Kim SH, Ha KI, Park JH, Kang JS, Oh SK, Oh I. Arthroscopic versus mini-open salvage repair of the rotator cuff tear: outcome analysis at 2 to 6 years follow-up. I am 67 years old and am an artist and my left arm which is the one in question is my dominate arm. 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. The search strategy will aim to find both published and unpublished studies. However, your doctor may also suggest surgery if you are very active and/or use your arms for overhead work or sports. Thanks for stopping by and leaving a comment. I have had shoulder pain for years and years. 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 Surgery: How it Works, Recovery Time | HSS The classic full thickness rotator cuff tendon tear involves the supraspinatus and then progresses to involve the long head of biceps, followed by the infraspinatus and subscapularis. I can say though that PT's are trained to help people with painful ROM. The pain and weakness in the shoulder may make routine activities, such as combing your hair or reaching behind your back, more difficult. Are you experiencing rib pain? No, it may not be too late to get relief. I will surf again! Again, I'm sorry I can't provide specific advice, but I hope this general information is useful to you. If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. Best to have a chat with your doctor. Other tests which may help your doctor confirm your diagnosis include: If you have a rotator cuff tear and keep using it despite increasing pain, you may cause further damage. Sorry we are unable to give specific advice over the internet, but I hope this general information is helpful! Read More 19. What we often don't see is the subsequent shoulder surgery and months of rehabilitation (sometimes in the off-season) to repair the damaged structures. There is certainly good clinical research evidence indicating that arthroscopic surgery can help the types of injuries you described. Most people with ongoing pain will usually try the conservative interventions before considering surgery. I am close to retirement and I am afraid I will not be able to do the things I once enjoyed, outdoor activities. My arm was nearly frozen for a period of about 10 minutes, but I slowly started regaining some ROM. Good luck! A full-thickness tear will decrease the capacity of a muscle to do work. Thanks for sharing this detailed account with everyone. These four muscles (supraspinatus, infraspinatus, subscapularis, and teres minor) stabilize the glenohumeral joint, enable rotation around the joint, and provide a counterforce to . I just received my MRI report which states : supraspinatus tendon is thickened and immediate in signal, with a small 3mm (transverse) x 3mm (AP) full thickness footplate tear. When the supraspinatus tendon is torn but not completely ruptured, usually a period of conservative management with a physical therapy program will be trialed rather than rushing into surgery. 7. You should also move commonly used items to lower shelves or drawers or similar easy-to-access spots, since its going to be a while before you regain your previous range of movement. I sleep fine as it does not hurt to lay on my back. but can get back fairly good motion about the shoulder . Supraspinatus Tear - Symptoms, Causes, Treatment & Rehabilitation 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? After 4 months of therapy and 3 injections I am unable to lift my right arm. Three techniques are used for rotator cuff repair: Traditional open repair Mini-open repair Arthroscopic repair Your orthopaedic surgeon can recommend which technique is best for you. 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. Following the post-surgery protocol will help minimize the chance of a poor outcome and further problems. Its often accompanied by other tears in the muscles that make up the rotator cuff. There may also be insurance implications etc. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. However, to date, I am not aware of any rigorous large-scale clinical trials that have demonstrated effectiveness (or otherwise) in humans. I have a second opinion on Monday. The rotator cuff exercises should not cause pain while the exercise is being performed. Most of the time, it is accompanied by another rotator cuff muscle tear. There are other things your physical therapist may be able to help you with to give you some relief in the short term. I don't think there is a clear answer to this one. Come September of 2010 I chose not to re-enlist and returned home. 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. In my reports say that I have less fluid and possible tear. What happens to patients when we do not repair their cuff tears? Five You mentioned rotator cuff and tendonosis like they were different things. 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 am really concerned about success rates for revision surgery. However, in some cases, the better option may be to consider surgery sooner rather than later (e.g. Supraspinatus tendon tears are the most common tendon tear in the shoulder region. I slept in a recliner for about 2 1/2 months following surgery (I don't think I slept at all before surgery :) ). This surgical method is a simple and effective I served in the Navy for many years, and in April of 2010 I had a little mishap. It is difficult to know whether your husband will need surgery based on this information alone. pain that increases with shoulder use. Thanks for stopping by and sharing your story. Mary Kay. Joanna Briggs Institute. 2. mild labral degeneration. A proposed search strategy for PubMed is detailed in Appendix I. some loss of motion in your shoulder. I don't lay on the side of the hurt arm as I don't think it will be good for it. old I was in good physical shape as a letter carrier(28 yrs) but have been mostly sedentary recovering from the first surgery. damage to the tendon without swelling). I am unable to carry any significant weight. I have been diagnosed with a tear of the supraspinatus tendon by exam and u/s. Rotator Cuff Tears in the. In some cases, surgery to repair the tendon is also required. Lol. @anonymous: Thanks for keeping us up to date. Your doctor should be able to explain your options and potential expected outcomes. 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)! This may give you relief, even if you have been getting symptoms for a few years. Because of the return of the recent pain, a another MRI was ordered and the Radiologist wrote: "1. It sounds like you are on the right track with your surgeon and physical therapist. Mild surface irregularity of the supraspinatus in keeping with scuffing-mild partial thickness bursal surface tearing. Jung HJ, Sim GB, Bae KH, Kekatpure AL, Chun JM, Jeon IH. Good luck! Full-thickness rotator cuff tear prevalence and correlation with function and co-morbidities in patients sixty-five years and older. pain at night. To be as specific as I can, It feels like someone shoved a knife right into the top of my shoulder blade and right down inside my shoulder. It was then I found out how messed up my shoulder actually is 1. 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. I'm quite apprehensive and nervous about the surgery but more so about the recovery. 11. 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. Titles and abstracts will then be screened by one reviewer for assessment against the inclusion criteria for the review. These tears, however, may still result in arm weakness and other symptoms. 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. The rehabilitation after surgery is likely to take time. My question to you is why can they not try to repair the rotator cuff using a graft of somesort. This article discusses shoulder impingement, rotator cuff rehabilitation exercises, and surgical considerations relating to rotator cuff tears and the supraspinatus tendon in particular. 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. 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. The majority of these tears occur amongst people over the age of 40. Lots of people express feeling useless, frustrated, and angry at times. 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. 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. 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). its been three months with some pt but no noticeable improvement. 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. However, in some cases it is clear that surgery is likely to be the best option. @pawpaw911: Hi Pawpaw911, thanks for dropping by. What little I have done has given me improvement. I think these are promising approaches for the types of pathology you described. Thanks for stopping by. 22. Does the reverse shoulder arthroplasty and deltoid repair be a possible option of treatment? People who have partial thickness supraspinatus tendon tears following a fall or mechanical trauma often report similar symptoms to people with whiplash associated disorders (aka whiplash). Is It a Full-Thickness or a Partial-Thickness Tear of the Rotator Cuff? It gets weak and tired pretty quickly, I can't sleep on my side and it aches all the time. Sounds like no guarantee of 100% return to normal, and I'm about 95% now, not to mention a lengthy recovery. ), while others do not. Productive acromioclavicular joint changes are associated with an anterolaterally down sloping type II acromial configuration. I am 55 and active, so I don't want to hurt my "golden" years, so I am not sure what to think. Particularly about what many people are likely to experience during the often long road to recovery. The reverse shoulder surgery is extremely involved so I am getting a second opinion. I could write another article regarding shoulder surgery for rotator cuff tears (perhaps another day!). Studies published from 2010 up to present will be included, as the review conducted by Downie, B. et al. It may take a while to overcome your shoulder pain, and you may even need to modify the types of activities you do, but working hard to be able to return to exercise is definitely a worthwhile goal. Don't be afraid to ask lots of questions about what is likely to happen if you do or don't have surgery. Thanks for stopping by and leaving a comment. My question to you is why can they not try and repair the rotator cuff using a graft of somesort. So quite often the best treatment approach is not always immediately clear. He did say that it can be done in the next few months and no urgent intervention required. The acriomioclavicular joint usually should have some fluid that helps lubricate the joint, but when it is specifically mentioned in an imaging report (like an MRI report), they are usually indicating that there are able to see more fluid then one might usually expect (in someone without any shoulder pathology). to maintaining your privacy and will not share your personal information without 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. I had a fall at my workplace and was suffering neck and shoulder pain. First, sorry for the delay in response. 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. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful. 13. 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. Critical appraisal instruments are available from the Joanna Briggs Institute Reviewers Manual.26 All studies, regardless of their methodological quality, will undergo data extraction and synthesis. 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. When getting a second opinion from another surgeon. The results showed a "partial tear of the supraspinatus tendon, with large swelling and irritation". The supraspinatous is one of the 4 muscles that make u. @anonymous: Thanks for sharing you story Marcia. There is compromise of the subacromial space with impression on the underlying torn supraspinatus. 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. It sounds like the damage is fairly minor in my shoulder yet I have a great deal of discomfort and limited ROM 2 1/2 months after my fall. 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.). From my perspective, I have seen many patients with supraspinatus tendinosis who have benefited a great deal from physical therapy (but nothing is certain, and some patients may not receive great benefit and require a different intervention). So probably worthwhile having a chat with your doctor and seeing what they recommend as a first step. 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. I also have an intermediate grade partial thickness tear of superior tendon bundle of Subscapularis without retraction or muscular atrophy. 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. 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). !!! will consult surgeon next week. 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. If pregnant or nursing, consult with a qualified provider on an individual basis. Whiplash is more difficult to detect with common imaging approaches, like an MRI, than supraspinatus tendon tears. Must also have to bring the arm back with my other arm if I am lying and have the arm overheadwhich now longer will lie flat on the floor if it is overhead.It has been recommende to do ART then PRP and possibly prolotherapy. Good luck! I am sorry, I can't give you specific advice over the internet about whether you will need surgery or not. 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. Thanks for the update and let us know how you go. I received my first steroid injection treatment during the summer of 2011 and went through a lengthy 6 moth physical therapy treatment. I'm sorry I can't give you specific advice about your situation, if you are unsure of which advice from your two doctors is correct a third opinion may help you make sense of it. Physiotherapy interventions typically consist of stretching and strengthening exercises but can also include electrotherapy and other physical modalities such as ultrasound, moist heat and laser therapy.16-19 Treatment by injections in recent studies often involves corticosteroids, hyaluronic acid and platelet-rich plasma.20-22 The literature suggests that the majority of patients begin with non-surgical treatment and if pain persists or improvement in function is less than optimal, surgery is considered. Time passed. Hi, I have had a partial supraspintus tear for 3 years now, and am wondering if it's too late to anything about it? 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. Mike!! Rotator Cuff Tears: Surgical Treatment Options, Rotator Cuff Tears: Frequently Asked Questions, Shoulder Impingement/Rotator Cuff Tendinitis. Even if surgery is required, the physical therapy program can help strengthen the rotator cuff muscles before the surgery. She said she had never heard anything like that before and it was not my rotater cuff like everyone else believed. A torn rotator cuff may weaken your shoulder. We will also discuss surgical interventions for tendon injuries. It is also worth mentioning that not all PTs are created equal. 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. I think it would be wise to listed to the advice from your doctor on this one! Being deployed and not receiving treatment makes it difficult. Good luck! 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. My best wishes go to all of them. Also, don't be afraid to ask doctors / surgeons lots of questions. @anonymous: Hi Donna, I am sorry to hear about this trouble you are having with your shoulder. Seek immediate help if you are experiencing a medical emergency. A full-thickness tear is when the wear in the tendon goes all the way through the tendon. Following an iltrasound scan I have been told I have a tear of the supraspinatus tendon and there is some retraction. But not result in a normal shoulder. 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? Management of rotator cuff tears can broadly be divided into surgical and non-surgical treatment.8 Surgical treatments include arthroscopic repairs, open repairs, mini open repairs, tendon reconstruction and reverse shoulder arthroplasty.11-15 Non-surgical treatments consist of physiotherapy or injection. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010. This study included patients with a repairable full-thickness tear of the supraspinatus tendon size < 5 cm. 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. Having the surgery sooner rather than later may help you to recover as much as possible by the time you fall pregnant. 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. The reverse shoulder surgery is extremely involved so I am getting a second opinion. Save my name, email, and website in this browser for the next time I comment. Had mild discomfort in shoulder for a few weeks in August. All Rights Reserved. List of pain and limited mobility for about a week. Treatment options, tips, knee surgery info, and medical videos are included. 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. Grade 1 strain of the lateral deltoid muscle and teres minor muscle. However, it sounds as though you must be under the care of a medical team in order to have received MRI results, which is a good thing. I'll go check out some of your lenses now. When a radiologist looks at an MRI scan, he or she must make a judgment about the type of the rotator cuff changes. Old age is also a major factor in supraspinatus tears; in fact, over 50% of people over seventy years old have a supraspinatus tear when they pass. Supraspinatus full thickness tendon tear - surgery - Patient Several factors contribute to degenerative, or chronic, rotator cuff tears. Here are the causes and treatments. How do you repair a rotator cuff tear? Where required, authors of papers will be contacted to request for missing or additional data. 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. In the interim, physio, chiro, massage, taping were part of my pain management and ROM for all pain sites relating to MVA. It sounds like you have several concerning symptoms there. Some studies suggest that young patients with traumatic tears may be best managed with surgery while many atraumatic rotator cuff tears, which is common in older patients, may be amenable to a non-surgical treatment.4 In addition, compared to younger patients (<50), rotator cuff tears in older patients (>70) are characterized by greater retraction in the frontal plane and greater fatty infiltration.6 A study showed that only 82.5% of rotator cuff tear patients older than 70 who exhibited these features had supraspinatus involvement and underwent arthroscopic rotator cuff repair achieved complete healing, compared to 95% in patients under 50. Am I destined for surgery in order to regain even 50% of what I've loss or should I try another round of prolotherapy? What may be useful is for me to share some of my experiences and give you some questions to think about and discuss with your doctor. They decided to do a re examination of my MRI to see if there was something they were missing. They do reveal most substantial soft tissue injuries, but they are only as useful as the person interpreting them is skilled. Your physical therapist should be able to help you improve the strength and functioning of your rotator cuff muscles. It is good that you have discussed the recovery with your surgeon already. It's very good of you to reply so promptly and clearly though. The technicians wont say more and nor will my doctor. 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). Unfortunately I can't give you specific advice over the internet, without conducting a physical examination etc. Thanks for stopping by and leaving a comment. Good luck! I think this is a common dilemma that people face. 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. While I can't give you specific advice over the internet, it sounds like you are doing a great job following the recommednations of your doctors. 2019;101(12):1050-60. If in doubt, don't be afraid to ask Ortho doc #2 about any questions or concerns you might have. Once the full thickness of the tendon is torn, we classify the tears based upon the shape and the number of tendons involved. If I need surgery,what is the recovry time.. This information is provided as an educational service and is not intended to serve as medical advice. I'm sorry I can't provide you with specific advice, rather I only provide some general information. There are two main causes of rotator cuff tears: injury and wear (degeneration). 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. All the best. I have full range of motion and only occasional soreness now and again, but can't sleep on that side. 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. An easy way to understand what I mean is to think about eating a steak. 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). Good luck! It extends slightly into the proximal subscapularis bursa. @DrMikeM: Thank you Dr. Mike for answering my question. Generally speaking, MRIs definitely help the surgeon to make a diagnosis and give them an idea of whether surgery will help. and seemed to be doing ok with Cortisone shots. Supraspinatus Tear Causes & Treatment - Melbourne Arm Clinic Especially since my injury has gotten worse instead of better. 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. Sometimes, it is difficult to tell from people recalling what happened whether a shoulder has been dislocated. Massage may give you some short term relief, but I'm not sure massage on its own will have long term benefit that is additional to natural healing. I see this is true of SSGtomn who has left a comment already. Of course, all these options should involve regular check-ups with your orthopaedic surgeon in order to make sure the problem isnt getting worse. It is certainly worth discussing a more conservative approach, such as seeing a physical therapist that specializes in shoulders, with your orthopedic surgeon; particularly if you feel you have noticed improvements previously. This sounds like a difficult situation. All material on this website is protected by copyright. Rotator cuff exercises will usually be important for anyone looking to return to a racket sport following a supraspinatus tendon tear or shoulder labrum tear (or even someone looking to prevent those injuries). @anonymous: Hi Hans, Thanks for stopping by and sharing your story. 2. 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. 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). I work construction and am self employed. It will also get you back to your normal routine quicker. 2023 Melbourne Arm Clinic. 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. Rotator Cuff and Shoulder Conditioning Program, Rotator Cuff and Shoulder Rehabilitation Exercises.
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