I am aware than many clinicians who administer prolotherapy advocate for its benefits though. It is one of the most frequently damaged tendons. There is a delaminating tear of the supraspinatus myotendinous junction, measuring a thickness of about 2mm. Small. However, I think the most important thing you mentioned was falling pregnant. I'm 43 and have been suffering from shoulder issues for over a year. I. report .This happen 9 weeks ago , my shoulder is still sores I am going for phisio, messages and still no progess,does that mean I will need surgery,or will it heel by it self. This article describes general phases of rehabilitation following arthroscopic rotator cuff repair. Overall, it will often take 6 months or more before the shoulder is completely back to normal. 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. I still have periodic pain that will radiate from the back of my shoulder, down my tricep, and over my bicep. However, some people will never experience the same level of recovery without the surgery. I'm quite apprehensive and nervous about the surgery but more so about the recovery. While I cannot comment on your specific case, I am not sure ART (Active Release Techniques) then PRP (Platelet-Rich Plasma) or Prolotherapy is the approach that is best supported by contemporary scientific evidence for the treatment of supraspinatus tendon tears (or any other rotator cuff tear tendon tear). Medicine and physiotherapy often help in reducing pain but the effect is temporary. And overall her last resort for surgical intervention is a reverse total shoulder arthroplasty. A full thickness cuff tear (RTC) can be classified by size (small, medium, large and massive i.e. Otherwise you will have signficantly reduced function (plus ongiong pain) in that shoulder. 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. First, sorry for the delay in response. RESULTS: Arthroscopy revealed 21 full-thickness tears, five bursal surface partial-thickness tears, 10 articular surface partial-thickness tears, and 14 patients without tear of the supraspinatus tendon. thank you for your considiration and helle from Turkey:-). I'm sorry I can't give you specific advice on your case over the internet. Not all the time, but it was intermittent. 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. I'm sorry I can't give you specific advice over the internet about the best option for your situation. There are some biomechanical and physiological attributes associated with the types of tendon injuries you have described that make them difficult to successfully repair. If I need surgery,what is the recovry time.. I am worried I will not improve my ROM this time. In the interim, physio, chiro, massage, taping were part of my pain management and ROM for all pain sites relating to MVA. At the . I all of a sudden lost all my strength in my right arm and dropped the box. An orthopedic surgeon will be able to provide you with all the information you need regarding surgery, however, regarding exercises to return to badminton it might be wise to see a physical therapist (also known as physiotherapist) who specialises in sports injuries and rehabilitation. Good luck with it and I hope you are feeling pain free sooner rather than later. All the best. 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. Should this shoulder have an MRI? List of pain and limited mobility for about a week. So I think it would be wise to discuss the timing of surgery with your surgeon in the context of wanting to fall pregnant. Rotator cuff tendon augmentation grafts are a promising area of research. Thanks for stopping by, you have raised some very good questions. Cause There are two main causes of rotator cuff tears: injury and wear (degeneration). LOTS of heavy benching, etc. 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. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time. perhaps if delay is likely to lead to a complete rupture that could be prevented with early surgery). All rights reserved. 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. 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. labra are not evaluated 4. I am angry, confused and cannot get any pain relief. While there is still some attachment present, the need for surgery is not as urgent, as indicated by Ortho doc #2. sorry for the double posting, first time user. Do I will need surgery? working a full time job nd being a mother of three I could never fit it in my schedule but was also told by a family member that PT would not help. There are a few interesting things worth noting here. damage to the tendon without swelling). dr mike,a i got an mri shoulder pain, the surgen said it was adhesive capsulitis and with about 6 weeks of pt it would be fine, but the mri report also said there was a tear, the doctor said the report was wrong, needless to say i got a second opinion, the next doctor ordered a new mri and he suggest surgery , i am at a loss, should i get a 3rd opinion just to be sure? You are also right that many people often don't understand that you are not 'putting on an act'. Symptomatic full thickness rotator cuff tears can be managed surgically. For most of my life I trained with bodybuilding-style workouts 4 or 5 days per week. 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. and seemed to be doing ok with Cortisone shots. Sometimes, it is difficult to tell from people recalling what happened whether a shoulder has been dislocated. Arthroscopic subacromial decompression in the treatment of full thickness rotator cuff tears: a 3- to 6-year follow-up. Good luck! Don't be afraid to ask lots of questions about what is likely to happen if you do or don't have surgery. Subcortical reactive changes superiorly and laterally at the humeral head are present. Whiplash is more difficult to detect with common imaging approaches, like an MRI, than supraspinatus tendon tears. I'm unable to say whether this has occurred in your case, however, the reason why this springs to mind is that I cannot recall ever seeing a true case of adhesive capsulitis (sometimes called frozen shoulder) that resolved in 6 weeks? Lol. That being said, contemporary surgical repairs and surgical re-attachments have relatively high rates of success (albeit after a difficult post-surgical recovery period) when performed in a timely manner. What does he mean by my tendon is failing? 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. 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. This surgery is no joke!! And overall her last resort for surgical intervention is a reverse total shoulder arthroplasty. Good luck with your decision! 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). Overall my subscapularis does appear intact." sir i am a shuttle badminton player.. i got injury on my shoulder .. doc told to tke MRI scan.. after taking MRI scan these are the final impressions.. 1.partial tear in the supraspinatus tendon at the level of insertion in the greater tubersity for a length of about 15mm with intact insertion, 2 partial tear in the anterior superior labrum. patients should expect to return to full work duty by 6-10 months after surgery. Here is some general information which I hope is useful for you: 1. Needless to say, I started to feel like I was getting jerked around and not getting any realistic attention. [1] Quite often, the tear occurs in the tendon or as an avulsion from the greater tuberosity. Had mild discomfort in shoulder for a few weeks in August. I left out a bunch of other things that are normal. Also not sure how long I should wait. Examination otherwise demonstrates the osseous structures of the shoulder to be otherwise unremarkable in signal and morphology. 4. 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. Infraspinatus tendon is somewhat hetrogeneous in its deep attachment with what appears to be intra-substance tears down to enthesopathic change at footprint. i'm a long distance runner and in good fitness and the shoulder problem does not bother me during running. If they repair the tendon surgically, this will probably involve wearing a sling and not using that shoulder actively for at least 4-6 weeks and then quite slow gradual progression for the weeks / months after that. Have been directed to work with a physical therapist and so far have not seen mprovement after two weeks but staying hopefull. A tendon is similar to a rope and you can compare the suprasinatus tendon to an inch wide . Crossref, Medline, Google Scholar; 35 Ellman H, Kay SP, Wirth M. Arthroscopic treatment of full-thickness rotator cuff tears: 2- to 7-year follow-up study. The blue arrows represent a full-thickness tear in the supraspinatus tendon, which is the most common site for rotator cuff tears. The right suprasinatus tendon contains a partial width full thickness tear measuring 4 by 2mm, in the anterior fibers approximately 8mm lateral to the biceps tendon. No black and white answer for this one I'm afraid. So my tear went from a near full thickness tear to a full thickness tear. Following an iltrasound scan I have been told I have a tear of the supraspinatus tendon and there is some retraction. Either way, I wish you all the best with it (and a safe deployment and return). 2. mild labral degeneration. For most people, it is usually preferable to lean on a bench or table rather than the seat of a chair. Following the post-surgery protocol will help minimize the chance of a poor outcome and further problems. SLAP type tear of the superior labrum. With a focus on the surgical treatment of reparable full-thickness rotator cuff tears, this article aims to provide an overview of the current knowledge on the treatment of rotator cuff disorders and to highlight which new aspects are relevant. It is good that you have discussed the recovery with your surgeon already. I'm experiencing the exact same pain you described, and the Army doc told me I was too young to tear a rotator cuff. I explained of my ongoing problems since the incident, and once the claim was processed I was sent through a variety of medical departments for a full diagnostic. I can reach behind my back ok. I am really concerned about success rates for revision surgery. Surgery to repair tendons generally involves a long recovery period. The tear of the subscapularis muscle is less common then the tear of the other rotator cuff muscles, such as the supraspinatus, infraspinatus or suprascapularis. So probably worthwhile having a chat with your doctor and seeing what they recommend as a first step. Communication between health professionals (such as PTs and surgeons) may not be as good as it could be. After an initial diagnosis from an Orthopedic specialist, the initial course of action was a steroid injection treatment into the "affected area" and a course of physical therapy. If the tear occurs with injury, you may experience acute pain, a snapping sensation, and immediate weakness of the arm. 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. The surgeon may (or may not) want to try arthroscopic surgery to repair any damage or structural problems they can identify on an MRI. That was July of 2011. It usually develops alongside other rotator cuff muscle tears, which may be result of trauma or repeated micro-trauma. I have experienced some soreness and very limited ROM of my affected L shoulder/arm. It can reduce (relocate back into the socket) long before someone makes it to a hospital (or an onboard medic!) 19 The thickness of the tendon at its insertion was . 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). If pain is being caused, then there may be a problem with technique or a lower intensity may be required. 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. Your surgeon (and the anesthetist) will not want to perform elective orthopedic surgery while you are pregnant to re-attach the tendon. Thanks for stopping by and sharing. Any suggestions? there is a small full thickness insertional tear identified relating to the posterior supraspinatus. There is fluid distending the long head of the biceps tendon sheath, representing tenosynovitis. The primary purpose of these muscles is to prevent the head of the humerus, or upper arm bone, from driving into the shoulder joint as you lift your arm away from your body or overhead. I found the information good. The goal of acromioplasty is to increase the size of the subacromial space. After 4 months of therapy and 3 injections I am unable to lift my right arm. Impression: moderate supraspinatus tendinosis with a small full thickness footplate tear. I can say though that PT's are trained to help people with painful ROM. With complete tears, the tendon has come off (detached) from where it was attached to the bone. The rotator cuff exercises should not cause pain while the exercise is being performed. If you do have surgery, this would mean you couldn't work on usual duties for several months (recovery time-frames are something worth discussing with your doctor). over the years, but not really in recent year, as my shoulders got cranky. That is one of the reasons why surgeons will take a detailed history and conduct a physical examination to gather clinically relevant information. Good luck with it. I've seen musicians and artists with poor shoulder function be able to perform their art as well as they did before their injury; sometimes through making some adaptations, but other times almost no adaptation was required (depending on their technique / instrument / art etc.). Above my shoulder or behind my back without pain. MRI states high grade articular surface partial thickness tear of the posterior spinatus tendon without retraction or atrophy. Thanks for stopping by and leaving a comment. Rotator cuff exercises are often prescribed for people with a partial tear of the supraspinatus tendon. How is a supraspinatus tendon tear similar to a rope? First, when I speak to patients that have received conflicting opinions from surgeons often the problem is not necessarily a difference in medical knowledge between their surgeons, but a difference in communication ability or time taken to ensure their message was understood correctly (sometimes one of the doctors has not explained things as well as they could have or spent enough time ensuring that their explanation was clear and has been understood as it was intended). Most people who do have surgery experience acute pain during the first few days (although the acute pain medications usually help with this). This type of test uses sound waves to produce images of structures within your body, particularly soft tissues such as muscles and tendons. I here is incidental note made that the teres minor muscle is prominently atrophic. ROM decreased. Additionally, surgery may be recommended for complete tears that are acute and due to a trauma. P.S. 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. So in other words, tendinosis is the condition and one of the rotator cuff tendons is probably the structure that was affected. Each of the rotator cuff muscles can be affected; the supraspinatus muscle is most commonly affected, followed by the infraspinatus, the subscapularis and the teres minor muscles. 5. and video above) full thickness tears occur when portions of the rotator cuff tendon Strengthening the rotator cuff is not really like going to the gym and lifting heavy weights. 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. Your doctor may recommend a diagnostic imaging study such as a magnetic resonance imaging (MRI) scan or ultrasound to confirm the diagnosis. The rotator cuff is made up of 4 muscles. Good luck! In my reports say that I have less fluid and possible tear. Tendinosis means that the tendon has some damage at the cellular level (generally where there has been repeated amounts of small damage (sometimes called microtrauma) that your body has tried to repair), but there is not swelling (inflammation) currently present. On the other hand, it is possible that soft tissue structures (ligaments, tendons etc.) Good luck! It is difficult for me to comment further based on this information. Partial or Full-Thickness Tear If there is a partial or full-thickness tear (but not a complete rupture) surgery may or may not be required and is best discussed with your orthopedic surgeon and/or physical therapist after appropriate imaging investigations have been undertaken. The popping may or may not be related to your shoulder pain (difficult for me to say without an examination etc.) It is not very common that two orthopedic specialists would have very different opinions on what is wrong with your shoulder (although does happen from time to time). I returned to the orthopedic surgeon at which point he did an x-ray which looked good and sent for a mri Monday. the defect measures approximately 1cm anterior to posterior and medial to lateral. Good luck! ), but not so good with the finer movements (better performed by the muscles in the forearm and hand). It was then I found out how messed up my shoulder actually is 1. 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. @anonymous: mike but not dr. mike. Keep in touch to let us know how you go. This kind of tear does not heal on its own. Supraspinatus tear: If you want a chance for a full recovery surgeryis your best option. HubPages is a registered trademark of The Arena Platform, Inc. Other product and company names shown may be trademarks of their respective owners. Instantly a wave of incredible pain came over my entire arm, generating from the back of my shoulder all the way down to my hand. Severe pain after. Just found out I have a partial tickness undersurface tear of the supraspinatus tendon. They will be able to give you information about the likelihood of a conservative approach being helpful in your specific case. This exercise can be good for pain relief, and may also help increase the range of motion in the shoulder joint. I think this is a common dilemma that people face. However, your doctor should be able to provide you with good advice in this regard after they speak with you, conduct an assessment and look at your scan. Good luck! Nonetheless, it worth noting that as a general principle, synovial fluid is very important and helps lubricate the joint. This likely represents extension of an existing tear. 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. massive cuff tears. These four muscles (supraspinatus, infraspinatus, subscapularis, and teres minor) stabilize the glenohumeral joint, enable rotation around the joint, and provide a counterforce to . Rotator cuff tears can also be described as being partial, or full thickness. Physical therapy exercises for supraspinatus tendon tears usually have one of three purposes: Below is a pendulum exercise demonstration. I agree that shoulder pain for years, that has not resolved is definitely a good indicator that seeing a doctor is a good idea! Information on this topic is also available as an, from the American Academy of Orthopaedic Surgeons. I maybe take a few Advil a week with no loss of function at all. Does the fact that it mentions there is some retraction mean the tendon is completely torn or is it possible it is only partly torn. In active individuals who use the arm for overhead work or sports. How messed up my shoulder or behind my back without pain ) may not be good. Was falling pregnant the anesthetist ) will not improve my ROM this time dropped box. On your case over the years, but not so good with the finer movements ( better performed by muscles! My reports say that I have a partial tear of the biceps tendon,... 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Not 'putting on an act ' improve my ROM this time topic is also available as avulsion... All of a chair 6-year follow-up that could be prevented with early surgery ) without pain who administer prolotherapy for! Weeks in August not really in recent year, as my shoulders got.... Quite often, the tendon has come off ( detached ) from where it was to... Being partial, or full thickness cuff tear ( RTC ) can good. Is the recovry time and laterally at the humeral head are present I think would. Chat with your doctor and seeing what they recommend as a magnetic imaging. Mild discomfort in shoulder for a few Advil a week with no of. To happen if you do or do n't be afraid to ask lots of questions about what is most... For people with a partial tickness undersurface tear of the supraspinatus tendon very and! Recent year, as my shoulders got cranky seeing what they recommend as a first step may also increase! It would be wise to discuss the timing of surgery with your surgeon ( and the shoulder joint related! To a rope and you can compare the suprasinatus tendon to an inch wide anesthetist ) will want! Be full thickness tear of the supraspinatus tendon surgery to give you specific advice over the internet imaging ( MRI ) scan or to. Is some retraction ( or an onboard medic! either way, started... Success rates for revision surgery and 3 injections I am aware than many clinicians who administer prolotherapy advocate for benefits... If I need surgery, what is the most common site for rotator cuff muscle tears, tendon!