People who do repetitive lifting or overhead activities are also at risk for rotator cuff tears. They may be perfectly justified in their opinion, but if their opinion is based on one or two other specific cases that they know of (or perhaps their own bad experience), it would be a shame to miss out on receiving some potential benefit because a well meaning friend or family is not as well informed on the topic as they may think. A proposed search strategy for PubMed is detailed in Appendix I. Full-thickness rotator cuff tear prevalence and correlation with function and co-morbidities in patients sixty-five years and older. They will check for other problems with your shoulder joint. Your surgeon (and the anesthetist) will not want to perform elective orthopedic surgery while you are pregnant to re-attach the tendon. I experienced a fall on August 31, 2012. 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. 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. The Arena Media Brands, LLC and respective content providers to this website may receive compensation for some links to products and services on this website. 13. When the most effective non-surgical interventions (such as physical therapy) have not been able to provide sufficient relief of symptoms, then arthroscopic shoulder surgery is often considered. left supraspinatus tendon tear,so what the process of curing? 6 months ago a different ortho diagnosed the problem as frozen shoulder and gave me a cortizone shot followed by physio therapy for few weeks. 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. (Left) The front view of a normal rotator cuff. Geary MB, Elfar JC. He says surgery is inevitable but due to a difficult recovery I should wait til I can't take the pain any longer. Just be aware that even in the best cases, the recovery time following surgery requires months (not weeks) so if you go ahead with the surgery don't be discouraged if you still have some pain in the first weeks after the surgery. 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. It is also worth mentioning that not all PTs are created equal. Some days later, I was called back to the VA so they could tell me what they found. Good luck with your decision! Have had physical therapy for 3 weeks with pain becoming worse so physical therapist suggested to dr. MRI of shoulder. Each year, almost 2 million people in the United States visit their doctors because of rotator cuff tears. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful. An important thing to consider (as you have correctly mentioned) is that a reverse shoulder replacement is probably unlikely to restore normal shoulder function and resolve the pain if substantial soft tissue problems are still present in the tendons around the shoulder. From my experience, orthopedic surgeons are not usually eager to perform surgery for something like this unless they think there is a good chance of a favorable outcome. Most people who do have surgery experience acute pain during the first few days (although the acute pain medications usually help with this). Some minor tears may be treated without surgery. In September '12 I had surgery to reattach both the right rotator supra and infraspinatus with excellent results. 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. 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. shoulder weakness. Rotator cuff tendon surgery and postoperative therapy. I have continued to have problems with my arm and initially was told that I had a partial tear of my rotator cuff. There are several video examples to accompany the written explanation. I was in a car accident about 18 months ago with damage to my left side of my body, stated with my fingers, to my leg and lastly my arm. Titles and abstracts will then be screened by one reviewer for assessment against the inclusion criteria for the review. Now I have these results stated above. Continue to next page:Rotator Cuff Tears: Surgical Treatment Options, To assist doctors in the management of rotator cuff tears, the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. or should you just ask for their opinion with no outside information> Thanks Judy. Degeneration of the infraspinatus tendon with bursa side fraying. On one hand, I want the second opinion to be formulated entirely based on my case information (not on what another surgeon did or did not recommend). Cause There are two main causes of rotator cuff tears: injury and wear (degeneration). Surgical repairs can be compromised when post-operative instructions are not followed, so if you have surgery make sure you know exactly what you should and should not do! It is also worth knowing there are just some jobs that seem to take a heavy toll on shoulders / supraspinatus tendons (unfortunately I think painter / sheet rock installer / any occupation where you need to hold things up above shoulder or head height are right at the top of that list). The supraspinatus is one of the four muscles that make up the rotator cuff group of muscles. I am 67 years old and am an artist and my left arm which is the one in question is my dominate arm. That is some interesting advice you have received. Physical examinations, imaging tests like X-rays, magnetic resonance imaging (MRIs), and ultrasound scans are all used to diagnose supraspinatus tears. Drugs, supplements, and natural remedies may have dangerous side effects. Had mild discomfort in shoulder for a few weeks in August. It is also very interesting to note that for those people who have persistent whiplash symptoms there is often a change in the way their brain processes sensation from the neck and shoulder region. In general terms of the types of MRI findings you have described, a combination of these types of pathology could require surgery; particularly if symptoms persisted after trying non-surgical interventions. 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! However, trauma (such as sporting injuries or motor vehicle accidents) can cause tears amongst people of any age. Tearing can be caused by atraumatic tears due to overuse and longstanding degeneration.4 Tear enlargement can occur due to increasing age.2 Patients who experience enlarging rotator cuff tears are five times more likely to develop symptoms than those with tears that remain the same.2 Older individuals have progressively become more active, increasing the chances of sustaining large and massive rotator cuff tears. I wear an arm sling a lot to relieve weight from my shoulder, which helps to some degree. 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. If you have only seen your family physician or general practitioner so far it would be a good idea to ask them about a referral to an orthopedic specialist who primarily treats patients with shoulder conditions. What do you think of the other therapies? Thanks for posting your question. Dr Mike, Please help me understand what options I might have in my case of job relater incident. 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. 1. Am I destined for surgery in order to regain even 50% of what I've loss or should I try another round of prolotherapy? Other signs that surgery may be a good option for you include: Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone). I plan on asking the surgeon these questions, but wanted your expert opinion. i d glad if ortopedist or physiotherapist reply ansver. The first relates to the potential risk of a poorer outcome due to the delay; this may occur due to further damage being caused in structures that are difficult or impossible to repair etc. But not result in a normal shoulder. Read More As I said been dealing with this for about nine months and in that time have run the gamut of treatment. From a mechanical point of view the muscles and soft tissues around the shoulder do an amazing job to keep the head of the humerus (ball) in the small glenoid fossa (bony component of the socket)! Partial tears can be just 1 millimeter deep (only about 10 percent of a tendon), or can be 50 percent or deeper. In most rotator cuff tears, the tendon is torn away from the bone. 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. For more information, please refer to our Privacy Policy. I'm quite apprehensive and nervous about the surgery but more so about the recovery. It is difficult for me to comment further based on this information. 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. When a radiologist looks at an MRI scan, he or she must make a judgment about the type of the rotator cuff changes. I've only got a couple of minutes, so I'll keep this short. 17. 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. In layman terms, I would say this means your supraspinatus tendon has probably been irritated for quite a while, and has a small tear near where it attaches to the bone (but tendon is currently still attached). For more information: Rotator Cuff Injuries - Clinical Practice Guideline (CPG) | American Academy of Orthopaedic Surgeons (aaos.org). My husband just had and MRI and it showed a Nonretracted small insertion full-thickness tear of the supraspinatus tendon. This sounds like quite a pain (literally). Of the eight studies included in the review, seven focused on surgical treatment and one compared the efficacy of sodium hyaluronate against corticosteroid injection. damage to the tendon without swelling). I just found out this week that I have Bursitis, and a tear in my Supraspinatus. Here are the best Nike shoes for heel pain when you have this uncomfortable condition. I understand most of it but I was wondering is there supposed to be fluid in the acromioclavicular joint. If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. What does he mean by my tendon is failing? Exercise is important for many reasons (not the least of which are physical and mental health benefits). That way you can make an informed decision in consultation with advice from your doctor. It can reduce (relocate back into the socket) long before someone makes it to a hospital (or an onboard medic!) 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. I received my first steroid injection treatment during the summer of 2011 and went through a lengthy 6 moth physical therapy treatment. The challenge lies in identifying patients with the greatest chance for a successful repair and optimizing timing such that the tear does not progress to a point of irreparability.8. 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. 19. This degeneration naturally occurs as we age and in most cases is relatively painless. 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. 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. Nonsurgical treatment options may include: A cortisone injection may relieve painful symptoms. Sorry for the delay, I have been away. I guarantee you will not be the last person to read this page wondering about a difference in doctor opinion or trying to figure out whether they have a supraspinatus tendon tear or adhesive capsulitis (or surgery versus no surgery). There is some spurring at the glenoid articular surface. That means it becomes more like fatty tissue. Selected studies will be critically appraised by two independent reviewers using standardized critical appraisal instruments from JBI SUMARI. Examination otherwise demonstrates the osseous structures of the shoulder to be otherwise unremarkable in signal and morphology. If they suggest surgery, ask them about what you can expect after surgery and the likely recovery time (including how long it is likely to be before you can use your arm for normal occupational or day to day activities). There are some biomechanical and physiological attributes associated with the types of tendon injuries you have described that make them difficult to successfully repair. Because of the risk of infection and and nerve damage. 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. From the information you have provided it is difficult to say whether surgery will be needed. I have been seeing an orthopedic doctor for the past 18 months. I returned to the orthopedic surgeon at which point he did an x-ray which looked good and sent for a mri Monday. 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. Unfortunately I can't give you specific advice over the internet. If you have been diagnosed with a partial thickness tear and begin experiencing more pain you should talk to your orthopaedic surgeon. 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. Judging by the description of atrophy in your rotator cuff muscles, I am guessing it has already been some time since the incident occurred. 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. Your message has been successfully sent to your colleague. Supraspinatus tendon tears are the most common tendon tear in the shoulder region. Lol. Your shoulder joints consist of three different bones the clavicle, humerus, and scapula and the head of the humerus and the glenoid cavity or fossa of the scapula combine to create the ball and socket joint that allows your arm to move at a wide range of angles. 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. Hopefully your orthopedic surgeon conducted a physical examination to help determine the relative contribution of the partial thickness supraspinatus tendon tear versus whiplash. 9. Is the arthroscopic modified tension band suture technique suitable for all full-thickness rotator cuff tears? Good luck! 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. 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. Rising trends in surgery for rotator cuff disease in Western Australia. Waiting until after the delivery of your baby to re-attach the tendon may increase the chance of a poorer outcome (not to mention the difficulty nursing a newborn with only one functional arm). These findings may guide clinicians to optimise loads, velocities and shoulder ranges . I maybe take a few Advil a week with no loss of function at all. The review will exclude studies which include patients with concomitant shoulder conditions such as osteoarthritis, fractures, osteonecrosis, instability, and additional intra-articular pathology or acromion morphology, as these conditions may necessitate intervention/s that may be different from patients who have rotator cuff tear only. I'll go check out some of your lenses now. perhaps if delay is likely to lead to a complete rupture that could be prevented with early surgery). You may have pain when you lie on the painful side at night. 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. Thanks again Dr. I'm sorry to hear of your shoulder trouble. The supraspinatus is part of the rotator cuff of the shoulder. The purpose of this study was to compare clinical outcome measures at least 1 year postoperatively between patients who had completion of a high-grade partial thickness supraspinatus tear to a full-thickness tear (PT) and those who had an isolated full-thickness supraspinatus tear (FT). If you have a spouse, partner, family member, or close friend on hand to help you out post-surgery for your supraspinatus muscle tear, youll be better off, since you wont be able to lift things over chest height or even do other simple tasks for around 2 to 6 weeks after your surgery. 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? I think it would be wise to listed to the advice from your doctor on this one! Think about all the times you lift your arms above shoulder height in a given day and try to rearrange your home accordingly. I found it very helpful as I am sure all your other subscribers found it to be too. 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. The supraspinatus tendon runs from the muscle body through quite a narrow gap under the acromion. However, improving rotator cuff functioning is usually a good idea and your physio should be able to assess your current situation and provide you with a suitable tailored program of exercises as they see fit. Consult with your orthopaedic surgeon to determine the best solution for your case, your supraspinatus tears, any other associated injuries, and your lifestyle. Being referrfed to a shoulder specialist Tuesday. I would make sure your surgeon knows you are planning on falling pregnant within the next 12 months. I have had shoulder pain for years and years. My question to you is why can they not try to repair the rotator cuff using a graft of somesort. only taking out for prescribed exercises (e.g. No black and white answer for this one I'm afraid. I know that since it has been years since seeing a dr about it that I should make an appointment, but what is your opinion of my situation? We will also discuss surgical interventions for tendon injuries. If you get a chance, drop by and let us know how you go with your recovery!
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