techniques (see details below) . Even if surgery is required, the physical therapy program can help strengthen the rotator cuff muscles before the surgery. 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)! So quite often the best treatment approach is not always immediately clear. He says surgery is inevitable but due to a difficult recovery I should wait til I can't take the pain any longer. It sounds like you may be putting yourself at unnecessary risk? The presence of greater tuberosity cortical irregularity and joint fluid was most important in the diagnosis of full-thickness supraspinatus . I then went to see another orthopaedic surgeon who said I have whiplash. 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. 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. Shoulder muscles are very good for stabilizing the ball and socket joint and making large movements (to help lift things, throw objects etc. There is supraspinatus muscular atrophy. Since then, my pain has gotten to the point where its starting to take effect of my day to day life. Physical therapy exercises for supraspinatus tendon tears usually have one of three purposes: Below is a pendulum exercise demonstration. When we finally returned home from sea a few weeks later, my shoulder had become so painful and stiff, It was nearly impossible to do just about anything. There is longitudinal split in the subscapularis tendon which extends from the humeral attachment to the musculotendinous junction. I am sorry I am unable to provide any specific advice over the internet without conducting a physical examination etc. When supraspinatus tendon tear symptoms are chronic and severe, an orthopedic specialist will be able to provide good advice on likely recovery and treatment options, including the likelihood of successful recovery with or without surgery. Good luck! Time passed. A full thickness cuff tear (RTC) can be classified by size (small, medium, large and massive i.e. the defect measures approximately 1cm anterior to posterior and medial to lateral. He did say that it can be done in the next few months and no urgent intervention required. A few months ago it seemed to hurt more and I had problems lifting my arm out or above my head. I received my first steroid injection treatment during the summer of 2011 and went through a lengthy 6 moth physical therapy treatment. I can reach behind my back ok. When I went in, he told me that after looking at my MRI, he did not think that anything was necessary, and instead wanted me to go back into physical therapy and continue to get steroid injection treatments. The anterior band of the supraspinatus (most common tear location) is an agonist to external rotation. 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. A couple of final remarks that may unfortunately muddy the waters for you: Adhesive capsulitis generally resolves without the need for surgery, and aggressive physical therapy may actually worsen the symptoms in some cases. If you get a chance, drop by and let us know how you go with your recovery! The process of recovery is different depending on a number of factors including the cause, severity and location of the tear, the biomechanics of the affected shoulder, the age of the individual just to name a few. I have not lost any ROM I just have severe pain in my right shoulder. its been 5 months since my partialthickness tear of mysupraspinatus the the footplate..im 56 and also have degenerative change o the acromioclavicular joint impinging on the supraspinatus at the myotendinous junctionNarrowing of the acromiohumral distancetenosynovitis of the lpng head of the bicepswill I need surgery???? How do you repair a rotator cuff tear? They can then make a diagnosis and begin treatment. I've started having a smoothie everyday of red vege's (beetroot) and fruit (all the berries) with a slice of ginger and the big one for inflammation turmeric! have got bursal thickening as well and mild thickening of. ROM hurts so I'm not sure. The words 'very large, nearly complete with 1cm retraction of tendon fibres' are a bit concerning. Sorry for the delay, I have been away. 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. LOTS of heavy benching, etc. 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. In your opinion, do I have any other option other than surgery? @anonymous: Hi Donna, I am sorry to hear about this trouble you are having with your shoulder. Thanks for stopping by and sharing your story. Players involved in sports requiring fast throwing actions (baseball) or overhead hitting (volleyball, tennis) may also sustain a traumatic injury to their rotator cuff and the supraspinatus tendon in particular. This may give you relief, even if you have been getting symptoms for a few years. Particularly about what many people are likely to experience during the often long road to recovery. Even though surgery repairs the defect in the tendon, the muscles around the arm remain weak, and a strong effort at rehabilitation is necessary for the procedure to succeed. Getting a second opinion when you are not sure about your first is also often a good idea. Some minor tears may be treated without surgery. In the interim, physio, chiro, massage, taping were part of my pain management and ROM for all pain sites relating to MVA. The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint. SLAP type tear of the superior labrum. I've seen musicians and artists with poor shoulder function be able to perform their art as well as they did before their injury; sometimes through making some adaptations, but other times almost no adaptation was required (depending on their technique / instrument / art etc.). It is also worth mentioning that not all PTs are created equal. 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 nearly complete tear were to become a complete tear, this would require surgery (ideally quite quickly) to re-attach the tendon otherwise the functioning of the supraspinatus muscle (it elevates the upper arm) would be lost. Productive acromioclavicular joint changes are associated with an anterolaterally down sloping type II acromial configuration. For anyone contemplating surgery, buy a recliner to sleep in after surgery. I had subacromial decompression February 2010 a year after a motor vehicle injury (I am currently a 34 year old female). @Reallmadhatter: Good question. Anyone want to shed a little light for a vet? 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. There are some biomechanical and physiological attributes associated with the types of tendon injuries you have described that make them difficult to successfully repair. I all of a sudden lost all my strength in my right arm and dropped the box. If they were consistent with each other it would seem remarkably unlikely that both reports were wrong. I have continued to have problems with my arm and initially was told that I had a partial tear of my rotator cuff. Always been natural. However, in other cases, it may be that delaying will not reduce the chance of surgical success, but permit a trial of more conservative treatments that may eliminate the need for surgery, or strengthen muscles that provide stability to the joint to help optimize the outcome following surgery. He says that my tendon is failing. If you get a chance drop by again and let us know how you went. By June '13 I was better in many ways than before the injury. 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. These four muscles (supraspinatus, infraspinatus, subscapularis, and teres minor) stabilize the glenohumeral joint, enable rotation around the joint, and provide a counterforce to . Most people who do have surgery experience acute pain during the first few days (although the acute pain medications usually help with this). 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. Can a supraspinatus tendon tear heal itself? With partial thickness rotator cuff tears only part of the tendon has torn off the bone. 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). About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. 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. I checked into my local VA hospital and initiated my disability claim. AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. Exercise is important for many reasons (not the least of which are physical and mental health benefits). Your doctor may also advise a trial of physical therapy to see if that can bring relief to his symptoms. Thanks! A rotator cuff tear can extend or get larger over time. Small to moderate glenohumeral joint effusion. 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. And overall her last resort for surgical intervention is a reverse total shoulder arthroplasty. I think it would be wise to listed to the advice from your doctor on this one! Information on this topic is also available as an OrthoInfo Basics PDF Handout. 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). Thankyou. I would expect the radiologist and orthopedic surgeon at a VA hospital would both be skilled in this regard. Generally speaking, treatment options for shoulder injuries that include supraspinatus tendon tears and other findings similar to those you have reported could include surgery, or more conservative treatments like a trial of physical therapy or injections. However, given that you already have an MRI it sounds like you are already under the care of your doctor, which is great. old I was in good physical shape as a letter carrier(28 yrs) but have been mostly sedentary recovering from the first surgery. This can occur normally over time, or with repetitive use or a re-injury. 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. They decided to do a re examination of my MRI to see if there was something they were missing. I am close to retirement and I am afraid I will not be able to do the things I once enjoyed, outdoor activities. I guess my question is does this always require surgery? [1] Quite often, the tear occurs in the tendon or as an avulsion from the greater tuberosity. Our hypothesis was that arthroscopic repair of full-thickness supraspinatus tears achieves a rate of complete tendon healing equivalent to those reported in the literature with open or mini-open techniques. Once the full thickness of the tendon is torn, we classify the tears based upon the shape and the number of tendons involved. I was an elite athlete most of my life and have accepted that I will no longer be able to return to my sport 100%. So first off, I should say that I have certainly seen situations where a small supraspinatus tear has been surgically repaired, only for a worsening of symptoms to occur after further pathology (such as other rotator cuff tendon tears) either develop or become easier to detect on imaging (e.g. Examination otherwise demonstrates the osseous structures of the shoulder to be otherwise unremarkable in signal and morphology. The pain is manageable if you stay on top of it with pain medication. 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. I have about 3" less range reaching up behind my back, but I think some pre-existing tears and arthritis were fixed. The supraspinatus is one of the four muscles that make up the rotator cuff group of muscles. Full thickness tear means a complete tear of the rotator cuff supraspinatus tendon. As a general principle, when soft tissues like tendons or ligaments are damaged (think sprain or strain), but are in very close proximity to one another (I don't consider 1cm retracted to be very close in this context), the structures can often heal and become as strong (or perhaps stronger) than they were before. It is common for patients with known rotator cuff disease to have acute pain and weakness following a minor injury. Here I am 5 days post op. Family is important, and I would not encourage people to discard their advice or offend their family and friends, but definitely weigh up advice on its merit. Any suggestions? Don't even think you won't need help, because you'll need help with even the most basic daily tasks. It is best to stick within the range of movement indicated on the video rather than try to rotate your arm too far out to the side and potentially aggravate already inflamed rotator cuff tendons. The supraspinatus muscle is a relatively small muscle, but very it's important one. 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. Good luck with it and I hope you are feeling pain free sooner rather than later. 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). Although I probably wouldn't be forthcoming with the name of the first surgeon or advice given unless the surgeon actually asked about this directly. Can a full thickness tear of the supraspinatus heal without 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 appreciate your thoughts on this matter. Questions: 1. Good luck! Thanks for stopping by and sharing your story. Following the post-surgery protocol will help minimize the chance of a poor outcome and further problems. I say promising because work in basic science and animal studies have demonstrated some quite promising findings. Any advice would be greatly appreciated. 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. Although very uncommon, it is possible that the report did contain an error. Unfortunately, I think 1cm retractions of torn tendon fibres do not favor natural healing of those portions of the tendon (without surgery). Let us know how things turn out for you. I am glad that you noticed some relief after the surgery on your right shoulder and that the exercises for your left shoulder have already helped you get better quality sleep. I wear an arm sling a lot to relieve weight from my shoulder, which helps to some degree. Good luck! Full thickness tears may involve only part of one tendon (usually the supraspinatus). 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). I would make sure your surgeon knows you are planning on falling pregnant within the next 12 months. I will surf again! He prescribed Vicodin and arthrotec for painbut I would like to get pregnant within a year but would like to be fixed first for obvious reasons. my MRI result come out that supraspinant tendom has partial tear. Conclusion: Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. The radiomics model of full- or partial-thickness tears displayed moderate performance with an accuracy of 76.4%, a sensitivity of 79.2%, and a specificity of 74.3% for . 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. Adhesive capsulitis will usually last at least 5 or 6 months (often considerably longer). If it hasn't resolved with time, then some kind of intervention (whether physical therapy, surgery etc.) 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? I slept in a recliner for about 2 1/2 months following surgery (I don't think I slept at all before surgery :) ). but can get back fairly good motion about the shoulder . Strengthening the rotator cuff muscles can give relief to some people wanting to avoid surgery. The rotator cuff tendons cover the head of the humerus (upper arm bone), helping you to raise and rotate your arm. Overall my subscapularis does appear intact." If you are in doubt, don't be afraid to get a second opinion. Your surgeon will be able to explain the potential risks and benefits (as well as if he thinks any alternatives are likely to be helpful). 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). A full thickness tear is not usually a complete rupture. 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. 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Do a re examination of my rotator cuff group of muscles and stabilize! Help, because you 'll need help, because you 'll need help with even the most basic tasks...
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