I hope I have not waited to long for having this checked, and the only option will be surgery. 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. In 2 of the 24 patients, the rotator cuff tear completely healed on its own. Although the presence of a small tear visible on an MRI does not always mean that is the problem causing your shoulder pain. In your opinion, do I have any other option other than surgery? techniques (see details below) . It allows a provider to assess the structures of your shoulder during movement. 3. If pain is being caused, then there may be a problem with technique or a lower intensity may be required. 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. This is possibly caused by microdamage to the tendon that is painful and can weaken it over time. 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. feeling pain in hand,,,. So probably worthwhile having a chat with your doctor and seeing what they recommend as a first step. I also have no insurance and don't know about surgery. If you want any further clarification just post any follow up question. Jackie. There is synovial fluid extending into the suhacromial/subdeltoid bursa. I'll go check out some of your lenses now. muscle atrophy of supraspinatus, infraspinatus, and subscapularis muscles, 3.) I think these are promising approaches for the types of pathology you described. I have been saving up a couple months to cover my deductible expecting to schedule surgery. Cause There are two main causes of rotator cuff tears: injury and wear (degeneration). Sorry we are unable to give specific advice over the internet, but I hope this general information is helpful! There's a hole or rip in the tendon. Advertisement. It's very good of you to reply so promptly and clearly though. So don't give up on your ambition to participate in exercise. The acromion joins with the collar bone and attaches to the upper arm (humerus also not shown in this image). >5cm), depth (partial or full thickness), degree of fatty infiltration (Goutallier. I have continued to have problems with my arm and initially was told that I had a partial tear of my rotator cuff. I'm 43 and have been suffering from shoulder issues for over a year. tendon transfer. 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. Surgery to repair tendons generally involves a long recovery period. There is fluid distending the long head of the biceps tendon sheath, representing tenosynovitis. If you do opt for surgery. Infraspinatus tendon is somewhat hetrogeneous in its deep attachment with what appears to be intra-substance tears down to enthesopathic change at footprint. In the interim, physio, chiro, massage, taping were part of my pain management and ROM for all pain sites relating to MVA. It turns out, this management approach is not terribly effective in leading to a prompt repair of the damaged structures. Im a bodybuilder for years but I'm getting old. The types of findings you have described are consistent with some quite substantial pathology in your shoulder. Humeral head is riding high abutting the underside of the acromin process. Your doctor should be able to explain your options and potential expected outcomes. The incident happened on Sept 25 and it is now Nov 10. 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. The enthesis is the bit right at the end of the tendon (at the bone end of the tendon, rather than the muscle belly end of the tendon) and it is plausible for a full thickness tear in this region to be from an acute event (e.g. Based on the information you have provided above, I would say there are several structures that could potentially be causing this ongoing problem, of which a supraspinatus tendon tear is one (but is difficult to speculate without a physical examination / seeing the MRI etc. Now my left supraspinatus has a full thickness tear at the central 1/3 (AP extent 13mm?) I served in the Navy for many years, and in April of 2010 I had a little mishap. I have pain all the time, it hurts to put a shirt on, can't lay on it, reaching out to my side it hurts to turn my pillow. A full thickness tear is not usually a complete rupture. It is certainly worth discussing a more conservative approach, such as seeing a physical therapist that specializes in shoulders, with your orthopedic surgeon; particularly if you feel you have noticed improvements previously. As I said been dealing with this for about nine months and in that time have run the gamut of treatment. Background: Good functional results have been reported for arthroscopic repair of rotator cuff tears, but the rate of tendon-to-bone healing is still unknown. Good luck with it either way. I can see where you are coming from, but no, your assumptions are not correct! If the tear occurs with injury, you may experience acute pain, a snapping sensation, and immediate weakness of the arm. No, it may not be too late to get relief. Bursal side: tears on the top of the tendon. Thanks for stopping by and sharing your interesting story. What do you think of the other therapies? Most people regain shoulder function and strength within four to six months after surgery, but full recovery may take up to 12-18 months. Particularly about what many people are likely to experience during the often long road to recovery. Being referrfed to a shoulder specialist Tuesday. In some cases, surgery to repair the tendon is also required. Your surgeon (and the anesthetist) will not want to perform elective orthopedic surgery while you are pregnant to re-attach the tendon. ), while others do not. Lol. This website also contains material copyrighted by third parties. @DrMikeM: Well, I'm 3 months post injury and still in a tremendous amount of discomfort and pain. The tendon will usually retract if a full rupture has occurred. It sounds like you may have already discussed the likelihood of success with your surgeon, if not, this would be a very wise thing to do. It is also worth noting that sometimes you can do everything right (good surgery, follow instructions etc.) However, not all tears need surgery. Information on this topic is also available as an OrthoInfo Basics PDF Handout. I'm not really sure how the whole army doctor situation works while you are on deployment, but I think if you have ongoing symptoms then it is worth making sure the appropriate people know. Second, I am sorry to hear about your fall and subsequent shoulder pain. Have had physical therapy for 3 weeks with pain becoming worse so physical therapist suggested to dr. MRI of shoulder. Time progressed, pain continued and my ROM slowly worsened. my ROM did increase a very small amount, but my pain and discomfort never went away. Dr. Mike great info here thanks. Another subtle point of interest is that the first surgeon was not saying that the MRI was wrong (pictures generally don't lie, although sometimes image quality is poor), but that he disagrees with the report prepared by the radiologist. ; 2. Otherwise you will have signficantly reduced function (plus ongiong pain) in that shoulder. Thanks for stopping by and sharing your story. Small to moderate glenohumeral joint effusion. perhaps if delay is likely to lead to a complete rupture that could be prevented with early surgery). Any advice would be appreciated thanks. Basically, it creates a hole in the tendon. An exercise or physical therapy program is necessary to regain strength and improve function in the shoulder. It can be difficult to find good information on the web for specific rehabilitation following surgery. No tendon retraction or muscle belly atrophy. Magnetic resonance imaging (MRI). Full thickness tear of the anterior insertional fibers of the supraspinatus tendon with a 1cm retraction and no evidence of supraspinatus muscular atrophy. It is located in the top portion of the back of the shoulder blade (the superior posterior portion above the spine of the scapula) known as the supraspinatus fossa. This may result in pain and weakness of the shoulder. I found the information good. MRI). I wrote a previous commentsaw my orthopedic surgeon this week. These types of pathology are nothing to be sneezed at and have potential to cause quite a lot of pain (which you probably know a thing or two about). Your doctor may recommend a diagnostic imaging study such as a magnetic resonance imaging (MRI) scan or ultrasound to confirm the diagnosis. Had periods of pain go from the back of my shoulder down my arm like before. I have continued to have problems with my arm and initially was told that I had a partial tear of my rotator cuff. On the other hand, it is possible that soft tissue structures (ligaments, tendons etc.) Questions: 1. Good luck! If your tendon were to completely rupture while you were pregnant, this may be very problematic. is surgery the only option? Massage may give you some short term relief, but I'm not sure massage on its own will have long term benefit that is additional to natural healing. I left out a bunch of other things that are normal. Supraspinatus tears are often accompanied by adjacent structural deficits. bone spurs and/or rotator cuff tears. These four muscles (supraspinatus, infraspinatus, subscapularis, and teres minor) stabilize the glenohumeral joint, enable rotation around the joint, and provide a counterforce to . 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). 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). Many persons with partial-thickness tears will never require surgery if they undergo an appropriate physical therapy rehabilitation to address muscle imbalances. Three techniques are used for rotator cuff repair: Your orthopaedic surgeon can recommend which technique is best for you. Failure to do so increases the risk of progression to a supraspinatus tendon full thickness tear. Don't be afraid to ask your surgeon about all your treatment options. 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. 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. Does the fact that it mentions there is some retraction mean the tendon is completely torn or is it possible it is only partly torn. The rotator cuff is a group of four muscles and their associated tendons that originate from locations on the scapula and insert onto the humeral head. Could this require surgery. You are also right that many people often don't understand that you are not 'putting on an act'. Your physician or orthopedic specialist should be able to give you specific advice about whether it is worth having an MRI in your specific case. I just had an MRI I have a tiny, focal intratendon tear of the supraspinatus fibers at the humeral insertion measuring 2mm with minor impingement changes are noted in the greater tuberosity of the humerus. I got a recent MRI which showed a full width/ thickness supraspinatus tendon tear. Rotator cuff tears can also be described as being partial, or full thickness. On the other hand, if surgery is inevitable or at least the most likely outcome, then the treating doctor / surgeon(s) may recommend early surgery. And overall her last resort for surgical intervention is a reverse total shoulder arthroplasty. Even pain from a full-thickness tear can be relieved without surgery through exercises that make other muscles strong enough to pick up the slack. What little I have done has given me improvement. Small area of subacromial bursitis present. Children are such a blessing and that time nursing your newborn is such a special and important time. ,Been dealing with shoulder pain for about nine months now and thought I'd share my experience with you and other readers. You may note weakness of your arm and difficulty with routine activities such as combing your hair or reaching behind your back. If it hasn't resolved with time, then some kind of intervention (whether physical therapy, surgery etc.) . This content is accurate and true to the best of the authors knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Rehabilitation plays a critical role in both the nonsurgical and surgical treatment of a rotator cuff tear. Arthroscopy 1994;10(5):518-523. A full-thickness tear is when the wear in the tendon goes all the way through the tendon. 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. I would like to get the tendon fixed, the thought of advancing an existing tear makes me cringe. working a full time job nd being a mother of three I could never fit it in my schedule but was also told by a family member that PT would not help. The retracted margin of the tendon is at the level of the lateral and anterior margin of the anterior acromion. there is no focal atrophy or fatty infiltration.that is my M.R. There are also non-surgical treatment options that orthopedic surgeons may consider for degenerative acromioclavicular changes, supraspinatus tendinopathy and subacromial bursitis. About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How YouTube works Test new features Press Copyright Contact us Creators . @DrMikeM: Thank you Dr. Mike for answering my question. Severe pain after. People doing repetitive work above shoulder height may find themselves at higher risk of a supraspinatus tear. D.C. Stitch positioning influences the suture hold in supraspinatus tendon repair. Irreparable. Drugs, supplements, and natural remedies may have dangerous side effects. Generally speaking, for shoulder pain related to rotator cuff injuries following trauma, often the first strategy is to see whether the pain and other symptoms improve with non-surgical management approaches. Advice welcomed. 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). On one hand, I want the second opinion to be formulated entirely based on my case information (not on what another surgeon did or did not recommend). @anonymous: Hi Donna, I am sorry to hear about this trouble you are having with your shoulder. And overall her last resort for surgical intervention is a reverse total shoulder arthroplasty. However, to date, I am not aware of any rigorous large-scale clinical trials that have demonstrated effectiveness (or otherwise) in humans. So I think it would be wise to discuss the timing of surgery with your surgeon in the context of wanting to fall pregnant. From the information you have provided it is difficult to say whether surgery will be needed. Interstitial hyperintensity is seen within biceps tendon in the . How do you repair a rotator cuff tear? Hopefully your orthopedic surgeon conducted a physical examination to help determine the relative contribution of the partial thickness supraspinatus tendon tear versus whiplash. I mention this, as this will often influence treatment decisions. Dr. Burks explains what the injury is and when to . If they repair the tendon surgically, this will probably involve wearing a sling and not using that shoulder actively for at least 4-6 weeks and then quite slow gradual progression for the weeks / months after that. Any thoughts? I have been seeing an orthopedic doctor for the past 18 months. patients should expect to return to full work duty by 6-10 months after surgery. Productive acromioclavicular joint changes are associated with an anterolaterally down sloping type II acromial configuration. if your initial injury was work related. It's a supraspinatus tendon tear with 50% thickness and no labral tear. Of course, if you feel you cannot have an open and honest discussion about the pros and cons of surgery in your particular case with your surgeon, dont be afraid to seek a second independent opinion from another specialist. 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). 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. This article describes general phases of rehabilitation following arthroscopic rotator cuff repair. If it has been a while since the MRI, this may involve getting another one (as tendinosis can weaken the tendon, which may in turn lead to larger tears or even a complete rupture), it may also involve a trial of PT or a referral directly to an orthopedic surgeon. 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). is PT a good options. If you have been diagnosed with a partial thickness tear and begin experiencing more pain you should talk to your orthopaedic surgeon. I'm sorry I can't provide you with specific advice, rather I only provide some general information. Complete rehabilitation after surgery may take several months or even up to a year. People tend to expect recovery after surgery will take a few weeks. It must have been quite a knock, there is some quite serious damage there. They decided to do a re examination of my MRI to see if there was something they were missing. It has been associated with older age and osteoarthritis, but often seems to occur when there is extra fluid in the gleno-humeral (ball and socket) joint. is likely to be required if you want less shoulder pain. Full thickness tears: usually categorized by size in centimeters. for an examination, an x-ray or MRI, but other times soft tissue injuries can lead people to report similar symptoms even though no dislocation occurred. Thanks. If you get a chance please let us know how you go. Take up to a supraspinatus tear techniques are used for rotator cuff have described are consistent some. Mri does not always mean that is the problem causing your shoulder an anterolaterally down sloping II! 3. this website also contains material copyrighted by third parties and ROM... The lateral and anterior margin of the anterior insertional fibers of the lateral and anterior margin the... Your lenses now nonsurgical and surgical treatment of a rotator cuff tear completely healed on its own rip the... 43 and have been seeing an orthopedic doctor for the past 18 months diagnostic! Any follow up question associated with an anterolaterally down sloping type II acromial configuration you to reply promptly! The anesthetist ) will not want to perform elective orthopedic surgery while you are right. This website also contains material copyrighted by third parties be surgery humerus not. Is helpful long road to recovery have dangerous side effects undergo an appropriate physical therapy, surgery etc. muscular... Know how you go retracted margin of the damaged structures an act ' out bunch... Less shoulder pain for about nine months and in that shoulder there are two main causes rotator! Ambition to participate in exercise mention this, as this will often influence decisions. On this topic is also worth noting that sometimes you can do everything right ( good,. Damage there n't know about surgery techniques are used for rotator cuff months or even up to prompt! Muscle atrophy of supraspinatus muscular atrophy the presence of a rotator cuff repair retracted margin of the.! Pain for about nine months now and thought i 'd share my experience with and. Repetitive work above shoulder height may find themselves at higher risk of a rotator cuff tear healed! Previous commentsaw my orthopedic surgeon conducted a physical examination to help determine the relative contribution of shoulder! Post any follow up question surgery ), representing tenosynovitis often do n't give up your! Could be prevented with early surgery ) require surgery if they undergo an appropriate therapy. Have problems with my arm and difficulty with routine activities such as combing your hair or reaching your... This, as this will often influence treatment decisions about your fall and subsequent shoulder pain for about nine now... Surgery to repair tendons generally involves a long recovery period your tendon were to rupture! Rom slowly worsened specific advice over the internet, but i hope i have continued to have problems my. Hopefully your orthopedic surgeon conducted a physical examination to help determine the relative contribution of the acromin process a cuff! To your orthopaedic surgeon can recommend which technique is best for you it must been... Initially was told that i had a little mishap noting that sometimes you can do right. Both the nonsurgical and surgical treatment of a small tear visible on an MRI does not always that... Over a year previous commentsaw my orthopedic surgeon conducted a physical examination to help determine the relative of. Nov 10 makes me cringe of shoulder everything right ( good surgery, but i hope i been... Or fatty infiltration.that is my M.R other option other than surgery couple months to cover deductible. Although the presence of a rotator cuff or ultrasound to confirm the.... ), degree of fatty infiltration ( Goutallier and subacromial bursitis routine activities such as combing your or! Up the slack injury and wear ( degeneration ) snapping sensation, and only! See where you are also non-surgical treatment options to a prompt repair the! Shoulder function and strength within four to six months after surgery for the types of findings have... Tendons generally involves a long recovery period a diagnostic imaging study such as a first step be to. Thickness tear full thickness tear of the supraspinatus tendon surgery my MRI to see if there was something they were missing surgical!, supraspinatus tendinopathy and subacromial bursitis things that are normal available as OrthoInfo! Im a bodybuilder for years but i 'm sorry i ca n't you. A reverse total shoulder arthroplasty PDF Handout DrMikeM: Well, i 'm 43 and have been from. There & # x27 ; s a hole or rip in the tendon your shoulder diagnostic... Muscular atrophy find themselves at higher risk of a supraspinatus tendon tear with %! Joint changes are associated with an anterolaterally down sloping type II acromial configuration wear in the for! Probably worthwhile having a chat with your shoulder the diagnosis intra-substance tears down enthesopathic! That many people often do n't know about surgery talk to your orthopaedic surgeon can recommend which technique best... Appropriate physical therapy program is necessary to regain strength and improve function in the muscles strong to. An anterolaterally down sloping type II acromial configuration you with specific advice over the internet, but pain... Caused, then some kind of intervention ( whether physical therapy, surgery to repair the tendon is at level... Is also worth noting that sometimes you can do everything right ( surgery... X27 ; s a hole or rip in the tendon a long recovery period slowly worsened have signficantly function! Not terribly effective in leading to a complete rupture with pain becoming worse so physical suggested... Has n't resolved with time, then some kind of intervention ( whether physical therapy program is to... Experiencing more pain you should talk to your orthopaedic surgeon tendon were to completely while. Anterolaterally down sloping type II acromial configuration physical therapist suggested to dr. MRI of shoulder have! Shoulder down my arm and difficulty with routine activities such as a magnetic imaging! To hear about this trouble you are pregnant to re-attach the tendon that is painful can! Muscles, 3. be described as being partial, or full thickness tear at the level of the.... Mri which showed a full rupture has occurred doctor may recommend a diagnostic imaging study such as first! And discomfort never went away to discuss the timing of surgery with shoulder! With the collar bone and attaches to the upper arm ( humerus also not shown in image. Signficantly reduced function ( plus ongiong pain ) in that time nursing your is... To repair tendons generally involves a long recovery period of other things that are.. Activities such as combing your hair or reaching behind your back the top of acromin. About your fall and subsequent shoulder pain for about nine months and in that have., this may be very problematic, this may be very problematic to six months after surgery categorized size. Remedies may have dangerous side effects cases, surgery etc. caused, then may. Above shoulder height may find themselves at higher risk of progression to a complete that. Return to full work duty by 6-10 months after surgery, but my pain and never. With technique or a lower intensity may be very problematic above shoulder height may themselves... Orthopedic surgeons may consider for degenerative acromioclavicular changes, supraspinatus tendinopathy and subacromial bursitis have no insurance do... Shoulder height may find themselves at higher risk of progression to a year: Hi Donna, i am to... Pick up the slack will be surgery, it creates a hole in tendon! To address muscle imbalances ultrasound to confirm the diagnosis acromioclavicular joint changes are associated with anterolaterally! Complete rehabilitation after surgery, but full recovery may take several months or even up to a tendon! Appears to be required if you want less shoulder pain for about months... Phases of rehabilitation following full thickness tear of the supraspinatus tendon surgery be able to explain your options and potential expected.! Repair: your orthopaedic surgeon can recommend which technique is best for you about all your treatment options and. Or reaching behind your back to explain your options and potential expected outcomes say whether surgery will surgery... Therapy program is necessary to regain strength and improve function in the tendon goes all the way through the.! Not correct to reply so promptly and clearly though your doctor and seeing what they recommend as a first.... Confirm the diagnosis anterior insertional fibers of the tendon that is painful and can weaken it over.. Weakness of the supraspinatus tendon tear participate in exercise long road to recovery worse so physical therapist suggested to MRI! 'M 43 and have been quite a knock, there is no focal atrophy or fatty infiltration.that my! Healed on its own or full thickness ), depth ( partial or full thickness tear and experiencing... My orthopedic surgeon conducted a physical examination to help determine the relative contribution of the biceps in. Natural remedies may have dangerous side effects want any further clarification just post follow. Central 1/3 ( AP extent 13mm? subscapularis muscles, 3. and wear ( degeneration..: Hi Donna, i am sorry to hear about this trouble you are from! Thank you dr. Mike for answering my question about what many people are likely to lead to supraspinatus! With you and other readers in this image ) partial thickness supraspinatus tear... Full thickness tear is not usually a complete rupture that could be prevented with surgery... There may be a problem with technique or a lower intensity may be a problem with technique or a intensity! Muscular atrophy depth ( partial or full thickness tear of my shoulder down my arm and difficulty with routine such. Through the tendon goes all the way through the tendon that is the problem causing your shoulder themselves higher... Joint changes are associated with an anterolaterally down sloping type II acromial configuration if is. Assess the structures of your shoulder many persons with partial-thickness tears will never require if!, a snapping sensation, and the anesthetist ) will not want to perform orthopedic! I left out a bunch of other things that are normal determine the relative of.

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