full thickness tear of the supraspinatus tendon surgery

Although the presence of a small tear visible on an MRI does not always mean that is the problem causing your shoulder pain. It was sometime in the early months of 2011 that I was sent off to have an MRI done. After an initial diagnosis from an Orthopedic specialist, the initial course of action was a steroid injection treatment into the "affected area" and a course of physical therapy. Come September of 2010 I chose not to re-enlist and returned home. Here are the best Nike shoes for heel pain when you have this uncomfortable condition. 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. My question to you is why can they not try and repair the rotator cuff using a graft of somesort. The databases to be searched include: CINAHL, Scopus, MEDLINE (PubMed), Embase, Web of Science and PEDro. Indirect signs on MRI are - subdeltoid bursal effusion, particularly if anterior, medial dislocation of biceps, fluid along biceps tendon . Dr Mike, Please help me understand what options I might have or questions to ask the surgeon about my full thickness rotator cuff tear. I'm sorry I can't give you specific advice over the internet about the best option for your situation. 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. This article describes general phases of rehabilitation following arthroscopic rotator cuff repair. damage to the tendon without swelling). An initial limited search of PubMed and CINAHL will be undertaken. SLAP type tear of the superior labrum. 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. It is not very common that two orthopedic specialists would have very different opinions on what is wrong with your shoulder (although does happen from time to time). In the case of a non-retracted full thickness supraspinatus tear and acromioclavicular degeneration, surgery may well be the best option to maximize the long term outcome. It sounds like you have several concerning symptoms there. By June '13 I was better in many ways than before the injury. 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. Old age is also a major factor in supraspinatus tears; in fact, over 50% of people over seventy years old have a supraspinatus tear when they pass. Any thoughts? Is surgery my only option? and still end up with an unexpected problem. The specific post-surgery rehabilitation is often differs between surgeons in different regions (depending on the specific techniques they use). 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. Mary Kay. I received today my results of a CT Scan from my right shoulder, which I had an accident like 5 months ago. They may also examine your neck to makesure that the pain is not coming from a pinched nerve, and to rule out other conditions, such as arthritis. There are at least three important factors that contribute to supraspinatus tendon tears. For all you that are going to have this surgery be prepared for the long haul you will feel the feelings of uselessness, frustration, anger, and people looking at you like your full of it hang in there! 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). This review will include studies which examined the effectiveness of non-surgical and/or surgical treatment. Garofalo R, Flanagin B, Castagna A, Calvisi V, Krishnan SG. The plastic surgeon gave me 3 options, leave it be and it would only get worse as i age, cortisone shots which is just temp obviously or fix it.. should i get another mri to see if its healed some, i have got partial thickness insertional tear in supraspinatus 9mm*5mm. I say promising because work in basic science and animal studies have demonstrated some quite promising findings. Mike!! I have always found the anatomy of the shoulder to be very interesting. Partial tears can be just 1 millimeter deep (only about 10 percent of a tendon), or can be 50 percent or deeper. Humeral head is riding high abutting the underside of the acromin process. Advice welcomed. It sounds as though you know a little bit about your shoulder situation already, so I won't re-state details about the anatomy that is affected. Is the arthroscopic modified tension band suture technique suitable for all full-thickness rotator cuff tears? Pain continued and got worse. INTRODUCTION. Without seeing the scan or conducting a physical examination, I can only offer some general comments in response. 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. 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? The tendon that seems to be most commonly affected is the supraspinatus, although it could also easily be either infraspinatus, long head of biceps, subscapularis or teres minor tendons. 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. Seek immediate help if you are experiencing a medical emergency. The results of the search will be reported in full in the final report and presented in a PRISMA flow diagram. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. The incident happened on Sept 25 and it is now Nov 10. bested on all of the above. Physiotherapy, including stretching and strengthening exercises, electrotherapy, ultrasound, moist heat and laser therapy. The bursa allows the rotator cuff tendons to glide freely when you move your arm. Good luck! That is some interesting advice you have received. 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. Family is important, and I would not encourage people to discard their advice or offend their family and friends, but definitely weigh up advice on its merit. It is interesting that you are not experiencing a lot of discomfort with a very large tear, but this sometimes happens and can lead to difficulty in diagnosing the exact structural damage that is causing the condition. 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. Shoulder arthroscopy and rotator cuff repair (supraspinatus repair) is the best treatment option with a 90 to 95 % success rate. Sometimes the success rate of a second surgery is not as high as the success rate of the first surgery but still much higher than any other alternative. Joanna Briggs Institute. 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. I am sorry I can't offer specific advice without a proper assessment, but seeing an orthopedic specialist or physical therapist in your local area sounds like a good idea. or should you just ask for their opinion with no outside information> Thanks Judy. prospective, randomised trial in 103 patients with a mean four-year follow-up. Management of Rotator Cuff Tears. He prescribed Vicodin and arthrotec for painbut I would like to get pregnant within a year but would like to be fixed first for obvious reasons. I've only got a couple of minutes, so I'll keep this short. (2) In the presence of a full-thickness tear, there is less ability to generate joint torque, hence a positive lag sign. If you get a chance please let us know how you go. Productive acromioclavicular joint changes are associated with an anterolaterally down sloping type II acromial configuration. (Right)A full-thickness tear in the supraspinatus tendon. I am 72, I just got the mri with same partial tear. You may have pain when you lie on the painful side at night. Painters, carpenters, and others who do overhead work also have a greater chance for tears. If youre going to have surgery to repair a full or partial thickness tear, you should keep in mind that youre going to have some significant recovery time where you wont be able to use the affected arm as usual. ,Been dealing with shoulder pain for about nine months now and thought I'd share my experience with you and other readers. Avoiding work above shoulder height can sometimes avoid aggravating the pain. Selected studies will be critically appraised by two independent reviewers using standardized critical appraisal instruments from JBI SUMARI. So first off, I should say that I have certainly seen situations where a small supraspinatus tear has been surgically repaired, only for a worsening of symptoms to occur after further pathology (such as other rotator cuff tendon tears) either develop or become easier to detect on imaging (e.g. Massage may give you some short term relief, but I'm not sure massage on its own will have long term benefit that is additional to natural healing. Communication between health professionals (such as PTs and surgeons) may not be as good as it could be. My MRI impression reads: suggestive of a full thickness, obliquely oriented tear through the supraspinatus insertion. It sounds like you are not following your surgeons instructions! However, to date, I am not aware of any rigorous large-scale clinical trials that have demonstrated effectiveness (or otherwise) in humans. 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. You don't need to lean over as far as demonstrated in this video. 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. I was referred to a surgeon who stated that they could not repair the rotator cuff due to the size of the tear from a surgical standpoint. 2. Effect sizes will be expressed as either odds ratios (for dichotomous data or weighted (or standardized) mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. 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. Subcortical reactive changes superiorly and laterally at the humeral head are present. Because of the risk of infection and and nerve damage. MRI). I hope some of the general information I provided in my response to Tim's (or others) comment is useful. They decided to do a re examination of my MRI to see if there was something they were missing. On the other hand, you will also need to ask about the likelihood of decent recovery without surgery. They will be able to give you information about the likelihood of a conservative approach being helpful in your specific case. The effect of neuromuscular electrical stimulation of the infraspinatus on shoulder external rotation force production after rotator cuff repair surgery. My best wishes go to all of them. What does he mean by my tendon is failing? @anonymous: Hi Mike, Good luck with your appointment next week, hopefully you will be able to find some relief one way or another after you consult your surgeon. But not result in a normal shoulder. Exercise is important for many reasons (not the least of which are physical and mental health benefits). In most rotator cuff tears, the tendon is torn away from the bone. This degeneration naturally occurs as we age and in most cases is relatively painless. There is some spurring at the glenoid articular surface. I have pain all the time, it hurts to put a shirt on, can't lay on it, reaching out to my side it hurts to turn my pillow. and seemed to be doing ok with Cortisone shots. 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. It will be worth developing a good relationship with your doctor (and physical therapist) who can help you do the right things to recover as quickly as possible. I wear an arm sling a lot to relieve weight from my shoulder, which helps to some degree. 2 Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, . The surgeon may (or may not) want to try arthroscopic surgery to repair any damage or structural problems they can identify on an MRI. That being said, contemporary surgical repairs and surgical re-attachments have relatively high rates of success (albeit after a difficult post-surgical recovery period) when performed in a timely manner. The rehabilitation after surgery is likely to take time. Because most rotator cuff tears are largely caused by the normal wear and tear that goes along with aging, people over 40 are at greater risk. its been three months with some pt but no noticeable improvement. 2012 completed their search in 2009.25. Any advice would be appreciated thanks. @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. Sleeping on my right side became impossible. if your initial injury was work related. If the injection does give you pain relief, it may allow you a couple of months without pain to do exercises that can strengthen your rotator cuff and improve the biomechanics at your shoulder in an effort to reduce irritation of the bursa and Supraspinatus tendon. What little I have done has given me improvement. A few months passed, and I was called into the orthopedic surgen, who was a shoulder specialist, for a "pre surgery consultation". Learn about different types of rib injuries and how they are treated. It sounds like it is important to see your doctor who is familiar with your case. The objective of this review is to synthesize the best available evidence on the effectiveness of non-surgical and surgical treatment on the clinical and functional outcomes of elderly patients with full thickness rotator cuff tear. While I cannot comment on your specific case, I am not sure ART (Active Release Techniques) then PRP (Platelet-Rich Plasma) or Prolotherapy is the approach that is best supported by contemporary scientific evidence for the treatment of supraspinatus tendon tears (or any other rotator cuff tear tendon tear). Either way, I wish you all the best with it (and a safe deployment and return). This can be one of the most frustrating things for people who have whiplash associated disorders. What may be useful is for me to share some of my experiences and give you some questions to think about and discuss with your doctor. There are a few interesting things worth noting here. @anonymous: Hi LB, Sorry for the delay, I have been away for visiting family for a week or so. I'll go check out some of your lenses now. 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). Your arm is kept in your shoulder socket by the rotator cuff. When a surgeon sutures 1 a healthy tendon, it holds. I am sure lots of people would like to hear how it turns out for you. Thanks for stopping by and leaving a comment. The recovery time after surgery is substantial (and may vary depending on the surgeon, and specific structures repaired). pendulum), which should be undertaken ensuring correct technique). If you have any follow up questions just post them here and I'll get back to them as soon as I'm able. MRI does demonstrate a complete massive tear of my rotator cuff with retraction and severe atrophy. I hope your shoulder has now recovered! I am angry, confused and cannot get any pain relief. Acute Tear If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. Good luck with it! Most people who I have seen with whiplash (albeit usually from motor vehicle accidents more than falls) tend to notice a great deal of improvement over the first few weeks, but some have symptoms that persist. Some surgeons will prescribe a slightly different post-operative rehabilitation program depending on the nature of the injury and precise surgery performed. In your opinion, do I have any other option other than surgery? 27. 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. There are some biomechanical and physiological attributes associated with the types of tendon injuries you have described that make them difficult to successfully repair. I'm experiencing the exact same pain you described, and the Army doc told me I was too young to tear a rotator cuff. The supraspinatus tendon is located on the back of your shoulder and helps your arm to move throughout its full range of motion and helps with power and strength. I've met with 2 orthopedic surgeons and both have indicated surgery is my best option for recovery. Original injury was 4 years ago in a MVA and I've been experiencing pain when sleeping on injured side, intermittent loss of sensation for the entire arm resulting in dropping things, loss of muscular endurance and increased pain for repetitive activities ranging from ribcage level and upward, loss of muscular strength and increased pain for lifting objects at the present moment equivalent in weight to a litre of milk or heavier, and an overall sense of lack of spacial awareness for the injured arm as if my arm is not "connected" to my body. The rotator cuff is a group of four muscles and their associated tendons that originate from locations on the scapula and insert onto the humeral head. Not all the time, but it was intermittent. If you are in doubt, don't be afraid to get a second opinion. This can occur due to trauma or repeated micro-trauma and present as a partial or full-thickness tear. Any disagreements that arise will be resolved through discussion or with a third reviewer. If you get a chance drop by again and let us know how you went. There is inhomogeneous and bulbous appearance of the distal .subscapularis tendon with tendinosis. Surgical repairs can be compromised when post-operative instructions are not followed, so if you have surgery make sure you know exactly what you should and should not do! There are other things your physical therapist may be able to help you with to give you some relief in the short term. This tear leaves only a very thin layer of intact cuff at the site, no impingement, labrum is intact. I explained of my ongoing problems since the incident, and once the claim was processed I was sent through a variety of medical departments for a full diagnostic. I have spoke with people that have had surgery on their shoulder and they say that is a very painful surgery, and they still have problems from time to time with their shoulder. At a 10-year follow-up, tendon repair is superior to physiotherapy in the treatment of small and medium-sized rotator cuff tears. There is fluid distending the long head of the biceps tendon sheath, representing tenosynovitis. The tendon will usually retract if a full rupture has occurred. 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. There are also non-surgical treatment options that orthopedic surgeons may consider for degenerative acromioclavicular changes, supraspinatus tendinopathy and subacromial bursitis. Sorry I can't give you specific advice over the internet, but it sounds like your shoulder specialist will be able to give you good personalized advice on Tues. I don't lay on the side of the hurt arm as I don't think it will be good for it. Yes, also a good idea about discussing with your surgeon the potential risks or benefits from delaying surgery in your case. The popping may or may not be related to your shoulder pain (difficult for me to say without an examination etc.) @DrMikeM: Well, I'm 3 months post injury and still in a tremendous amount of discomfort and pain. Over time, the pain may become more noticeable at rest and no longer goes away with medications. 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. 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. I just had an MRI I have a tiny, focal intratendon tear of the supraspinatus fibers at the humeral insertion measuring 2mm with minor impingement changes are noted in the greater tuberosity of the humerus. Once the full thickness of the tendon is torn, we classify the tears based upon the shape and the number of tendons involved. I don't think there is a clear answer to this one. This is possibly caused by microdamage to the tendon that is painful and can weaken it over time. In about 80 to 85% of patients, nonsurgical treatment relieves pain and improves function in the shoulder. If you are seeing the orthopedic surgeon it is a good idea to tell them about therapies you have received and about your persistent pain. 21. i d glad if ortopedist or physiotherapist reply ansver. The full text of selected studies will be retrieved and assessed in detail against the inclusion criteria. It did manage to decrease my overall pain but I still feel like I'm suffering unnecessarily. Even if surgery is required, the physical therapy program can help strengthen the rotator cuff muscles before the surgery. Thanks for stopping by and leaving a comment. 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. i'm a long distance runner and in good fitness and the shoulder problem does not bother me during running. 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. The shoulder is a ball-and-socket joint: The ball, or head, of the upper arm bone fits into a shallow socket in the shoulder blade. The supraspinatous is one of the 4 muscles that make u. Treatment options, tips, knee surgery info, and medical videos are included. If youve experienced a rotator cuff tear, theres a good chance that it could be a supraspinatus tear. We excluded patients with isolated tears of the subscapularis tendon, those with a previous shoulder surgery, and those who had any type of injection . Should you tell him what the other surgeons name is and what they advised. Joanna Briggs Institute reviewers manual: 2017 edition [Internet]. I take anti-inflammatory meds for a long time for other problems, but it sure has not helped my arm. 23. If the nearly complete tear were to become a complete tear, this would require surgery (ideally quite quickly) to re-attach the tendon otherwise the functioning of the supraspinatus muscle (it elevates the upper arm) would be lost. This is just general information of course. The pain is mostly in neck and shoulder blade and collar. Because of the return of the recent pain, a another MRI was ordered and the Radiologist wrote: "1. Osteophytes and inferior capsular swelling indents the superior margin of the mytendinous junction of supraspinatus. 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.) 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. Bae KH, Kim JW, Kim TK, Kweon SH, Kang HJ, Kim JY, et al. 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? I mention this, as this will often influence treatment decisions. 16. that can be just as difficult to resolve as any structural injury. He did say that it can be done in the next few months and no urgent intervention required. I did this as instructed, but, to little improvement. A significant amount of these occur in the supraspinatus muscle, although other areas of the rotator cuff may be involved. Symptoms. However, your doctor may also suggest surgery if you are very active and/or use your arms for overhead work or sports. 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. The soft tissues in their neck that were affected by the initial trauma may actually have healed, but they may still be feeling discomfort. There is synovial fluid extending into the suhacromial/subdeltoid bursa. Some minor tears may be treated without surgery. It is located in the top portion of the back of the shoulder blade (the superior posterior portion above the spine of the scapula) known as the supraspinatus fossa. 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. Hope that helps! For more information: Rotator Cuff Injuries - Clinical Practice Guideline (CPG) | American Academy of Orthopaedic Surgeons (aaos.org). These tears can be painful. Rotator Cuff Tears: Surgical Treatment Options, Rotator Cuff Tears: Frequently Asked Questions, Shoulder Impingement/Rotator Cuff Tendinitis. I was released from the P.T. The rotator cuff exercises should not cause pain while the exercise is being performed. 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. Men over forty are the most likely to have degenerative supraspinatus tears. I sleep fine as it does not hurt to lay on my back. Acute tears of the tendons in your shoulder occur due to sports or similar activities, along with more general wear and tear on the tendon depending on your age or lifestyle. 4. some loss of motion in your shoulder. Drugs, supplements, and natural remedies may have dangerous side effects. have got bursal thickening as well and mild thickening of. Exercise rehabilitation in the non-operative management of rotator cuff tears: a review of the literature. 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). 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. Stay informed on the latest news and updates from Melbourne Arm Clinic. 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. I completed 6 treatments of prolotherapy approximately 9 months ago prior to this latest diagnosis. You may be trying to access this site from a secured browser on the server. I think this is a common dilemma that people face. Adhesive capsulitis will usually last at least 5 or 6 months (often considerably longer). 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. A soft tissue hematoma occurs when a ruptured blood vessel leaks blood into the surrounding fatty tissue. 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. If tendon tears (including small tears) have not responded to conservative (non-surgical) treatments or recovered naturally after a few months, then surgery is often considered.
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