The reverse shoulder surgery is extremely involved so I am getting a second opinion. Although the presence of a small tear visible on an MRI does not always mean that is the problem causing your shoulder pain. Could this require surgery. However, in some cases, the better option may be to consider surgery sooner rather than later (e.g. I'm sorry I can't give you specific advice about whether you will need surgery or not over the internet. Athletes are especially vulnerable to overuse tears, particularly tennis players and baseball pitchers. Here is a link to a recent academic journal article on the topic that should be free to access. 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. Rotator cuff tendon surgery and postoperative therapy. Information on this topic is also available as an, from the American Academy of Orthopaedic Surgeons, Nonsteroidal anti-inflammatory drugs (NSAIDs), Rotator Cuff Injuries - Clinical Practice Guideline (CPG) | American Academy of Orthopaedic Surgeons (aaos.org), When only a small part of the tendon is detached from the bone, it is referred to as a, When a tendon is completely detached from the bone, it is referred to as a, Pain at rest and at night, particularly if lying on the affected shoulder, Pain when lifting and lowering your arm or with specific movements, Weakness when lifting or rotating your arm, Crepitus, or a crackling sensation, when moving your shoulder in certain positions. I'm not sure whether the doctor you mentioned is a family physician / general practitioner or an orthopedic consultant / surgeon. On the other hand, you will also need to ask about the likelihood of decent recovery without surgery. Any advice would be appreciated thanks. JBI Evidence Synthesis16(8):1628-1633, August 2018. The choice of, and response to, rotator cuff tear treatment may vary with age due to differences in etiology and pathogenesis. It sounds like you may be putting yourself at unnecessary risk? ( x-ray, phys ther,corticosteroid inj. Comparison of functional gains after arthroscopic rotator cuff repair in patients over 70 years of age versus patients under 50 years of age: a prospective multicenter study. That means it becomes more like fatty tissue. Full text studies that do not meet the inclusion criteria will be excluded and reasons for exclusion will be provided in an appendix in the final systematic review report. its been three months with some pt but no noticeable improvement. Medicine and physiotherapy often help in reducing pain but the effect is temporary. So don't give up on your ambition to participate in exercise. After a formal assessment, they will be able to prescribe a course of rehabilitative exercises or recommend surgery. Rising trends in surgery for rotator cuff disease in Western Australia. Thankyou. The results of the search will be reported in full in the final report and presented in a PRISMA flow diagram. Jung HJ, Sim GB, Bae KH, Kekatpure AL, Chun JM, Jeon IH. sorry for the double posting, first time user. Recovery after surgical supraspinatus tendon repairs will often require the arm to be in a sling for approximately 6 weeks or so, then another ~6-8 weeks gradually starting to building up strength again. A systematic review in 2012 set out to identify which treatment, surgical or non-surgical, provided the best results for elderly patients with full-thickness rotator cuff tears.25 The reviewers concluded there could be improved outcomes with surgical patients; however, heterogeneity of the studies and risk of bias made it difficult to make a definitive conclusion on the best treatment approach. pendulum), which should be undertaken ensuring correct technique). Because of the risk of infection and and nerve damage. I received my first steroid injection treatment during the summer of 2011 and went through a lengthy 6 moth physical therapy treatment. 3 Supraspinatus tear of the rotator cuff Fig. Getting a second opinion when you are not sure about your first is also often a good idea. 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. For awhile I was able to get my arm somewhat back to normal but wilh slight aching. Moderate subacromial/sub deltoid bursitis. That is some interesting advice you have received. Those words exactly. Thank you for the info posted on this page. I was in a car accident about 18 months ago with damage to my left side of my body, stated with my fingers, to my leg and lastly my arm. Your shoulder joints consist of three different bones the clavicle, humerus, and scapula and the head of the humerus and the glenoid cavity or fossa of the scapula combine to create the ball and socket joint that allows your arm to move at a wide range of angles. 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. These types of tears can also be symptomatic meaning that it causes significant pain and impedes your ability to perform basic everyday tasks or asymptomatic, meaning that the tear doesnt cause significant pain, but should still be monitored by an orthopaedic surgeon since tears can grow worse over time. Your surgeon (and the anesthetist) will not want to perform elective orthopedic surgery while you are pregnant to re-attach the tendon. there is minimal AC arthrosis. It will also get you back to your normal routine quicker. If you have been diagnosed with a partial thickness tear and begin experiencing more pain you should talk to your orthopaedic surgeon. It might be best to get an opinion from your orthopedic specialist sooner rather than later (if possible)! 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. There is longitudinal split in the subscapularis tendon which extends from the humeral attachment to the musculotendinous junction. I think this is a common dilemma that people face. If you research it it's a complicated operation that demands some of the best surgerical skills. While it is true that rotator cuff tears are more common among middle aged and older people, they can indeed occur among younger people too; particularly when they are performing heavy work or have some kind of trauma event (contact sport, car accident, gym accident etc.). Thanks for stopping by and leaving a comment. Judging by the description of atrophy in your rotator cuff muscles, I am guessing it has already been some time since the incident occurred. Jackie. Here are the causes and treatments. You mentioned rotator cuff and tendonosis like they were different things. As far as general information goes, it is also worthwhile noting that chronic pain and inflammation at a joint can lead to secondary changes (weakening muscles, changes in the way the body processes pain etc.) Time progressed, pain continued and my ROM slowly worsened. No, it may not be too late to get relief. 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. When you speak to your doctor and discuss your plan for treatment, make sure you discuss any relevant work / sport related activities so you both know what to expect. 25. I would make sure your surgeon knows you are planning on falling pregnant within the next 12 months. 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. Sorry we are unable to give specific advice over the internet, but I hope this general information is helpful! Modify Sport Techniques . There are two main causes of rotator cuff tears: injury and wear (degeneration). Waiting until after the delivery of your baby to re-attach the tendon may increase the chance of a poorer outcome (not to mention the difficulty nursing a newborn with only one functional arm). Available from gradepro.org. ROM hurts so I'm not sure. First thing to say is that when the best way forward seems uncertain to someone, seeking a second opinion is usually not a bad idea. Wolters Kluwer Health MRI). Repair of Rotator Cuff Tears - UW Orthopaedics and Sports Medicine There may be a snapping sensation and immediate weakness in your upper arm. As I said been dealing with this for about nine months and in that time have run the gamut of treatment. I've only got a couple of minutes, so I'll keep this short. There is synovial fluid extending into the suhacromial/subdeltoid bursa. These four muscles (supraspinatus, infraspinatus, subscapularis, and teres minor) stabilize the glenohumeral joint, enable rotation around the joint, and provide a counterforce to . Now, my Ortho doc #2 who recommended i do the MRI also reccomends a surgery to fix the tear. If you have any uncertainty around the need for your sling use, please call your surgeon's office today. Geary MB, Elfar JC. A full thickness tear of the supraspinatus. Jacquot A, Dezaly C, Goetzmann T, Roche O, Sirveaux F, Mole D. Is rotator cuff repair appropriate in patients older than 60 years of age? The MRI report says: 1. very large, nearly complete tear of the supraspinatus tendon from the tendon insertion with 1cm retraction of tendon fibers. This was caused by contact with another person and (I'm self diagnosing) some prior existing minor tendon tears. 14. 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). I had surgery last Thursday for a complete tear of the supraspinatus tendon due to a car accident and was told the tendon was repaired with titanium staples.My concern is of the staples coming out ,I wear a sling whenever outside but have been taking it off when sleeping in my recliner which I've found the best since the accident.If I am just walking around the house I've let it hang down and do not feel pain at the shoulder so figure there is no risk of them pulling out by doing this,am I correct? Gumina S, Carbone S, Campagna V, Candela V, Sacchetti FM, Giannicola G. The impact of aging on rotator cuff tear size. Make sure you ask the orthopedic surgeon about what to expect after the surgery and the likely recovery time. Many people will recover after receiving treatment from a physiotherapist (or physical therapist in USA). Good luck! I also have no insurance and don't know about surgery. 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. 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. Couldn't even lay down. Most tears are the result of a wearing down of the tendon that occurs slowly over time. To be as specific as I can, It feels like someone shoved a knife right into the top of my shoulder blade and right down inside my shoulder. 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. Now my left supraspinatus has a full thickness tear at the central 1/3 (AP extent 13mm?) Studies have reported that, compared to older individuals, younger patients under 55 years have a higher ratio of smaller tears likely to occur from traumatic events.5,6 Patients over 60 have been found to be twice as likely to experience large rotator cuff tears and three times more likely to experience massive rotator cuff tears compared with younger patients.7,8 The prevalence of full-thickness rotator cuff tears may occur in up to 22% of all patients over 65.9 Approximately 25% of patients in their 60 s and 45% of patients in their 70 s suffer from rotator cuff tears.10 Patients 80 years and over have an even higher occurrence rate of 80%.8, Rotator cuff tear management aims to relieve pain, restore movement and improve function of the shoulder. Are you wondering if it's possible to dislocate a rib? I have had this problem with my shoulder/arm for about 6 months maybe. At a 10-year follow-up, tendon repair is superior to physiotherapy in the treatment of small and medium-sized rotator cuff tears. I am sorry I am unable to provide any specific advice over the internet without conducting a physical examination etc. This review will include studies which examined the effectiveness of non-surgical and/or surgical treatment. Your arm is kept in your shoulder socket by the rotator cuff. The tendon will usually retract if a full rupture has occurred. This can occur due to trauma or repeated micro-trauma and present as a partial or full-thickness tear. Infraspinatus Pain Causes, Symptoms, and Treatments - Healthline If they were consistent with each other it would seem remarkably unlikely that both reports were wrong. Most people who do have surgery experience acute pain during the first few days (although the acute pain medications usually help with this). 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. Construction work and other high-risk physical jobs can also increase the likelihood of experiencing this type of injury. Each year, almost 2 million people in the United States visit their doctors because of rotator cuff tears. MRI states high grade articular surface partial thickness tear of the posterior spinatus tendon without retraction or atrophy. Also an ex ray of my shoulder "Demonstrate my humeral head close to abutting my acromion. Poorly defined large full-thickness tear of the supraspinatus and infraspinatus tendon measuring at least 2 cm in anteroposterior dimension. It will be your Godsend. This degeneration naturally occurs as we age and in most cases is relatively painless. Some studies suggest that young patients with traumatic tears may be best managed with surgery while many atraumatic rotator cuff tears, which is common in older patients, may be amenable to a non-surgical treatment.4 In addition, compared to younger patients (<50), rotator cuff tears in older patients (>70) are characterized by greater retraction in the frontal plane and greater fatty infiltration.6 A study showed that only 82.5% of rotator cuff tear patients older than 70 who exhibited these features had supraspinatus involvement and underwent arthroscopic rotator cuff repair achieved complete healing, compared to 95% in patients under 50. 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. Recovery after surgery can be quite drawn out, often requiring 6 months or more before functioning becomes similar to before the injury. All Rights Reserved. 2. mild labral degeneration. It can be difficult to find good information on the web for specific rehabilitation following surgery. The size of the tear may increase over time. 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. Follow up not til next Wednesday. So my tear went from a near full thickness tear to a full thickness tear. ; 3; Where can I found documentation in the web for the rehabilitation? 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. If it has been a while since the MRI, this may involve getting another one (as tendinosis can weaken the tendon, which may in turn lead to larger tears or even a complete rupture), it may also involve a trial of PT or a referral directly to an orthopedic surgeon. Full thickness tears will not heal without surgery. I don't know what exactly to do, or what my REALISTIC problem could be. What does all that mean in simple layman terms? Although overuse tears caused by sports activity or overhead work also occur in younger people, most tears in young adults are caused by a traumatic injury, like a fall. They decided to do a re examination of my MRI to see if there was something they were missing. I worked closely with a physiotherapist for a good four months and pain got worse. Mild surface irregularity of the supraspinatus in keeping with scuffing-mild partial thickness bursal surface tearing. 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. Rotator cuff tendon augmentation grafts are a promising area of research. That being said, I am scheduled for surgery on 6 Nov. 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.). Thanks for stopping by and leaving a comment. Avoiding work above shoulder height can sometimes avoid aggravating the pain. 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. The pain is manageable if you stay on top of it with pain medication. I work construction and am self employed. @anonymous: Hi Elania, Thanks for stopping by and sharing. I'm sorry I can't provide you with specific advice, rather I only provide some general information. This article will discuss the nature of tendon injuries in the hand, how to know if, in fact, a tendon has been severed, and some tips on how to avoid such injuries. The reference list of all studies selected for critical appraisal will be screened for additional studies. If muscles of the rotator cuff are not providing adequate stability throughout the shoulder's range of motion, this can contribute to shoulder impingement and a break down of the supraspinatus tendon. I am sorry I can't provide you specific advice over the internet. There is no conflict of interest in this project. Severe pain after. I now am having surgery but is it safe to have with whiplash symptoms. In some cases, surgery to repair the tendon is also required. 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. I just found out this week that I have Bursitis, and a tear in my Supraspinatus. Because of the return of the recent pain, another MRI was ordered and the Radiologist wrote: "1. Advice welcomed. Also not sure how long I should wait. Supraspinatus tendon tears are the most common tendon tear in the shoulder region. However, I can just mention some general information that may be of interest. It must have been quite a knock, there is some quite serious damage there. Exercise is important for many reasons (not the least of which are physical and mental health benefits). How I Avoided Shoulder Surgery for a Torn Rotator Cuff Muscular and tendinous structures including remaining portions of the rotator cuff are also felt to remain otherwise unremarkable in signal and morphology. I do not want a metal shoulder. Any disagreements that arise will be resolved through discussion or with a third reviewer. So I think it would be wise to discuss the timing of surgery with your surgeon in the context of wanting to fall pregnant. Men over forty are the most likely to have degenerative supraspinatus tears. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do. Even if surgery is required, the physical therapy program can help strengthen the rotator cuff muscles before the surgery. Subgroup analyses will be conducted if appropriate based on participant age, type of non-surgical, and type of surgical treatment. 2012 completed their search in 2009.25. Thanks for stopping by and leaving a comment. Rotator Cuff Tears: Surgical Treatment Options, Rotator Cuff Tears: Frequently Asked Questions, Shoulder Impingement/Rotator Cuff Tendinitis. Read More Rotator Cuff Tears in the. I agree that shoulder pain for years, that has not resolved is definitely a good indicator that seeing a doctor is a good idea! Top 6 Supraspinatus Exercises for Rehabbing an Injured Shoulder In the interim, physio, chiro, massage, taping were part of my pain management and ROM for all pain sites relating to MVA. The rehabilitation after surgery is likely to take time. Depending on the severity of your shoulder tear and other injuries, your age, general health, and lifestyle, it might be possible to alleviate the pain and minimize the issues resulting from a supraspinatus year through a combination of non-invasive tactics like medication and physiotherapy. 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. 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 purpose of this study was to compare clinical outcome measures at least 1 year postoperatively between patients who had completion of a high-grade partial thickness supraspinatus tear to a full-thickness tear (PT) and those who had an isolated full-thickness supraspinatus tear (FT). I am not aware of any studies that have shown rotator cuff exercises impair healing in supraspinatus tendons that have a partial thickness tear. 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. (Right) A full-thickness tear in the supraspinatus tendon. Chronic shoulder and arm pain are good reasons to see your doctor. I had a fall at my workplace and was suffering neck and shoulder pain. Fig.1 Normal rotator cuff attachment around the humeral head Fig.

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