairs the defect in the tendon, the muscles around the arm remain weak, and a strong effort at rehabilitation is necessary for the procedure to succeed. If you are seeing a physio for this condition, they should be able to provide you some good information about the post-surgery protocols that surgeons in your local area will be likely to prescribe. Heuberer et al 15 used the knotless cinch-bridge technique for supraspinatus tears. If they suggest surgery, ask them about what you can expect after surgery and the likely recovery time (including how long it is likely to be before you can use your arm for normal occupational or day to day activities). Also can I try a more Conservative approach and see a phy therapist that specializes in shoulders before any surgery. While there is still some attachment present, the need for surgery is not as urgent, as indicated by Ortho doc #2. The tendon will usually retract if a full rupture has occurred. Like Helpful Hug REPLY Bursal side: tears on the top of the tendon. The supraspinatus tendon has a tendency to weaken with age and become prone to tendon tears. Even if surgery is required, the physical therapy program can help strengthen the rotator cuff muscles before the surgery. My arm is very weak. The majority of rotator cuff tears can be treated nonsurgically using one or more of these treatments: The goals of treatment are to relieve pain and restore strength to the involved shoulder. They do reveal most substantial soft tissue injuries, but they are only as useful as the person interpreting them is skilled. Hopefully your doctor can give you specific advice in this regard. After the injury, you had a partial width full thickness tear of your supraspinatus tendon. The rotator cuff tendons attach to the head of the humerus in bony spots referred to as the greater and lesser tuberosities. Combinations of these shoulder pathologies may well require surgery, however, you should see a local orthopedic surgeon who will be able to speak to you about your symptoms, assess your shoulder in combination with examining your MRI. Unfortunately, I think 1cm retractions of torn tendon fibres do not favor natural healing of those portions of the tendon (without surgery). The right suprasinatus tendon contains a partial width full thickness tear measuring 4 by 2mm, in the anterior fibers approximately 8mm lateral to the biceps tendon. I had subacromial decompression February 2010 a year after a motor vehicle injury (I am currently a 34 year old female). there is minimal AC arthrosis. Also an ex ray of my shoulder "Demonstrate my humeral head close to abutting my acromion. while that helped in the short term and improved my left arm motion range, after i stopped the therapy the pain came back and reduced the range. If the tear occurs with injury, you may experience acute pain, a snapping sensation, and immediate weakness of the arm. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time. But not result in a normal shoulder. Impression: moderate supraspinatus tendinosis with a small full thickness footplate tear. I think this is a common dilemma that people face. If you get a chance please let us know how you go. So in other words, tendinosis is the condition and one of the rotator cuff tendons is probably the structure that was affected. I am sorry I can't give you any specific advice over the internet, but here are some thoughts that may be useful to you. The researchers used a custom-built shoulder testing system to measure the effects of varying loads placed on the muscles of the rotator cuff and parascapular muscles. I hope I will not follow suit! Risk of infection and nerve damage are worthy of consideration for any surgery, particularly one as involved as a reverse shoulder replacement. You don't need to lean over as far as demonstrated in this video. This is partly because rehabilitation following surgery will depend on the surgical technique used. I was in a car accident about 18 months ago with damage to my left side of my body, stated with my fingers, to my leg and lastly my arm. The Arena Media Brands, LLC and respective content providers to this website may receive compensation for some links to products and services on this website. My question to you is why can they not try to repair the rotator cuff using a graft of somesort. I plan on asking the surgeon these questions, but wanted your expert opinion. I received my first steroid injection treatment during the summer of 2011 and went through a lengthy 6 moth physical therapy treatment. For anyone contemplating surgery, buy a recliner to sleep in after surgery. Patients ranged in age from twenty-nine to seventy-nine years. J Bone . The blue arrows indicate a full-thickness tear in the supraspinatus tendon, the most common location for rotator cuff tears. 50% of symptomatic full-thickness tears progress at 2 years and bigger tears progress faster. Some days later, I was called back to the VA so they could tell me what they found. If pain is being caused, then there may be a problem with technique or a lower intensity may be required. With partial thickness rotator cuff tears only part of the tendon has torn off the bone. Many people will recover after receiving treatment from a physiotherapist (or physical therapist in USA). Articular side: tears on the bottom of the tendon. MRI does demonstrate a complete massive tear of my rotator cuff with retraction and severe atrophy. Also can I try a more Conservative approach and see a phy therapist that specializes in shoulders before any surgery. infraspinatus tendon had full-thickness tear . If tendon tears (including small tears) have not responded to conservative (non-surgical) treatments or recovered naturally after a few months, then surgery is often considered. In general terms of the types of MRI findings you have described, a combination of these types of pathology could require surgery; particularly if symptoms persisted after trying non-surgical interventions. At the . I am sorry I can't provide you specific advice over the internet. It's been very frustrating dealing with the chronic pain and reduction of normal activities in an attempt to adapt to my "new normal". The supraspinatus tendon runs from the muscle body through quite a narrow gap under the acromion. If the injection does give you pain relief, it may allow you a couple of months without pain to do exercises that can strengthen your rotator cuff and improve the biomechanics at your shoulder in an effort to reduce irritation of the bursa and Supraspinatus tendon. Thanks for stopping by and sharing your story with everyone! Unfortunately I can't give you specific advice over the internet. patients should expect to return to full work duty by 6-10 months after surgery. Surgical repairs can be compromised when post-operative instructions are not followed, so if you have surgery make sure you know exactly what you should and should not do! Following the post-surgery protocol will help minimize the chance of a poor outcome and further problems. Generally speaking, treatment options for shoulder injuries that include supraspinatus tendon tears and other findings similar to those you have reported could include surgery, or more conservative treatments like a trial of physical therapy or injections. If you are not keen to rush into surgery don't be afraid to ask your orthopedic specialist about conservative treatment options that may be worth trialing, on the other hand, your surgeon may be able to give you a good indication of whether they think surgery is the most promising option. Whiplash is more difficult to detect with common imaging approaches, like an MRI, than supraspinatus tendon tears. If you have any uncertainty around the need for your sling use, please call your surgeon's office today. When supraspinatus tendon tear symptoms are chronic and severe, an orthopedic specialist will be able to provide good advice on likely recovery and treatment options, including the likelihood of successful recovery with or without surgery. I am sorry I can't offer you specific advice over the internet regarding surgery or specific exercises. The medical staff there did an x-ray, which did not turn anything up, and once again, were not overly concerned with my condition, but just instructed me to continue to ice pack my shoulder and take some pain medication. The rotator cuff is a group of four muscles that come together as tendons to form a "cuff," or cover, over the head of the humerus (upper arm bone). Unless the shoulder is actually dislocated at the time of the x-ray, or there is a noticeable bone abnormality (chipped or broken bone, bone spur that is visible on x-ray etc. So a second opinion may not always yield the same advice (even though both surgeons may be giving appropriate advice based on their own circumstances and information). I also have no insurance and don't know about surgery. Shoulder arthroscopy and rotator cuff repair (supraspinatus repair) is the best treatment option with a 90 to 95 % success rate. and seemed to be doing ok with Cortisone shots. It was then I found out how messed up my shoulder actually is 1. No black and white answer for this one I'm afraid. Thank you for the info posted on this page. I took a not so graceful fall on a sidewalk about 9 weeks ago and landed on my shoulder. But not result in a normal shoulder. There are generally (at least) two main foci when considering whether to have surgery soon or to delay as long as possible. You may find it interesting to note that a prior subacriomial decompression is not necessarily an indication that future surgery to address other injuries or further biomechanical problems will not be successful. Partial thickness tears. Either way, this kind of ongoing shoulder pain is not good. As I think you already suspect, an MRI is likely to have greater diagnostic accuracy for ruling out (or in) the involvement of other structures in your shoulder, such as the long head of Biceps Brachi. Overall my subscapularis does appear intact." I had periodic pain and tingling running all the way down my forearm. They may be perfectly justified in their opinion, but if their opinion is based on one or two other specific cases that they know of (or perhaps their own bad experience), it would be a shame to miss out on receiving some potential benefit because a well meaning friend or family is not as well informed on the topic as they may think. It will be your Godsend. )amount of fluid in acromioclavicular joint and last but not least 5.) The radiomics model of full- or partial-thickness tears displayed moderate performance with an accuracy of 76.4%, a sensitivity of 79.2%, and a specificity of 74.3% for . Acute Tear If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. I'm sorry I can't provide you with specific advice, rather I only provide some general information. A complete, full thickness tear means that the tear goes all the way through the tendon. This is just general information of course. Subcortical reactive changes superiorly and laterally at the humeral head are present. I'm still processing in my head what I heard in a VM left 10hrs ago, because I finally found out the findings from my shoulder MRI/Arthogram completed about 6 weeks ago. is surgery the only option? The Physician is online now Related Medical Questions It is plausible to sustain one or the other (or both) from a fall. Thanks for stopping by and sharing your interesting story. One of the most painful experiences ever. pendulum), which should be undertaken ensuring correct technique). Good luck with it. Sometimes the success rate of a second surgery is not as high as the success rate of the first surgery but still much higher than any other alternative. I am intrigued by the patient's symptoms and active shoulder range of motion versus her imaging. Partial or Full-Thickness Tear If there is a partial or full-thickness tear (but not a complete rupture) surgery may or may not be required and is best discussed with your orthopedic surgeon and/or physical therapist after appropriate imaging investigations have been undertaken. Remaining tendons of the rotator cuff are normal in signal and morphology. I can reach behind my back ok. They do have potential to improve the biomechanics of the shoulder joint during arm movement which may help mitigate the cause of the tear (like shoulder impingement). Failure to do so increases the risk of progression to a supraspinatus tendon full thickness tear. The speed of recovery after surgery will depend on the type of surgery and following the surgeon's recommended protocol. @DrMikeM: Well, I'm 3 months post injury and still in a tremendous amount of discomfort and pain. Lots of people express feeling useless, frustrated, and angry at times. This level of degradation is not particularly common for someone so young, but does happen from time to time and may well lead to a complete rupture. My doctor has told me I need to have arthroscopic revision rotator cuff repair. I am 67 years old and am an artist and my left arm which is the one in question is my dominate arm. X-rays are often not very useful in diagnosing shoulder injuries. Having the surgery sooner rather than later may help you to recover as much as possible by the time you fall pregnant. ), a shoulder x-ray may not reveal anything conclusive. If you know you have a rotator cuff tear, worsening pain and decreasing strength may mean the tear is getting larger. Many persons with partial-thickness tears will never require surgery if they undergo an appropriate physical therapy rehabilitation to address muscle imbalances. When I visit my DR. what are the thing I need to be aware for the diagnostic? Although the presence of a small tear visible on an MRI does not always mean that is the problem causing your shoulder pain. Call Us: (239) 308-4701 Email Us Give us a Call! I don't lay on the side of the hurt arm as I don't think it will be good for it. Good luck with it! My best wishes go to all of them. The specific post-surgery rehabilitation is often differs between surgeons in different regions (depending on the specific techniques they use). A full-thickness rotator cuff tear is characterized by a focal transmural tendon discontinuity, . I guarantee you will not be the last person to read this page wondering about a difference in doctor opinion or trying to figure out whether they have a supraspinatus tendon tear or adhesive capsulitis (or surgery versus no surgery). Tendinosis means that the tendon has some damage at the cellular level (generally where there has been repeated amounts of small damage (sometimes called microtrauma) that your body has tried to repair), but there is not swelling (inflammation) currently present. the defect measures approximately 1cm anterior to posterior and medial to lateral. I'm sorry I can't give you specific advice about your situation, if you are unsure of which advice from your two doctors is correct a third opinion may help you make sense of it. I will congratulate you on actually doing your exercises! So while surgery always carries some risks (which your surgeon will be able to explain), for some people this is the only option to experience a good outcome. I just found out this week that I have Bursitis, and a tear in my Supraspinatus. In the case of a non-retracted full thickness supraspinatus tear and acromioclavicular degeneration, surgery may well be the best option to maximize the long term outcome. Thanks for the update and let us know how you go. This muscle is often used by people who practice different types of sports, including swimming, racquetball and throwing spears or weights. Your orthopedist may now be recommending a rotator cuff surgery or management with non-surgical methods. Subacromial decompression surgery is the most common option to open up the subacromial space and is combined with a rotator cuff repair if the supraspinatus tendon is torn. Could this require surgery. A full-thickness tear might also be described as extending from the anterior leading edge with 1 cm of supraspinatus remaining intact or as involving the midportion with 1 cm of supraspinatus intact anteriorly and 1 cm of infraspinatus intact posteriorly, and so forth. Sought 2 nd opinion 3weeks later due to the server pain. Thanks for stopping by. Depending on your age and lifestyle, physical therapy may be a better option than surgery even for complete rotator cuff tears. I also have an intermediate grade partial thickness tear of superior tendon bundle of Subscapularis without retraction or muscular atrophy. Any suggestions and generally how long is the recovery period? Sleeping on my right side became impossible. It will be worth developing a good relationship with your doctor (and physical therapist) who can help you do the right things to recover as quickly as possible. Nonetheless, it worth noting that as a general principle, synovial fluid is very important and helps lubricate the joint. Her MRI shows a full thickness tear of supraspinatus tendon and a tear of the majority of the infraspinatus tendon (with a few lower infraspinatus fibers still attached). The pain is mostly in neck and shoulder blade and collar. its been three months with some pt but no noticeable improvement. Having pain and sub-optimal shoulder functioning while you are nursing would not be ideal. Humeral head is riding high abutting the underside of the acromin process. This is partly because rehabilitation following surgery will depend on the web for specific rehabilitation following surgery and weakness! ) amount of fluid in acromioclavicular joint and last but not least 5. back the... Later may help you to recover as much as possible nd opinion 3weeks later due to the local army hospital! 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If the tear is characterized by a focal transmural tendon discontinuity, never...