I have also been doing the pendulum exercise as prescribed and figured walking with the sling off would be no more risky to the staples. The technicians wont say more and nor will my doctor. Generally speaking, for shoulder pain related to rotator cuff injuries following trauma, often the first strategy is to see whether the pain and other symptoms improve with non-surgical management approaches. Muscular and tendinous structures including remaining portions of the rotator cuff are also felt to remain otherwise unremarkable in signal and morphology. I received my first steroid injection treatment during the summer of 2011 and went through a lengthy 6 moth physical therapy treatment. It also allows a quick comparison between the affected shoulder and the healthy shoulder. 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. Here is a link to a recent academic journal article on the topic that should be free to access. is surgery the only option? damage to the tendon without swelling). I had a fall at my workplace and was suffering neck and shoulder pain. A rotator cuff tear can extend or get larger over time. 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). Advertisement. A few months ago it seemed to hurt more and I had problems lifting my arm out or above my head. 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. With full thickness tears the entire tendon has separated or torn from the bone. 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. patients should expect to return to full work duty by 6-10 months after surgery. While it is estimated that 65-70% of all shoulder pain involves the rotator cuff tendon, it has been estimated that 5 to 40 % of people without shoulder pain have full-thickness tears of the rotator cuff. Sorry I can't give you specific advice over the internet, but it sounds like your shoulder specialist will be able to give you good personalized advice on Tues. Good luck with it. It is one of the most frequently damaged tendons. 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. Thanks for stopping by and leaving a comment. In this study, 24 patients who had full thickness supraspinatus tears and who opted to forego surgery were tracked over time. A full thickness cuff tear (RTC) can be classified by size (small, medium, large and massive i.e. Overall, it will often take 6 months or more before the shoulder is completely back to normal. . 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 am 67 years old and am an artist and my left arm which is the one in question is my dominate arm. Good luck with it! 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. If not what is this indictative of. This type of test uses sound waves to produce images of structures within your body, particularly soft tissues such as muscles and tendons. 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). i'm a long distance runner and in good fitness and the shoulder problem does not bother me during running. Poorly defined large full-thickness tear of the supraspinatus and infraspinatus tendon measuring at least 2 cm in anteroposterior dimension. I have full-thickness tear of supraspinatus tendon ,with 1.5 cm cap without tendon retraction plus supraspinatus Ask an Expert Medical Questions The Physician, Doctor 1,261 Satisfied Customers Versatile Emergency Physician, 20 years experience as a Physician. bested on all of the above. The anterior band of the supraspinatus (most common tear location) is an agonist to external rotation. When a radiologist looks at an MRI scan, he or she must make a judgment about the type of the rotator cuff changes. 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. Sought 2 nd opinion 3weeks later due to the server pain. Approximately 1% of the adult population will have shoulder pain at some point in their lives. pain management and physical therapy) may be the first choice to see if surgery can be avoided. My husband just had and MRI and it showed a Nonretracted small insertion full-thickness tear of the supraspinatus tendon. For anyone contemplating surgery, buy a recliner to sleep in after surgery. They may extend to become massive involving multiple tendons as shown in the figure. Hope that helps. I think it would be wise to listed to the advice from your doctor on this one! Background: Good functional results have been reported for arthroscopic repair of rotator cuff tears, but the rate of tendon-to-bone healing is still unknown. Hopefully your orthopedic surgeon conducted a physical examination to help determine the relative contribution of the partial thickness supraspinatus tendon tear versus whiplash. Just found out I have a partial tickness undersurface tear of the supraspinatus tendon. 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). It is worth noting that dislocating a shoulder generally causes soft tissue trauma, like tears in the glenoid labrum (the bit that acts like a big suction cup keeping the ball part of the arm in the shoulder socket), as well as other structures. Good luck! Hi there. It's a supraspinatus tendon tear with 50% thickness and no labral tear. Supraspinatus rupture is a condition caused by rupture of supraspinatus muscle or tendon. That being said, a surgeon's own experiences, skills and abilities (as well as risk tolerance) may factor into their decision as to whether a surgical repair (and the nature of the repair) is something they will advise. Complete tears: More commonly referred to as a full-thickness tear, this injury entirely separates the tendon from the bone. Typically, you will feel pain in the front of your shoulder that radiates down the side of your arm. Make sure you understand their explanation of what problems are occurring around you shoulder and what treatment options are available to you. I hope some of the general information I provided in my response to Tim's (or others) comment is useful. shoulder or arm weakness. I will surf again! I had an MRI done on my left shoulder last week and it turns out, to my surprise, that I have a full-thickness supraspinatus tear. Cause There are two main causes of rotator cuff tears: injury and wear (degeneration). They do reveal most substantial soft tissue injuries, but they are only as useful as the person interpreting them is skilled. So a second opinion may not always yield the same advice (even though both surgeons may be giving appropriate advice based on their own circumstances and information). I would make sure your surgeon knows you are planning on falling pregnant within the next 12 months. Combinations of these shoulder pathologies may well require surgery, however, you should see a local orthopedic surgeon who will be able to speak to you about your symptoms, assess your shoulder in combination with examining your MRI. Most people who do have surgery experience acute pain during the first few days (although the acute pain medications usually help with this). Grade 1 strain of the lateral deltoid muscle and teres minor muscle. I'm sorry I can't give you specific advice about whether you will need surgery or not over the internet. Edema is seen involving an intracapsular segment of biceps tendon with possible interstitial tears. @anonymous: mike but not dr. mike. infraspinatus tendon had full-thickness tear . Thanks to my hubby for finding this site. Pain continued and got worse. there is a small full thickness insertional tear identified relating to the posterior supraspinatus. This was caused by contact with another person and (I'm self diagnosing) some prior existing minor tendon tears. It is possible this tear may communicate with the bursal surface anteriorly. 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 rotator cuff is a group of four muscles and their associated tendons that originate from locations on the scapula and insert onto the humeral head. Once the full thickness of the tendon is torn, we classify the tears based upon the shape and the number of tendons involved. Can a full thickness tear of the supraspinatus heal without surgery? The supraspinatus is the tendon that tends to suffer from partial tears most commonly. Our hypothesis was that arthroscopic repair of full-thickness supraspinatus tears achieves a rate of complete tendon healing equivalent to those reported in the literature with open or mini-open techniques. The type of repair performed is based on the findings at surgery. Good luck! According to Dr. Bob Burks, professor of orthopedics, 60 percent to 70 percent of patients will have some sort of tear by age 80. It allows a provider to assess the structures of your shoulder during movement. If a condition stays the same or become worse, then its usually a good idea to get it checked out again, or even a second opinion if you are not happy. 2. OpenStax College (CC 3.0) via Wikimedia Commons. Thanks. Good luck! Don't even think you won't need help, because you'll need help with even the most basic daily tasks. In the beginning of 2012, I returned to the Orthopedic specialist at the VA, and the medical staff seemed very surprised that my god awful pain and discomfort was still going on. Don't be afraid to ask lots of questions about what is likely to happen if you do or don't have surgery. pain that gets worse when you lift your arm. Knee Surgery . I found it very helpful as I am sure all your other subscribers found it to be too. Second, I am sorry to hear about your fall and subsequent shoulder pain. 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). 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? Needless to say, I started to feel like I was getting jerked around and not getting any realistic attention. In terms of general information that may be useful to you, I am not sure I have seen any sound clinical research evidence indicating that prolotherapy is likely to provide long lasting benefits for people with MRI diagnosed supraspinatus tendon tears. Many people with supraspinatus tears receive very good relief following a period of PT, but others do not. 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. Again, I'm sorry I can't provide specific advice, but I hope this general information is useful to you. Thanks again Dr. I wish you a speedy and full recovery. I see this is true of SSGtomn who has left a comment already. Results are as followsstudy demonstrates degenerative arthritis around the acromioclavicular joint. In my reports say that I have less fluid and possible tear. Twelve patients in Group 1 received an intra-substance injection into rupture area of supraspinatus tendon with Diprospan 1 cc (betamethasone disodium phosphate 2 mg and betamethasone dipropionate 5 mg) and . I am angry, confused and cannot get any pain relief. It is difficult to know whether your husband will need surgery based on this information alone. There are several video examples to accompany the written explanation. Lol. Seek immediate help if you are experiencing a medical emergency. Being deployed and not receiving treatment makes it difficult. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. If the injection does give you pain relief, it may allow you a couple of months without pain to do exercises that can strengthen your rotator cuff and improve the biomechanics at your shoulder in an effort to reduce irritation of the bursa and Supraspinatus tendon. 19 The thickness of the tendon at its insertion was . Full thickness tears: usually categorized by size in centimeters. Yes, also a good idea about discussing with your surgeon the potential risks or benefits from delaying surgery in your case. 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.). MRI does demonstrate a complete massive tear of my rotator cuff with retraction and severe atrophy. Complete: With a full-thickness or complete tear, the tendon separates completely from the bone. 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. I am 67 years old and am an artist and my left arm which is the one in question is my dominate arm. 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). So I think it would be wise to discuss the timing of surgery with your surgeon in the context of wanting to fall pregnant. Early diagnosis and treatment of a rotator cuff tear may prevent symptoms such as loss of strength and loss of motion from setting in. Overall my subscapularis does appear intact." 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. These injections usually include an anti-inflammatory that can last for a couple months delivered directly to the problem area(s) and a local anesthetic that will work for the first few days until the anti-inflammatory starts to give relief. Then follow up by asking him about any risks associated with the surgery in your particular case (your surgeon should know your particular circumstances in detail and be able to provide you with specific advice about options available to you). There is some spurring at the glenoid articular surface. This muscle is often used by people who practice different types of sports, including swimming, racquetball and throwing spears or weights. Your doctor should be able to explain your options and potential expected outcomes. However, there are certainly injuries and structures other than rotator cuff tears that can cause some of the symptoms Tim described above. I wrote a previous commentsaw my orthopedic surgeon this week. This may include things like having a lesser ability to detect hot versus cold on their skin in the neck region, they may also genuinely feel pain to what would usually be non-painful stimulus. Did MRI of neck 1st which showed degenerative disc disease in c5-6 and c7-t1. You are also right that many people often don't understand that you are not 'putting on an act'. Advice welcomed. 4. 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). only taking out for prescribed exercises (e.g. Glenohumeral joint effusion and finding may signify capsulosynovitis or perhaps capsular strain. In September '12 I had surgery to reattach both the right rotator supra and infraspinatus with excellent results. Some general information that may be useful to know is that some people who have similar pathology to that which you have described end up having surgery while other do not. What I think is more common, is two doctors not taking the time to explain something in normal everyday language and ensuring their patients have understood whatever it is they are trying to say (so lots of people feel like they are being told different things)! Also not sure how long I should wait. This level of degradation is not particularly common for someone so young, but does happen from time to time and may well lead to a complete rupture. LOTS of heavy benching, etc. 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. I've met with 2 orthopedic surgeons and both have indicated surgery is my best option for recovery. . I am sorry I can't offer you specific advice over the internet about whether you should or should not have surgery. its been three months with some pt but no noticeable improvement. Your surgeon (and the anesthetist) will not want to perform elective orthopedic surgery while you are pregnant to re-attach the tendon. Conclusion: Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. Let us know how you go! I have a feeling this is going to be a long recovery! A rotator cuff tear may result from an acute injury, such as a fall, or may be caused by normal aging-related wear and tear with degeneration of the tendon. Without seeing the scan or conducting a physical examination, I can only offer some general comments in response. What ever recommendation you received, you are looking up more information on line. I went to one orthopedic doctor and he immediately said surgery is my only option. 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. What I can say is that for anyone looking to return to unrestricted badminton following a partial thickness supraspinatus tendon tear and shoulder labrum tear (particularly a SLAP lesion) will not be quick or easy. 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. There also is mild tendinosis of the infraspinatus at the footprint. Most people who I have seen with whiplash (albeit usually from motor vehicle accidents more than falls) tend to notice a great deal of improvement over the first few weeks, but some have symptoms that persist. The incident happened on Sept 25 and it is now Nov 10. Three techniques are used for rotator cuff repair: Your orthopaedic surgeon can recommend which technique is best for you. It must have been quite a knock, there is some quite serious damage there. That is some interesting advice you have received. Particularly about what many people are likely to experience during the often long road to recovery. I don't know what exactly to do, or what my REALISTIC problem could be. ), but not so good with the finer movements (better performed by the muscles in the forearm and hand). Thanks for the update and let us know how you go. Sorry for the delay, I have been away. The fact that you still have full shoulder ROM is a good thing, now just need to get the muscles /tendons (or potentially other structures) working as they should. In the mean time, I received another steroid injection treatment. Magnetic resonance imaging (MRI). Supraspinatus tendon tear symptoms commonly go on for months (or even years) until the underlying problem is resolved (usually through improving the functioning of the rotator cuff, surgery, or both). A recent study from Kim et al 19 used en masse suture bridge techniques for full-thickness supraspinatus tears. However, there are a variety of factors that will need to be considered. The MRI report says: 1. very large, nearly complete tear of the supraspinatus tendon from the tendon insertion with 1cm retraction of tendon fibers. It can be difficult to find good information on the web for specific rehabilitation following surgery. indications. He says the tendon is fraying like a ropethat he would need to reattach to the bone. Of the 49 rim-rent tears, 24 (49.0%) involved the anterior-most fibers of the supraspinatus tendon, one of which extended to involve the infraspinatus tendon. Assess the structures of your arm in my response to Tim 's ( or ). 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