It usually develops alongside other rotator cuff muscle tears, which may be result of trauma or repeated micro-trauma. With partial thickness rotator cuff tears only part of the tendon has torn off the bone. I plan on asking the surgeon these questions, but wanted your expert opinion. Hope that helps. I tried to figure out what the onset was, but could never figure it out, it just seemed completely random. You mentioned rotator cuff and tendonosis like they were different things. However, worse yet would be delaying in such a way that you miss out on falling pregnant or delivering a healthy baby. Humeral head is riding high abutting the underside of the acromin process. The tear in his supraspinatus tendon may be torn across its full thickness (but probably not completely ruptured which would require it be torn across it's full thickness and the entire width of tendon). A recent study from Kim et al 19 used en masse suture bridge techniques for full-thickness supraspinatus tears. If your doctor does end up recommending surgery, make sure you have a good chat about what to expect after the specific surgery they are planning. Good luck with it and I hope you are feeling pain free sooner rather than later. Retraction of the supraspinatus tendon medial to the glenoid. Unfortunately, I think 1cm retractions of torn tendon fibres do not favor natural healing of those portions of the tendon (without surgery). In addition to arm elevation, the supraspinatus muscle is critical in pulling the head of the humerus (the ball part of the ball and socket joint) into the glenoid (socket). Advertisement. Although very uncommon, it is possible that the report did contain an error. 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. Recovery after surgery can be quite drawn out, often requiring 6 months or more before functioning becomes similar to before the injury. Also can I try a more Conservative approach and see a phy therapist that specializes in shoulders before any surgery. In full-thickness tears, surgery is indicated in many patients. 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. 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. Results are as followsstudy demonstrates degenerative arthritis around the acromioclavicular joint. Unfortunately I can't give you specific advice over the internet, without conducting a physical examination etc. Some minor tears may be treated without surgery. Pain is moderate. If you have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment. If you want any further clarification just post any follow up question. If you have any uncertainty around the need for your sling use, please call your surgeon's office today. ), but not so good with the finer movements (better performed by the muscles in the forearm and hand). A rotator cuff tear can extend or get larger over time. Lots of people express feeling useless, frustrated, and angry at times. 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. I received today my results of a CT Scan from my right shoulder, which I had an accident like 5 months ago. I am in aching pain consistently. I'm sorry to hear of your shoulder trouble. 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. if applied to the common anterior supraspinatus tendon tear, the term full thickness means that if the tear is viewed . It is also worth noting that whiplash associated disorders are complex. I have continued to have problems with my arm and initially was told that I had a partial tear of my rotator cuff. If you are in doubt, don't be afraid to get a second opinion. Early diagnosis and treatment of a rotator cuff tear may prevent symptoms such as loss of strength and loss of motion from setting in. coracoacromial ligament. The MRI report says: 1. very large, nearly complete tear of the supraspinatus tendon from the tendon insertion with 1cm retraction of tendon fibers. Let us know how things turn out for you. Most of the time, it is accompanied by another rotator cuff muscle tear. There is supraspinatus muscular atrophy. Rotator cuff tears may be degenerative (the defect arose in tendon of poor quality) or they may be traumatic (the tear arose from a major injury to otherwise healthy tissue). I have often seen these cases improve substantially after further surgery to repair these rotator cuff tears + post surgery rehabilitation therapies. 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. Supraspinatus tear: If you want a chance for a full recovery surgeryis your best option. I here is incidental note made that the teres minor muscle is prominently atrophic. 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. There is longitudinal split in the subscapularis tendon which extends from the humeral attachment to the musculotendinous junction. If you have any follow up questions just post them here and I'll get back to them as soon as I'm able. Cause There are two main causes of rotator cuff tears: injury and wear (degeneration). Thanks to my hubby for finding this site. I also can't give you specific advice about your situation over the internet etc. Dr. Mike great info here thanks. sorry for the double posting, first time user. Had mild discomfort in shoulder for a few weeks in August. is surgery the only option? 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.). labra are not evaluated 4. I'm sure it is no surprise to you, but when someone is experiencing worsening pain with conventional conservative management like physical therapy this is also not a good sign for a speedy recovery without surgery. The majority of these tears occur amongst people over the age of 40. From my experience, orthopedic surgeons are not usually eager to perform surgery for something like this unless they think there is a good chance of a favorable outcome. In some cases, surgery to repair the tendon is also required. It is difficult for me to comment further based on this information. This will help you figure out what you are deciding between. A tendon is similar to a rope and you can compare the suprasinatus tendon to an inch wide . feeling pain in hand,,,. In 9 of the 24 the tear was smaller. Have had physical therapy for 3 weeks with pain becoming worse so physical therapist suggested to dr. MRI of shoulder. @anonymous: Hi Les, I am glad you found this information helpful. 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. Complete rehabilitation after surgery may take several months or even up to a year. 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? However, in some cases, the better option may be to consider surgery sooner rather than later (e.g. However, to date, I am not aware of any rigorous large-scale clinical trials that have demonstrated effectiveness (or otherwise) in humans. I then went to see another orthopaedic surgeon who said I have whiplash. 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. The rotator cuff exercises should not cause pain while the exercise is being performed. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? This has caused thickening and abnormal signal in the supraspinatus tendon consistent with tendinopathy and/or a partial tear. Full thickness tears: usually categorized by size in centimeters. 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.). 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 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. 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. The technicians wont say more and nor will my doctor. Basically, it creates a hole in the tendon. If you have injured your shoulder or have chronic shoulder and arm pain, it is best to see an orthopaedic surgeon. Also, don't be afraid to ask doctors / surgeons lots of questions. 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). 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). It is also worth mentioning that when surgeons send patients for PT and don't hear from them for a while, they may well have just assumed everything went well and there is no more problem (or they have so many patients that they haven't given it much thought). The acriomioclavicular joint usually should have some fluid that helps lubricate the joint, but when it is specifically mentioned in an imaging report (like an MRI report), they are usually indicating that there are able to see more fluid then one might usually expect (in someone without any shoulder pathology). The blue arrows represent a full-thickness tear in the supraspinatus tendon, which is the most common site for rotator cuff tears. Symptomatic full thickness rotator cuff tears can be managed surgically. A rotator cuff tear can be caused by an acute injury such as a fall or by normal age-related wear and tear combined with tendon degeneration. A supraspinatus tear is the most common malady of the shoulder that appears in my orthopedic practice. Particularly about what many people are likely to experience during the often long road to recovery. I went to one orthopedic doctor and he immediately said surgery is my only option. Of course, I am sure his orthopedic surgeon will be able to give good advice in this regard (after a full clinical assessment etc.). It sounds like you may have already discussed the likelihood of success with your surgeon, if not, this would be a very wise thing to do. Some can be altered with conservative rehabilitation exercises in order to prevent further tearing and ongoing pain, while others cannot be altered without surgery. It turns out, this management approach is not terribly effective in leading to a prompt repair of the damaged structures. There also is mild tendinosis of the infraspinatus at the footprint. 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)! 2. Hope that helps! What we often don't see is the subsequent shoulder surgery and months of rehabilitation (sometimes in the off-season) to repair the damaged structures. and retracted 2 cm. I am sorry I can't give you any specific advice over the internet, but here are some thoughts that may be useful to you. (Right) A full-thickness tear in the supraspinatus tendon. 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. 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. 3. I all of a sudden lost all my strength in my right arm and dropped the box. Best to have a chat with your doctor. For most of my life I trained with bodybuilding-style workouts 4 or 5 days per week. ), a shoulder x-ray may not reveal anything conclusive. Rehabilitation plays a critical role in both the nonsurgical and surgical treatment of a rotator cuff tear. I wish you a speedy and full recovery. Strengthening the rotator cuff is not really like going to the gym and lifting heavy weights. will consult surgeon next week. Conclusion: Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. 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. 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. damage to the tendon without swelling). It was a small rotator cuff tear. For anyone contemplating surgery, buy a recliner to sleep in after surgery. My question to you is why can they not try and repair the rotator cuff using a graft of somesort. 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'm sorry I can't give you specific advice over the internet, but hopefully you will find the following general information interesting. To recap I have had debridement and subacromial decompression, am 34 years old and now have arthritis, bursitis, tendinitis and impingement. All the best. Irreparable. My arm was nearly frozen for a period of about 10 minutes, but I slowly started regaining some ROM. 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. I'm experiencing the exact same pain you described, and the Army doc told me I was too young to tear a rotator cuff. 1 Supraspinatus Rupture causes microscopic tear, major tear and dislocation from its attachment to humerus and scapula. Depending on your age and lifestyle, physical therapy may be a better option than surgery even for complete rotator cuff tears. I have experienced some soreness and very limited ROM of my affected L shoulder/arm. I plan on asking the surgeon these questions, but wanted your expert opinion. 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. 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. A full thickness cuff tear (RTC) can be classified by size (small, medium, large and massive i.e. So quite often the best treatment approach is not always immediately clear. pendulum), which should be undertaken ensuring correct technique). Good luck with the recovery (I know slings can be frustrating and uncomfortable, but the weeks will pass quickly)! Symptomatic full thickness rotator cuff tears can be managed surgically. Good luck! I'm only 38 and am not willing to give up everything I love doing and from what I read there are many more options available. X-rays are often not very useful in diagnosing shoulder injuries. Adhesive capsulitis will usually last at least 5 or 6 months (often considerably longer). It is common for patients with known rotator cuff disease to have acute pain and weakness following a minor injury. there is minimal AC arthrosis. bone spurs and/or rotator cuff tears. On the other hand, you will also need to ask about the likelihood of decent recovery without surgery. Full-thickness tears of the supraspinatus and infraspinatus tendons at their attachment site with retraction of torn fibers up to the lateral aspects of the acromial process. There is some spurring at the glenoid articular surface. Either way, I wish you all the best with it (and a safe deployment and return). Three techniques are used for rotator cuff repair: Your orthopaedic surgeon can recommend which technique is best for you. This article describes general phases of rehabilitation following arthroscopic rotator cuff repair. 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. Have been directed to work with a physical therapist and so far have not seen mprovement after two weeks but staying hopefull. When supraspinatus tendon tear symptoms are chronic and severe, an orthopedic specialist will be able to provide good advice on likely recovery and treatment options, including the likelihood of successful recovery with or without surgery. There are generally (at least) two main foci when considering whether to have surgery soon or to delay as long as possible. Remaining tendons of the rotator cuff are normal in signal and morphology. muscle atrophy of supraspinatus, infraspinatus, and subscapularis muscles, 3.) Mild surface irregularity of the supraspinatus in keeping with scuffing-mild partial thickness bursal surface tearing. 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