How do you repair a rotator cuff tear? The radiomics model of no tears or tears achieved a high overall accuracy of 93.6%, sensitivity of 91.6%, and specificity of 95.2% for supraspinatus tendon tears. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. 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). @DrMikeM: wheather arthoscopy surgry ll help for my injury sir ?what type of surgery needed for dis type of injuries sir.ortho doc told Do exercise for 2 weeks aftr tat if it not improved ll do arthoscopic surgery sir Due to a fall and resulting shoulder pain my doctor prescribed to have an MRI, the findings were; moderate tendinitis in the supraspinatus. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time. techniques (see details below) . From the description of your MRI report it sounds like your shoulder must have been quite painful and inflamed at the time (perhaps it still is)! I was instructed to ice pack my shoulder and take it easy. The reverse shoulder surgery is extremely involved so I am getting a second opinion. Any advice would be greatly appreciated. What I really want right now is to regain enough to get through normal everyday activities and not feel limited trying to lift an object and also not drop things so frequently. I have noticed these types of shoulder pathology often occur among people who work (or have worked) in jobs that are physically demanding on the shoulders (or have a recreation / sporting background that may have contributed to shoulder girdle degeneration). So in summary Tim, I would say I feel for you buddy. He says that my tendon is failing. Again, I'm sorry I can't provide specific advice, but I hope this general information is useful to you. This information is provided as an educational service and is not intended to serve as medical advice. Like Helpful Hug REPLY 3. It is also very interesting to note that for those people who have persistent whiplash symptoms there is often a change in the way their brain processes sensation from the neck and shoulder region. A-C joint is moderately to severely degenerative. The rotator cuff exercises should not cause pain while the exercise is being performed. muscle atrophy of supraspinatus, infraspinatus, and subscapularis muscles, 3.) Of course, I am sure his orthopedic surgeon will be able to give good advice in this regard (after a full clinical assessment etc.). I have often seen these cases improve substantially after further surgery to repair these rotator cuff tears + post surgery rehabilitation therapies. (2) In the presence of a full-thickness tear, there is less ability to generate joint torque, hence a positive lag sign. I have full range of motion and only occasional soreness now and again, but can't sleep on that side. X-rays are often not very useful in diagnosing shoulder injuries. At the final follow-up, the VAS, Constant, ASES, and UCLA scores were 1.1 0.9, 84.3 16.4, 88.3 17.4, and 31.1 6.0, respectively. Small area of subacromial bursitis present. 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.). I suspect you have a bit of work to do over the next 6 months or so to help your shoulder recover. Have been taking 800 mg Motrin tid. Ongoing serious pain influencing daily life, sleep etc. Tendonosis literally means chronic pathology without inflammation (i.e. Not too sure if this article is still active but I'll ask anyways. 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. The incident happened on Sept 25 and it is now Nov 10. Good luck with your decision! There are a few interesting things worth noting here. There are several video examples to accompany the written explanation. Full thickness tears are the complete disruption of the fibers of the supraspinatus muscle, and generally require a more aggressive treatment plan and surgery. It is good that you have discussed the recovery with your surgeon already. Muscular and tendinous structures including remaining portions of the rotator cuff are also felt to remain otherwise unremarkable in signal and morphology. Judging by the description of atrophy in your rotator cuff muscles, I am guessing it has already been some time since the incident occurred. Strengthening the rotator cuff is not really like going to the gym and lifting heavy weights. 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. If muscles of the rotator cuff are not providing adequate stability throughout the shoulder's range of motion, this can contribute to shoulder impingement and a break down of the supraspinatus tendon. . Overall my subscapularis does appear intact." 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. I had periodic pain and tingling running all the way down my forearm. 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. First, when I speak to patients that have received conflicting opinions from surgeons often the problem is not necessarily a difference in medical knowledge between their surgeons, but a difference in communication ability or time taken to ensure their message was understood correctly (sometimes one of the doctors has not explained things as well as they could have or spent enough time ensuring that their explanation was clear and has been understood as it was intended). Your doctor may recommend a diagnostic imaging study such as a magnetic resonance imaging (MRI) scan or ultrasound to confirm the diagnosis. I have continued to have problems with my arm and initially was told that I had a partial tear of my rotator cuff. For many years shoulder dislocations were commonly managed by making sure the ball was back in the socket, giving a bit of ice, perhaps some anti-inflammatory medications and putting the arm in an internal rotation sling (a sling that holds the arm near the body with the elbow bent at about 90 degrees). It has been associated with older age and osteoarthritis, but often seems to occur when there is extra fluid in the gleno-humeral (ball and socket) joint. Sorry for the delay in response. thank you for your considiration and helle from Turkey:-). @anonymous: Hi Kazikp, I am sorry I cannot give you advice over the internet but here is some general information you may find useful. 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. I am 67 years old and am an artist and my left arm which is the one in question is my dominate arm. If you have any uncertainty around the need for your sling use, please call your surgeon's office today. I have always found the anatomy of the shoulder to be very interesting. There is a delaminating tear of the supraspinatus myotendinous junction, measuring a thickness of about 2mm. People doing repetitive work above shoulder height may find themselves at higher risk of a supraspinatus tear. If you are not keen to rush into surgery don't be afraid to ask your orthopedic specialist about conservative treatment options that may be worth trialing, on the other hand, your surgeon may be able to give you a good indication of whether they think surgery is the most promising option. Sorry for the delay, I have been away. 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). The blue arrows represent a full-thickness tear in the supraspinatus tendon, which is the most common site for rotator cuff tears. Can a supraspinatus tendon tear heal itself? 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. Also can I try a more Conservative approach and see a phy therapist that specializes in shoulders before any surgery. I can reach behind my back ok. @Reallmadhatter: Good question. Irreparable. I'm sorry I can't give you specific advice over the internet about the best option for your situation. 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! A good doc should be able to assess your shoulder and give you some specific advice regarding the best next plan of attack. I am sorry, I can't give you specific advice over the internet about whether you will need surgery or not. So I think it would be wise to discuss the timing of surgery with your surgeon in the context of wanting to fall pregnant. 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). Drugs, supplements, and natural remedies may have dangerous side effects. An orthopedic surgeon will be able to provide you with all the information you need regarding surgery, however, regarding exercises to return to badminton it might be wise to see a physical therapist (also known as physiotherapist) who specialises in sports injuries and rehabilitation. Full thickness tear means a complete tear of the rotator cuff supraspinatus tendon. The acromion connects with the collar bone (clavicle) very close to the ball and socket (glenohumeral) joint of the shoulder. Some minor tears may be treated without surgery. J Bone . If you have been diagnosed with a partial thickness tear and begin experiencing more pain you should talk to your orthopaedic surgeon. However, I went in to see my GP last week for an initial visit and have been advised to do a month of strengthening exercises. 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. This will help you figure out what you are deciding between. A rotator cuff tear can be caused by an acute injury such as a fall or by normal age-related wear and tear combined with tendon degeneration. From the information you have provided it is difficult to say whether surgery will be needed. What little I have done has given me improvement. Avoiding work above shoulder height can sometimes avoid aggravating the pain. sorry for the double posting, first time user. Supraspinatus tendon tears require specific rehabilitation of the rotator cuff and muscles that stabilize the shoulder blade. I returned to the orthopedic surgeon at which point he did an x-ray which looked good and sent for a mri Monday. The reverse shoulder surgery is extremely involved so I am getting a second opinion. Generally, if an injury is going to heal on it's own, it gets better over time, unless it is re-injured. They can then make a diagnosis and begin treatment. 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. 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. Usually getting a second opinion is not a bad option if you are not confident that the first opinion is going to lead to the best outcome for you, but I expect that may well be impossible while you are still on deployment? Because of the return of the recent pain, another MRI was ordered and the Radiologist wrote: "1. If the injection does give you pain relief, it may allow you a couple of months without pain to do exercises that can strengthen your rotator cuff and improve the biomechanics at your shoulder in an effort to reduce irritation of the bursa and Supraspinatus tendon. Other symptoms of a subscapularis tear are unique to this injury. I worked closely with a physiotherapist for a good four months and pain got worse. Three kids will no doubt also be keeping you busy and missing out sleep because of your shoulder pain doesn't sound like much fun. The supraspinatus is one of four muscles that make up a group referred to as the rotator cuff muscles. Good luck! On the other hand, physical therapy can often help supraspinatus tendon tears but sometimes they do need surgery in order for a suitable recovery to occur. Good luck! 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. In some cases, surgery to repair the tendon is also required. I'm experiencing the exact same pain you described, and the Army doc told me I was too young to tear a rotator cuff. I do not want a metal shoulder. Productive acromioclavicular joint changes are associated with an anterolaterally down sloping type II acromial configuration. She said she had never heard anything like that before and it was not my rotater cuff like everyone else believed. Some days later, I was called back to the VA so they could tell me what they found. I'm sorry I can't give you specific advice about whether you will need surgery or not over the internet. patients should expect to return to full work duty by 6-10 months after surgery. There is compromise of the subacromial space with impression on the underlying torn supraspinatus. can be damaged without a dislocation occurring at all, particularly when carry heavy items up ladders or performing repetitious activities. Good luck! 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. 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. I am unable to carry any significant weight. Thanks to my hubby for finding this site. On the other hand, if surgery is inevitable or at least the most likely outcome, then the treating doctor / surgeon(s) may recommend early surgery. Partial or Full-Thickness Tear 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. SLAP type tear of the superior labrum. 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. 4. @pawpaw911: Hi Pawpaw911, thanks for dropping by. but unfortunately, the results were extremely minor. Shoulder muscles are very good for stabilizing the ball and socket joint and making large movements (to help lift things, throw objects etc. Above my shoulder or behind my back without pain. Partial tears can be just 1 millimeter deep (only about 10 percent of a tendon), or can be 50 percent or deeper. and still end up with an unexpected problem. 1 Supraspinatus Rupture causes microscopic tear, major tear and dislocation from its attachment to humerus and scapula. 2023 The Arena Media Brands, LLC and respective content providers on this website. 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. I am sorry I can't provide you specific advice over the internet. Good luck with it. It is possible this tear may communicate with the bursal surface anteriorly. Symptomatic full thickness rotator cuff tears can be managed surgically. However, trauma (such as sporting injuries or motor vehicle accidents) can cause tears amongst people of any age. )amount of fluid in acromioclavicular joint and last but not least 5.) The primary indication for an acromioplasty in a patient with a full-thickness or bursal rotator cuff tear is for a type 2 or 3 acromion with a frayed CA ligament attachment. Twenty-one of the 70 partial-thickness tears were not rim-rent tears: there were nine (12.9%) tears in the critical zone, 10 (14.3%) interstitial tears, and two (2.9%) bursal-sided tears. I have a second opinion on Monday. You don't need to lean over as far as demonstrated in this video. ; 2. indications. I work construction and am self employed. I all of a sudden lost all my strength in my right arm and dropped the box. Dr. Mike great info here thanks. Good luck! If a condition stays the same or become worse, then its usually a good idea to get it checked out again, or even a second opinion if you are not happy. 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 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. Anyone want to shed a little light for a vet? As I said been dealing with this for about nine months and in that time have run the gamut of treatment. The tendons may tear from their attachment either after an injury such as a fall or from long-term wear and tear. The supraspinatus tendon was assessed at its insertion by moving the transducer anteriorly, where the bony landmarks were the greater tuberosity laterally and the junction of the tendon footprint and articular cartilage of the humerus medially, 2 mm posterior to the long head of biceps. Hey DrMikeM doin some research and came across your sight and thought I'd add my two cents. I take anti-inflammatory meds for a long time for other problems, but it sure has not helped my arm. I am not aware of any studies that have shown rotator cuff exercises impair healing in supraspinatus tendons that have a partial thickness tear. No, it may not be too late to get relief. The right suprasinatus tendon contains a partial width full thickness tear measuring 4 by 2mm, in the anterior fibers approximately 8mm lateral to the biceps tendon. How is a supraspinatus tendon tear similar to a rope? Dr Mike, Please help me understand what options I might have or questions to ask the surgeon about my full Reallmadhatter Mar 14, 2013 @ 3:44 pm. Good luck! For anyone contemplating surgery, buy a recliner to sleep in after surgery. Here is some general information that may be useful. Although the presence of a small tear visible on an MRI does not always mean that is the problem causing your shoulder pain. I was told that there were a few other muscles around the supraspinatus that were torn and I also had some bone spurs that could also be causing some irritation. i was recently diagnosed via MRI that i have a supraspinatus tendon tear. This website also contains material copyrighted by third parties. is surgery the only option? Methods: Between 1995 and 1999, 139 full arthroscopic rotator cuff repairs were performed; 37 were repairs of full-thickness supraspinatus tears. In physio just weeks after the onset of injury, I was unable to lift a 1lb weight with the injured arm bent near armpit while lying on my back. It may be as small as a pinpoint, or the tear may involve the entire tendon. I'm sorry I can't give you specific advice on your case over the internet. over the years, but not really in recent year, as my shoulders got cranky. There is inhomogeneous and bulbous appearance of the distal .subscapularis tendon with tendinosis. I hope your shoulder has now recovered! All rights reserved. In general, seeing your orthopedic specialist would be an important step, these types of injuries are not likely to allow you to recover to your normal level of work functioning anytime soon without some kind of treatment. 6 months ago a different ortho diagnosed the problem as frozen shoulder and gave me a cortizone shot followed by physio therapy for few weeks. While it is estimated that 65-70% of all shoulder pain involves the rotator cuff tendon, it has been estimated that 5 to 40 % of people without shoulder pain have full-thickness tears of the rotator cuff. I wear an arm sling a lot to relieve weight from my shoulder, which helps to some degree. A recent study from Kim et al 19 used en masse suture bridge techniques for full-thickness supraspinatus tears. I've started having a smoothie everyday of red vege's (beetroot) and fruit (all the berries) with a slice of ginger and the big one for inflammation turmeric! There is some spurring at the glenoid articular surface. An important thing to consider (as you have correctly mentioned) is that a reverse shoulder replacement is probably unlikely to restore normal shoulder function and resolve the pain if substantial soft tissue problems are still present in the tendons around the shoulder. MRI does demonstrate a complete massive tear of my rotator cuff with retraction and severe atrophy. 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 have been seeing an orthopedic doctor for the past 18 months. In full-thickness tears, surgery is indicated in many patients. I don't want to experience what you've gone through, but I'm currently deployed and am not getting treated. And overall her last resort for surgical intervention is a reverse total shoulder arthroplasty. Follow up not til next Wednesday. The pain is manageable if you stay on top of it with pain medication. Full thickness tear of the anterior insertional fibers of the supraspinatus tendon with a 1cm retraction and no evidence of supraspinatus muscular atrophy. Adhesive capsulitis will usually last at least 5 or 6 months (often considerably longer). infraspinatus tendon had full-thickness tear . Thanks for stopping by and sharing your story. I am 55 and active, so I don't want to hurt my "golden" years, so I am not sure what to think. If your primary physician has already made the diagnosis, an orthopaedic surgeon can review both surgical and nonsurgical options and start treatment. 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. He did say that it can be done in the next few months and no urgent intervention required. The rotator cuff is a group of tightly connected muscles that stabilize the shoulder joint. 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