Dr Mike, Please help me understand what options I might have in my case of job relater incident. Management of Rotator Cuff Tears. Sleeping on my right side became impossible. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. If pregnant or nursing, consult with a qualified provider on an individual basis. My story is a little lengthy, but I am desperate to find some insight for anyone that could help. Of course, all these options should involve regular check-ups with your orthopaedic surgeon in order to make sure the problem isnt getting worse. pain while . The review will exclude studies which include patients with concomitant shoulder conditions such as osteoarthritis, fractures, osteonecrosis, instability, and additional intra-articular pathology or acromion morphology, as these conditions may necessitate intervention/s that may be different from patients who have rotator cuff tear only. So probably worthwhile having a chat with your doctor and seeing what they recommend as a first step. The rotator cuff is a group of four muscles that come together as tendons to form a covering around the head of the humerus. Medicine and physiotherapy often. This website also contains material copyrighted by third parties. Should this shoulder have an MRI? However, to date, I am not aware of any rigorous large-scale clinical trials that have demonstrated effectiveness (or otherwise) in humans. Also now taking Tylenol 500 with5 hydrocodone. McMaster University, 2015 (developed by Evidence Prime, Inc.). 2 Rotator cuff viewed from above Fig. We excluded patients with isolated tears of the subscapularis tendon, those with a previous shoulder surgery, and those who had any type of injection . I see this is true of SSGtomn who has left a comment already. Chronic shoulder and arm pain are good reasons to see your doctor. MRI does demonstrate a complete massive tear of my rotator cuff with retraction and severe atrophy. Remember that you are not aiming for speed; slow, steady, and controlled movement is best. I have been seeing an orthopedic doctor for the past 18 months. It can be difficult to find good information on the web for specific rehabilitation following surgery. A partial or complete rotator cuff tear makes it difficult to raise and move your arm. 2023 Melbourne Arm Clinic. thank you for your considiration and helle from Turkey:-). In my reports say that I have less fluid and possible tear. This will inform the development of a search strategy which will be tailored for each information source. This can be one of the most frustrating things for people who have whiplash associated disorders. Partial or full thickness tears that are not complete ruptures are generally far more common than complete ruptures (not common, but require surgery with some level of urgency). There are some biomechanical and physiological attributes associated with the types of tendon injuries you have described that make them difficult to successfully repair. They will check for other problems with your shoulder joint. I wrote a previous commentsaw my orthopedic surgeon this week. Any thoughts on treatment for this considering previous surgery? Good luck! A disc protrusion, or herniated disc, often occurs in the lumbar spine and can be very painful. It is also worth mentioning that not all PTs are created equal. However, you would need to discuss this with your surgeon who will also be able to take a detailed history and conduct a full examination etc. 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? Your future self will thank you! Abrisham SM, Kermani-Alghoraishi M, Ghahramani R, Jabbari L, Jomeh H, Zare M. Additive effects of low-level laser therapy with exercise on subacromial syndrome: a randomised, double-blind, controlled trial. Supraspinatus tear: If you want a chance for a full recovery surgery is your best option. Early treatment can prevent your symptoms from getting worse. Deciding to have surgery is never an easy decision and you may require some time to recover, but if your shoulder joint issues such as supraspinatus tear are having a significant negative impact on your life, surgery and the associated downtime and physiotherapy may very well be worth it. I left out a bunch of other things that are normal. I say promising because work in basic science and animal studies have demonstrated some quite promising findings. Many people with supraspinatus tears receive very good relief following a period of PT, but others do not. Yes, surgery can be painful initially, but your surgeon should be able to tell you the likelihood of a successful outcome of surgery based on your specific circumstances. Strengthening the rotator cuff is not really like going to the gym and lifting heavy weights. @anonymous: Hi Donald, I'm sorry to hear about your shoulder trouble and insurance situation. Nike shoes helped manage my plantar fasciitis. Most tears are the result of a wearing down of the tendon that occurs slowly over time. I served in the Navy for many years, and in April of 2010 I had a little mishap. Recovery after surgical supraspinatus tendon repairs will often require the arm to be in a sling for approximately 6 weeks or so, then another ~6-8 weeks gradually starting to building up strength again. Couldn't even lay down. The likeliness of these issues increases with age and is more common in the dominant hand; in addition, if you experience a degenerative tear in one shoulder, youre at a greater risk for a tear in the other shoulder. I checked into my local VA hospital and initiated my disability claim. On the other hand, you will also need to ask about the likelihood of decent recovery without surgery. The types of findings you have described are consistent with some quite substantial pathology in your shoulder. The purpose of this study was to compare clinical outcome measures at least 1 year postoperatively between patients who had completion of a high-grade partial thickness supraspinatus tear to a full-thickness tear (PT) and those who had an isolated full-thickness supraspinatus tear (FT). Comparison of functional gains after arthroscopic rotator cuff repair in patients over 70 years of age versus patients under 50 years of age: a prospective multicenter study. Surgery to repair those types of injuries would mean the arm would have to be not used (at all) for at least a couple of months (maybe quite a few months before back to being able to work normally). Time passed. I now am having surgery but is it safe to have with whiplash symptoms. In terms of general information that may be useful to you, I am not sure I have seen any sound clinical research evidence indicating that prolotherapy is likely to provide long lasting benefits for people with MRI diagnosed supraspinatus tendon tears. If I need surgery,what is the recovry time.. Some can be altered with conservative rehabilitation exercises in order to prevent further tearing and ongoing pain, while others cannot be altered without surgery. For more information, please refer to our Privacy Policy. but can get back fairly good motion about the shoulder . These types of tears can also be symptomatic meaning that it causes significant pain and impedes your ability to perform basic everyday tasks or asymptomatic, meaning that the tear doesnt cause significant pain, but should still be monitored by an orthopaedic surgeon since tears can grow worse over time. This is partly because rehabilitation following surgery will depend on the surgical technique used. And overall her last resort for surgical intervention is a reverse total shoulder arthroplasty. I all of a sudden lost all my strength in my right arm and dropped the box. He did say that it can be done in the next few months and no urgent intervention required. (Right) A full-thickness tear in the supraspinatus tendon. Good luck! If you have a spouse, partner, family member, or close friend on hand to help you out post-surgery for your supraspinatus muscle tear, youll be better off, since you wont be able to lift things over chest height or even do other simple tasks for around 2 to 6 weeks after your surgery. Jacquot A, Dezaly C, Goetzmann T, Roche O, Sirveaux F, Mole D. Is rotator cuff repair appropriate in patients older than 60 years of age? Sometimes in cases like this your surgeon may want to try an injection. This study included patients with a repairable full-thickness tear of the supraspinatus tendon size < 5 cm. It seems as though you have now had two MRI reports. For all you that are going to have this surgery be prepared for the long haul you will feel the feelings of uselessness, frustration, anger, and people looking at you like your full of it hang in there! your express consent. Several factors contribute to degenerative, or chronic, rotator cuff tears. A soft tissue hematoma occurs when a ruptured blood vessel leaks blood into the surrounding fatty tissue. Risk of infection and nerve damage are worthy of consideration for any surgery, particularly one as involved as a reverse shoulder replacement. 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). This will help minimize strain on the back. 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. The supraspinatous is one of the 4 muscles that make u. If you do have surgery, this would mean you couldn't work on usual duties for several months (recovery time-frames are something worth discussing with your doctor). If your shoulder joint has pain and are seriously affecting your quality of life and your ability to work or perform basic everyday tasks without pain, then you need to speak with an orthopaedic surgeon about the next steps. I have continued to have problems with my arm and initially was told that I had a partial tear of my rotator cuff. I work construction and am self employed. If your tendon were to completely rupture while you were pregnant, this may be very problematic. Small tear involving the supraspinatus tendon only Fig. Strengthening the rotator cuff muscles can give relief to some people wanting to avoid surgery. 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. The results are: full thickness cuff tear 2.3 cm AP involving supra spinets and a portion of infra spinets at distal critical zone and enthesis. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm. I am sorry I can't offer you specific advice over the internet about whether you should or should not have surgery. Surgical repairs of complete tendon tears from a traumatic event, like a car accident, can easily fail when surgeons instructions aren't followed. Even if surgery is required, the physical therapy program can help strengthen the rotator cuff muscles before the surgery. You don't need to lean over as far as demonstrated in this video. Depending on the severity of your tear, your surgeon may recommend starting with a non-surgical treatment like physiotherapy and supraspinatus tear exercises with the goal of restoring the range of movement and the strength of the shoulder, activity modification (changing your lifestyle to avoid the tasks that increase your pain and may exacerbate the tear), pain management with non-steroidal anti-inflammatory medications, analgesics, and cortisone injections. Had mild discomfort in shoulder for a few weeks in August. Equally as important is a discussion about the likelihood of certain outcomes without further surgery. Infraspinatus tendon is somewhat hetrogeneous in its deep attachment with what appears to be intra-substance tears down to enthesopathic change at footprint. The lack of a normal amount of synovial fluid in the joint space could potentially be a sign of adhesive capsulitis (also known as frozen shoulder) among some people. I can reach behind my back ok. I then went to see another orthopaedic surgeon who said I have whiplash. Again, I'm sorry I can't provide specific advice, but I hope this general information is useful to you. 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). Full thickness tearing is characterized by the complete removal of the tendon from the bone.2 This includes large tears (35 cm) and massive tears (>5 cm).3 In the geriatric population, rotator cuff tears are a prominent clinical problem and many patients report difficulty with routine tasks of daily living. Being referrfed to a shoulder specialist Tuesday. 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. I'm sorry I can't give you specific advice over the internet, but hopefully you will find the following general information interesting. The rotator cuff exercises should not cause pain while the exercise is being performed. Where statistical pooling is not possible, the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate. Rotator cuff tendon augmentation grafts are a promising area of research. 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. 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. The popping may or may not be related to your shoulder pain (difficult for me to say without an examination etc.) It might be best to get an opinion from your orthopedic specialist sooner rather than later (if possible)! I think these are promising approaches for the types of pathology you described. 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. They will be able to help you return to sport. There may also be insurance implications etc. Just be aware that even in the best cases, the recovery time following surgery requires months (not weeks) so if you go ahead with the surgery don't be discouraged if you still have some pain in the first weeks after the surgery. months or years after the original injury is definitely a good indicator that a further orthopedic review / opinion is warranted. It must have been quite a knock, there is some quite serious damage there. This article describes general phases of rehabilitation following arthroscopic rotator cuff repair. There is a delaminating tear of the supraspinatus myotendinous junction, measuring a thickness of about 2mm. After an initial diagnosis from an Orthopedic specialist, the initial course of action was a steroid injection treatment into the "affected area" and a course of physical therapy. Your surgeon (and the anesthetist) will not want to perform elective orthopedic surgery while you are pregnant to re-attach the tendon. Here is some general information which I hope is useful for you: 1. there is a small full thickness insertional tear identified relating to the posterior supraspinatus. There are also non-surgical treatment options that orthopedic surgeons may consider for degenerative acromioclavicular changes, supraspinatus tendinopathy and subacromial bursitis. The majority of these tears occur amongst people over the age of 40. I take anti-inflammatory meds for a long time for other problems, but it sure has not helped my arm. I am disappointed not to have been referred to a surgeon, but I have to admit the exercises have already helped me sleep better. Nganga, Michael1,2; Lizarondo, Lucylynn2; Krishnan, Jegan1,3; Stephenson, Matthew2, 1The International Musculoskeletal Research Institute Inc., Adelaide, South Australia, 2Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia, 3Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia, Correspondence: Michael Nganga, [emailprotected]. Rotator cuff tear management aims to relieve pain, restore movement and improve function of the shoulder. Unfortunately I can't give you specific advice over the internet. Having the surgery sooner rather than later may help you to recover as much as possible by the time you fall pregnant. Then follow up by asking him about any risks associated with the surgery in your particular case (your surgeon should know your particular circumstances in detail and be able to provide you with specific advice about options available to you). The choice of, and response to, rotator cuff tear treatment may vary with age due to differences in etiology and pathogenesis. Once the full thickness of the tendon is torn, we classify the tears based upon the shape and the number of tendons involved. Cai YZ, Zhang C, Lin XJ. Berth A, Neumann W, Awiszus F, Pap G. Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair. I have lost about 45+% of my ROM in my right arm. Do I will need surgery? X-rays are often not very useful in diagnosing shoulder injuries. In physio just weeks after the onset of injury, I was unable to lift a 1lb weight with the injured arm bent near armpit while lying on my back. I found it very helpful as I am sure all your other subscribers found it to be too. Drugs, supplements, and natural remedies may have dangerous side effects. The specific post-surgery rehabilitation is often differs between surgeons in different regions (depending on the specific techniques they use). The most common symptoms of a rotator cuff tear include: Tears that happen suddenly, such as from a fall, usually cause intense pain. Geary MB, Elfar JC. The glenoid labrum and bicipital tendon appear unremarkable in position and morphology. If you have any uncertainty around the need for your sling use, please call your surgeon's office today. If in doubt call your surgeons office. So I think it would be wise to discuss the timing of surgery with your surgeon in the context of wanting to fall pregnant. Subcortical reactive changes superiorly and laterally at the humeral head are present. In some cases, surgery to repair the tendon is also required. Arthroscopic shoulder surgery may be required, or even rotator cuff tear procedures may be advised depending on the extent of the injury or damage to your supraspinatus muscle and surrounding bones, tendons, and muscles. 16. If you research it it's a complicated operation that demands some of the best surgerical skills. The shoulder is a ball-and-socket joint: The ball, or head, of the upper arm bone fits into a shallow socket in the shoulder blade. 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. Injection therapy, including corticosteroids, hyaluronic acid and platelet-rich plasma. 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. 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. 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? Good luck! Quality of life, measured using any validated instrument. Communication between health professionals (such as PTs and surgeons) may not be as good as it could be. Thoughts on surgery? Braune C, von Eisenhart-Rothe R, Welsch F, Teufel M, Jaeger A. Mid-term results and quantitative comparison of postoperative shoulder function in traumatic and non-traumatic rotator cuff tears. 24. You mention your shoulder makes a popping noise, generally speaking the sound a joint makes is not a good indicator of anything (particularly if the popping noise itself is not accompanied by pain). 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. Some will have more training, experience or ability in helping patients to overcome the biomechanical factors that can cause shoulder impingement and supraspinatus tears. Think about all the times you lift your arms above shoulder height in a given day and try to rearrange your home accordingly. I have a second opinion on Monday. Overall my subscapularis does appear intact." 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. As mentioned in the video, the aim of these resistance band exercises is not to increase your range of movement but to instead strengthen the rotator cuff muscles which will help protect the soft tissue structures around the shoulder in the long term. )amount of fluid in acromioclavicular joint and last but not least 5.) Highlight selected keywords in the article text. I plan on asking the surgeon these questions, but wanted your expert opinion. and seemed to be doing ok with Cortisone shots. You have asked for information about potential options. 2019;101(12):1050-60. Rotator cuff integrity, measured by direct magnetic resonance arthrography or conventional MRI. There are a few interesting things worth noting here. Effects of exercise therapy for the treatment of symptomatic full-thickness supraspinatus tears on in vivo glenohumeral kinematics. Thanks for stopping by and leaving a comment. I am aware than many clinicians who administer prolotherapy advocate for its benefits though. Make sure you understand their explanation of what problems are occurring around you shoulder and what treatment options are available to you. 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. You may have pain in the shoulder when you lift your arm, or pain that moves down your arm. Also, if you were concerned about any advice given by your doctor, don't be afraid to ask for a second opinion from another doctor who can conduct a full examination and look at your MRI. A rotator cuff tear is a common cause of shoulder pain and disability among adults. 5. There are other things your physical therapist may be able to help you with to give you some relief in the short term. I'm not sure whether the doctor you mentioned is a family physician / general practitioner or an orthopedic consultant / surgeon. This will help you figure out what you are deciding between. From the information you have provided it is difficult to say whether surgery will be needed. Rotator Cuff and Shoulder Conditioning Program, Rotator Cuff and Shoulder Rehabilitation Exercises. In general, seeing your orthopedic specialist would be an important step, these types of injuries are not likely to allow you to recover to your normal level of work functioning anytime soon without some kind of treatment. Impression: moderate supraspinatus tendinosis with a small full thickness footplate tear. If not then, your surgeon will be able to give the likely benefits, risks and recovery time following surgery. Effect sizes will be expressed as either odds ratios (for dichotomous data or weighted (or standardized) mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. In many cases, surgery is required. The CT impression read like this: High-grade partial tear of the supraspinatus tendon at its insertion (rim rent tear). If pain is being caused, then there may be a problem with technique or a lower intensity may be required. What does all that mean in simple layman terms? This modified tear completion repair, by conversion to full-thickness tears through a small incision, has less damage to the supraspinatus tendon on the side of the bursa compared to traditional tear completion repair in the treatment of PASTA lesions. 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. 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. Thorpe A, Hurworth M, O'Sullivan P, Mitchell T, Smith A. Read More Generally speaking, MRIs definitely help the surgeon to make a diagnosis and give them an idea of whether surgery will help. I did PT around December for a month, twice a week. 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. Went down a water slide on a mat head first arms supporting my body. Because of the return of the recent pain, another MRI was ordered and the Radiologist wrote: "1. Sometimes, it is difficult to tell from people recalling what happened whether a shoulder has been dislocated. Search for Similar Articles Tears that develop slowly due to overuse may also cause pain and arm weakness. ; 2. 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. Are you wondering if it's possible to dislocate a rib? Exercise rehabilitation in the non-operative management of rotator cuff tears: a review of the literature. The close proximity of the supraspinatus tendon to the acromion-clavicular arch is a common contributing factor in supraspinatus tears, particularly when the tendon becomes impinged between these bone structures with activities that require arm elevation. I'm quite apprehensive and nervous about the surgery but more so about the recovery. muscle atrophy of supraspinatus, infraspinatus, and subscapularis muscles, 3.) I'm sorry I can't give you specific advice on your case over the internet. Either way, I wish you all the best with it (and a safe deployment and return). Humeral head is riding high abutting the underside of the acromin process. 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. Thanks for stopping by and sharing your story. The rotator cuff tendons cover the head of the humerus (upper arm bone), helping you to raise and rotate your arm. No black and white answer for this one I'm afraid. This is possibly caused by microdamage to the tendon that is painful and can weaken it over time. Grade 1 strain of the lateral deltoid muscle and teres minor muscle. It extends slightly into the proximal subscapularis bursa.
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