Abrisham SM, Kermani-Alghoraishi M, Ghahramani R, Jabbari L, Jomeh H, Zare M. Additive effects of low-level laser therapy with exercise on subacromial syndrome: a randomised, double-blind, controlled trial. If in doubt call your surgeons office. 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. 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. After a formal assessment, they will be able to prescribe a course of rehabilitative exercises or recommend surgery. 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. the defect measures approximately 1cm anterior to posterior and medial to lateral. The types of findings you have described are consistent with some quite substantial pathology in your shoulder. Dr Mike, Please help me understand what options I might have in my case of job relater incident. Bae KH, Kim JW, Kim TK, Kweon SH, Kang HJ, Kim JY, et al. Lazarides AL, Alentorn-Geli E, Choi JH, Stuart JJ, Lo IK, Garrigues GE, et al. If you are in doubt, don't be afraid to get a second opinion. The review will consider studies that include elderly patients aged 60 and over who have full thickness rotator cuff tears confirmed with magnetic resonance imaging (MRI), ultrasound or arthrography. I take anti-inflammatory meds for a long time for other problems, but it sure has not helped my arm. Thorpe A, Hurworth M, O'Sullivan P, Mitchell T, Smith A. Let us know how you go! while that helped in the short term and improved my left arm motion range, after i stopped the therapy the pain came back and reduced the range. 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. And overall her last resort for surgical intervention is a reverse total shoulder arthroplasty. 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's been very frustrating dealing with the chronic pain and reduction of normal activities in an attempt to adapt to my "new normal". I can say though that PT's are trained to help people with painful ROM. 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. 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? Let us know how you go. Good luck! and seemed to be doing ok with Cortisone shots. 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. Rotator cuff injuries are common, especially as you get older. Thanks for stopping by, you have raised some very good questions. If the pain has been present for only a couple of months (or less) and there were minimal risk of worsening the condition with delay, then often a trial of conservative management (e.g. If you have any follow up questions just post them here and I'll get back to them as soon as I'm able. Rotator Cuff Tears: Surgical Treatment Options, Rotator Cuff Tears: Frequently Asked Questions, Shoulder Impingement/Rotator Cuff Tendinitis. Small tear involving the supraspinatus tendon only Fig. Drugs, supplements, and natural remedies may have dangerous side effects. that can be just as difficult to resolve as any structural injury. If they were consistent with each other it would seem remarkably unlikely that both reports were wrong. 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. Stocking up on prepared foods or meal prepping in advance and freezing things, as well as scheduling services like house cleaning and laundry is also helpful. Reinold MM, Macrina LC, Wilk KE, Dugas JR, Cain EL, Andrews JR. Selected studies will be critically appraised by two independent reviewers using standardized critical appraisal instruments from JBI SUMARI. These four muscles (supraspinatus, infraspinatus, subscapularis, and teres minor) stabilize the glenohumeral joint, enable rotation around the joint, and provide a counterforce to . Early treatment can prevent your symptoms from getting worse. The supraspinatus muscle is a relatively small muscle, but very it's important one. is surgery the only option? In most rotator cuff tears, the tendon is torn away from the bone. Efficacy of platelet-rich plasma in arthroscopic repair of full-thickness rotator cuff tears: a meta-analysis. 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. That means it becomes more like fatty tissue. An updated systematic review is now needed to identify the best treatment approach for full thickness rotator cuff tears in the elderly. P.S. He says that my tendon is failing. Painters, carpenters, and others who do overhead work also have a greater chance for tears. For anyone contemplating surgery, buy a recliner to sleep in after surgery. Any suggestions and generally how long is the recovery period? 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. old I was in good physical shape as a letter carrier(28 yrs) but have been mostly sedentary recovering from the first surgery. I worked closely with a physiotherapist for a good four months and pain got worse. If you are not keen to rush into surgery don't be afraid to ask your orthopedic specialist about conservative treatment options that may be worth trialing, on the other hand, your surgeon may be able to give you a good indication of whether they think surgery is the most promising option. 9. Partial or full thickness tears that are not complete ruptures are generally far more common than complete ruptures (not common, but require surgery with some level of urgency). 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. Data extraction will be undertaken by the primary author with verification by another author to minimize potential bias and potential errors. Having pain and sub-optimal shoulder functioning while you are nursing would not be ideal. That is one of the reasons why surgeons will take a detailed history and conduct a physical examination to gather clinically relevant information. Men over forty are the most likely to have degenerative supraspinatus tears. One of the most painful experiences ever. Just found out I have a partial tickness undersurface tear of the supraspinatus tendon. I wear an arm sling a lot to relieve weight from my shoulder, which helps to some degree. Mary Kay. Taking on certain pain, loss of motion and lengthy recovery scares me given my mostly normal function. Braune C, von Eisenhart-Rothe R, Welsch F, Teufel M, Jaeger A. Mid-term results and quantitative comparison of postoperative shoulder function in traumatic and non-traumatic rotator cuff tears. It was sometime in the early months of 2011 that I was sent off to have an MRI done. Exercise is important for many reasons (not the least of which are physical and mental health benefits). I then went to see another orthopaedic surgeon who said I have whiplash. Continued pain is the main indication for surgery. 23. Unfortunately, I think 1cm retractions of torn tendon fibres do not favor natural healing of those portions of the tendon (without surgery). i d glad if ortopedist or physiotherapist reply ansver. Similarly pain and dysfunction in the shoulder may cause you to use it less, which may in turn lead to weaker muscles and tendons (which may lead to more difficulty during and after a subsequent surgery). Are you experiencing rib pain? That being said, I am scheduled for surgery on 6 Nov. )amount of fluid in acromioclavicular joint and last but not least 5.) No tendon retraction or muscle belly atrophy. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010. Nonsurgical treatment options may include: A cortisone injection may relieve painful symptoms. You may search for similar articles that contain these same keywords or you may I do not want a metal shoulder. 3 Supraspinatus tear of the rotator cuff Fig. I found the information good. I also can't give you specific advice about your situation over the internet etc. There are a few options for repairing 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. An easy way to understand what I mean is to think about eating a steak. However, some people will never experience the same level of recovery without the surgery. I did PT around December for a month, twice a week. People who do repetitive lifting or overhead activities are also at risk for rotator cuff tears. When a rotator cuff is torn, the tendon part of the muscle tears away from the bone of the upper arm. Impression: moderate supraspinatus tendinosis with a small full thickness footplate tear. 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. Rotator cuff exercises are often prescribed for people with a partial tear of the supraspinatus tendon. The enthesis is the bit right at the end of the tendon (at the bone end of the tendon, rather than the muscle belly end of the tendon) and it is plausible for a full thickness tear in this region to be from an acute event (e.g. Thanks for stopping by and sharing your story. So while the cost of surgery can be expensive, people who can't do their job one-handed may also need to consider potential loss of income as well or making alternative work arrangements. Miller RM, Popchak A, Vyas D, Tashman S, Irrgang JJ, Musahl V, et al. 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. The majority of these tears occur amongst people over the age of 40. Just got my MRI report back on right shoulder and wanted to know if you could shed some light on it. Don't be afraid to ask your surgeon about all your treatment options. I have often seen these cases improve substantially after further surgery to repair these rotator cuff tears + post surgery rehabilitation therapies. First, sorry for the delay in response. This surgical method is a simple and effective Hope that helps! How do you repair a rotator cuff tear? ), but not so good with the finer movements (better performed by the muscles in the forearm and hand). I am really concerned about success rates for revision surgery. @anonymous: mike but not dr. mike. Went to an orthopedic surgeon who said I had frozen shoulder and injected the capsule with cortisone and told me to return in 3 months. There is no conflict of interest in this project. Thanks for stopping by and sharing your story with everyone! When they try to suture through fatty tissue, it just tears right through. 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. Now my left supraspinatus has a full thickness tear at the central 1/3 (AP extent 13mm?) Although very uncommon, it is possible that the report did contain an error. In most patients the supraspinatus tendon is the most vulnerable and 90% of rotator cuff tears involve this tendon. ( x-ray, phys ther,corticosteroid inj. If in doubt, don't be afraid to ask Ortho doc #2 about any questions or concerns you might have. Any type of tear should be regularly monitored by your orthopaedic surgeon in case of further progression or damage. I would make sure your surgeon knows you are planning on falling pregnant within the next 12 months. This content is accurate and true to the best of the authors knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. If pain is being caused, then there may be a problem with technique or a lower intensity may be required. The supraspinatus tendon runs from the muscle body through quite a narrow gap under the acromion. 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. The pain is mostly in neck and shoulder blade and collar. Good luck! 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. Thanks for stopping by and sharing. There are generally (at least) two main foci when considering whether to have surgery soon or to delay as long as possible. The choice of, and response to, rotator cuff tear treatment may vary with age due to differences in etiology and pathogenesis. My story is a little lengthy, but I am desperate to find some insight for anyone that could help. i'm a long distance runner and in good fitness and the shoulder problem does not bother me during running. In the supraspinatus tendon, increased expression of MMP-1, MMP-9, MMP-13, and vascular endothelial growth factor was found in the full-thickness group. 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). Here are the causes and treatments. I have always found the anatomy of the shoulder to be very interesting. Many people with supraspinatus tears receive very good relief following a period of PT, but others do not. I am 67 years old and am an artist and my left arm which is the one in question is my dominate arm. For awhile I was able to get my arm somewhat back to normal but wilh slight aching. 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. Good luck! 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. The rotator cuff contributes to both stability and movement of the glenohumeral joint and is vital to the functioning of the upper limb.1 It consists of the supraspinatus, subscapularis, teres minor and infraspinatus muscles. I've met with 2 orthopedic surgeons and both have indicated surgery is my best option for recovery. What does he mean by my tendon is failing? Jung HJ, Sim GB, Bae KH, Kekatpure AL, Chun JM, Jeon IH. Good Luck to all the other guys, especially the deployed guy, my son has just returned. 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. There is certainly good clinical research evidence indicating that arthroscopic surgery can help the types of injuries you described. The databases to be searched include: CINAHL, Scopus, MEDLINE (PubMed), Embase, Web of Science and PEDro.
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