I think it would be wise to listed to the advice from your doctor on this one! I plan on asking the surgeon these questions, but wanted your expert opinion. RCTs in older patients are predominantly attributed to degenerative tears. The likeliness of these issues increases with age and is more common in the dominant hand; in addition, if you experience a degenerative tear in one shoulder, youre at a greater risk for a tear in the other shoulder. I then went to see another orthopaedic surgeon who said I have whiplash. 4. Statistical tests for funnel plot asymmetry (Egger test, Begg test, Harbord test) will be performed, where appropriate. OpenStax College (CC 3.0) via Wikimedia Commons. Time progressed, pain continued and my ROM slowly worsened. Come September of 2010 I chose not to re-enlist and returned home. No visible labral tear. The Summary of Findings will present the following information where appropriate: absolute risks for treatment and control, estimates of relative risk, and a ranking of the quality of the evidence based on study limitations (risk of bias), indirectness, inconsistency, imprecision and publication bias. Available from. Abstract Background: 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. Let us know how you go. 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. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm. 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. Interpretation: There is a focally retracted full thickness 1.2 x 1.2 cm tear of the supraspinatus tendon at its anterior attachment site on the humerus. Popping noises can occur for a variety of reasons, the most common of which are completely normal. I agree that shoulder pain for years, that has not resolved is definitely a good indicator that seeing a doctor is a good idea! Nonetheless, it worth noting that as a general principle, synovial fluid is very important and helps lubricate the joint. Your doctor may also advise a trial of physical therapy to see if that can bring relief to his symptoms. However, I think the most important thing you mentioned was falling pregnant. my ROM did increase a very small amount, but my pain and discomfort never went away. Adelaide, South Australia; 2017 [cited 2017 Jul 16]. perhaps if delay is likely to lead to a complete rupture that could be prevented with early surgery). 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. Judging by the description of atrophy in your rotator cuff muscles, I am guessing it has already been some time since the incident occurred. Overall my subscapularis does appear intact." 19. I don't lay on the side of the hurt arm as I don't think it will be good for it. Your surgeon (and the anesthetist) will not want to perform elective orthopedic surgery while you are pregnant to re-attach the tendon. The glenoid labrum and bicipital tendon appear unremarkable in position and morphology. I experienced a fall on August 31, 2012. I do not want a metal shoulder. Good Luck to all the other guys, especially the deployed guy, my son has just returned. The initial keywords include rotator cuff tear, full-thickness tear, elderly, conservative treatment and surgery: This review is to contribute to the completion of the Master of Clinical Science degree at The University of Adelaide, Adelaide, South Australia, for MN. These tears, however, may still result in arm weakness and other symptoms. 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). It will be your Godsend. there is a small full thickness insertional tear identified relating to the posterior supraspinatus. 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. GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. 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? Pain is really consistent and moderate with moments of severe. Risk of infection and nerve damage are worthy of consideration for any surgery, particularly one as involved as a reverse shoulder replacement. Cold therapy cold therapy cold therapy!! Dr. Mike. What little I have done has given me improvement. will consult surgeon next week. Osteophytes and inferior capsular swelling indents the superior margin of the mytendinous junction of supraspinatus. Good luck! is PT a good options. Now my left supraspinatus has a full thickness tear at the central 1/3 (AP extent 13mm?) Remember that you are not aiming for speed; slow, steady, and controlled movement is best. Superior subluxation of the humeral head. I am really concerned about success rates for revision surgery. Good luck with it either way. @anonymous: Oh Tonia, I feel for you. However, there are a variety of factors that will need to be considered. Here are a few notes/tips before you begin: Below is a demonstration of this exercise. The supraspinatus muscle runs along the top of the shoulder blade and inserts at the top of the arm (humerus bone). People tend to expect recovery after surgery will take a few weeks. feeling pain in hand,,,. Good luck! However, worse yet would be delaying in such a way that you miss out on falling pregnant or delivering a healthy baby. However, if no benefit has been observed after 6 weeks of PT, then discussion your options with your surgeon sounds like a good plan. Studies that include patients under 60, provided they report the results separately for patients aged 60 and over, will also be included in the review. However, in some cases it is clear that surgery is likely to be the best option. There are generally (at least) two main foci when considering whether to have surgery soon or to delay as long as possible. The tendon will usually retract if a full rupture has occurred. (Right) A full-thickness tear in the supraspinatus tendon. The outcomes to be included will be range of motion, muscle strength, rotator cuff integrity, pain scores, shoulder function, patient satisfaction, and quality of life. Acromioclavicular joint degenerative changes, which means nothing to me. 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. The size of the tear may increase over time. Joanna Briggs Institute reviewers manual: 2017 edition [Internet]. 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. 8. As I said been dealing with this for about nine months and in that time have run the gamut of treatment. I have had this problem with my shoulder/arm for about 6 months maybe. Rising trends in surgery for rotator cuff disease in Western Australia. A Summary of Findings will be created using GRADEPro GDT software.27 The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for grading the quality of evidence will be followed. the defect measures approximately 1cm anterior to posterior and medial to lateral. It was then I found out how messed up my shoulder actually is 1. It turns out, this management approach is not terribly effective in leading to a prompt repair of the damaged structures. Decided to see ortho who ordered an MRi last week. Her MRI shows a full thickness tear of supraspinatus tendon and a tear of the majority of the infraspinatus tendon (with a few lower infraspinatus fibers still attached). This exercise can be good for pain relief, and may also help increase the range of motion in the shoulder joint. The longer these tears are left untreated, the more chance the tendon tear will enlarge and retract which results in more difficult surgery to repair this damage. Large tear involving the supraspinatus and infraspinatus Fig. 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! These types of injuries seem quite common for people who work in construction and are often associated with doing work above shoulder height. pain while . 16. It is also worth mentioning that not all PTs are created equal. 2012 completed their search in 2009.25. Article Google Scholar Ratte-Larouche M, Szekeres M, Sadi J, Faber KJ. There are also non-surgical treatment options that orthopedic surgeons may consider for degenerative acromioclavicular changes, supraspinatus tendinopathy and subacromial bursitis. Unfortunately I can't give you specific advice over the internet, without conducting a physical examination etc. 3. Dwyer T, Razmjou H, Holtby R. Full-thickness rotator cuff tears in patients younger than 55 years: clinical outcome of arthroscopic repair in comparison with older patients. Needless to say, I started to feel like I was getting jerked around and not getting any realistic attention. If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. Management of Rotator Cuff Tears. People who play baseball, tennis, and similar sports with a lot of overhead or overarm motions as well people in trades like painting, carpentry, plumbing, and other construction work that involves a lot of overhead motion are also more prone to degenerative tears of the supraspinatus and the other tendons that make up your shoulder joint. Indirect signs on MRI are - subdeltoid bursal effusion, particularly if anterior, medial dislocation of biceps, fluid along biceps tendon . If you give PT a go, make sure you follow their instructions and specific techniques for the exercises they give you (most likely to strengthen your rotator cuff). 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)! old I was in good physical shape as a letter carrier(28 yrs) but have been mostly sedentary recovering from the first surgery. A good doc should be able to assess your shoulder and give you some specific advice regarding the best next plan of attack. There are several treatment options for a rotator cuff tear, and the best option is different for every person. The medical staff there did an x-ray, which did not turn anything up, and once again, were not overly concerned with my condition, but just instructed me to continue to ice pack my shoulder and take some pain medication. They decided to do a re examination of my MRI to see if there was something they were missing. Good luck! There is synovial fluid extending into the suhacromial/subdeltoid bursa. Unfortunately, I suspect that a whole bunch of people will read your account and hear bits and pieces that remind them of their own circumstance. The retracted margin of the tendon is at the level of the lateral and anterior margin of the anterior acromion. There are several video examples to accompany the written explanation. For more information, please refer to our Privacy Policy. Most people with ongoing pain will usually try the conservative interventions before considering surgery. substantial trauma from a fall), or from repeated microtrauma (e.g due to biomechanics + / - age-associated changes). The pain is manageable if you stay on top of it with pain medication. Edwards P, Ebert J, Joss B, Bhabra G, Ackland T, Wang A. I have experienced some soreness and very limited ROM of my affected L shoulder/arm. Shoulder function, measured by shoulder-specific scales including but not limited to ASES, Simple Shoulder Test, UCLA shoulder scoring scale. Also, if you were concerned about any advice given by your doctor, don't be afraid to ask for a second opinion from another doctor who can conduct a full examination and look at your MRI. dull ache in your shoulder and upper arm. 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. MRI). I was told that there were a few other muscles around the supraspinatus that were torn and I also had some bone spurs that could also be causing some irritation. I still have periodic pain that will radiate from the back of my shoulder, down my tricep, and over my bicep. Those words exactly. After discussing your symptoms and medical history, your doctor will examine your shoulder. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful. My doctor has told me I need to have arthroscopic revision rotator cuff repair. I served in the Navy for many years, and in April of 2010 I had a little mishap. If they were consistent with each other it would seem remarkably unlikely that both reports were wrong. If you want any further clarification just post any follow up question. This may result in pain and weakness of the shoulder. The reverse shoulder surgery is extremely involved so I am getting a second opinion. A disc protrusion, or herniated disc, often occurs in the lumbar spine and can be very painful. Since then, my pain has gotten to the point where its starting to take effect of my day to day life. This review will consider studies that have measured one or more of the following outcomes: This review will consider randomized controlled trials, pseudo-randomized controlled trials, quasi-experimental studies, case-control studies and cohort studies. I also have no insurance and don't know about surgery. There is a lubricating sac called a bursa between the rotator cuff and the bone on top of the shoulder (acromion). This will help you figure out what you are deciding between. 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%. 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. What happens to patients when we do not repair their cuff tears? Five Fig.1 Normal rotator cuff attachment around the humeral head Fig. The rotator cuff is what keeps the head of the humerus in place, and it is composed of the supraspinatus, infraspinatus, subscapularis, and teres minor tendons. The orthopedic said that after 6 weeks of PT if there is pain then we looka possible surgery, is there something else that I should do or look at? Recovery after surgery can be quite drawn out, often requiring 6 months or more before functioning becomes similar to before the injury. There is a small band of hyperintensity on the footprint attachment of the anterior aspect of supraspintus in keeping with tendinopathy -small unretracted intra-substance tear. damage to the tendon without swelling). Hope that helps. to maintaining your privacy and will not share your personal information without I don't lay on the side of the hurt arm as I don't think it will be good for it. They will be able to tell you the likelihood of a supraspinatus tear and adhesive capsulitis (or any other pathology), as well as the recommended course of action for your particular circumstance. I will surf again! The popping may or may not be related to your shoulder pain (difficult for me to say without an examination etc.) Sorry for the delay in response. In most patients the supraspinatus tendon is the most vulnerable and 90% of rotator cuff tears involve this tendon. I appreciate your thoughts on this matter. Good luck! Rotator Cuff and Shoulder Conditioning Program, Rotator Cuff and Shoulder Rehabilitation Exercises. The databases to be searched include: CINAHL, Scopus, MEDLINE (PubMed), Embase, Web of Science and PEDro. Repair of high-grade partial thickness supraspinatus tears after Rotator Cuff Tears: Causes, Symptoms & Treatment - Cleveland Clinic The rehabilitation after surgery is likely to take time. It sounds like you are not following your surgeons instructions! @anonymous: Hi Hans, Thanks for stopping by and sharing your story. 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. Your shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). Rotator cuff exercises are often prescribed for people with a partial tear of the supraspinatus tendon. Baumer TG, Chan D, Mende V, Dischler J, Zauel R, van Holsbeeck M, et al. I can reach behind my back ok. My question to you is why can they not try to repair the rotator cuff using a graft of somesort. I am in aching pain consistently. But shoulder exercises from now until I die. 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 is one of the four rotator cuff muscles. Lots of people express feeling useless, frustrated, and angry at times. 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. Thanks for stopping by and sharing your story. All the best. I wear an arm sling a lot to relieve weight from my shoulder, which helps to some degree. Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. I see this is true of SSGtomn who has left a comment already. There may also be insurance implications etc. If you get a chance please let us know how you go. A few months passed, and I was called into the orthopedic surgen, who was a shoulder specialist, for a "pre surgery consultation". What does all that mean in simple layman terms? Following the post-surgery protocol will help minimize the chance of a poor outcome and further problems. I am 67 years old and am an artist and my left arm which is the one in question is my dominate arm. A supraspinatus tendon tear can be full thickness (meaning that the entire muscle is affected) or partial thickness (or an incomplete tear). The rotator cuff exercises should not cause pain while the exercise is being performed. I don't think there is a clear answer to this one. @DrMikeM: Dr Mike - as you rightly say I must wait to learn the actual facts of my case - and I have an appointment soon so I will learn then I hope. The results showed a "partial tear of the supraspinatus tendon, with large swelling and irritation". Arthroscopic repair of partial articular supraspinatus tendon - PubMed Deciding to have surgery is never an easy decision and you may require some time to recover, but if your shoulder joint issues such as supraspinatus tear are having a significant negative impact on your life, surgery and the associated downtime and physiotherapy may very well be worth 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. Re-attaching the tendon to the bone as you have described is a substantial surgery, the first months of recovery after this type of surgery are very important to ensure that the tendon does not detach / rupture and optimal recovery can occur. I also can't give you specific advice about your situation over the internet etc. In the interim, physio, chiro, massage, taping were part of my pain management and ROM for all pain sites relating to MVA. Large rotator cuff tear with early loss of the cartilage of . 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. The goal of any treatment is to reduce pain and restore function. If you are in doubt, don't be afraid to get a second opinion. The chief advantage of nonsurgical treatment is that it avoids the major risks of surgery, such as: The disadvantages of nonsurgical treatment are: Your doctor may recommend surgery if your pain does not improve with nonsurgical methods. Most of the time, it is accompanied by another rotator cuff muscle tear. There is certainly good clinical research evidence indicating that arthroscopic surgery can help the types of injuries you described. Physical therapy exercises for supraspinatus tendon tears usually have one of three purposes: Below is a pendulum exercise demonstration. A proposed search strategy for PubMed is detailed in Appendix I. When a radiologist looks at an MRI scan, he or she must make a judgment about the type of the rotator cuff changes. I suspect you have a bit of work to do over the next 6 months or so to help your shoulder recover. shoulder stiffness. Thank you for the info posted on this page. 2023 The Arena Media Brands, LLC and respective content providers on this website. Any disagreements that arise will be resolved through discussion or with a third reviewer. Your question regarding using a graft of some sort to help repair a rotator cuff tendon is an interesting one. i was recently diagnosed via MRI that i have a supraspinatus tendon tear. Data will be extracted from papers included in the review using standardized data extraction tools in JBI SUMARI.26 The data extracted will include specific details about the populations, interventions, study methods and outcomes of significance to the review question and objectives. It is also worth noting that sometimes you can do everything right (good surgery, follow instructions etc.) My arm is very weak. Don't be afraid to have an open discussion with your GP about whether or not a referral to a surgeon is the right way to go (or not) for your specific circumstance. Have been taking 800 mg Motrin tid. I appreciate your thoughts on this matter. There are many sub-types of SLAP tears and varying severity. Full thickness tear of supraspinatus tendon treatment I can say though that PT's are trained to help people with painful ROM. You may be trying to access this site from a secured browser on the server. The supraspinatous is one of the 4 muscles that make u. First, sorry for the delay in response. It is certainly worth discussing a more conservative approach, such as seeing a physical therapist that specializes in shoulders, with your orthopedic surgeon; particularly if you feel you have noticed improvements previously. Schmidt CC, Jarrett CD, Brown BT. This information is provided as an educational service and is not intended to serve as medical advice. Also, don't be afraid to ask doctors / surgeons lots of questions. Players involved in sports requiring fast throwing actions (baseball) or overhead hitting (volleyball, tennis) may also sustain a traumatic injury to their rotator cuff and the supraspinatus tendon in particular. 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. Partial thickness tears of the supraspinatus muscle are an incomplete disruption of muscle fibers; note that these can progress to a complete or full thickness tear of the supraspinatus muscle, and larger tears pose a higher risk of progression to full tears, even if they are asymptomatic. There are at least three important factors that contribute to supraspinatus tendon tears. Good luck! 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 say promising because work in basic science and animal studies have demonstrated some quite promising findings. 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. pendulum), which should be undertaken ensuring correct technique). Some general information you may find useful is that generally not a lot of people seem to have a full recovery following a SLAP lesion without surgery. Rotator cuff surgery in patients older than 75 years with large and massive tears. 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. Either way, I wish you all the best with it (and a safe deployment and return). Especially since my injury has gotten worse instead of better. I work construction and am self employed. Some simple tests during a physical examination should enable your doctor to determine whether your symptoms are likely to improved with a surgical repair of the tendon. Available from gradepro.org. This may give you relief, even if you have been getting symptoms for a few years. When they try to suture through fatty tissue, it just tears right through. 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)! Rotator cuff tendon augmentation grafts are a promising area of research. I'm 43 and have been suffering from shoulder issues for over a year. 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. Thanks for stopping by and sharing your story. Where statistical pooling is not possible, the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate. Based on the information you have provided above, I would say there are several structures that could potentially be causing this ongoing problem, of which a supraspinatus tendon tear is one (but is difficult to speculate without a physical examination / seeing the MRI etc.