The supraspinatus is one of four rotator cuff muscles in our shoulder. pain management and physical therapy) may be the first choice to see if surgery can be avoided. AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. It sounds like you have several concerning symptoms there. A full rupture will require surgery (usually quite urgently). If you have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment. I got a recent MRI which showed a full width/ thickness supraspinatus tendon tear. This was caused by contact with another person and (I'm self diagnosing) some prior existing minor tendon tears. Surgery may also involve orthopedic alteration of biomechanical factors around the shoulder joint in order to prevent further ongoing damage to the supraspinatus tendon. I don't know what exactly to do, or what my REALISTIC problem could be. Since then, my pain has gotten to the point where its starting to take effect of my day to day life. You have asked for information about potential options. However, in some cases it is clear that surgery is likely to be the best option. They do reveal most substantial soft tissue injuries, but they are only as useful as the person interpreting them is skilled. A complete, full thickness tear means that the tear goes all the way through the tendon. This article discusses shoulder impingement, rotator cuff rehabilitation exercises, and surgical considerations relating to rotator cuff tears and the supraspinatus tendon in particular. It may be helpful to think of the rotator cuff as a group of muscles and each muscle is connected to the bone via a tendon. On the other hand, if your surgeon thought your tendon would be able to endure pregnancy and nursing your baby without the need for strong medications or the need for surgery, then this may influence your decision on timing for surgery etc. patients should expect to return to full work duty by 6-10 months after surgery. At the . This tear leaves only a very thin layer of intact cuff at the site, no impingement, labrum is intact. massive cuff tears. ROM hurts so I'm not sure. Questions: 1. So it would seem strange that your surgeon would expect adhesive capsulitis to resolve with 6 weeks of physical therapy, unless you had already had the condition for many months and he had started to detect improvement? This will help you figure out what you are deciding between. 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. (See Fig. What does he mean by my tendon is failing? 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. When he says your tendon is failing, I think what he is trying to convey is that once some strands of a rope start to break, then there is more load on the remaining strands which may cause more strands to break (and then more load on remaining individual strands, more strands tear and so on). My MRI impression reads: suggestive of a full thickness, obliquely oriented tear through the supraspinatus insertion. The tear may be a partial or full thickness tear. That was July of 2011. What I can say is that for anyone looking to return to unrestricted badminton following a partial thickness supraspinatus tendon tear and shoulder labrum tear (particularly a SLAP lesion) will not be quick or easy. bested on all of the above. However, in some cases, the better option may be to consider surgery sooner rather than later (e.g. Another subtle point of interest is that the first surgeon was not saying that the MRI was wrong (pictures generally don't lie, although sometimes image quality is poor), but that he disagrees with the report prepared by the radiologist. coracoacromial ligament. is surgery the only option? @anonymous: Hi Bobby, Thanks for stopping by and leaving a comment. My doctor has told me I need to have arthroscopic revision rotator cuff repair. Full-thickness rotator cuff tears are diagnosed with the help of a thorough history and physical examination, as well as the use of imaging studies, most commonly, MRI. 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.) An exercise or physical therapy program is necessary to regain strength and improve function in the shoulder. 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. As you have correctly identified, there is quite a long recovery period following surgical repairs of rotator cuff injuries, but on the other hand, there is a pretty good success rate among people who follow the post-operative instructions. I am sorry I am unable to provide any specific advice over the internet without conducting a physical examination etc. Being deployed and not receiving treatment makes it difficult. The process of recovery is different depending on a number of factors including the cause, severity and location of the tear, the biomechanics of the affected shoulder, the age of the individual just to name a few. The rotator cuff is a group of four muscles that come together as tendons to form a "cuff," or cover, over the head of the humerus (upper arm bone). No, it may not be too late to get relief. indications. but can get back fairly good motion about the shoulder . Methods: Between 1995 and 1999, 139 full arthroscopic rotator cuff repairs were performed; 37 were repairs of full-thickness supraspinatus tears. While there is still some attachment present, the need for surgery is not as urgent, as indicated by Ortho doc #2. When a rotator cuff is torn, the tendon part of the muscle tears away from the bone of the upper arm. 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. Communication between health professionals (such as PTs and surgeons) may not be as good as it could be. The recovery time after surgery is substantial (and may vary depending on the surgeon, and specific structures repaired). I started adding exercise back in to my life a couple of months ago and what had been intermittent pain has once again become fairly continual. The speed of recovery after surgery will depend on the type of surgery and following the surgeon's recommended protocol. muscle atrophy of supraspinatus, infraspinatus, and subscapularis muscles, 3.) Once the full thickness of the tendon is torn, we classify the tears based upon the shape and the number of tendons involved. ; 2. Massive. Sometimes in cases like this your surgeon may want to try an injection. Full thickness tear means a complete tear of the rotator cuff supraspinatus tendon. Articular side: tears on the bottom of the tendon. have got bursal thickening as well and mild thickening of. @anonymous: mike but not dr. mike. twice, second time relief only lasted 5 minutes) finally local doc ordered M.R.I. 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. I am now off again to another specialist as the 2nd opinion specialist said there was not much he could do to improve the situation! 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. Thanks for posting your question. However, given that you already have an MRI it sounds like you are already under the care of your doctor, which is great. I slept in a recliner for about 2 1/2 months following surgery (I don't think I slept at all before surgery :) ). Three techniques are used for rotator cuff repair: Your orthopaedic surgeon can recommend which technique is best for you. I am sorry I can't provide you specific advice over the internet. So probably worthwhile having a chat with your doctor and seeing what they recommend as a first step. I am sorry, I can't give you specific advice over the internet about whether you will need surgery or not. I say promising because work in basic science and animal studies have demonstrated some quite promising findings. The soft tissues in their neck that were affected by the initial trauma may actually have healed, but they may still be feeling discomfort. Don't be afraid to ask your surgeon about all your treatment options. I'll go check out some of your Lenses. 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. It can reduce (relocate back into the socket) long before someone makes it to a hospital (or an onboard medic!) All the best with it. But shoulder exercises from now until I die. Overall my subscapularis does appear intact." 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. In most patients the supraspinatus tendon is the most vulnerable and 90% of rotator cuff tears involve this tendon. Good luck with it. Thanks for stopping by and leaving a comment. There is a moderate amount of fluid distending the subdeltoid bursa maximal over the anterior aspect of supraspinatus and the rotator interval. The presence of greater tuberosity cortical irregularity and joint fluid was most important in the diagnosis of full-thickness supraspinatus . But not result in a normal shoulder. There is synovial fluid at the glenohumeral articulation. Do not complete these exercises if they cause an increase in pain; instead, seek specific advice from an appropriately qualified professional such as a physical therapist or physician. I mention this, as this will often influence treatment decisions. I have a referral to a specialist and hopefully I will have some answers soon. @DrMikeM: Thank you Dr. Mike for answering my question. Most people with ongoing pain will usually try the conservative interventions before considering surgery. I'm sorry I can't give you specific advice on your case over the internet. is likely to be required if you want less shoulder pain. Either way, I wish you all the best with it (and a safe deployment and return). A full-thickness tear might also be described as extending from the anterior leading edge with 1 cm of supraspinatus remaining intact or as involving the midportion with 1 cm of supraspinatus intact anteriorly and 1 cm of infraspinatus intact posteriorly, and so forth. 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. This exercise can be good for pain relief, and may also help increase the range of motion in the shoulder joint. Gloria Freeman from Alabama USA on January 21, 2013: Hi lot of good info and tips here. 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. 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). It sounds like you are on the right track with your surgeon and physical therapist. @anonymous: Thanks for keeping us up to date. There are a few interesting things worth noting here. Good luck! It is also worth noting that whiplash associated disorders are complex. It has been helpful. Best to have a chat with your doctor. Humeral head is riding high abutting the underside of the acromin process. 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). Good luck! It extends slightly into the proximal subscapularis bursa. Of the 49 rim-rent tears, 24 (49.0%) involved the anterior-most fibers of the supraspinatus tendon, one of which extended to involve the infraspinatus tendon. How do you treat a supraspinatus tear? With full thickness tears the entire tendon has separated or torn from the bone. Bursal side: tears on the top of the tendon. It would be particularly unusual for a radiologist to see a tear that was non-existent (perhaps more likely to miss one that was hard to see than to see one that is not there). The rotator cuff is made up of 4 muscles. For awhile I was able to get my arm somewhat back to normal but wilh slight aching. Do I will need surgery? This muscle is often used by people who practice different types of sports, including swimming, racquetball and throwing spears or weights. Can a full thickness tear of the supraspinatus heal without surgery? MRI). Twelve patients in Group 1 received an intra-substance injection into rupture area of supraspinatus tendon with Diprospan 1 cc (betamethasone disodium phosphate 2 mg and betamethasone dipropionate 5 mg) and . Thank you for the info posted on this page. Poorly defined large full-thickness tear of the supraspinatus and infraspinatus tendon measuring at least 2 cm in anteroposterior dimension. This is possibly caused by microdamage to the tendon that is painful and can weaken it over time. 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? Failure to do so increases the risk of progression to a supraspinatus tendon full thickness tear. 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. 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. 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.). 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). It was a small rotator cuff tear. I will congratulate you on actually doing your exercises! Let us know how things turn out for you. The specific post-surgery rehabilitation is often differs between surgeons in different regions (depending on the specific techniques they use). What do you think of the other therapies? There is certainly good clinical research evidence indicating that arthroscopic surgery can help the types of injuries you described. A few months ago it seemed to hurt more and I had problems lifting my arm out or above my head. The goal of acromioplasty is to increase the size of the subacromial space. And overall her last resort for surgical intervention is a reverse total shoulder arthroplasty. So in other words, tendinosis is the condition and one of the rotator cuff tendons is probably the structure that was affected. No black and white answer for this one I'm afraid. 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. I wrote a previous commentsaw my orthopedic surgeon this week. dr mike,a i got an mri shoulder pain, the surgen said it was adhesive capsulitis and with about 6 weeks of pt it would be fine, but the mri report also said there was a tear, the doctor said the report was wrong, needless to say i got a second opinion, the next doctor ordered a new mri and he suggest surgery , i am at a loss, should i get a 3rd opinion just to be sure? ), while others do not. The rehabilitation after surgery is likely to take time. The types of findings you have described are consistent with some quite substantial pathology in your shoulder. @anonymous: Hi LB, Sorry for the delay, I have been away for visiting family for a week or so. Osteophytes and inferior capsular swelling indents the superior margin of the mytendinous junction of supraspinatus. Good luck! RESULTS: Arthroscopy revealed 21 full-thickness tears, five bursal surface partial-thickness tears, 10 articular surface partial-thickness tears, and 14 patients without tear of the supraspinatus tendon. Good luck with it. While I can't give you specific advice over the internet, it sounds like you are doing a great job following the recommednations of your doctors. I had subacromial decompression February 2010 a year after a motor vehicle injury (I am currently a 34 year old female). Pain is really consistent and moderate with moments of severe. In full-thickness tears, surgery is indicated in many patients. Supraspinatus tendon tear symptoms commonly go on for months (or even years) until the underlying problem is resolved (usually through improving the functioning of the rotator cuff, surgery, or both). Have been taking 800 mg Motrin tid. >5cm), depth (partial or full thickness), degree of fatty infiltration (Goutallier. I can reach behind my back ok. Risk of infection and nerve damage are worthy of consideration for any surgery, particularly one as involved as a reverse shoulder replacement. Conclusion: Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. Between 1997 and 1999, there were 24 patients who had a complete arthroscopic . Good luck! Could this require surgery. List of pain and limited mobility for about a week. These muscles can be torn in a traumatic injury or simply by age-related wear and tear. 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. I returned to the orthopedic surgeon at which point he did an x-ray which looked good and sent for a mri Monday. 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. . That is one of the reasons why surgeons will take a detailed history and conduct a physical examination to gather clinically relevant information. Most people regain shoulder function and strength within four to six months after surgery, but full recovery may take up to 12-18 months. It's a supraspinatus tendon tear with 50% thickness and no labral tear. My arm was nearly frozen for a period of about 10 minutes, but I slowly started regaining some ROM. 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. However, there are certainly injuries and structures other than rotator cuff tears that can cause some of the symptoms Tim described above. substantial trauma from a fall), or from repeated microtrauma (e.g due to biomechanics + / - age-associated changes). Im a bodybuilder for years but I'm getting old. This study was done in order to identify stages of rotator cuff tears that signal the need for surgery. Moderate subacromial/sub deltoid bursitis. I think this is a common dilemma that people face. . It is best to stick within the range of movement indicated on the video rather than try to rotate your arm too far out to the side and potentially aggravate already inflamed rotator cuff tendons. Did MRI of neck 1st which showed degenerative disc disease in c5-6 and c7-t1. They may be perfectly justified in their opinion, but if their opinion is based on one or two other specific cases that they know of (or perhaps their own bad experience), it would be a shame to miss out on receiving some potential benefit because a well meaning friend or family is not as well informed on the topic as they may think. 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). I guess my question is does this always require surgery? I've . 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. They may extend to become massive involving multiple tendons as shown in the figure. 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! This may not give immediate relief, but hopefully will show some benefit within 6 weeks. It is not possible for me to give you any specific advice over the internet etc., but here are some general thoughts. 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. A few months ago it seemed to hurt more and I had problems lifting my arm out or above my head. Also now taking Tylenol 500 with5 hydrocodone. Those words exactly. Thanks again Dr. Can a supraspinatus tendon tear heal itself? Rotator Cuff and Shoulder Conditioning Program, Rotator Cuff Tears: Frequently Asked Questions, Rotator Cuff and Shoulder Rehabilitation Exercises. 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