Also an ex ray of my shoulder "Demonstrate my humeral head close to abutting my acromion. )amount of fluid in acromioclavicular joint and last but not least 5.) I am 55 and active, so I don't want to hurt my "golden" years, so I am not sure what to think. 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. The results are: full thickness cuff tear 2.3 cm AP involving supra spinets and a portion of infra spinets at distal critical zone and enthesis. 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 specific post-surgery rehabilitation is often differs between surgeons in different regions (depending on the specific techniques they use). The chief advantage of nonsurgical treatment is that it avoids the major risks of surgery, such as: The disadvantages of nonsurgical treatment are: Your doctor may recommend surgery if your pain does not improve with nonsurgical methods. 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. Good luck! There is inhomogeneous and bulbous appearance of the distal .subscapularis tendon with tendinosis. MRI does demonstrate a complete massive tear of my rotator cuff with retraction and severe atrophy. 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. So in summary Tim, I would say I feel for you buddy. Joanna Briggs Institute reviewers manual: 2017 edition [Internet]. Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Partial thickness tears of the supraspinatus muscle are an incomplete disruption of muscle fibers; note that these can progress to a complete or full thickness tear of the supraspinatus muscle, and larger tears pose a higher risk of progression to full tears, even if they are asymptomatic. 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). Pain score, measured using visual analog scale (VAS), or shoulder-specific scales including but not limited to American Shoulder and Elbow Surgeons (ASES) outcome survey, Constant-Murley score. If you get a chance, drop by and let us know how you go with your recovery! Good luck! Instead specific movements are required, these shouldn't cause pain while performing the exercise. ; 3; Where can I found documentation in the web for the rehabilitation? While there is still some attachment present, the need for surgery is not as urgent, as indicated by Ortho doc #2. Grade 1 strain of the lateral deltoid muscle and teres minor muscle. Rotator cuff surgery in patients older than 75 years with large and massive tears. Judging by the description of atrophy in your rotator cuff muscles, I am guessing it has already been some time since the incident occurred. but can get back fairly good motion about the shoulder . 6. If youve experienced a rotator cuff tear, theres a good chance that it could be a supraspinatus tear. 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. Search for Similar Articles
A few months passed, and I was called into the orthopedic surgen, who was a shoulder specialist, for a "pre surgery consultation". The types of findings you have described are consistent with some quite substantial pathology in your shoulder. It is difficult for me to comment further based on this information. A few months ago it seemed to hurt more and I had problems lifting my arm out or above my head. On the other hand, you will also need to ask about the likelihood of decent recovery without surgery. Gialanella B, Bertolinelli M. Corticosteroids injection in rotator cuff tears in elderly patient: pain outcome prediction. Good luck! 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. You may be trying to access this site from a secured browser on the server. This tear leaves only a very thin layer of intact cuff at the site, no impingement, labrum is intact. There is a lubricating sac called a bursa between the rotator cuff and the bone on top of the shoulder (acromion). 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. Tenderness, loss of function, shoulder weakness, shoulder impingement, and pain when raising or rotating the arm are the main physical signs your orthopaedic surgeon will be looking for in the physical examination, while the imaging tests will show changes in the bones such as shoulder blade shape via X-rays and changes in the movement, shape, thickness of the tendons and other problems like bursitis or arthritis via MRIs and ultrasound testing. 7. 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 I need surgery,what is the recovry time.. Thank you. @anonymous: Hi Hans, Thanks for stopping by and sharing your story. Pain is really consistent and moderate with moments of severe. P.S. 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. The effect of neuromuscular electrical stimulation of the infraspinatus on shoulder external rotation force production after rotator cuff repair surgery. It is also worth mentioning that when surgeons send patients for PT and don't hear from them for a while, they may well have just assumed everything went well and there is no more problem (or they have so many patients that they haven't given it much thought). Here are the best Nike shoes for heel pain when you have this uncomfortable condition. You should not feel pain in the shoulder during the movement. Also, don't be afraid to ask doctors / surgeons lots of questions. If in doubt call your surgeons office. I wear an arm sling a lot to relieve weight from my shoulder, which helps to some degree. Efficacy of platelet-rich plasma in arthroscopic repair of full-thickness rotator cuff tears: a meta-analysis. Nike shoes helped manage my plantar fasciitis. MRI does demonstrate a complete massive tear of my rotator cuff with retraction and severe atrophy. 15. Quality of life, measured using any validated instrument. If pain is being caused, then there may be a problem with technique or a lower intensity may be required. This information is provided as an educational service and is not intended to serve as medical advice. They will check to see whether it is tender in any area or whether there is a deformity. Factors like smoking, hypercholesterolemia, weight and BMI, height, bone spurs, and other genetic factors increase the chances as well. Children are such a blessing and that time nursing your newborn is such a special and important time. @anonymous: Hi LB, Sorry for the delay, I have been away for visiting family for a week or so. Any advice would be greatly appreciated. There is some really good information in what you have said. 8. After discussing your symptoms and medical history, your doctor will examine your shoulder. It may be as small as a pinpoint, or the tear may involve the entire tendon. However, there are a variety of factors that will need to be considered. Sometimes, it is difficult to tell from people recalling what happened whether a shoulder has been dislocated. 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). I'm sorry I can't give you specific advice over the internet about the best option for your situation. They do have potential to improve the biomechanics of the shoulder joint during arm movement which may help mitigate the cause of the tear (like shoulder impingement). 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. Acromioclavicular joint degenerative changes, which means nothing to me. Surgery to repair tendons generally involves a long recovery period. The reverse shoulder surgery is extremely involved so I am getting a second opinion. It is plausible to sustain one or the other (or both) from a fall. 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. 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. Thanks again Dr. I would expect the radiologist and orthopedic surgeon at a VA hospital would both be skilled in this regard. 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. I don't lay on the side of the hurt arm as I don't think it will be good for it. 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. Treatment of rotator cuff tears in older individuals: a systematic review. @anonymous: Hi Donald, I'm sorry to hear about your shoulder trouble and insurance situation. The supraspinatus tendon has a tendency to weaken with age and become prone to tendon tears. Let us know how things turn out for you. 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. Thoughts on surgery? I have full range of motion and only occasional soreness now and again, but can't sleep on that side. 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. Again, I'm sorry I can't provide specific advice, but I hope this general information is useful to you. The surgeon(s) who ordered the imaging are usually the best person to speak with regarding the pros and cons in any particular case. My husband just had and MRI and it showed a Nonretracted small insertion full-thickness tear of the supraspinatus tendon. An easy way to understand what I mean is to think about eating a steak. 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. 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. i was recently diagnosed via MRI that i have a supraspinatus tendon tear. 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. Shoulder function, measured by shoulder-specific scales including but not limited to ASES, Simple Shoulder Test, UCLA shoulder scoring scale. If not what is this indictative of. 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. However, if no benefit has been observed after 6 weeks of PT, then discussion your options with your surgeon sounds like a good plan. 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. One thing that you may find encouraging is that often artists don't lift (elevate) their shoulders much when they create art (paint etc.). Even if surgery is required, the physical therapy program can help strengthen the rotator cuff muscles before the surgery. It can reduce (relocate back into the socket) long before someone makes it to a hospital (or an onboard medic!) shoulder stiffness. For full thickness tears and more major tears (or if the tear involves more than one tendon) or there is significant damage to the tendon, various surgical procedures may be required. ), but not so good with the finer movements (better performed by the muscles in the forearm and hand). I cannot give you specific information on your specific tear, but someone mentioning a tendon tear with some retraction may be referring to a tear that is not a complete rupture. Thanks for stopping by and sharing. You can partially or fully tear your supraspinatus muscle, and remember that these sorts of tears can be symptomatic (meaning they cause supraspinatus pain and inhibit your range of motion and ability to perform everyday tasks) or asymptomatic, meaning the tear is present but it not currently causing you pain or otherwise causing problems in your life. Does the reverse shoulder arthroplasty and deltoid repair be a possible option of treatment? Tendinosis means that the tendon has some damage at the cellular level (generally where there has been repeated amounts of small damage (sometimes called microtrauma) that your body has tried to repair), but there is not swelling (inflammation) currently present. However, your doctor should be able to provide you with good advice in this regard after they speak with you, conduct an assessment and look at your scan. 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. @anonymous: Hi Donna, I am sorry to hear about this trouble you are having with your shoulder. prospective, randomised trial in 103 patients with a mean four-year follow-up. So while the cost of surgery can be expensive, people who can't do their job one-handed may also need to consider potential loss of income as well or making alternative work arrangements. Could this require surgery. 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. Patients 55 years and over have recently been found to be receiving surgical treatment for rotator cuff tears, indicating a rising trend towards surgical repair of rotator cuff tears.24 While surgery is considered an effective treatment, recurrent tears are common, especially degenerative tears, which are frequent in the older population.1 Studies on non-surgical treatments have also demonstrated positive results for full thickness rotator cuff tears.2 Exercise therapy may improve joint stability and reduce translation of the glenoid humeral joint, but has difficulty restoring kinematics to that of an intact rotator cuff.16. Exercise is important for many reasons (not the least of which are physical and mental health benefits). I can say though that PT's are trained to help people with painful ROM. but can get back fairly good motion about the shoulder . Jeffrey Yang J, Robbins M, Reilly J, Maerz T, Anderson K. The Clinical Effect of a Rotator Cuff Retear: A Meta-analysis of Arthroscopic Single-Row and Double-Row Repairs. By June '13 I was better in many ways than before the injury. Full thickness tear means a complete tear of the rotator cuff supraspinatus tendon. Avoiding work above shoulder height can sometimes avoid aggravating the pain. I then took the second opinion of an orthopaedic surgeon who found a superantanaus partial tendon thickness tear and rotator cuff dysfunction through mri scan. She said she had never heard anything like that before and it was not my rotater cuff like everyone else believed. 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. First, sorry for the delay in response. 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). A degenerative tear is the opposite instead of a single catastrophic episode or trauma to the shoulder, these tears are the result of damage and wear on the joint slowly over time. I have about 3" less range reaching up behind my back, but I think some pre-existing tears and arthritis were fixed. There are two main causes of rotator cuff tears: injury and wear (degeneration). Nonetheless, it worth noting that as a general principle, synovial fluid is very important and helps lubricate the joint. if your initial injury was work related. Re-attaching the tendon to the bone as you have described is a substantial surgery, the first months of recovery after this type of surgery are very important to ensure that the tendon does not detach / rupture and optimal recovery can occur. 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? Yes, also a good idea about discussing with your surgeon the potential risks or benefits from delaying surgery in your case. I am sorry, this is not a nice situation to be in, but doesn't sound as though you are at the end of the line yet. Good luck! Your surgeon (and the anesthetist) will not want to perform elective orthopedic surgery while you are pregnant to re-attach the tendon. I hope I have not waited to long for having this checked, and the only option will be surgery. 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. It can be difficult to find good information on the web for specific rehabilitation following surgery. 1. In September '12 I had surgery to reattach both the right rotator supra and infraspinatus with excellent results. However, I think the most important thing you mentioned was falling pregnant. Sorry for the delay in response. So in other words, tendinosis is the condition and one of the rotator cuff tendons is probably the structure that was affected. 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. The best treatment option for alleviation of pain and restored shoulder function in the elderly is still debated.8 Studies have shown satisfactory healing and promising clinical outcomes following surgical repair. 4. What does a "full thickness tear of the supraspinatus tendon" mean? This is partly because rehabilitation following surgery will depend on the surgical technique used. 2. If you have any uncertainty around the need for your sling use, please call your surgeon's office today. First thing to say is that when the best way forward seems uncertain to someone, seeking a second opinion is usually not a bad idea. Mild AC arthropathy. Don't be afraid to ask your surgeon about all your treatment options. I'm sorry I can't provide you with specific advice, rather I only provide some general information. 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.
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