From the information you have provided it is difficult to say whether surgery will be needed. 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)! Data is temporarily unavailable. It's been very frustrating dealing with the chronic pain and reduction of normal activities in an attempt to adapt to my "new normal". This will inform the development of a search strategy which will be tailored for each information source. If a medical doctor (assuming they have nothing to personally gain by referring you to another health professional) suggests something may work based on their years of training, in depth understanding of anatomy, physiology, common pathology, research evidence and clinical experience with many patients, it is usually worth considering what a family or friend (albeit that they are usually well meaning) is basing their opinion on. 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. Otherwise you will have signficantly reduced function (plus ongiong pain) in that shoulder. In most patients the supraspinatus tendon is the most vulnerable and 90% of rotator cuff tears involve this tendon. Schmidt CC, Jarrett CD, Brown BT. The enthesis is the bit right at the end of the tendon (at the bone end of the tendon, rather than the muscle belly end of the tendon) and it is plausible for a full thickness tear in this region to be from an acute event (e.g. So my tear went from a near full thickness tear to a full thickness tear. It is difficult for me to comment further based on this information. There are several video examples to accompany the written explanation. Anyone want to shed a little light for a vet? Re-attaching the tendon to the bone as you have described is a substantial surgery, the first months of recovery after this type of surgery are very important to ensure that the tendon does not detach / rupture and optimal recovery can occur. Shoulder function, measured by shoulder-specific scales including but not limited to ASES, Simple Shoulder Test, UCLA shoulder scoring scale. It did manage to decrease my overall pain but I still feel like I'm suffering unnecessarily. Please try again soon. @anonymous: Thanks for keeping us up to date. The recovery time after surgery is substantial (and may vary depending on the surgeon, and specific structures repaired). Your doctor should be able to explain your options and potential expected outcomes. Mary Kay. Good luck with it. @will-nelson-790693: Hi Will, Thanks for stopping by and sharing your experience. Risk of infection and nerve damage are worthy of consideration for any surgery, particularly one as involved as a reverse shoulder replacement. 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. I see this is true of SSGtomn who has left a comment already. 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. A systematic review in 2012 set out to identify which treatment, surgical or non-surgical, provided the best results for elderly patients with full-thickness rotator cuff tears.25 The reviewers concluded there could be improved outcomes with surgical patients; however, heterogeneity of the studies and risk of bias made it difficult to make a definitive conclusion on the best treatment approach. Some people will say that exercises didn't work for them, but it turns out actually doing the exercises (rather than just thinking about them) drastically increases the chance of them being effective! When a radiologist looks at an MRI scan, he or she must make a judgment about the type of the rotator cuff changes. Thanks for the update and let us know how you go. My arm is very weak. Thanks to my hubby for finding this site. It is located in the top portion of the back of the shoulder blade (the superior posterior portion above the spine of the scapula) known as the supraspinatus fossa. If you are seeing a physio for this condition, they should be able to provide you some good information about the post-surgery protocols that surgeons in your local area will be likely to prescribe. I'm experiencing the exact same pain you described, and the Army doc told me I was too young to tear a rotator cuff. This is a good example of why MRI's can be very valuable in cases like this. All material on this website is protected by copyright. Good luck! Supraspinatus is the most commonly injured rotator cuff tendon. Also an ex ray of my shoulder "Demonstrate my humeral head close to abutting my acromion. The supraspinatus tendon has a tendency to weaken with age and become prone to tendon tears. There is fluid distending the long head of the biceps tendon sheath, representing tenosynovitis. Children are such a blessing and that time nursing your newborn is such a special and important time. That way you can make an informed decision in consultation with advice from your doctor. 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. I get asked about this a lot, perhaps I should write a page on rehabilitation following surgical repair of supraspinatus tendon tears! Many people with supraspinatus tears receive very good relief following a period of PT, but others do not. Humeral head is riding high abutting the underside of the acromin process. Pain continued and got worse. When they try to suture through fatty tissue, it just tears right through. 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. This will help you figure out what you are deciding between. The reverse shoulder surgery is extremely involved so I am getting a second opinion. Supraspinatus tendon tears require specific rehabilitation of the rotator cuff and muscles that stabilize the shoulder blade. (Right) A full-thickness tear in the supraspinatus tendon. It must have been quite a knock, there is some quite serious damage there. I'm not sure whether the doctor you mentioned is a family physician / general practitioner or an orthopedic consultant / surgeon. Poorly defined large full-thickness tear of the supraspinatus and infraspinatus tendon measuring at least 2 cm in anteroposterior dimension. Data will be extracted from papers included in the review using standardized data extraction tools in JBI SUMARI.26 The data extracted will include specific details about the populations, interventions, study methods and outcomes of significance to the review question and objectives. This is partly because rehabilitation following surgery will depend on the surgical technique used. I say promising because work in basic science and animal studies have demonstrated some quite promising findings. I have full range of motion and only occasional soreness now and again, but can't sleep on that side. Now I have these results stated above. Geary MB, Elfar JC. After 4 months of therapy and 3 injections I am unable to lift my right arm. The soft tissues in their neck that were affected by the initial trauma may actually have healed, but they may still be feeling discomfort. I am now off again to another specialist as the 2nd opinion specialist said there was not much he could do to improve the situation! 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. 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. It's a supraspinatus tendon tear with 50% thickness and no labral tear. Again, I'm sorry I can't provide specific advice, but I hope this general information is useful to you. Over-the-counter medication, such as aspirin, ibuprofen, or naproxen, may relieve the pain. Yes, also a good idea about discussing with your surgeon the potential risks or benefits from delaying surgery in your case. Mild AC arthropathy. Make sure you ask the orthopedic surgeon about what to expect after the surgery and the likely recovery time. In some cases, surgery to repair the tendon is also required. I don't know what exactly to do, or what my REALISTIC problem could be. 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. Thanks for stopping by and sharing your story. if your initial injury was work related. Even if surgery is required, the physical therapy program can help strengthen the rotator cuff muscles before the surgery. However, there are certainly injuries and structures other than rotator cuff tears that can cause some of the symptoms Tim described above. This information is provided as an educational service and is not intended to serve as medical advice. I plan on asking the surgeon these questions, but wanted your expert opinion. Berth A, Neumann W, Awiszus F, Pap G. Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair. Generally speaking, do small tears need surgical repair? Very much appreciated. This can occur due to trauma or repeated micro-trauma and present as a partial or full-thickness tear. 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). 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. When you speak to your doctor and discuss your plan for treatment, make sure you discuss any relevant work / sport related activities so you both know what to expect. Read More 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? Being referrfed to a shoulder specialist Tuesday. A few months ago it seemed to hurt more and I had problems lifting my arm out or above my head. If you research it it's a complicated operation that demands some of the best surgerical skills. Management of Rotator Cuff Tears. The incident happened on Sept 25 and it is now Nov 10. 6. I just had an MRI I have a tiny, focal intratendon tear of the supraspinatus fibers at the humeral insertion measuring 2mm with minor impingement changes are noted in the greater tuberosity of the humerus. However, some people will never experience the same level of recovery without the surgery. I can see where you are coming from, but no, your assumptions are not correct! I was referred to a surgeon who stated that they could not repair the rotator cuff due to the size of the tear from a surgical standpoint. Some simple tests during a physical examination should enable your doctor to determine whether your symptoms are likely to improved with a surgical repair of the tendon. If it hasn't resolved with time, then some kind of intervention (whether physical therapy, surgery etc.) A degenerative tear is the opposite instead of a single catastrophic episode or trauma to the shoulder, these tears are the result of damage and wear on the joint slowly over time. However, trauma (such as sporting injuries or motor vehicle accidents) can cause tears amongst people of any age. However, I can just mention some general information that may be of interest. Acute Tear If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. some loss of motion in your shoulder. Generally, if an injury is going to heal on it's own, it gets better over time, unless it is re-injured. Thank you. 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. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time. The surgeon(s) who ordered the imaging are usually the best person to speak with regarding the pros and cons in any particular case. Sorry we are unable to give specific advice over the internet, but I hope this general information is helpful! 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. Rotator cuff surgery in patients older than 75 years with large and massive tears. The plastic surgeon gave me 3 options, leave it be and it would only get worse as i age, cortisone shots which is just temp obviously or fix it.. should i get another mri to see if its healed some, i have got partial thickness insertional tear in supraspinatus 9mm*5mm. old I was in good physical shape as a letter carrier(28 yrs) but have been mostly sedentary recovering from the first surgery. I was released from the P.T. Osti L, Buda M, Buono AD, Osti R, Massari L. Clinical evidence in the treatment of rotator cuff tears with hyaluronic acid. What I really want right now is to regain enough to get through normal everyday activities and not feel limited trying to lift an object and also not drop things so frequently. 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. On the other hand, if surgery is inevitable or at least the most likely outcome, then the treating doctor / surgeon(s) may recommend early surgery. I'm not really sure how the whole army doctor situation works while you are on deployment, but I think if you have ongoing symptoms then it is worth making sure the appropriate people know. I can reach behind my back ok. I plan on asking the surgeon these questions, but wanted your expert opinion. Men over forty are the most likely to have degenerative supraspinatus tears. Is surgery my only option? The databases to be searched include: CINAHL, Scopus, MEDLINE (PubMed), Embase, Web of Science and PEDro. The best treatment option for alleviation of pain and restored shoulder function in the elderly is still debated.8 Studies have shown satisfactory healing and promising clinical outcomes following surgical repair. If youve experienced acute damage or a recent shoulder injury, or are otherwise experiencing pain in your shoulder or rotator cuff area, consult your doctor and an orthopaedic surgeon as soon as possible, particularly if you work in a field, play a sport, or have a hobby that involves lots of overhead lifting and repetitive arm motions. He kind of scared me regarding the recovery for this. Having the surgery sooner rather than later may help you to recover as much as possible by the time you fall pregnant. Moderately large joint effusion. I would expect the radiologist and orthopedic surgeon at a VA hospital would both be skilled in this regard. 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). It is also worth mentioning that not all PTs are created equal. But not result in a normal shoulder. Drugs, supplements, and natural remedies may have dangerous side effects. Sometimes, it is difficult to tell from people recalling what happened whether a shoulder has been dislocated. Had periods of pain go from the back of my shoulder down my arm like before. Thanks for stopping by and sharing your story. Information on this topic is also available as an, from the American Academy of Orthopaedic Surgeons, Nonsteroidal anti-inflammatory drugs (NSAIDs), Rotator Cuff Injuries - Clinical Practice Guideline (CPG) | American Academy of Orthopaedic Surgeons (aaos.org), When only a small part of the tendon is detached from the bone, it is referred to as a, When a tendon is completely detached from the bone, it is referred to as a, Pain at rest and at night, particularly if lying on the affected shoulder, Pain when lifting and lowering your arm or with specific movements, Weakness when lifting or rotating your arm, Crepitus, or a crackling sensation, when moving your shoulder in certain positions. So while surgery always carries some risks (which your surgeon will be able to explain), for some people this is the only option to experience a good outcome. The rotator cuff tendons cover the head of the humerus (upper arm bone), helping you to raise and rotate your arm. Especially since my injury has gotten worse instead of better. Bae KH, Kim JW, Kim TK, Kweon SH, Kang HJ, Kim JY, et al. Of course, if you feel you cannot have an open and honest discussion about the pros and cons of surgery in your particular case with your surgeon, dont be afraid to seek a second independent opinion from another specialist. It has been associated with older age and osteoarthritis, but often seems to occur when there is extra fluid in the gleno-humeral (ball and socket) joint. )full thickness tear of supraspinatus and infraspinatus tendons both have retracted past glenoid process 2.) Good luck! X-rays are often not very useful in diagnosing shoulder injuries. 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. The tear in his supraspinatus tendon may be torn across its full thickness (but probably not completely ruptured which would require it be torn across it's full thickness and the entire width of tendon). GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. I have continued to have problems with my arm and initially was told that I had a partial tear of my rotator cuff. Again, because your case is not straightforward, seeking advice from your surgeon(s) in this regard is certainly wise. 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. Sorry for the delay in response. It was a small rotator cuff tear. An initial limited search of PubMed and CINAHL will be undertaken. Depending on the severity of your shoulder tear and other injuries, your age, general health, and lifestyle, it might be possible to alleviate the pain and minimize the issues resulting from a supraspinatus year through a combination of non-invasive tactics like medication and physiotherapy.
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