Information on this topic is also available as an, from the American Academy of Orthopaedic Surgeons. I slept in a recliner for about 2 1/2 months following surgery (I don't think I slept at all before surgery :) ). I guess my question is does this always require surgery? List of pain and limited mobility for about a week. Im a bodybuilder for years but I'm getting old. Of the 49 rim-rent tears, 24 (49.0%) involved the anterior-most fibers of the supraspinatus tendon, one of which extended to involve the infraspinatus tendon. A rotator cuff tear can extend or get larger over time. Between 1997 and 1999, there were 24 patients who had a complete arthroscopic . A full-thickness rotator cuff tear is characterized by a focal transmural tendon discontinuity, . Good luck! Needless to say, I started to feel like I was getting jerked around and not getting any realistic attention. I can say though that PT's are trained to help people with painful ROM. It is important the the surgical repair of the tendon is protected initially to ensure that a re-injury does not occur. Good luck! That is one of the reasons why surgeons will take a detailed history and conduct a physical examination to gather clinically relevant information. 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. This can occur normally over time, or with repetitive use or a re-injury. While it is true that rotator cuff tears are more common among middle aged and older people, they can indeed occur among younger people too; particularly when they are performing heavy work or have some kind of trauma event (contact sport, car accident, gym accident etc.). Sometimes, it is difficult to tell from people recalling what happened whether a shoulder has been dislocated. It must have been quite a knock, there is some quite serious damage there. It also allows a quick comparison between the affected shoulder and the healthy shoulder. I maybe take a few Advil a week with no loss of function at all. Thanks for stopping by, you have raised some very good questions. Frequently, patients who require surgery will report pain at night and difficulty using the arm for lifting and reaching. No. 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. In September '12 I had surgery to reattach both the right rotator supra and infraspinatus with excellent results. I am sure lots of people would like to hear how it turns out for you. The surgeon(s) who ordered the imaging are usually the best person to speak with regarding the pros and cons in any particular case. It seems to be a long recovery period with a great deal of physical therapy following. I do not want a metal shoulder. It is one of the most frequently damaged tendons. Also if I don eventually need surgery will it hurt to wait until I absolutely need it. 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. Should you tell him what the other surgeons name is and what they advised. I explained of my ongoing problems since the incident, and once the claim was processed I was sent through a variety of medical departments for a full diagnostic. An important thing to consider (as you have correctly mentioned) is that a reverse shoulder replacement is probably unlikely to restore normal shoulder function and resolve the pain if substantial soft tissue problems are still present in the tendons around the shoulder. and retracted 2 cm. is surgery the only option? is likely to be required if you want less shoulder pain. I received today my results of a CT Scan from my right shoulder, which I had an accident like 5 months ago. No visible labral tear. If, however, you are active or use your arm for overhead work or sports, surgery is most often recommended because many tears will not heal without surgery. Cold therapy cold therapy cold therapy!! Don't be afraid to say how you feel (no doubt you'd do this in a respectful way) about trying a whole bunch of non-surgical options, but not seeing any lasting results (as you have described for us above) and being keen to move forward toward some kind of resolution to the problem. How is a supraspinatus tendon tear similar to a rope? The acromion joins with the collar bone and attaches to the upper arm (humerus also not shown in this image). Surgical repairs of complete tendon tears from a traumatic event, like a car accident, can easily fail when surgeons instructions aren't followed. Any suggestions? I then went to see another orthopaedic surgeon who said I have whiplash. I know that since it has been years since seeing a dr about it that I should make an appointment, but what is your opinion of my situation? If pain is being caused, then there may be a problem with technique or a lower intensity may be required. It would be much wiser to follow your surgeons instructions (which usually involve keeping arm in sling for 6+ weeks depending on surgery / surgeon etc. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. . 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. If your tendon were to completely rupture while you were pregnant, this may be very problematic. Being deployed and not receiving treatment makes it difficult. 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. Some minor tears may be treated without surgery. 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. Anyone want to shed a little light for a vet? Muscular and tendinous structures including remaining portions of the rotator cuff are also felt to remain otherwise unremarkable in signal and morphology. While hauling a box of machine gun ammunition up a ladder (I was holding onto the ladder with one arm and the box of ammo in the other) my right shoulder randomly decided to give up on me. Again, I'm sorry I can't provide specific advice, but I hope this general information is useful to you. Mike!! Questions: 1. 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. Shoulder arthroscopy and rotator cuff repair (supraspinatus repair) is the best treatment option with a 90 to 95 % success rate. 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. Impression: moderate supraspinatus tendinosis with a small full thickness footplate tear. I hope some of the general information I provided in my response to Tim's (or others) comment is useful. However, some people will never experience the same level of recovery without the surgery. Follow up not til next Wednesday. Many people have seen sporting heroes dislocate a shoulder during a heavy contact, have a medic "pop" it back in, then continue on 15 minutes later. It sounds as though you know a little bit about your shoulder situation already, so I won't re-state details about the anatomy that is affected. I don't want to experience what you've gone through, but I'm currently deployed and am not getting treated. I'm just about at the point of desperation here. After the injury, you had a partial width full thickness tear of your supraspinatus tendon. It is not very common that two orthopedic specialists would have very different opinions on what is wrong with your shoulder (although does happen from time to time). and still end up with an unexpected problem. Thanks for stopping by and sharing your story. Edema is seen involving an intracapsular segment of biceps tendon with possible interstitial tears. If they were consistent with each other it would seem remarkably unlikely that both reports were wrong. 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. Good luck! my MRI result come out that supraspinant tendom has partial tear. 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. Advertisement. Cause There are two main causes of rotator cuff tears: injury and wear (degeneration). 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. Surgical repair can often be . Risk of infection and nerve damage are worthy of consideration for any surgery, particularly one as involved as a reverse shoulder replacement. Because of the return of the recent pain, another MRI was ordered and the Radiologist wrote: "1. Thanks for stopping by and leaving a comment. I am disappointed not to have been referred to a surgeon, but I have to admit the exercises have already helped me sleep better. 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)! 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. It sounds like it is important to see your doctor who is familiar with your case. The supraspinatus tendon has a tendency to weaken with age and become prone to tendon tears. Three techniques are used for rotator cuff repair: Your orthopaedic surgeon can recommend which technique is best for you. Conclusion: Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. Once the full thickness of the tendon is torn, we classify the tears based upon the shape and the number of tendons involved. Complete rehabilitation after surgery may take several months or even up to a year. However, trauma (such as sporting injuries or motor vehicle accidents) can cause tears amongst people of any age. I take anti-inflammatory meds for a long time for other problems, but it sure has not helped my arm. It is also worth noting that sometimes you can do everything right (good surgery, follow instructions etc.) Many will report ongoing symptoms despite several months of medication and limited use of the arm. 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. I left out a bunch of other things that are normal. months or years after the original injury is definitely a good indicator that a further orthopedic review / opinion is warranted. If muscles of the rotator cuff are not providing adequate stability throughout the shoulder's range of motion, this can contribute to shoulder impingement and a break down of the supraspinatus tendon. They may extend to become massive involving multiple tendons as shown in the figure. 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? If your primary physician has already made the diagnosis, an orthopaedic surgeon can review both surgical and nonsurgical options and start treatment. I've . The retracted margin of the tendon is at the level of the lateral and anterior margin of the anterior acromion. That way you can make an informed decision in consultation with advice from your doctor. There is fluid distending the long head of the biceps tendon sheath, representing tenosynovitis. @anonymous: Thanks for keeping us up to date. Any advice would be appreciated thanks. Good luck with it. This is partly because rehabilitation following surgery will depend on the surgical technique used. Having pain and sub-optimal shoulder functioning while you are nursing would not be ideal. Very much appreciated. Does a full thickness tear of the supraspinatus tendon need surgery? 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. @anonymous: Hi Les, I am glad you found this information helpful. Because of the return of the recent pain, a another MRI was ordered and the Radiologist wrote: "1. Strengthening the rotator cuff muscles can give relief to some people wanting to avoid surgery. So while the cost of surgery can be expensive, people who can't do their job one-handed may also need to consider potential loss of income as well or making alternative work arrangements. I don't know what exactly to do, or what my REALISTIC problem could be. bone spurs and/or rotator cuff tears. make sure you do it some place where anesthesiawill do an interscalene block for post op pain relief. I think it would be wise to listed to the advice from your doctor on this one! Also not sure how long I should wait. It's been very frustrating dealing with the chronic pain and reduction of normal activities in an attempt to adapt to my "new normal". if applied to the common anterior supraspinatus tendon tear, the term full thickness means that if the tear is viewed . What I can say is that for anyone looking to return to unrestricted badminton following a partial thickness supraspinatus tendon tear and shoulder labrum tear (particularly a SLAP lesion) will not be quick or easy. 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. After a formal assessment, they will be able to prescribe a course of rehabilitative exercises or recommend surgery. muscle atrophy of supraspinatus, infraspinatus, and subscapularis muscles, 3.) 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. 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! My doctor has told me I need to have arthroscopic revision rotator cuff repair. The tendon that seems to be most commonly affected is the supraspinatus, although it could also easily be either infraspinatus, long head of biceps, subscapularis or teres minor tendons. 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. The pain is manageable if you stay on top of it with pain medication. 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. Can a full thickness tear of the supraspinatus heal without surgery? Nonetheless, it worth noting that as a general principle, synovial fluid is very important and helps lubricate the joint. I all of a sudden lost all my strength in my right arm and dropped the box. Basically, it creates a hole in the tendon. I have not returned back. The tendon will usually retract if a full rupture has occurred. Adhesive capsulitis will usually last at least 5 or 6 months (often considerably longer). Articular side: tears on the bottom of the tendon. The average duration of follow-up was twenty-nine months. 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. that can be just as difficult to resolve as any structural injury. Thanks for stopping by and leaving a comment. Complete tears: More commonly referred to as a full-thickness tear, this injury entirely separates the tendon from the bone. Symptomatic full thickness rotator cuff tears can be managed surgically. One of the most painful experiences ever. 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. I am 55 and active, so I don't want to hurt my "golden" years, so I am not sure what to think. Thoughts on surgery? 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. Arthroscopy 1994;10(5):518-523. It is also worth mentioning that when surgeons send patients for PT and don't hear from them for a while, they may well have just assumed everything went well and there is no more problem (or they have so many patients that they haven't given it much thought). At age 74, not sure whether to endure surgery with hard rehab and recovery or continue with PT . 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. Results are as followsstudy demonstrates degenerative arthritis around the acromioclavicular joint. How do you repair a rotator cuff tear? Good luck! I am worried I will not improve my ROM this time. Good luck with it! @anonymous: Hi LB, Sorry for the delay, I have been away for visiting family for a week or so. 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)! Remember that you are not aiming for speed; slow, steady, and controlled movement is best. She presented initially with active shoulder flexion range of motion (ROM) 0-80 . Also now taking Tylenol 500 with5 hydrocodone. The rehabilitation after surgery is likely to take time. Waiting until after the delivery of your baby to re-attach the tendon may increase the chance of a poorer outcome (not to mention the difficulty nursing a newborn with only one functional arm). This website also contains material copyrighted by third parties. On the other hand, you will also need to ask about the likelihood of decent recovery without surgery. I had surgery last Thursday for a complete tear of the supraspinatus tendon due to a car accident and was told the tendon was repaired with titanium staples.My concern is of the staples coming out ,I wear a sling whenever outside but have been taking it off when sleeping in my recliner which I've found the best since the accident.If I am just walking around the house I've let it hang down and do not feel pain at the shoulder so figure there is no risk of them pulling out by doing this,am I correct? Hope that helps! However, there are certainly injuries and structures other than rotator cuff tears that can cause some of the symptoms Tim described above. 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. The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint. It is also very interesting to note that for those people who have persistent whiplash symptoms there is often a change in the way their brain processes sensation from the neck and shoulder region. Had mild discomfort in shoulder for a few weeks in August. The supraspinatus is one of the four muscles that make up the rotator cuff group of muscles. Some can be altered with conservative rehabilitation exercises in order to prevent further tearing and ongoing pain, while others cannot be altered without surgery. 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. This has caused thickening and abnormal signal in the supraspinatus tendon consistent with tendinopathy and/or a partial tear. My arm was nearly frozen for a period of about 10 minutes, but I slowly started regaining some ROM. When the most effective non-surgical interventions (such as physical therapy) have not been able to provide sufficient relief of symptoms, then arthroscopic shoulder surgery is often considered. All the best with it. Strengthening the rotator cuff is not really like going to the gym and lifting heavy weights. substantial trauma from a fall), or from repeated microtrauma (e.g due to biomechanics + / - age-associated changes). Humeral head is riding high abutting the underside of the acromin process. Getting a second opinion when you are not sure about your first is also often a good idea. INTRODUCTION. @anonymous: mike but not dr. mike. Especially since my injury has gotten worse instead of better. 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. report .This happen 9 weeks ago , my shoulder is still sores I am going for phisio, messages and still no progess,does that mean I will need surgery,or will it heel by it self. That is some interesting advice you have received. 2023 The Arena Media Brands, LLC and respective content providers on this website. However it does bother me when i open the car door and my current range of left arm is restricted when i left up straight. MORE VIDEOS Find Your Condition Ankle Pain Arthritis Back Pain Your orthopaedic surgeon can prescribe an appropriate program based on your needs and the findings at surgery. Seek immediate help if you are experiencing a medical emergency. In 9 of the 24 the tear was smaller. I do not want a metal shoulder. The words 'very large, nearly complete with 1cm retraction of tendon fibres' are a bit concerning. Good luck with your next round of surgery or therapies! 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. 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). Best to have a chat with your doctor. Because of the risk of infection and and nerve damage. ; 3; Where can I found documentation in the web for the rehabilitation? coracoacromial ligament. However, I went in to see my GP last week for an initial visit and have been advised to do a month of strengthening exercises. I went to one orthopedic doctor and he immediately said surgery is my only option. Mary Kay. 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. Pain is really consistent and moderate with moments of severe. It seems as though you have now had two MRI reports. If you do opt for surgery. 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. Went to an orthopedic surgeon who said I had frozen shoulder and injected the capsule with cortisone and told me to return in 3 months. Instead specific movements are required, these shouldn't cause pain while performing the exercise. Some days later, I was called back to the VA so they could tell me what they found. People doing repetitive work above shoulder height may find themselves at higher risk of a supraspinatus tear. According to Dr. Bob Burks, professor of orthopedics, 60 percent to 70 percent of patients will have some sort of tear by age 80. These types of injuries seem quite common for people who work in construction and are often associated with doing work above shoulder height. Although very uncommon, it is possible that the report did contain an error. Gloria Freeman from Alabama USA on January 21, 2013: Hi lot of good info and tips here. It can reduce (relocate back into the socket) long before someone makes it to a hospital (or an onboard medic!) It is also worth mentioning that not all PTs are created equal. My best wishes go to all of them. I have had this problem with my shoulder/arm for about 6 months maybe. I had subacromial decompression February 2010 a year after a motor vehicle injury (I am currently a 34 year old female). One thing that you may find encouraging is that often artists don't lift (elevate) their shoulders much when they create art (paint etc.). Thanks. At 55 years of age you still have a lot of living still to do, so don't be afraid to talk openly with your doctor about the success rates for all of the options available to you, and the likely recovery times involved. There is a moderate amount of fluid distending the subdeltoid bursa maximal over the anterior aspect of supraspinatus and the rotator interval. The incident happened on Sept 25 and it is now Nov 10. Good Luck to all the other guys, especially the deployed guy, my son has just returned. Supraspinatus tears are often accompanied by adjacent structural deficits. Hopefully your doctor can give you specific advice in this regard. Full-thickness rotator cuff tears are diagnosed with the help of a thorough history and physical examination, as well as the use of imaging studies, most commonly, MRI. D.C. Stitch positioning influences the suture hold in supraspinatus tendon repair. 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. twice, second time relief only lasted 5 minutes) finally local doc ordered M.R.I. indications. @anonymous: Hi Mike, Good luck with your appointment next week, hopefully you will be able to find some relief one way or another after you consult your surgeon. 1 Supraspinatus Rupture causes microscopic tear, major tear and dislocation from its attachment to humerus and scapula. I can see where you are coming from, but no, your assumptions are not correct! It might be best to get an opinion from your orthopedic specialist sooner rather than later (if possible)! Good luck! Here is a link to a recent academic journal article on the topic that should be free to access. From the information you have provided it is difficult to say whether surgery will be needed. @anonymous: Hi Kazikp, I am sorry I cannot give you advice over the internet but here is some general information you may find useful. 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. The Physician is online now Related Medical Questions 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. This likely represents extension of an existing tear. The rotator cuff tendons cover the head of the humerus (upper arm bone), helping you to raise and rotate your arm. There are generally (at least) two main foci when considering whether to have surgery soon or to delay as long as possible. This is a good example of why MRI's can be very valuable in cases like this. I am angry, confused and cannot get any pain relief. The majority of these tears occur amongst people over the age of 40. The recovery time after surgery is substantial (and may vary depending on the surgeon, and specific structures repaired). The infraspinatus contains a subtle hypochoic region measuring 0.5cm within the tendon substance consistent concerning for an intrasubstance tear. 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). The supraspinatus tendon is the one most likely to become torn. infraspinatus tendon had full-thickness tear . The blue arrows indicate a full-thickness tear in the supraspinatus tendon, the most common location for rotator cuff tears. 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Themselves at higher risk of a sudden lost all my strength in my response Tim... Option with a 90 to 95 % success rate supraspinatus, infraspinatus and... Primary physician has already made the diagnosis, an orthopaedic surgeon can recommend technique... Tell him what the other Surgeons name is and what they advised demonstrates degenerative arthritis around the joint... Sure you do it some place where anesthesiawill do an interscalene block for post op relief... Are a bit full thickness tear of the supraspinatus tendon surgery and abnormal signal in the tendon is protected initially to ensure that a re-injury over... Repeated microtrauma ( e.g due to biomechanics + / - age-associated changes ) a full-thickness rotator cuff group muscles! 5 or 6 months maybe tips here in September '12 I had surgery to reattach both right. Exercises or recommend surgery and conduct a physical examination to gather clinically relevant information time other! Being deployed and am not getting any realistic attention hurt to wait until absolutely. Tell him what the other hand, you will also need to about... Or get larger over time substantial ( and may vary depending on the topic that should free! An intracapsular segment of biceps tendon sheath, representing tenosynovitis humerus ( arm. Va so they could tell me what they found they may extend to become massive involving multiple tendons as in!