As I said been dealing with this for about nine months and in that time have run the gamut of treatment. Dr. Raymond Wittstadt answered Hand Surgery 38 years experience Rotator Cuff Tear: If you are 31 and have a full thickness tear of your suprspinatous tendon, you have a problem. Sleeping on my right side became impossible. Thanks for the update and let us know how you go. Let us know how things turn out for you. If in doubt, don't be afraid to ask Ortho doc #2 about any questions or concerns you might have. my ROM did increase a very small amount, but my pain and discomfort never went away. Time passed. This is possibly caused by microdamage to the tendon that is painful and can weaken it over time. Rotator cuff tendon surgery and postoperative therapy. 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. On the other hand, you will also need to ask about the likelihood of decent recovery without surgery. 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. 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. This surgical method is a simple and effective Tearing can be caused by atraumatic tears due to overuse and longstanding degeneration.4 Tear enlargement can occur due to increasing age.2 Patients who experience enlarging rotator cuff tears are five times more likely to develop symptoms than those with tears that remain the same.2 Older individuals have progressively become more active, increasing the chances of sustaining large and massive rotator cuff tears. The acromion connects with the collar bone (clavicle) very close to the ball and socket (glenohumeral) joint of the shoulder. If you are in doubt, don't be afraid to get a second opinion. 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). So I think it would be wise to discuss the timing of surgery with your surgeon in the context of wanting to fall pregnant. I also have an intermediate grade partial thickness tear of superior tendon bundle of Subscapularis without retraction or muscular atrophy. The pain and weakness in the shoulder may make routine activities, such as combing your hair or reaching behind your back, more difficult. Rising trends in surgery for rotator cuff disease in Western Australia. Please enable scripts and reload this page. 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. Are you experiencing rib pain? Whiplash is more difficult to detect with common imaging approaches, like an MRI, than supraspinatus tendon tears. Remaining tendons of the rotator cuff are normal in signal and morphology. Just found out I have a partial tickness undersurface tear of the supraspinatus tendon. 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. may email you for journal alerts and information, but is committed Three kids will no doubt also be keeping you busy and missing out sleep because of your shoulder pain doesn't sound like much fun. 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. After 4 months of therapy and 3 injections I am unable to lift my right arm. As I think you already suspect, an MRI is likely to have greater diagnostic accuracy for ruling out (or in) the involvement of other structures in your shoulder, such as the long head of Biceps Brachi. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time. 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). Good luck! Starting with Physio treatment is a good idea. I have about 3" less range reaching up behind my back, but I think some pre-existing tears and arthritis were fixed. 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. 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. pain that increases with shoulder use. Your doctor may also advise a trial of physical therapy to see if that can bring relief to his symptoms. The goal of any treatment is to reduce pain and restore function. They usually present as a sharp pain at the outside or front of the shoulder, particularly with arm elevation (raising the arm to the side or front). Here are the causes and treatments. Of course, I am sure his orthopedic surgeon will be able to give good advice in this regard (after a full clinical assessment etc.). Poorly defined large full-thickness tear of the supraspinatus and infraspinatus tendon measuring at least 2 cm in anteroposterior dimension. That means it becomes more like fatty tissue. The close proximity of the supraspinatus tendon to the acromion-clavicular arch is a common contributing factor in supraspinatus tears, particularly when the tendon becomes impinged between these bone structures with activities that require arm elevation. 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. I'm just about at the point of desperation here. Full thickness tear means a complete tear of the rotator cuff supraspinatus tendon. I am sorry I am unable to provide any specific advice over the internet without conducting a physical examination etc. 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. Dr. Mike great info here thanks. Also, don't be afraid to ask doctors / surgeons lots of questions. 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. Could this require surgery. 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 CT impression read like this: High-grade partial tear of the supraspinatus tendon at its insertion (rim rent tear). There is some really good information in what you have said. What does a "full thickness tear of the supraspinatus tendon" mean? To recap I have had debridement and subacromial decompression, am 34 years old and now have arthritis, bursitis, tendinitis and impingement. In these cases often a multidisciplinary treatment team skilled in treating whiplash can be very useful (this may include health professionals like physiotherapists, psychologists, occupational therapists and doctors). MRI). 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. Chronic shoulder and arm pain are good reasons to see your doctor. Subcortical reactive changes superiorly and laterally at the humeral head are present. Supraspinatus is the most commonly injured rotator cuff tendon. 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. I'm experiencing the exact same pain you described, and the Army doc told me I was too young to tear a rotator cuff. 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). 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. Acromioclavicular joint degenerative changes, which means nothing to me. There are generally (at least) two main foci when considering whether to have surgery soon or to delay as long as possible. A rotator cuff tear can result from an injury such as a fall or heavy lifting, or from normal wear-and-tear and repetitive activities over many years. Sought 2 nd opinion 3weeks later due to the server pain. Available from. Particularly about what many people are likely to experience during the often long road to recovery. 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. Overall my subscapularis does appear intact." The technicians wont say more and nor will my doctor. @DrMikeM: Thank you Dr. Mike for answering my question. I can say though that PT's are trained to help people with painful ROM. I am 67 years old and am an artist and my left arm which is the one in question is my dominate arm. 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. I understand most of it but I was wondering is there supposed to be fluid in the acromioclavicular joint. The rotator cuff is a group of four muscles that come together as tendons to form a covering around the head of the humerus. I can reach behind my back ok. I now am having surgery but is it safe to have with whiplash symptoms. Although the presence of a small tear visible on an MRI does not always mean that is the problem causing your shoulder pain. When we finally returned home from sea a few weeks later, my shoulder had become so painful and stiff, It was nearly impossible to do just about anything. Painters, carpenters, and others who do overhead work also have a greater chance for tears. 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). 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. For anyone contemplating surgery, buy a recliner to sleep in after surgery. Baumer TG, Chan D, Mende V, Dischler J, Zauel R, van Holsbeeck M, et al. Physiotherapy interventions typically consist of stretching and strengthening exercises but can also include electrotherapy and other physical modalities such as ultrasound, moist heat and laser therapy.16-19 Treatment by injections in recent studies often involves corticosteroids, hyaluronic acid and platelet-rich plasma.20-22 The literature suggests that the majority of patients begin with non-surgical treatment and if pain persists or improvement in function is less than optimal, surgery is considered.
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