Learn about different types of rib injuries and how they are treated. My question to you is why can they not try to repair the rotator cuff using a graft of somesort. Please enable scripts and reload this page. Thoughts on surgery? Management of full thickness rotator cuff tears in the : JBI Also can I try a more Conservative approach and see a phy therapist that specializes in shoulders before any surgery. A good doc should be able to assess your shoulder and give you some specific advice regarding the best next plan of attack. @anonymous: Hi Vicki, I'm glad the information was useful to you. This tear leaves only a very thin layer of intact cuff at the site, no impingement, labrum is intact. I have a second opinion on Monday. Wish me luck!!! 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. Heterogeneity will be assessed statistically using the standard chi-squared and I-squared tests. This may result in pain and weakness of the shoulder. Fig.1 Normal rotator cuff attachment around the humeral head Fig. 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. its been 5 months since my partialthickness tear of mysupraspinatus the the footplate..im 56 and also have degenerative change o the acromioclavicular joint impinging on the supraspinatus at the myotendinous junctionNarrowing of the acromiohumral distancetenosynovitis of the lpng head of the bicepswill I need surgery???? 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. 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. and retracted 2 cm. These tears, however, may still result in arm weakness and other symptoms. Full thickness tear means a complete tear of the rotator cuff supraspinatus tendon. 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). It is also worth mentioning that not all PTs are created equal. Deciding to have surgery is never an easy decision and you may require some time to recover, but if your shoulder joint issues such as supraspinatus tear are having a significant negative impact on your life, surgery and the associated downtime and physiotherapy may very well be worth it. Quality of life, measured using any validated instrument. 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. Productive acromioclavicular joint changes are associated with an anterolaterally down sloping type II acromial configuration. A full-thickness tear will decrease the capacity of a muscle to do work. This sounds like a difficult situation. However, there are a variety of factors that will need to be considered. Good luck with it. The initial keywords include rotator cuff tear, full-thickness tear, elderly, conservative treatment and surgery: This review is to contribute to the completion of the Master of Clinical Science degree at The University of Adelaide, Adelaide, South Australia, for MN. If the ball is popping out of the joint (dislocating), then that is a major concern (but this usually doesn't occur without trauma)! I wear an arm sling a lot to relieve weight from my shoulder, which helps to some degree. Construction work and other high-risk physical jobs can also increase the likelihood of experiencing this type of injury. It is good that you have discussed the recovery with your surgeon already. The most common symptoms of a rotator cuff tear include: Tears that happen suddenly, such as from a fall, usually cause intense pain. I do so appreciate the advice and direction you have given to myself and others through this posting. Small tear involving the supraspinatus tendon only Fig. This can occur due to trauma or repeated micro-trauma and present as a partial or full-thickness tear. The reverse shoulder surgery is extremely involved so I am getting a second opinion. Full thickness tears are the complete disruption of the fibers of the supraspinatus muscle, and generally require a more aggressive treatment plan and surgery. JBI Evidence Synthesis16(8):1628-1633, August 2018. I have often seen these cases improve substantially after further surgery to repair these rotator cuff tears + post surgery rehabilitation therapies. PDF Rotator Cuff Tear - University Hospital Coventry (Left) The front view of a normal rotator cuff. Moderate subacromial/sub deltoid bursitis. Miller RM, Popchak A, Vyas D, Tashman S, Irrgang JJ, Musahl V, et al. 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. Otherwise you will have signficantly reduced function (plus ongiong pain) in that shoulder. Your shoulder specialist will be able to provide you with specific advice regarding your chance of recovery without surgery, as well as what to expect if you do decide to go down the surgery path. The anterior band of the supraspinatus (most common tear location) is an agonist to external rotation. You can live with a damaged rotator cuff for some time, especially the tearing is minimal and you can manage the pain with activity modification. Even if surgery is required, the physical therapy program can help strengthen the rotator cuff muscles before the surgery. 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.) Baumer TG, Chan D, Mende V, Dischler J, Zauel R, van Holsbeeck M, et al. Have been directed to work with a physical therapist and so far have not seen mprovement after two weeks but staying hopefull. Exercise is important for many reasons (not the least of which are physical and mental health benefits). They will check to see whether it is tender in any area or whether there is a deformity. Most tears are the result of a wearing down of the tendon that occurs slowly over time. Patients 80 years and over have an even higher occurrence rate of 80%. feeling pain in hand,,,. Geary MB, Elfar JC. 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. Infraspinatus Pain Causes, Symptoms, and Treatments - Healthline That being said, I am scheduled for surgery on 6 Nov. Yes, also a good idea about discussing with your surgeon the potential risks or benefits from delaying surgery in your case. I plan on asking the surgeon these questions, but wanted your expert opinion. Full-thickness RCTs are present in approximately 25 % of individuals in their 60 s and 50 % of individuals in their 80 s; however, the reported incidence is lower for patients < 55 years of age (4-8 %) [ 1, 2 ]. Rotator cuff tendon augmentation grafts are a promising area of research. Good luck! 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. Advice welcomed. Surgery to repair tendons generally involves a long recovery period. Getting a second opinion when you are not sure about your first is also often a good idea. Also, don't be afraid to ask doctors / surgeons lots of questions. Pain continued and got worse. your express consent. 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? Please try again soon. I get asked about this a lot, perhaps I should write a page on rehabilitation following surgical repair of supraspinatus tendon tears! It is also worth noting that sometimes you can do everything right (good surgery, follow instructions etc.) INTRODUCTION. Exercise rehabilitation in the non-operative management of rotator cuff tears: a review of the literature. This is partly because rehabilitation following surgery will depend on the surgical technique used. 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. 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. Here are the causes and treatments. I have continued to have problems with my arm and initially was told that I had a partial tear of my rotator cuff. Small to moderate glenohumeral joint effusion. This website also contains material copyrighted by third parties. 2. Some quite compelling research has indicated that a substantial proportion of people (particularly young people) who receive this kind of treatment will go on to have further shoulder problems (sometimes instability in the shoulder joint or pain and discomfort from damaged structures). Popping noises can occur for a variety of reasons, the most common of which are completely normal. JBI Database of Systematic Reviews and Implementation Reports, Get new journal Tables of Contents sent right to your email inbox, https://reviewersmanual.joannabriggs.org/, Management of full thickness rotator cuff tears in the elderly: a systematic review protocol, Articles in Google Scholar by Michael Nganga, Other articles in this journal by Michael Nganga, Privacy Policy (Updated December 15, 2022). Thanks! 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. You mention your shoulder makes a popping noise, generally speaking the sound a joint makes is not a good indicator of anything (particularly if the popping noise itself is not accompanied by pain). Is surgery required for a full-thickness supraspinatus tear? - HealthTap If you do have surgery, this would mean you couldn't work on usual duties for several months (recovery time-frames are something worth discussing with your doctor). These tears can be painful. Some can be altered with conservative rehabilitation exercises in order to prevent further tearing and ongoing pain, while others cannot be altered without surgery. 4. Available from. 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. Subcortical reactive changes superiorly and laterally at the humeral head are present. I'm not sure whether the doctor you mentioned is a family physician / general practitioner or an orthopedic consultant / surgeon. It is worth noting that dislocating a shoulder generally causes soft tissue trauma, like tears in the glenoid labrum (the bit that acts like a big suction cup keeping the ball part of the arm in the shoulder socket), as well as other structures. It's very good of you to reply so promptly and clearly though. and still end up with an unexpected problem. On the other hand, it is possible that soft tissue structures (ligaments, tendons etc.) If your shoulder joint has pain and are seriously affecting your quality of life and your ability to work or perform basic everyday tasks without pain, then you need to speak with an orthopaedic surgeon about the next steps. First, sorry for the delay in response. Arthroscopic shoulder surgery may be required, or even rotator cuff tear procedures may be advised depending on the extent of the injury or damage to your supraspinatus muscle and surrounding bones, tendons, and muscles. And overall her last resort for surgical intervention is a reverse total shoulder arthroplasty. there is no focal atrophy or fatty infiltration.that is my M.R. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time. Thanks for stopping by and sharing your story. Repair of Rotator Cuff Tears - UW Orthopaedics and Sports Medicine Management of rotator cuff tears - UpToDate The majority of these tears occur amongst people over the age of 40. Thanks to my hubby for finding this site. The types of findings you have described are consistent with some quite substantial pathology in your shoulder. Subgroup analyses will be conducted if appropriate based on participant age, type of non-surgical, and type of surgical treatment. Shoulder arthroscopy and rotator cuff repair (supraspinatus repair) is the best treatment option with a 90 to 95 % success rate. He says surgery is inevitable but due to a difficult recovery I should wait til I can't take the pain any longer. Don't be afraid to have an open discussion with your GP about whether or not a referral to a surgeon is the right way to go (or not) for your specific circumstance. Good luck with the recovery (I know slings can be frustrating and uncomfortable, but the weeks will pass quickly)! Now I have these results stated above. My story is a little lengthy, but I am desperate to find some insight for anyone that could help. In your opinion, do I have any other option other than surgery? 27. A few hours after the incident, I was able to seek some medical attention from our on board medic, who believed I had dislocated my shoulder, but was not overly concerned with my condition. For this reason, many doctors first recommend management of rotator cuff tears with physical therapy and other nonsurgical treatments. I have had this problem with my shoulder/arm for about 6 months maybe. If in doubt, don't be afraid to ask Ortho doc #2 about any questions or concerns you might have. This information is provided as an educational service and is not intended to serve as medical advice. Edwards P, Ebert J, Joss B, Bhabra G, Ackland T, Wang A. There are several treatment options for a rotator cuff tear, and the best option is different for every person. The Summary of Findings will present the following information where appropriate: absolute risks for treatment and control, estimates of relative risk, and a ranking of the quality of the evidence based on study limitations (risk of bias), indirectness, inconsistency, imprecision and publication bias. Massive irreparable rotator cuff tear and associated deltoid tear. Jung HJ, Sim GB, Bae KH, Kekatpure AL, Chun JM, Jeon IH. Any type of tear should be regularly monitored by your orthopaedic surgeon in case of further progression or damage. Is the arthroscopic modified tension band suture technique suitable for all full-thickness rotator cuff tears? It is also worth noting that some conditions, particularly when joints are unstable or there is ongoing aggrevation, have better outcomes by being seen and receiving intervention sooner rather than later. I received today my results of a CT Scan from my right shoulder, which I had an accident like 5 months ago. Your physical therapist should be able to help you improve the strength and functioning of your rotator cuff muscles. I was released from the P.T. All material on this website is protected by copyright. Superior subluxation of the humeral head. In many cases, torn tendons begin by fraying. Supraspinatus Tear - Symptoms, Causes, Treatment & Rehabilitation That means it becomes more like fatty tissue. 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. McMaster University, 2015 (developed by Evidence Prime, Inc.). perhaps if delay is likely to lead to a complete rupture that could be prevented with early surgery). Is It a Full-Thickness or a Partial-Thickness Tear of the Rotator Cuff? Judging by the description of atrophy in your rotator cuff muscles, I am guessing it has already been some time since the incident occurred. On one hand, I want the second opinion to be formulated entirely based on my case information (not on what another surgeon did or did not recommend). They will have you move your arm in several different directions to measure the range of motion of your shoulder. From the information you have provided it is difficult to say whether surgery will be needed. In the interim, physio, chiro, massage, taping were part of my pain management and ROM for all pain sites relating to MVA. 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). The surgeon(s) who ordered the imaging are usually the best person to speak with regarding the pros and cons in any particular case. I slept in a recliner for about 2 1/2 months following surgery (I don't think I slept at all before surgery :) ). Ongoing serious pain influencing daily life, sleep etc. The first relates to the potential risk of a poorer outcome due to the delay; this may occur due to further damage being caused in structures that are difficult or impossible to repair etc. 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. Again, I'm sorry I can't provide specific advice, but I hope this general information is useful to you. But shoulder exercises from now until I die. So probably worthwhile having a chat with your doctor and seeing what they recommend as a first step. pain management and physical therapy) may be the first choice to see if surgery can be avoided. An acute tear of the supraspinatus muscle can occur alongside injuries like shoulder dislocation, clavicle fractures, or other rotator cuff injuries that can happen as the result of things like a fall on your outstretched arm or attempting to lift something too heavy; plus there are a variety of sports where the athletes are prone to shoulder damage like baseball, basketball, rugby, AFL Football, and tennis. sorry for the double posting, first time user. My doctor has told me I need to have arthroscopic revision rotator cuff repair. Rotator Cuff Surgery: How it Works, Recovery Time | HSS 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. This will help minimize strain on the back. A few months ago it seemed to hurt more and I had problems lifting my arm out or above my head. A funnel plot will be generated to assess publication bias if there are 10 or more studies included in a meta-analysis. MRI does demonstrate a complete massive tear of my rotator cuff with retraction and severe atrophy. I appreciate your thoughts on this matter. No visible labral tear. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm. 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. 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. This surgical method is a simple and effective 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. I am really hoping to find some outside advice. Good luck with it either way. 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? 20. 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. 23. Downie BK, Miller BS. Sorry for the delay, I have been away. There may be a snapping sensation and immediate weakness in your upper arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful. I have a referral to a specialist and hopefully I will have some answers soon. Shoulder muscles are very good for stabilizing the ball and socket joint and making large movements (to help lift things, throw objects etc. There is fluid distending the long head of the biceps tendon sheath, representing tenosynovitis. Poorly defined large full-thickness tear of the supraspinatus and infraspinatus tendon measuring at least 2 cm in anteroposterior dimension. People who have partial thickness supraspinatus tendon tears following a fall or mechanical trauma often report similar symptoms to people with whiplash associated disorders (aka whiplash). 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. Needless to say, I started to feel like I was getting jerked around and not getting any realistic attention. I think this is a common dilemma that people face. i d glad if ortopedist or physiotherapist reply ansver. If you research it it's a complicated operation that demands some of the best surgerical skills. 9. 3. 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. Adhesive capsulitis will usually last at least 5 or 6 months (often considerably longer). Here are the best Nike shoes for heel pain when you have this uncomfortable condition. @anonymous: Hi Bobby, Thanks for stopping by and leaving a comment. The recovery after surgical tendon repairs often takes longer than recovering from broken bones. If you have any follow up questions just post them here and I'll get back to them as soon as I'm able. 22. There is a lubricating sac called a bursa between the rotator cuff and the bone on top of the shoulder (acromion). J Bone Joint Surg (Am Vol). I think these are promising approaches for the types of pathology you described. This sounds like quite a pain (literally). some loss of motion in your shoulder. It did manage to decrease my overall pain but I still feel like I'm suffering unnecessarily. Thanks again Dr. The supraspinatus tendon runs from the muscle body through quite a narrow gap under the acromion. Strengthening the rotator cuff is not really like going to the gym and lifting heavy weights. Full thickness tearing is characterized by the complete removal of the tendon from the bone.2 This includes large tears (35 cm) and massive tears (>5 cm).3 In the geriatric population, rotator cuff tears are a prominent clinical problem and many patients report difficulty with routine tasks of daily living. Effects of Rotator Cuff Pathology and Physical Therapy on In Vivo Shoulder Motion and Clinical Outcomes in Patients With a Symptomatic Full-Thickness Rotator Cuff Tear. So while surgery always carries some risks (which your surgeon will be able to explain), for some people this is the only option to experience a good outcome. 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 supraspinatus is one of the four muscles that make up the rotator cuff group of muscles. I don't want to experience what you've gone through, but I'm currently deployed and am not getting treated. I did this as instructed, but, to little improvement. We excluded patients with isolated tears of the subscapularis tendon, those with a previous shoulder surgery, and those who had any type of injection . There is synovial fluid at the glenohumeral articulation. The glenoid labrum and bicipital tendon appear unremarkable in position and morphology. The classic full thickness rotator cuff tendon tear involves the supraspinatus and then progresses to involve the long head of biceps, followed by the infraspinatus and subscapularis. 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'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.). Your arm is kept in your shoulder socket by the rotator cuff. @brando87: Thanks brando87, that's what I aim for! 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. If not then, your surgeon will be able to give the likely benefits, risks and recovery time following surgery. Mary Kay. Overall my subscapularis does appear intact." 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. 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. Symptoms. Athletes are especially vulnerable to overuse tears, particularly tennis players and baseball pitchers. An analysis of the text words contained in the title and abstract, and of the index terms used to describe the articles will then be conducted. Your doctor will test your range of motion by having you move your arm in different directions. Good luck! No tendon retraction or muscle belly atrophy. The bursa allows the rotator cuff tendons to glide freely when you move your arm. 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. MRI states high grade articular surface partial thickness tear of the posterior spinatus tendon without retraction or atrophy. I would make sure your surgeon knows you are planning on falling pregnant within the next 12 months. This level of degradation is not particularly common for someone so young, but does happen from time to time and may well lead to a complete rupture. Good luck!

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