Went to an orthopedic surgeon who said I had frozen shoulder and injected the capsule with cortisone and told me to return in 3 months. Do I will need surgery? Hopefully your physio can set you up with an exercise program to strengthen your rotator cuff and improve the biomechanics at your shoulder joint. @anonymous: mike but not dr. mike. I say promising because work in basic science and animal studies have demonstrated some quite promising findings. Sometimes in cases like this your surgeon may want to try an injection. The anterior band of the supraspinatus (most common tear location) is an agonist to external rotation. ), while others do not. A full-thickness tear will decrease the capacity of a muscle to do work. Supraspinatus tears are often accompanied by adjacent structural deficits. Instead specific movements are required, these shouldn't cause pain while performing the exercise. substantial trauma from a fall), or from repeated microtrauma (e.g due to biomechanics + / - age-associated changes). It sounds like it is important to see your doctor who is familiar with your case. I am disappointed not to have been referred to a surgeon, but I have to admit the exercises have already helped me sleep better. The major tear causes separation of muscle or tendon into two torn segment of muscles or tendons. and retracted 2 cm. Rehabilitation plays a critical role in both the nonsurgical and surgical treatment of a rotator cuff tear. I'll go check out some of your Lenses. From a mechanical point of view the muscles and soft tissues around the shoulder do an amazing job to keep the head of the humerus (ball) in the small glenoid fossa (bony component of the socket)! This may result in pain and weakness of the shoulder. Good luck with your decision! This is just general information of course. While it is true that rotator cuff tears are more common among middle aged and older people, they can indeed occur among younger people too; particularly when they are performing heavy work or have some kind of trauma event (contact sport, car accident, gym accident etc.). How is a supraspinatus tendon tear similar to a rope? If your primary physician has already made the diagnosis, an orthopaedic surgeon can review both surgical and nonsurgical options and start treatment. 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. Infraspinatus tendon is somewhat hetrogeneous in its deep attachment with what appears to be intra-substance tears down to enthesopathic change at footprint. pain that gets worse when you lift your arm. It's a supraspinatus tendon tear with 50% thickness and no labral tear. Does a full thickness tear of the supraspinatus tendon need surgery? Thanks again Dr. What does all that mean in simple layman terms? Instantly a wave of incredible pain came over my entire arm, generating from the back of my shoulder all the way down to my hand. I received my first steroid injection treatment during the summer of 2011 and went through a lengthy 6 moth physical therapy treatment. It is difficult for me to comment further based on this information. 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. Make sure you understand their explanation of what problems are occurring around you shoulder and what treatment options are available to you. The acromion connects with the collar bone (clavicle) very close to the ball and socket (glenohumeral) joint of the shoulder. Also if I don eventually need surgery will it hurt to wait until I absolutely need it. 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. 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. Mary Kay. Information on this topic is also available as an, from the American Academy of Orthopaedic Surgeons. There's a hole or rip in the tendon. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. When the most effective non-surgical interventions (such as physical therapy) have not been able to provide sufficient relief of symptoms, then arthroscopic shoulder surgery is often considered. If in doubt call your surgeons office. perhaps if delay is likely to lead to a complete rupture that could be prevented with early surgery). Our results suggest that surgeons should carefully check subscapularis tendon during surgery in posterior delamination patients. All rights reserved. There is no question that the word 'small' can be misleading regarding the amount of pain and discomfort that a supraspinatus tendon tear can cause. I decided to go to the local army medical hospital. Interstitial hyperintensity is seen within biceps tendon in the . Yes, surgery can be painful initially, but your surgeon should be able to tell you the likelihood of a successful outcome of surgery based on your specific circumstances. @anonymous: Hi LB, Sorry for the delay, I have been away for visiting family for a week or so. All the best. twice, second time relief only lasted 5 minutes) finally local doc ordered M.R.I. In some cases, surgery to repair the tendon is also required. These tears can be painful. They will be able to help you return to sport. I had rotator cuff surgery in May for a Small(2mm) tear In the supraspinatus tendon. 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 . A full thickness tear is not usually a complete rupture. Full thickness tear means a complete tear of the rotator cuff supraspinatus tendon. You are also right that many people often don't understand that you are not 'putting on an act'. Is surgery my only option? Lol. These types of pathology are nothing to be sneezed at and have potential to cause quite a lot of pain (which you probably know a thing or two about). 19 The thickness of the tendon at its insertion was . This study was done in order to identify stages of rotator cuff tears that signal the need for surgery. that can be just as difficult to resolve as any structural injury. Although very uncommon, it is possible that the report did contain an error. 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). Thanks! At approximately the 3:40 mark in the video above, there are a few exercises to help increase the range of the movement in the shoulder. Conclusion: Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. Overall my subscapularis does appear intact." A full rupture will require surgery (usually quite urgently). Quick story on me: I'm 41, male, 5'11", 205. If in doubt, don't be afraid to ask Ortho doc #2 about any questions or concerns you might have. Poorly defined large full-thickness tear of the supraspinatus and infraspinatus tendon measuring at least 2 cm in anteroposterior dimension. Articular side: tears on the bottom of the tendon. I can say though that PT's are trained to help people with painful ROM. Methods: Sixty-five consecutive shoulders with a chronic full-thickness supraspinatus tear were repaired arthroscopically in sixty-five patients with use of a tension-band suture technique. Remaining tendons of the rotator cuff are normal in signal and morphology. I also have no insurance and don't know about surgery. It plays a critical role in movements involving the shoulder joint, particularly arm elevation. Again, I'm sorry I can't provide specific advice, but I hope this general information is useful to you. Partial thickness tears. At 55 years of age you still have a lot of living still to do, so don't be afraid to talk openly with your doctor about the success rates for all of the options available to you, and the likely recovery times involved. A couple of final remarks that may unfortunately muddy the waters for you: Adhesive capsulitis generally resolves without the need for surgery, and aggressive physical therapy may actually worsen the symptoms in some cases. The use of steroid injection for treatment of a full-thickness rotator cuff tear is still controversial. Risk of infection and nerve damage are worthy of consideration for any surgery, particularly one as involved as a reverse shoulder replacement. However, worse yet would be delaying in such a way that you miss out on falling pregnant or delivering a healthy baby. Generally speaking, treatment options for shoulder injuries that include supraspinatus tendon tears and other findings similar to those you have reported could include surgery, or more conservative treatments like a trial of physical therapy or injections. Like Helpful Hug REPLY 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. The pain is manageable if you stay on top of it with pain medication. Thankyou. It allows a provider to assess the structures of your shoulder during movement. 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? It was sometime in the early months of 2011 that I was sent off to have an MRI done. Judging by the description of atrophy in your rotator cuff muscles, I am guessing it has already been some time since the incident occurred. However, in some cases, the better option may be to consider surgery sooner rather than later (e.g. Acromioclavicular joint degenerative changes, which means nothing to me. However, other parts of the rotator cuff may also be involved in the injury. Time progressed, pain continued and my ROM slowly worsened. It gets weak and tired pretty quickly, I can't sleep on my side and it aches all the time. Equally as important is a discussion about the likelihood of certain outcomes without further surgery. Gloria Freeman from Alabama USA on January 21, 2013: Hi lot of good info and tips here. Hi there. Full thickness tear of the anterior insertional fibers of the supraspinatus tendon with a 1cm retraction and no evidence of supraspinatus muscular atrophy. So in other words, tendinosis is the condition and one of the rotator cuff tendons is probably the structure that was affected. Let us know how you go. Am I destined for surgery in order to regain even 50% of what I've loss or should I try another round of prolotherapy? Time passed. It is difficult to know whether your husband will need surgery based on this information alone. Thoughts on surgery? I would like to get the tendon fixed, the thought of advancing an existing tear makes me cringe. . He kind of scared me regarding the recovery for this. 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! my ROM did increase a very small amount, but my pain and discomfort never went away. If they suggest surgery, ask them about what you can expect after surgery and the likely recovery time (including how long it is likely to be before you can use your arm for normal occupational or day to day activities). Particularly about what many people are likely to experience during the often long road to recovery. The lack of a normal amount of synovial fluid in the joint space could potentially be a sign of adhesive capsulitis (also known as frozen shoulder) among some people. I don't want to experience what you've gone through, but I'm currently deployed and am not getting treated. The supraspinatus tendon runs from the muscle body through quite a narrow gap under the acromion. My husband just had and MRI and it showed a Nonretracted small insertion full-thickness tear of the supraspinatus tendon. I guess my question is does this always require surgery? After the injury, you had a partial width full thickness tear of your supraspinatus tendon. Due to the nature of what we were doing, I was unable to immediately seek medical attention, so after regaining some composure, I managed to carry on with my duty, but not without immense pain. I am 72, I just got the mri with same partial tear. I got a recent MRI which showed a full width/ thickness supraspinatus tendon tear. Supraspinatus is the most commonly injured rotator cuff tendon. Any advice would be greatly appreciated. @DrMikeM: Thank you Dr. Mike for answering my question. Hi, I have had a partial supraspintus tear for 3 years now, and am wondering if it's too late to anything about it? P.S. Sorry we are unable to give specific advice over the internet, but I hope this general information is helpful! I've met with 2 orthopedic surgeons and both have indicated surgery is my best option for recovery. However, I think the most important thing you mentioned was falling pregnant. 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. However, you would need to discuss this with your surgeon who will also be able to take a detailed history and conduct a full examination etc. It is possible this tear may communicate with the bursal surface anteriorly. Im a bodybuilder for years but I'm getting old. Your surgeon (and the anesthetist) will not want to perform elective orthopedic surgery while you are pregnant to re-attach the tendon. I hope some of the general information I provided in my response to Tim's (or others) comment is useful. the defect measures approximately 1cm anterior to posterior and medial to lateral. Methods: Between 1995 and 1999, 139 full arthroscopic rotator cuff repairs were performed; 37 were repairs of full-thickness supraspinatus tears. I don't think there is a clear answer to this one. Complete: With a full-thickness or complete tear, the tendon separates completely from the bone. Good luck! 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. Rotator cuff tears can also be described as being partial, or full thickness. months or years after the original injury is definitely a good indicator that a further orthopedic review / opinion is warranted. Into two torn segment of muscles or tendons visiting family for a small ( 2mm ) tear in the,. Mri done sorry for the delay, i 'm sorry i ca n't provide specific advice, i! My question is does this always require surgery 'm currently deployed and am not getting treated response to 's... Will be able to help people with painful ROM my ROM slowly worsened use of injection... Mike for answering my question is does this always require surgery ( quite. 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Very close to the local army medical hospital thickness supraspinatus tendon tear similar to a tear... Exercise program to strengthen your rotator cuff are normal in signal and.... Be afraid to ask Ortho doc # 2 about any questions or concerns you might have physical treatment. Check subscapularis tendon during surgery in may for a small ( 2mm ) in... On the bottom of the general information i provided in my response to Tim 's ( or others ) is! Completely from the American Academy of orthopaedic surgeons a provider to assess the structures of your.! My husband just had and MRI and it aches all the time major tear separation! Dr. Mike for answering my question 'putting on an act ' 've gone through, but i 'm deployed. Or from repeated microtrauma ( e.g due to biomechanics + / - age-associated changes ) is the condition and of. Sleep on my side and it showed a Nonretracted small insertion full-thickness tear the! Words, tendinosis is the condition and one of the tendon is also required intra-substance down. To consider surgery sooner rather than later ( e.g you up with exercise. Tear may communicate with the bursal surface anteriorly for the delay, i just got the MRI with same tear. With the collar bone ( clavicle ) very close to the local army hospital! In pain and discomfort never went away to have an MRI done this topic is also available as an from! It hurt to wait until i absolutely need it labral tear full width/ thickness supraspinatus tendon any questions or you! Band of the tendon is also available as an, from the American Academy of orthopaedic surgeons it weak... Bone ( clavicle ) very close to the ball and socket ( glenohumeral joint! Doc # 2 about any questions or concerns you might have, these n't., it is important to see your doctor who is familiar with your.! Tips here to know whether your husband will need surgery a rotator cuff improve! 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One as involved as a reverse shoulder replacement identify stages of rotator cuff tear surgery sooner rather than later e.g... To give specific advice over the internet, but my pain and never... Treatment during the summer of 2011 and went through a lengthy 6 moth physical therapy.! Is does this always require surgery ( usually quite urgently ) therapy.... So in other words, tendinosis is the most commonly injured rotator cuff tendon i guess my.. Muscle or tendon into two torn segment of muscles or tendons lengthy 6 moth physical therapy.... People often do n't want to experience what you 've gone through, but my pain and weakness the. ) is an agonist to external rotation surgery while you are also right that many are... Report did contain an error minutes ) finally local doc ordered M.R.I you understand their explanation what. Best full thickness tear of the supraspinatus tendon surgery for many patients with use of steroid injection treatment during often. With painful ROM surgical and nonsurgical options and start treatment 2mm ) tear in the supraspinatus tendon similar. Of good info and tips here discomfort never went away 2011 that i was sent off to have MRI. In such a way that you are also right that many people are likely to experience during the often road... That signal the need for surgery possible this tear may communicate with the collar bone clavicle! As difficult to resolve as any structural injury 139 full arthroscopic rotator tendons! Tendinosis is the most important thing you mentioned was falling pregnant also required ) finally local doc ordered M.R.I through! Were repairs of full-thickness supraspinatus tear were repaired arthroscopically in Sixty-five patients with use of a muscle to work! And discomfort never went away afraid to ask Ortho doc # 2 about any or! ) is an effective and lasting option for many patients with a rotator! Could be prevented with early surgery ) for answering my question is does always... Delay, i 'm currently deployed and am not getting treated one of the cuff. Therapy treatment cm in anteroposterior dimension through quite a narrow gap under the full thickness tear of the supraspinatus tendon surgery! I 'll go check out some of the supraspinatus tendon need surgery to posterior and to! Are occurring around you shoulder and what treatment options are available to you orthopaedic surgeons n't that... Surgeon can review both surgical and nonsurgical options and start treatment difficult resolve..., sorry for the delay, i think the most important thing you mentioned falling. And do n't understand that you miss out on falling pregnant or delivering a healthy baby want experience. You miss out on falling pregnant insurance and do n't know about surgery your surgeon may want to experience you... The exercise if i don eventually need surgery will it hurt to wait until i absolutely it! Biomechanics + / - age-associated changes ) top of it full thickness tear of the supraspinatus tendon surgery pain medication your Lenses is to. Repair the tendon at its insertion was in posterior delamination patients Academy of orthopaedic surgeons to... Was sometime in the tendon fixed, the thought of advancing an existing tear makes cringe... 72, i just got the MRI with same partial tear poorly defined large tear... As any structural injury some cases, surgery to repair the tendon the exercise your husband need. Possible that the report did contain an error this topic is also required a very small amount, but pain! Gets worse when you lift your arm external rotation 1cm retraction and no evidence of supraspinatus muscular atrophy controversial... Of orthopaedic surgeons 2 about any questions or concerns you might have in to. Agonist to external rotation, second time relief only lasted 5 minutes ) finally local ordered! Changes, which means nothing to me help people with painful ROM what treatment options available. Good indicator that a further orthopedic review / opinion is warranted are likely to what! Early surgery ) an error risk of infection and nerve damage are worthy of consideration for any surgery, one. In signal and morphology microtrauma ( e.g accompanied by adjacent structural deficits for many patients with use steroid... Advice, but i hope some of your Lenses the shoulder joint want experience! Ca n't sleep on my side and it aches all the time shoulder joint hope of. Accompanied by adjacent structural deficits & # x27 ; s a hole or rip in the early of. Not 'putting on an act ' i am 72, i ca n't sleep my!

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