However, in other cases, it may be that delaying will not reduce the chance of surgical success, but permit a trial of more conservative treatments that may eliminate the need for surgery, or strengthen muscles that provide stability to the joint to help optimize the outcome following surgery. It's very good of you to reply so promptly and clearly though. If pain is being caused, then there may be a problem with technique or a lower intensity may be required. Generally, if an injury is going to heal on it's own, it gets better over time, unless it is re-injured. Those words exactly. Decided to see ortho who ordered an MRi last week. No black and white answer for this one I'm afraid. 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. 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. If you are seeing a physio for this condition, they should be able to provide you some good information about the post-surgery protocols that surgeons in your local area will be likely to prescribe. The results showed a "partial tear of the supraspinatus tendon, with large swelling and irritation". Dr Mike, Please help me understand what options I might have or questions to ask the surgeon about my full thickness rotator cuff tear. Don't be afraid to say how you feel (no doubt you'd do this in a respectful way) about trying a whole bunch of non-surgical options, but not seeing any lasting results (as you have described for us above) and being keen to move forward toward some kind of resolution to the problem. Even though most tears cannot heal on their own, you can often achieve good function without surgery. but can get back fairly good motion about the shoulder . Many will report ongoing symptoms despite several months of medication and limited use of the arm. If not what is this indictative of. The tendons may tear from their attachment either after an injury such as a fall or from long-term wear and tear. I'm sorry to hear of your shoulder trouble. That being said, I am scheduled for surgery on 6 Nov. I was very optimistic about the P.T. HubPages is a registered trademark of The Arena Platform, Inc. Other product and company names shown may be trademarks of their respective owners. ,Been dealing with shoulder pain for about nine months now and thought I'd share my experience with you and other readers. I completed 6 treatments of prolotherapy approximately 9 months ago prior to this latest diagnosis. 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. My best wishes go to all of them. and retracted 2 cm. Does a full thickness tear of the supraspinatus tendon need surgery? Because of the return of the recent pain, another MRI was ordered and the Radiologist wrote: "1. I have about 3" less range reaching up behind my back, but I think some pre-existing tears and arthritis were fixed. I think this is a common dilemma that people face. 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. It can be difficult to find good information on the web for specific rehabilitation following surgery. The researchers used a custom-built shoulder testing system to measure the effects of varying loads placed on the muscles of the rotator cuff and parascapular muscles. If you know you have a rotator cuff tear, worsening pain and decreasing strength may mean the tear is getting larger. As another rule of thumb, if you are getting mixed opinions from non-specialist doctors, it is often a good idea to refer you to a specialist (who will have most likely have seen your condition ever other day and have plenty of experience treating it). At the . pain that gets worse when you lift your arm. A few months ago it seemed to hurt more and I had problems lifting my arm out or above my head. Good luck! I have been diagnosed with a tear of the supraspinatus tendon by exam and u/s. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. Starting with Physio treatment is a good idea. Mike!! Your physician or orthopedic specialist should be able to give you specific advice about whether it is worth having an MRI in your specific case. 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. For awhile I was able to get my arm somewhat back to normal but wilh slight aching. In your opinion, do I have any other option other than surgery? Thankyou. 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)! I am now off again to another specialist as the 2nd opinion specialist said there was not much he could do to improve the situation! If, however, you are active or use your arm for overhead work or sports, surgery is most often recommended because many tears will not heal without surgery. Thanks for stopping by and sharing your interesting story. With complete tears, the tendon has come off (detached) from where it was attached to the bone. If surgery is not indicated, your doctor should be able to refer you to a physical therapist who will likely assess your shoulder movement and be able to provide you with a tailored program to help strengthen your rotator cuff. Some minor tears may be treated without surgery. The incident happened on Sept 25 and it is now Nov 10. This will help you figure out what you are deciding between. for an examination, an x-ray or MRI, but other times soft tissue injuries can lead people to report similar symptoms even though no dislocation occurred. When a rotator cuff is torn, the tendon part of the muscle tears away from the bone of the upper arm. labra are not evaluated 4. 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. Productive acromioclavicular joint changes are associated with an anterolaterally down sloping type II acromial configuration. Communication between health professionals (such as PTs and surgeons) may not be as good as it could be. If you get a chance, drop by and let us know how you go with your recovery! It is also worth noting that sometimes you can do everything right (good surgery, follow instructions etc.) If you are seeing the orthopedic surgeon it is a good idea to tell them about therapies you have received and about your persistent pain. Thanks for stopping by and sharing your story with everyone! 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. My arm is very weak. I work construction and am self employed. 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. That is some interesting advice you have received. I had rotator cuff surgery in May for a Small(2mm) tear In the supraspinatus tendon. The recovery time after surgery is substantial (and may vary depending on the surgeon, and specific structures repaired). So don't give up on your ambition to participate in exercise. This may not give immediate relief, but hopefully will show some benefit within 6 weeks. ; 2. It gets weak and tired pretty quickly, I can't sleep on my side and it aches all the time. @anonymous: Hi Elania, Thanks for stopping by and sharing. 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! I say promising because work in basic science and animal studies have demonstrated some quite promising findings. He did say that it can be done in the next few months and no urgent intervention required. I appreciate your thoughts on this matter. Thoughts on surgery? Did MRI of neck 1st which showed degenerative disc disease in c5-6 and c7-t1. I can't comment on the nature of care you have received, but I can say that you are not alone in this type of experience! It is difficult for me to comment further based on this information. A full thickness cuff tear (RTC) can be classified by size (small, medium, large and massive i.e. I was an elite athlete most of my life and have accepted that I will no longer be able to return to my sport 100%. 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). I had surgery in Mar 2012 for decompression,near full thickness bursa tear and a near full thickness supraspinatus tear with degeneration and general multi-directional laxity of the shoulder capsule.I know the work I have preformed and physical activities over the past 20yrs haven't helped but it was an acute injury that ended it.Since surgery I have been to a physiotherapist but after a few sessions I was experiencing a spot of pain (hot spot) which the physio dismissed as surgery related pain.To make a long story short, gym didn't go well to which I was told by my physio that I was overdoing it (I followed the program to the letter) anyway a second opinion found I have got a high grade partial tear and possible partial full thickness tear and bursa thickening and bunching on adduction. So probably worthwhile having a chat with your doctor and seeing what they recommend as a first step. 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. coracoacromial ligament. Anyways, my appointment for surgery on my right shoulder is in 2 weeks.. Arthroscopic.. it use to ache and ache at night but recently its not so bad. So my tear went from a near full thickness tear to a full thickness tear. In some cases, surgery to repair the tendon is also required. Bursal side: tears on the top of the tendon. I am in aching pain consistently. However, in some cases, the better option may be to consider surgery sooner rather than later (e.g. However, other parts of the rotator cuff may also be involved in the injury. Hi there. Questions: 1. Knee Surgery . @brando87: Thanks brando87, that's what I aim for! It may be as small as a pinpoint, or the tear may involve the entire tendon. This kind of tear does not heal on its own. You mentioned rotator cuff and tendonosis like they were different things. I also have no insurance and don't know about surgery. The presence of greater tuberosity cortical irregularity and joint fluid was most important in the diagnosis of full-thickness supraspinatus . 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. They can then make a diagnosis and begin 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)! Good luck! I am sorry I can't offer you specific advice over the internet about whether you should or should not have surgery. I have always found the anatomy of the shoulder to be very interesting. In the mean time, I received another steroid injection treatment. 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. Full thickness tear means a complete tear of the rotator cuff supraspinatus tendon. I guess my question is does this always require surgery? Thanks for stopping by. I am 60 years old and do not want surgery but if it helps to stop it getting worse as I get older I will have to. You have a full thickness rotator cuff tear. Articular side: tears on the bottom of the tendon. The use of steroid injection for treatment of a full-thickness rotator cuff tear is still controversial. What does all that mean in simple layman terms? Some can be altered with conservative rehabilitation exercises in order to prevent further tearing and ongoing pain, while others cannot be altered without surgery. Could this require surgery. The tear may be a partial or full thickness tear. . Yes, the surgery will be over very quickly, but it is the rest of the recovery that takes time and effort (and a fair bit of frustration being careful to keep within the movement restrictions). 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. I get asked about this a lot, perhaps I should write a page on rehabilitation following surgical repair of supraspinatus tendon tears! While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time. Gloria Freeman from Alabama USA on January 21, 2013: Hi lot of good info and tips here. I had subacromial decompression February 2010 a year after a motor vehicle injury (I am currently a 34 year old female). @anonymous: Hi Donna, I am sorry to hear about this trouble you are having with your shoulder. 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. It plays a critical role in movements involving the shoulder joint, particularly arm elevation. In active individuals who use the arm for overhead work or sports. There is no question that the word 'small' can be misleading regarding the amount of pain and discomfort that a supraspinatus tendon tear can cause. Thanks for sharing this detailed account with everyone. 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? In the interim, physio, chiro, massage, taping were part of my pain management and ROM for all pain sites relating to MVA. If your tendon were to completely rupture while you were pregnant, this may be very problematic. Fluid signal anterior to the proximal humerus as well as within the sucoracoid bursa. At approximately the 3:40 mark in the video above, there are a few exercises to help increase the range of the movement in the shoulder. Yes, surgery can be painful initially, but your surgeon should be able to tell you the likelihood of a successful outcome of surgery based on your specific circumstances. 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). Full-thickness rotator cuff tears are diagnosed with the help of a thorough history and physical examination, as well as the use of imaging studies, most commonly, MRI. With full thickness tears the entire tendon has separated or torn from the bone. Generally speaking, treatment options for shoulder injuries that include supraspinatus tendon tears and other findings similar to those you have reported could include surgery, or more conservative treatments like a trial of physical therapy or injections. The supraspinatus is part of the rotator cuff of the shoulder. Now my left supraspinatus has a full thickness tear at the central 1/3 (AP extent 13mm?) People doing repetitive work above shoulder height may find themselves at higher risk of a supraspinatus tear. Ongoing serious pain influencing daily life, sleep etc. Judging by the description of atrophy in your rotator cuff muscles, I am guessing it has already been some time since the incident occurred. Small. It is plausible to sustain one or the other (or both) from a fall. I am 55 and active, so I don't want to hurt my "golden" years, so I am not sure what to think. Many people have seen sporting heroes dislocate a shoulder during a heavy contact, have a medic "pop" it back in, then continue on 15 minutes later. Hey DrMikeM doin some research and came across your sight and thought I'd add my two cents. The postoperative recovery period following a surgical rotator cuff repair will take months and involve a specific program of range of motion and strengthening exercises that your surgeon will prescribe, often in conjunction with a physical therapist who will teach you exercises and monitor your progression. If the nearly complete tear were to become a complete tear, this would require surgery (ideally quite quickly) to re-attach the tendon otherwise the functioning of the supraspinatus muscle (it elevates the upper arm) would be lost. This can occur normally over time, or with repetitive use or a re-injury. Wish me luck!!! Modify Sport Techniques . Your shoulder specialist will be able to provide you with specific advice regarding your chance of recovery without surgery, as well as what to expect if you do decide to go down the surgery path. I'm just about at the point of desperation here. Thanks for stopping by and leaving a comment! There are also non-surgical treatment options that orthopedic surgeons may consider for degenerative acromioclavicular changes, supraspinatus tendinopathy and subacromial bursitis. Purpose: The objective of this study is to report on the complete arthroscopic repair of full-thickness tears of the supraspinatus.Type of Study: Prospective cohort study. )full thickness tear of supraspinatus and infraspinatus tendons both have retracted past glenoid process 2.) For anyone contemplating surgery, buy a recliner to sleep in after surgery. @will-nelson-790693: Hi Will, Thanks for stopping by and sharing your experience. I would make sure your surgeon knows you are planning on falling pregnant within the next 12 months. My story is a little lengthy, but I am desperate to find some insight for anyone that could help. Instead specific movements are required, these shouldn't cause pain while performing the exercise. INTRODUCTION. These muscles can be torn in a traumatic injury or simply by age-related wear and tear. No. When I went in, he told me that after looking at my MRI, he did not think that anything was necessary, and instead wanted me to go back into physical therapy and continue to get steroid injection treatments. only taking out for prescribed exercises (e.g. 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. 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. It is possible this tear may communicate with the bursal surface anteriorly. 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. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. Thanks for stopping by and leaving a comment. Have been directed to work with a physical therapist and so far have not seen mprovement after two weeks but staying hopefull. The type of repair performed is based on the findings at surgery. @anonymous: mike but not dr. mike. An exercise or physical therapy program is necessary to regain strength and improve function in the shoulder. The lack of a normal amount of synovial fluid in the joint space could potentially be a sign of adhesive capsulitis (also known as frozen shoulder) among some people. ), a shoulder x-ray may not reveal anything conclusive. How do you repair a rotator cuff tear? I also have an intermediate grade partial thickness tear of superior tendon bundle of Subscapularis without retraction or muscular atrophy. 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. Thanks to my hubby for finding this site. However, some people will never experience the same level of recovery without the surgery. I worked closely with a physiotherapist for a good four months and pain got worse. Following an iltrasound scan I have been told I have a tear of the supraspinatus tendon and there is some retraction. 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). Partial tear of the rotator cuff tear is getting larger always require surgery to more! Therapy program is necessary to regain strength and improve function in the mean time, I n't. 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