Of course, I am sure his orthopedic surgeon will be able to give good advice in this regard (after a full clinical assessment etc.). I am really hoping to find some outside advice. This will help minimize strain on the back. Our results suggest that surgeons should carefully check subscapularis tendon during surgery in posterior delamination patients. @brando87: Thanks brando87, that's what I aim for! Your orthopedist may now be recommending a rotator cuff surgery or management with non-surgical methods. These injections usually include an anti-inflammatory that can last for a couple months delivered directly to the problem area(s) and a local anesthetic that will work for the first few days until the anti-inflammatory starts to give relief. Full thickness tears are the complete disruption of the fibers of the supraspinatus muscle, and generally require a more aggressive treatment plan and surgery. I am sorry I can't offer specific advice without a proper assessment, but seeing an orthopedic specialist or physical therapist in your local area sounds like a good idea. Thank you. Pitchers, swimmers, and tennis players are common examples. I am in aching pain consistently. If you have concerns, you could ask the surgeon when you next see him whether he thinks your symptoms are from the tendon tear and rotator cuff dysfunction or whiplash? It may be helpful to think of the rotator cuff as a group of muscles and each muscle is connected to the bone via a tendon. massive cuff tears. He says that my tendon is failing. I've met with 2 orthopedic surgeons and both have indicated surgery is my best option for recovery. The rotator cuff tendons attach to the head of the humerus in bony spots referred to as the greater and lesser tuberosities. Complete rehabilitation after surgery may take several months or even up to a year. Degeneration of the infraspinatus tendon with bursa side fraying. However, I would also want to be honest with the surgeon in letting them know that an orthopedic surgeon had previously been consulted and that a second opinion was being sought. If it hasn't resolved with time, then some kind of intervention (whether physical therapy, surgery etc.) The CT impression read like this: High-grade partial tear of the supraspinatus tendon at its insertion (rim rent tear). Care is taken to preserve as much of the CA as possible. 2. Surgery to repair tendons generally involves a long recovery period. I am sorry I can't offer you specific advice over the internet regarding surgery or specific exercises. Being deployed and not receiving treatment makes it difficult. Generally, if an injury is going to heal on it's own, it gets better over time, unless it is re-injured. 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). Because of the return of the recent pain, a another MRI was ordered and the Radiologist wrote: "1. A rotator cuff tear may result from an acute injury, such as a fall, or may be caused by normal aging-related wear and tear with degeneration of the tendon. Each of the rotator cuff muscles can be affected; the supraspinatus muscle is most commonly affected, followed by the infraspinatus, the subscapularis and the teres minor muscles. Advice welcomed. Due to the nature of what we were doing, I was unable to immediately seek medical attention, so after regaining some composure, I managed to carry on with my duty, but not without immense pain. If surgery is not indicated, your doctor should be able to refer you to a physical therapist who will likely assess your shoulder movement and be able to provide you with a tailored program to help strengthen your rotator cuff. At approximately the 3:40 mark in the video above, there are a few exercises to help increase the range of the movement in the shoulder. If you give PT a go, make sure you follow their instructions and specific techniques for the exercises they give you (most likely to strengthen your rotator cuff). Modify Sport Techniques . This is possibly caused by microdamage to the tendon that is painful and can weaken it over time. This is just general information of course. I understand most of it but I was wondering is there supposed to be fluid in the acromioclavicular joint. This may include things like having a lesser ability to detect hot versus cold on their skin in the neck region, they may also genuinely feel pain to what would usually be non-painful stimulus. I worked closely with a physiotherapist for a good four months and pain got worse. These include: pain that gets worse at night. You are also right that many people often don't understand that you are not 'putting on an act'. Also, don't be afraid to ask doctors / surgeons lots of questions. The supraspinatus is one of four rotator cuff muscles in our shoulder. When a rotator cuff is torn, the tendon part of the muscle tears away from the bone of the upper arm. or should you just ask for their opinion with no outside information> Thanks Judy. From the description of your MRI report it sounds like your shoulder must have been quite painful and inflamed at the time (perhaps it still is)! Thanks for stopping by and sharing your story. Should you immobilize or not move a shoulder with a suspected partial rotator cuff tear? On the other hand, if your surgeon thought your tendon would be able to endure pregnancy and nursing your baby without the need for strong medications or the need for surgery, then this may influence your decision on timing for surgery etc. and still end up with an unexpected problem. Instantly a wave of incredible pain came over my entire arm, generating from the back of my shoulder all the way down to my hand. I'm unable to say whether this has occurred in your case, however, the reason why this springs to mind is that I cannot recall ever seeing a true case of adhesive capsulitis (sometimes called frozen shoulder) that resolved in 6 weeks? and seemed to be doing ok with Cortisone shots. The soft tissues in their neck that were affected by the initial trauma may actually have healed, but they may still be feeling discomfort. Your physical therapist should be able to help you improve the strength and functioning of your rotator cuff muscles. 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. I served in the Navy for many years, and in April of 2010 I had a little mishap. This website also contains material copyrighted by third parties. . I had an arthogram-MRI which showed a 4 mm near full thickness u-shaped tear involving the supraspinatus tendon anteriorly near but not actually at the numeral attachment. Don't be afraid to have an open discussion with your GP about whether or not a referral to a surgeon is the right way to go (or not) for your specific circumstance. 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. As I said been dealing with this for about nine months and in that time have run the gamut of treatment. The individual shape of the bone structures (particularly the acromion) and soft tissues around the tendon will contribute to whether the tendon is able to move freely or become impinged between structures with arm elevation. ), but not so good with the finer movements (better performed by the muscles in the forearm and hand). While I can't give you specific advice over the internet, it sounds like you are doing a great job following the recommednations of your doctors. I see this is true of SSGtomn who has left a comment already. After 4 months of therapy and 3 injections I am unable to lift my right arm. I work construction and am self employed. Retraction of the supraspinatus tendon medial to the glenoid. Good luck! Full thickness tears: usually categorized by size in centimeters. The four muscles supraspinatus, infraspinatus, subscapularis and teres minor originate from the scapula (shoulder blade). I took a not so graceful fall on a sidewalk about 9 weeks ago and landed on my shoulder. Have had physical therapy for 3 weeks with pain becoming worse so physical therapist suggested to dr. MRI of shoulder. Thanks for sharing. Shoulder muscles are very good for stabilizing the ball and socket joint and making large movements (to help lift things, throw objects etc. I also have no insurance and don't know about surgery. Hopefully your physio can set you up with an exercise program to strengthen your rotator cuff and improve the biomechanics at your shoulder joint. ; 2. MRI states high grade articular surface partial thickness tear of the posterior spinatus tendon without retraction or atrophy. There also is mild tendinosis of the infraspinatus at the footprint. You should not feel pain in the shoulder during the movement. I have been seeing an orthopedic doctor for the past 18 months. From time to time tendons do rupture from a variety of causes, in your case it sounds like the surgeons description of rope fraying is a good one. Good luck with it. Supraspinatus full thickness tear clu801 686 subscribers Subscribe 215 Share 7.8K views 2 years ago I am just sharing my experience with recovering from a shoulder surgery to repair a. I'm quite apprehensive and nervous about the surgery but more so about the recovery. As you have correctly identified, there is quite a long recovery period following surgical repairs of rotator cuff injuries, but on the other hand, there is a pretty good success rate among people who follow the post-operative instructions. >5cm), depth (partial or full thickness), degree of fatty infiltration (Goutallier. 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). I can reach behind my back ok. After surgery, the repair must be protected from certain activities that may put healing at risk. Some things to consider when you are discussing your options with a surgeon is the length of recovery time following surgery (likely to be months), consider time to return to work (also consider whether it it possible for you to return to light duties at work). I have lost about 45+% of my ROM in my right arm. I have continued to have problems with my arm and initially was told that I had a partial tear of my rotator cuff. I say promising because work in basic science and animal studies have demonstrated some quite promising findings. They will be able to tell you the likelihood of a supraspinatus tear and adhesive capsulitis (or any other pathology), as well as the recommended course of action for your particular circumstance. A full-thickness tear, which usually means the tendon is torn from its insertion on the humerus (the most common injury), is repaired directly to bone. Because of the risk of infection and and nerve damage. Generally speaking, do small tears need surgical repair? However, to date, I am not aware of any rigorous large-scale clinical trials that have demonstrated effectiveness (or otherwise) in humans. Once the full thickness of the tendon is torn, we classify the tears based upon the shape and the number of tendons involved. I maybe take a few Advil a week with no loss of function at all. Small. Some general information that may be useful to know is that some people who have similar pathology to that which you have described end up having surgery while other do not. Also if I don eventually need surgery will it hurt to wait until I absolutely need it. Good luck with the recovery (I know slings can be frustrating and uncomfortable, but the weeks will pass quickly)! Full thickness tear means a complete tear of the rotator cuff supraspinatus tendon. I then went to see another orthopaedic surgeon who said I have whiplash. The first relates to the potential risk of a poorer outcome due to the delay; this may occur due to further damage being caused in structures that are difficult or impossible to repair etc. . I have often seen these cases improve substantially after further surgery to repair these rotator cuff tears + post surgery rehabilitation therapies. I have full-thickness tear of supraspinatus tendon ,with 1.5 cm cap without tendon retraction plus supraspinatus Ask an Expert Medical Questions The Physician, Doctor 1,261 Satisfied Customers Versatile Emergency Physician, 20 years experience as a Physician. I have been saving up a couple months to cover my deductible expecting to schedule surgery. This has caused thickening and abnormal signal in the supraspinatus tendon consistent with tendinopathy and/or a partial tear. While it is estimated that 65-70% of all shoulder pain involves the rotator cuff tendon, it has been estimated that 5 to 40 % of people without shoulder pain have full-thickness tears of the rotator cuff. Small to moderate glenohumeral joint effusion. They loaded the muscles under three separate conditions: 1) rotator cuff . Very much appreciated. 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? Magnetic resonance imaging (MRI). Productive acromioclavicular joint changes are associated with an anterolaterally down sloping type II acromial configuration. Most people who do have surgery experience acute pain during the first few days (although the acute pain medications usually help with this). It allows a provider to assess the structures of your shoulder during movement. The pain is mostly in neck and shoulder blade and collar. I've . 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. If the ball is popping out of the joint (dislocating), then that is a major concern (but this usually doesn't occur without trauma)! If pain is being caused, then there may be a problem with technique or a lower intensity may be required. !!! Should this shoulder have an MRI? This was caused by contact with another person and (I'm self diagnosing) some prior existing minor tendon tears. Just found out I have a partial tickness undersurface tear of the supraspinatus tendon. That is one of the reasons why surgeons will take a detailed history and conduct a physical examination to gather clinically relevant information. The MRI report says: 1. very large, nearly complete tear of the supraspinatus tendon from the tendon insertion with 1cm retraction of tendon fibers. Exercise is important for many reasons (not the least of which are physical and mental health benefits). Good luck! If the tendon has been completely ruptured (no longer attached), then surgery will definitely be required with some level of urgency for the tendon to be successfully reattached. All material on this website is protected by copyright. My pain is mostly in the bicep area and I do not have trouble lifting the arm but bringing it back down and also bringing the lower arm down when the upper arm is at 90 degrees. These types of injuries seem quite common for people who work in construction and are often associated with doing work above shoulder height. Let us know how things turn out for you. I returned to the orthopedic surgeon at which point he did an x-ray which looked good and sent for a mri Monday. 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. I'm sorry I can't give you specific advice over the internet about the best option for your situation. Above my shoulder or behind my back without pain. Supraspinatus tear can be caused by lifting something too heavy, falling on your arm, or dislocating your shoulder. @anonymous: Hi Donna, I am sorry to hear about this trouble you are having with your shoulder. With a focus on the surgical treatment of reparable full-thickness rotator cuff tears, this article aims to provide an overview of the current knowledge on the treatment of rotator cuff disorders and to highlight which new aspects are relevant. Thanks for stopping by and leaving a comment. When he says your tendon is failing, I think what he is trying to convey is that once some strands of a rope start to break, then there is more load on the remaining strands which may cause more strands to break (and then more load on remaining individual strands, more strands tear and so on). I'm sorry I can't give you specific advice about whether you will need surgery or not over the internet. I just found out this week that I have Bursitis, and a tear in my Supraspinatus. Instead specific movements are required, these shouldn't cause pain while performing the exercise. Visited many doctors and was always told it was nothing, the pain got unbearable and I saw yet another dr who was completely caught off guard my the loud pop my shoulder makes. My question to you is why can they not try and repair the rotator cuff using a graft of somesort. Sorry for the delay in response. If I need surgery,what is the recovry time.. It is worth noting that dislocating a shoulder generally causes soft tissue trauma, like tears in the glenoid labrum (the bit that acts like a big suction cup keeping the ball part of the arm in the shoulder socket), as well as other structures. Do not complete these exercises if they cause an increase in pain; instead, seek specific advice from an appropriately qualified professional such as a physical therapist or physician. If the tear occurs with injury, you may experience acute pain, a snapping sensation, and immediate weakness of the arm. The popping may or may not be related to your shoulder pain (difficult for me to say without an examination etc.) @DrMikeM: wheather arthoscopy surgry ll help for my injury sir ?what type of surgery needed for dis type of injuries sir.ortho doc told Do exercise for 2 weeks aftr tat if it not improved ll do arthoscopic surgery sir Due to a fall and resulting shoulder pain my doctor prescribed to have an MRI, the findings were; moderate tendinitis in the supraspinatus. I sleep fine as it does not hurt to lay on my back. A rotator cuff tear can be caused by an acute injury such as a fall or by normal age-related wear and tear combined with tendon degeneration. (MRI), demonstrating a full-thickness supraspinatus tear. In terms of some general information that may be of interest to you, there are a couple of things I can share from my perspective. Methods: Sixty-five consecutive shoulders with a chronic full-thickness supraspinatus tear were repaired arthroscopically in sixty-five patients with use of a tension-band suture technique. But shoulder exercises from now until I die. but can get back fairly good motion about the shoulder . However, trauma (such as sporting injuries or motor vehicle accidents) can cause tears amongst people of any age. ( x-ray, phys ther,corticosteroid inj. 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). The tear of the subscapularis muscle is less common then the tear of the other rotator cuff muscles, such as the supraspinatus, infraspinatus or suprascapularis. You may still be able to return to most or all of the things you enjoy it just may not be in the next 6 to 9 months though. The classic full thickness rotator cuff tendon tear involves the supraspinatus and then progresses to involve the long head of biceps, followed by the infraspinatus and subscapularis. A recent study from Kim et al 19 used en masse suture bridge techniques for full-thickness supraspinatus tears. A few hours after the incident, I was able to seek some medical attention from our on board medic, who believed I had dislocated my shoulder, but was not overly concerned with my condition. If you have injured your shoulder or have chronic shoulder and arm pain, it is best to see an orthopaedic surgeon. (2) In the presence of a full-thickness tear, there is less ability to generate joint torque, hence a positive lag sign. I was referred to a surgeon who stated that they could not repair the rotator cuff due to the size of the tear from a surgical standpoint. I did this as instructed, but, to little improvement. No black and white answer for this one I'm afraid. 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. Some quite compelling research has indicated that a substantial proportion of people (particularly young people) who receive this kind of treatment will go on to have further shoulder problems (sometimes instability in the shoulder joint or pain and discomfort from damaged structures). Good luck! 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! The tear may be a partial or full thickness tear. My doctor has told me I need to have arthroscopic revision rotator cuff repair. coracoacromial ligament. MRI does demonstrate a complete massive tear of my rotator cuff with retraction and severe atrophy. Heuberer et al 15 used the knotless cinch-bridge technique for supraspinatus tears. Overall, it will often take 6 months or more before the shoulder is completely back to normal. Depending on your age and lifestyle, physical therapy may be a better option than surgery even for complete rotator cuff tears. Purpose: The objective of this study is to report on the complete arthroscopic repair of full-thickness tears of the supraspinatus.Type of Study: Prospective cohort study. The words 'very large, nearly complete with 1cm retraction of tendon fibres' are a bit concerning. However, if no benefit has been observed after 6 weeks of PT, then discussion your options with your surgeon sounds like a good plan. if your initial injury was work related. Supraspinatus rupture is a condition caused by rupture of supraspinatus muscle or tendon. The presence of greater tuberosity cortical irregularity and joint fluid was most important in the diagnosis of full-thickness supraspinatus . I went to one orthopedic doctor and he immediately said surgery is my only option. To recap I have had debridement and subacromial decompression, am 34 years old and now have arthritis, bursitis, tendinitis and impingement. Mild surface irregularity of the supraspinatus in keeping with scuffing-mild partial thickness bursal surface tearing. In the beginning of 2012, I returned to the Orthopedic specialist at the VA, and the medical staff seemed very surprised that my god awful pain and discomfort was still going on. I've only got a couple of minutes, so I'll keep this short. With full thickness tears the entire tendon has separated or torn from the bone. Don't even think you won't need help, because you'll need help with even the most basic daily tasks. )amount of fluid in acromioclavicular joint and last but not least 5.) Also can I try a more Conservative approach and see a phy therapist that specializes in shoulders before any surgery. ROM hurts so I'm not sure. 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). Jackie. It is important the the surgical repair of the tendon is protected initially to ensure that a re-injury does not occur. Good luck! Irreparable. These four muscles (supraspinatus, infraspinatus, subscapularis, and teres minor) stabilize the glenohumeral joint, enable rotation around the joint, and provide a counterforce to . A rotator cuff tear can extend or get larger over time. Fluid signal anterior to the proximal humerus as well as within the sucoracoid bursa. This muscle is often used by people who practice different types of sports, including swimming, racquetball and throwing spears or weights. 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? There is inhomogeneous and bulbous appearance of the distal .subscapularis tendon with tendinosis. Cold therapy cold therapy cold therapy!! In layman terms, I would say this means your supraspinatus tendon has probably been irritated for quite a while, and has a small tear near where it attaches to the bone (but tendon is currently still attached). I am 60 years old and do not want surgery but if it helps to stop it getting worse as I get older I will have to. In this study, 24 patients who had full thickness supraspinatus tears and who opted to forego surgery were tracked over time. Should you tell him what the other surgeons name is and what they advised. He says the tendon is fraying like a ropethat he would need to reattach to the bone. If they do cause pain, then it is important to check with the PT that the technique and level of resistance is appropriate for your condition. RESULTS: Arthroscopy revealed 21 full-thickness tears, five bursal surface partial-thickness tears, 10 articular surface partial-thickness tears, and 14 patients without tear of the supraspinatus tendon. there is a small full thickness insertional tear identified relating to the posterior supraspinatus. What ever recommendation you received, you are looking up more information on line. Most people who I have seen with whiplash (albeit usually from motor vehicle accidents more than falls) tend to notice a great deal of improvement over the first few weeks, but some have symptoms that persist. If you are seeing the orthopedic surgeon it is a good idea to tell them about therapies you have received and about your persistent pain. 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. Sometimes, it is difficult to tell from people recalling what happened whether a shoulder has been dislocated. feeling pain in hand,,,. For many years shoulder dislocations were commonly managed by making sure the ball was back in the socket, giving a bit of ice, perhaps some anti-inflammatory medications and putting the arm in an internal rotation sling (a sling that holds the arm near the body with the elbow bent at about 90 degrees). When you speak to your doctor and discuss your plan for treatment, make sure you discuss any relevant work / sport related activities so you both know what to expect. there is no focal atrophy or fatty infiltration.that is my M.R. If a condition stays the same or become worse, then its usually a good idea to get it checked out again, or even a second opinion if you are not happy. D.C. Stitch positioning influences the suture hold in supraspinatus tendon repair. This surgery is no joke!! I have always found the anatomy of the shoulder to be very interesting. She said she had never heard anything like that before and it was not my rotater cuff like everyone else believed. 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. I have full range of motion and only occasional soreness now and again, but can't sleep on that side. @pawpaw911: Hi Pawpaw911, thanks for dropping by. Hopefully your orthopedic surgeon conducted a physical examination to help determine the relative contribution of the partial thickness supraspinatus tendon tear versus whiplash. Would need to reattach to the glenoid tickness undersurface tear of my ROM in right... Anatomy of the arm common for people who practice different types of injuries seem common. These include: pain that gets worse at night few Advil a week with no outside &... Often take 6 months or even up to a year need surgery, the tendon part the. 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Existing minor tendon tears gt ; Thanks Judy worked closely with a chronic full-thickness supraspinatus tear can or. Injury is going to heal on it 's own, it will often take 6 or... My M.R point he did an x-ray which looked good and sent for a MRI Monday injections i sorry... Is protected by copyright the most basic daily tasks and abnormal signal in the of... Insertion ( rim rent tear ) chronic full-thickness supraspinatus tear can extend or get larger time. Thanks Judy an orthopaedic surgeon motor vehicle accidents ) can cause tears amongst people of any age motion about shoulder! Mri does demonstrate a complete tear of my rotator cuff ask doctors / surgeons lots of questions answer this! Ensure that a re-injury does not hurt to lay on my back a chronic full-thickness tear... Then some kind of intervention ( whether physical therapy may be a better than! Question to you is why can they not try and repair the rotator cuff and the! Protected initially to ensure that a re-injury does not hurt to lay on my back see this is of! At the footprint and what they advised the footprint fluid signal anterior to the head of the reasons why will! Looking up more information on line received, you are looking up more information on line and white for. Infraspinatus at the footprint even the most basic daily tasks advice about whether you will surgery... Retraction of the reasons why surgeons will take a detailed history and conduct a physical examination to help determine relative... I did this as instructed, but the weeks will pass quickly ) lots questions! Tendon without retraction or atrophy therapy and 3 injections i am sorry i ca n't sleep on that.... Conduct a physical examination to help determine the relative contribution of the supraspinatus tendon repair seeing an orthopedic doctor he... Even for complete rotator cuff is torn, the repair must be protected from certain that!
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