If youre going to have surgery to repair a full or partial thickness tear, you should keep in mind that youre going to have some significant recovery time where you wont be able to use the affected arm as usual. 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. It is possible this tear may communicate with the bursal surface anteriorly. The anterior band of the supraspinatus (most common tear location) is an agonist to external rotation. I had rotator cuff surgery in May for a Small(2mm) tear In the supraspinatus tendon. Do I will need surgery? Good luck! Here is some general information which I hope is useful for you: 1. i'm a long distance runner and in good fitness and the shoulder problem does not bother me during running. Additionally, you do not want to be dependent on strong medications to reduce pain while you are pregnant. ,Been dealing with shoulder pain for about nine months now and thought I'd share my experience with you and other readers. Rotator cuff exercises are often prescribed for people with a partial tear of the supraspinatus tendon. Supraspinatus tendon tear symptoms commonly go on for months (or even years) until the underlying problem is resolved (usually through improving the functioning of the rotator cuff, surgery, or both). Because most rotator cuff tears are largely caused by the normal wear and tear that goes along with aging, people over 40 are at greater risk. Conclusion: Lengthening of the supraspinatus occurs with surgery, altering the length-tension relationship of the muscle, which can compromise muscle function and lead to inferior surgical outcomes. Good luck with it. 15. There are some biomechanical and physiological attributes associated with the types of tendon injuries you have described that make them difficult to successfully repair. prospective, randomised trial in 103 patients with a mean four-year follow-up. Overall my subscapularis does appear intact." I don't lay on the side of the hurt arm as I don't think it will be good for it. 2. Repair of high-grade partial thickness supraspinatus tears after I suspect you have a bit of work to do over the next 6 months or so to help your shoulder recover. In the supraspinatus tendon, increased expression of MMP-1, MMP-9, MMP-13, and vascular endothelial growth factor was found in the full-thickness group. You can partially or fully tear your supraspinatus muscle, and remember that these sorts of tears can be symptomatic (meaning they cause supraspinatus pain and inhibit your range of motion and ability to perform everyday tasks) or asymptomatic, meaning the tear is present but it not currently causing you pain or otherwise causing problems in your life. This includes small (01 cm) and medium (13 cm) tears. Abstract Background: 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. can be damaged without a dislocation occurring at all, particularly when carry heavy items up ladders or performing repetitious activities. Thorpe A, Hurworth M, O'Sullivan P, Mitchell T, Smith A. Thoughts on surgery? I am sorry, I can't give you specific advice over the internet about whether you will need surgery or not. Please enable scripts and reload this page. There is certainly good clinical research evidence indicating that arthroscopic surgery can help the types of injuries you described. My pain is mostly in the bicep area and I do not have trouble lifting the arm but bringing it back down and also bringing the lower arm down when the upper arm is at 90 degrees. It did manage to decrease my overall pain but I still feel like I'm suffering unnecessarily. For full thickness tears and more major tears (or if the tear involves more than one tendon) or there is significant damage to the tendon, various surgical procedures may be required. J Bone Joint Surg (Am Vol). List of pain and limited mobility for about a week. 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. Adhesive capsulitis will usually last at least 5 or 6 months (often considerably longer). What do you think of the other therapies? This will help you figure out what you are deciding between. Studies that meet or could potentially meet the inclusion criteria will be retrieved in full and their details imported into the Joanna Briggs Institute System for the unified Management Assessment and Review of Information package (JBI SUMARI). @Reallmadhatter: Good question. I say promising because work in basic science and animal studies have demonstrated some quite promising findings. There is longitudinal split in the subscapularis tendon which extends from the humeral attachment to the musculotendinous junction. Rotator cuff tear is the term commonly used by the general public to describe any detachment or tear of the tendons that connect that connect or attach the muscle from your shoulder to the head of the humerus. Stocking up on prepared foods or meal prepping in advance and freezing things, as well as scheduling services like house cleaning and laundry is also helpful. They usually present as a sharp pain at the outside or front of the shoulder, particularly with arm elevation (raising the arm to the side or front). I sleep fine as it does not hurt to lay on my back. The popping may or may not be related to your shoulder pain (difficult for me to say without an examination etc.) I plan on asking the surgeon these questions, but wanted your expert opinion. 5. Supraspinatus tear: If you want a chance for a full recovery surgery is your best option. Best to have a chat with your doctor. Just got my MRI report back on right shoulder and wanted to know if you could shed some light on it. With complete tears, the tendon has come off (detached) from where it was attached to the bone. 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. I have a second opinion on Monday. 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. It turns out, this management approach is not terribly effective in leading to a prompt repair of the damaged structures. Either way, don't be afraid to ask your surgeon lots of questions (likelihood of success in your case, what will happen after surgery, recovery time-frames etc.). Medicine and physiotherapy often. Thanks for stopping by and sharing your story. Top 6 Supraspinatus Exercises for Rehabbing an Injured Shoulder Hey DrMikeM doin some research and came across your sight and thought I'd add my two cents. 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. [1] Quite often, the tear occurs in the tendon or as an avulsion from the greater tuberosity. However, it is worth noting a common misconception about full thickness tears. 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. I experienced a fall on August 31, 2012. Those words exactly. 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. 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. It must have been quite a knock, there is some quite serious damage there. Overall function increased by 47.67% from pre-op to post-op3. I appreciate your thoughts on this matter. Your surgeon (and the anesthetist) will not want to perform elective orthopedic surgery while you are pregnant to re-attach the tendon. I have a feeling this is going to be a long recovery! Does the reverse shoulder arthroplasty and deltoid repair be a possible option of treatment? Because of the return of the recent pain, a another MRI was ordered and the Radiologist wrote: "1. I had subacromial decompression February 2010 a year after a motor vehicle injury (I am currently a 34 year old female). 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. Sleeping on my right side became impossible. The rotator cuff exercises should not cause pain while the exercise is being performed. You have a large tear (more than 3 cm) and the quality of the surrounding tissue is good, You have significant weakness and loss of function in your shoulder, Your tear was caused by a recent, acute injury. However, in some cases, the better option may be to consider surgery sooner rather than later (e.g. Gloria Freeman from Alabama USA on January 21, 2013: Hi lot of good info and tips here. 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 types of findings you have described are consistent with some quite substantial pathology in your shoulder. It is interesting that you are not experiencing a lot of discomfort with a very large tear, but this sometimes happens and can lead to difficulty in diagnosing the exact structural damage that is causing the condition. Rotator Cuff Tears: Causes, Symptoms & Treatment - Cleveland Clinic Glenohumeral joint effusion and finding may signify capsulosynovitis or perhaps capsular strain. I am really hoping to find some outside advice. I wish you a speedy and full recovery. Because of the risk of infection and and nerve damage. I returned to the orthopedic surgeon at which point he did an x-ray which looked good and sent for a mri Monday. Am I destined for surgery in order to regain even 50% of what I've loss or should I try another round of prolotherapy? 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. Good luck with it! The goal of any treatment is to reduce pain and restore function. It is the most common tendon to be damaged in the shoulder. I am sorry, this is not a nice situation to be in, but doesn't sound as though you are at the end of the line yet. I take anti-inflammatory meds for a long time for other problems, but it sure has not helped my arm. Large rotator cuff tear with early loss of the cartilage of . The surgeon may (or may not) want to try arthroscopic surgery to repair any damage or structural problems they can identify on an MRI. On the other hand, if your surgeon thought your tendon would be able to endure pregnancy and nursing your baby without the need for strong medications or the need for surgery, then this may influence your decision on timing for surgery etc. Full-thickness rotator cuff tear prevalence and correlation with function and co-morbidities in patients sixty-five years and older. Pain can also be brought on by laying on the side. Sorry for the delay, I have been away. Yes, the surgery will be over very quickly, but it is the rest of the recovery that takes time and effort (and a fair bit of frustration being careful to keep within the movement restrictions). I am really concerned about success rates for revision surgery. The objective of this review is to synthesize the best available evidence on the effectiveness of non-surgical and surgical treatment on the clinical and functional outcomes of elderly patients with full thickness rotator cuff tear. Rotator Cuff Tears in the. I was instructed to ice pack my shoulder and take it easy. Most people with ongoing pain will usually try the conservative interventions before considering surgery. Thanks for posting your question. Having the surgery sooner rather than later may help you to recover as much as possible by the time you fall pregnant. They may also examine your neck to makesure that the pain is not coming from a pinched nerve, and to rule out other conditions, such as arthritis. If they were consistent with each other it would seem remarkably unlikely that both reports were wrong. some loss of motion in your shoulder. That is some interesting advice you have received. I think it would be wise to listed to the advice from your doctor on this one! On the other hand, there is nothing speedy about recovery after surgery but at least there usually is recovery (albeit slow). Unfortunately I can't give you specific advice over the internet. It seems to be a long recovery period with a great deal of physical therapy following. A rotator cuff tear is a common cause of shoulder pain and disability among adults. Small tear involving the supraspinatus tendon only Fig. perhaps if delay is likely to lead to a complete rupture that could be prevented with early surgery). Rotator cuff tendon surgery and postoperative therapy. @anonymous: Thanks for sharing you story Marcia. Drugs, supplements, and natural remedies may have dangerous side effects. It was a small rotator cuff tear. 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. 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). Mike!! 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. Any thoughts? However, if no benefit has been observed after 6 weeks of PT, then discussion your options with your surgeon sounds like a good plan. Elderly patients; full thickness rotator cuff tear; non-surgical and surgical treatment. The tendons may tear from their attachment either after an injury such as a fall or from long-term wear and tear. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. Some people will recover quickly without any treatment, other people will recover after commencing non-surgical interventions (such as physical therapy and rotator cuff exercises and / or receiving a steroid injection), while others will still have pain after many months and may require surgery. You have asked for information about potential options. What happens to patients when we do not repair their cuff tears? Five 4. 23. These findings may guide clinicians to optimise loads, velocities and shoulder ranges . twice, second time relief only lasted 5 minutes) finally local doc ordered M.R.I. So probably worthwhile having a chat with your doctor and seeing what they recommend as a first step. Remember that you are not aiming for speed; slow, steady, and controlled movement is best. Your doctor should be able to explain your options and potential expected outcomes. Generally speaking, MRIs definitely help the surgeon to make a diagnosis and give them an idea of whether surgery will help. If youve experienced a rotator cuff tear, theres a good chance that it could be a supraspinatus tear. I took a not so graceful fall on a sidewalk about 9 weeks ago and landed on my shoulder. Think about all the times you lift your arms above shoulder height in a given day and try to rearrange your home accordingly. but unfortunately, the results were extremely minor. All material on this website is protected by copyright. I do not want a metal shoulder. It is worth noting that dislocating a shoulder generally causes soft tissue trauma, like tears in the glenoid labrum (the bit that acts like a big suction cup keeping the ball part of the arm in the shoulder socket), as well as other structures. Good luck! Some things to consider when you are discussing your options with a surgeon is the length of recovery time following surgery (likely to be months), consider time to return to work (also consider whether it it possible for you to return to light duties at work). I was an elite athlete most of my life and have accepted that I will no longer be able to return to my sport 100%. 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)! When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful. As far as general information goes, it is also worthwhile noting that chronic pain and inflammation at a joint can lead to secondary changes (weakening muscles, changes in the way the body processes pain etc.) Where required, authors of papers will be contacted to request for missing or additional data. Mary Kay. So it would seem strange that your surgeon would expect adhesive capsulitis to resolve with 6 weeks of physical therapy, unless you had already had the condition for many months and he had started to detect improvement? Here is a link to a recent academic journal article on the topic that should be free to access. 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. 18. If you are seeing the orthopedic surgeon it is a good idea to tell them about therapies you have received and about your persistent pain. It is also worth noting that sometimes you can do everything right (good surgery, follow instructions etc.) Painters, carpenters, and others who do overhead work also have a greater chance for tears. Any disagreements that arise will be resolved through discussion or with a third reviewer. Moderately large joint effusion. The chief advantage of nonsurgical treatment is that it avoids the major risks of surgery, such as: The disadvantages of nonsurgical treatment are: Your doctor may recommend surgery if your pain does not improve with nonsurgical methods. Over time, the pain may become more noticeable at rest and no longer goes away with medications. Jung HJ, Sim GB, Bae KH, Kekatpure AL, Chun JM, Jeon IH. I will congratulate you on actually doing your exercises! Starting with Physio treatment is a good idea. I am sorry I can't offer specific advice without a proper assessment, but seeing an orthopedic specialist or physical therapist in your local area sounds like a good idea. 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. I have had this problem with my shoulder/arm for about 6 months maybe. But not result in a normal shoulder. I left out a bunch of other things that are normal. My doctor has told me I need to have arthroscopic revision rotator cuff repair. Good luck! Wish me luck!!! The initial keywords include rotator cuff tear, full-thickness tear, elderly, conservative treatment and surgery: This review is to contribute to the completion of the Master of Clinical Science degree at The University of Adelaide, Adelaide, South Australia, for MN. Miller RM, Popchak A, Vyas D, Tashman S, Irrgang JJ, Musahl V, et al. For most people, it is usually preferable to lean on a bench or table rather than the seat of a chair. There is no conflict of interest in this project. There is a moderate amount of fluid distending the subdeltoid bursa maximal over the anterior aspect of supraspinatus and the rotator interval. Nonetheless, it worth noting that as a general principle, synovial fluid is very important and helps lubricate the joint. Large rotator cuff tear with poor quality tissue Fig. Treatment options, tips, knee surgery info, and medical videos are included. At a 10-year follow-up, tendon repair is superior to physiotherapy in the treatment of small and medium-sized rotator cuff tears. A full-thickness tear, which usually means the tendon is torn from its insertion on the humerus (the most common injury), is repaired directly to bone. If your tendon were to completely rupture while you were pregnant, this may be very problematic. Thanks for stopping by and sharing your story. Good luck! No, it may not be too late to get relief. Thanks to my hubby for finding this site. This study included patients with a repairable full-thickness tear of the supraspinatus tendon size < 5 cm. I'm sure it is no surprise to you, but when someone is experiencing worsening pain with conventional conservative management like physical therapy this is also not a good sign for a speedy recovery without surgery. 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. But not result in a normal shoulder. For more information, please refer to our Privacy Policy. She said she had never heard anything like that before and it was not my rotater cuff like everyone else believed. It would be particularly unusual for a radiologist to see a tear that was non-existent (perhaps more likely to miss one that was hard to see than to see one that is not there). left supraspinatus tendon tear,so what the process of curing? If they do cause pain, then it is important to check with the PT that the technique and level of resistance is appropriate for your condition. Another study found similar findings and reported that rotator cuff tear repair was much more successful in younger patients compared with an older cohort.23 Therefore, based on the evidence, treatment options that may be effective for younger patients may not necessarily provide the same results for elderly patients. 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. He says the tendon is fraying like a ropethat he would need to reattach to the bone. Supraspinatus tendon tears require specific rehabilitation of the rotator cuff and muscles that stabilize the shoulder blade. Some days later, I was called back to the VA so they could tell me what they found. If you research it it's a complicated operation that demands some of the best surgerical skills. There is no question that the word 'small' can be misleading regarding the amount of pain and discomfort that a supraspinatus tendon tear can cause. Time progressed, pain continued and my ROM slowly worsened. GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. Severe pain after. The comparators of interest will be non-surgical interventions against non-surgical interventions, non-surgical interventions against surgical interventions, and surgical interventions against surgical interventions. The most sensitive finding in full-thickness tears is thought to be the presence of fluid signal intensity in the location of the rotator cuff on fat-saturated T2-weighted or intermediate-weighted images 5. It was sometime in the early months of 2011 that I was sent off to have an MRI done. Although overuse tears caused by sports activity or overhead work also occur in younger people, most tears in young adults are caused by a traumatic injury, like a fall. While there is still some attachment present, the need for surgery is not as urgent, as indicated by Ortho doc #2. I all of a sudden lost all my strength in my right arm and dropped the box. Learn about different types of rib injuries and how they are treated.