I just found out this week that I have Bursitis, and a tear in my Supraspinatus. 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). The supraspinatus is one of four muscles that make up a group referred to as the rotator cuff muscles. Osteophytes and inferior capsular swelling indents the superior margin of the mytendinous junction of supraspinatus. 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. According to Dr. Bob Burks, professor of orthopedics, 60 percent to 70 percent of patients will have some sort of tear by age 80. Thanks again Dr. I have about 3" less range reaching up behind my back, but I think some pre-existing tears and arthritis were fixed. 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. Good luck! 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). However, worse yet would be delaying in such a way that you miss out on falling pregnant or delivering a healthy baby. I am sure lots of people would like to hear how it turns out for you. Taking on certain pain, loss of motion and lengthy recovery scares me given my mostly normal function. This will help minimize strain on the back. 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? Supraspinatus is the most commonly injured rotator cuff tendon. A full-thickness rotator cuff tear is characterized by a focal transmural tendon discontinuity, . I am 55 and active, so I don't want to hurt my "golden" years, so I am not sure what to think. A tendon is similar to a rope and you can compare the suprasinatus tendon to an inch wide . @anonymous: Hi Les, I am glad you found this information helpful. perhaps if delay is likely to lead to a complete rupture that could be prevented with early surgery). A supraspinatus tear is a tear or rupture of the tendon of the supraspinatus muscle, which is located at the back of the shoulder. Dr. Mike great info here thanks. The rotator cuff is made up of 4 muscles. When a tear occurs, there is frequently atrophy of the muscles around the arm and loss of motion of the shoulder. I wear an arm sling a lot to relieve weight from my shoulder, which helps to some degree. 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'll go check out some of your Lenses. I just received my MRI report which states : supraspinatus tendon is thickened and immediate in signal, with a small 3mm (transverse) x 3mm (AP) full thickness footplate tear. I had surgery last Thursday for a complete tear of the supraspinatus tendon due to a car accident and was told the tendon was repaired with titanium staples.My concern is of the staples coming out ,I wear a sling whenever outside but have been taking it off when sleeping in my recliner which I've found the best since the accident.If I am just walking around the house I've let it hang down and do not feel pain at the shoulder so figure there is no risk of them pulling out by doing this,am I correct? @anonymous: Hi LB, Sorry for the delay, I have been away for visiting family for a week or so. I have full-thickness tear of supraspinatus tendon ,with 1.5 cm cap without tendon retraction plus supraspinatus Ask an Expert Medical Questions The Physician, Doctor 1,261 Satisfied Customers Versatile Emergency Physician, 20 years experience as a Physician. I've only got a couple of minutes, so I'll keep this short. I'm quite apprehensive and nervous about the surgery but more so about the recovery. Can a supraspinatus tendon tear heal itself? Surgery to repair those types of injuries would mean the arm would have to be not used (at all) for at least a couple of months (maybe quite a few months before back to being able to work normally). Complete: With a full-thickness or complete tear, the tendon separates completely from the bone. Make sure you understand their explanation of what problems are occurring around you shoulder and what treatment options are available to you. i was recently diagnosed via MRI that i have a supraspinatus tendon tear. . So my tear went from a near full thickness tear to a full thickness tear. Don't be afraid to ask lots of questions about what is likely to happen if you do or don't have surgery. When he says your tendon is failing, I think what he is trying to convey is that once some strands of a rope start to break, then there is more load on the remaining strands which may cause more strands to break (and then more load on remaining individual strands, more strands tear and so on). Lots of people express feeling useless, frustrated, and angry at times. Because of the risk of infection and and nerve damage. Background: Good functional results have been reported for arthroscopic repair of rotator cuff tears, but the rate of tendon-to-bone healing is still unknown. Also not sure how long I should wait. Good luck with it. So first off, I should say that I have certainly seen situations where a small supraspinatus tear has been surgically repaired, only for a worsening of symptoms to occur after further pathology (such as other rotator cuff tendon tears) either develop or become easier to detect on imaging (e.g. The supraspinatus muscle is a relatively small muscle, but very it's important one. I have full range of motion and only occasional soreness now and again, but can't sleep on that side. It sounds like you are on the right track with your surgeon and physical therapist. You may find it interesting to note that a prior subacriomial decompression is not necessarily an indication that future surgery to address other injuries or further biomechanical problems will not be successful. On the other hand, you will also need to ask about the likelihood of decent recovery without surgery. An exercise or physical therapy program is necessary to regain strength and improve function in the shoulder. Does a full thickness tear of the supraspinatus tendon need surgery? 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). Small to moderate glenohumeral joint effusion. It gets weak and tired pretty quickly, I can't sleep on my side and it aches all the time. 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! Supraspinatus tears are often accompanied by adjacent structural deficits. 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). In many cases, surgery is required. 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). Following an iltrasound scan I have been told I have a tear of the supraspinatus tendon and there is some retraction. Quick story on me: I'm 41, male, 5'11", 205. @anonymous: Oh Tonia, I feel for you. A full thickness cuff tear (RTC) can be classified by size (small, medium, large and massive i.e. Being referrfed to a shoulder specialist Tuesday. So I think it would be wise to discuss the timing of surgery with your surgeon in the context of wanting to fall pregnant. The blue arrows indicate a full-thickness tear in the supraspinatus tendon, the most common location for rotator cuff tears. Does a full thickness tear of the supraspinatus tendon need surgery? Large. @anonymous: Hi Mike, Good luck with your appointment next week, hopefully you will be able to find some relief one way or another after you consult your surgeon. 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! Articular side: tears on the bottom of the tendon. Either way, don't be afraid to ask your surgeon lots of questions (likelihood of success in your case, what will happen after surgery, recovery time-frames etc.). You mentioned rotator cuff and tendonosis like they were different things. 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. Thanks for stopping by and sharing your story. What ever recommendation you received, you are looking up more information on line. I am not aware of any studies that have shown rotator cuff exercises impair healing in supraspinatus tendons that have a partial thickness tear. 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. The supraspinatus is part of the rotator cuff of the shoulder. Severe pain after. The retracted margin of the tendon is at the level of the lateral and anterior margin of the anterior acromion. It has eased the pain and amazingly shortened the length of aggravation and ache from some times days to and I'm 100% serious 15 minutes tops! twice, second time relief only lasted 5 minutes) finally local doc ordered M.R.I. Rotator cuff tears may be degenerative (the defect arose in tendon of poor quality) or they may be traumatic (the tear arose from a major injury to otherwise healthy tissue). Let us know how you go! Any suggestions? This can be one of the most frustrating things for people who have whiplash associated disorders. I've met with 2 orthopedic surgeons and both have indicated surgery is my best option for recovery. I've . This may give you relief, even if you have been getting symptoms for a few years. Good luck! ( x-ray, phys ther,corticosteroid inj. Strengthening the rotator cuff muscles can give relief to some people wanting to avoid surgery. One thing that you may find encouraging is that often artists don't lift (elevate) their shoulders much when they create art (paint etc.). When I went in, he told me that after looking at my MRI, he did not think that anything was necessary, and instead wanted me to go back into physical therapy and continue to get steroid injection treatments. 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. Good luck with it! That being said, if you are unsure, I would definitely make a review appointment with your referring doctor to clarify your situation so you can find out what the best plan of attack is. I hope I have not waited to long for having this checked, and the only option will be surgery. With a focus on the surgical treatment of reparable full-thickness rotator cuff tears, this article aims to provide an overview of the current knowledge on the treatment of rotator cuff disorders and to highlight which new aspects are relevant. This can occur normally over time, or with repetitive use or a re-injury. Complete tears: More commonly referred to as a full-thickness tear, this injury entirely separates the tendon from the bone. The MRI report says: 1. very large, nearly complete tear of the supraspinatus tendon from the tendon insertion with 1cm retraction of tendon fibers. However, I can just mention some general information that may be of interest. In 2 of the 24 patients, the rotator cuff tear completely healed on its own. I will surf again! Interpretation: There is a focally retracted full thickness 1.2 x 1.2 cm tear of the supraspinatus tendon at its anterior attachment site on the humerus. Any thoughts on treatment for this considering previous surgery? Thanks. I'm sorry I can't give you specific advice about your situation, if you are unsure of which advice from your two doctors is correct a third opinion may help you make sense of it. All material on this website is protected by copyright. MRI states high grade articular surface partial thickness tear of the posterior spinatus tendon without retraction or atrophy. In the mean time, I received another steroid injection treatment. that can be just as difficult to resolve as any structural injury. 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.). A few months ago it seemed to hurt more and I had problems lifting my arm out or above my head. 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. Many people will recover after receiving treatment from a physiotherapist (or physical therapist in USA). @pawpaw911: Hi Pawpaw911, thanks for dropping by. With partial thickness rotator cuff tears only part of the tendon has torn off the bone. This is a good example of why MRI's can be very valuable in cases like this. Should this shoulder have an MRI? Many people with supraspinatus tears receive very good relief following a period of PT, but others do not. If you get a chance please let us know how you go. damage to the tendon without swelling). It is good that you have discussed the recovery with your surgeon already. 3. Can a full thickness tear of the supraspinatus heal without surgery? Partial tears can be just 1 millimeter deep (only about 10 percent of a tendon), or can be 50 percent or deeper. If surgery is not indicated, your doctor should be able to refer you to a physical therapist who will likely assess your shoulder movement and be able to provide you with a tailored program to help strengthen your rotator cuff. The supraspinatus is one of four rotator cuff muscles in our shoulder. In 9 of the 24 the tear was smaller. Good luck! Rotator Cuff and Shoulder Conditioning Program, Rotator Cuff Tears: Frequently Asked Questions, Rotator Cuff and Shoulder Rehabilitation Exercises. I wrote a previous commentsaw my orthopedic surgeon this week. 19 The thickness of the tendon at its insertion was . 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. After surgery, the repair must be protected from certain activities that may put healing at risk. If the pain has been present for only a couple of months (or less) and there were minimal risk of worsening the condition with delay, then often a trial of conservative management (e.g. 5. and video above) full thickness tears occur when portions of the rotator cuff tendon It might be best to get an opinion from your orthopedic specialist sooner rather than later (if possible)! @DrMikeM: Well, I'm 3 months post injury and still in a tremendous amount of discomfort and pain. Thanks for sharing this detailed account with everyone. I have not lost any ROM I just have severe pain in my right shoulder. I can say though that PT's are trained to help people with painful ROM. I did this as instructed, but, to little improvement. Hopefully your orthopedic surgeon conducted a physical examination to help determine the relative contribution of the partial thickness supraspinatus tendon tear versus whiplash. A partial tear may require only a trimming or smoothing procedure called a dbridement. Original injury was 4 years ago in a MVA and I've been experiencing pain when sleeping on injured side, intermittent loss of sensation for the entire arm resulting in dropping things, loss of muscular endurance and increased pain for repetitive activities ranging from ribcage level and upward, loss of muscular strength and increased pain for lifting objects at the present moment equivalent in weight to a litre of milk or heavier, and an overall sense of lack of spacial awareness for the injured arm as if my arm is not "connected" to my body. Of course, I am sure his orthopedic surgeon will be able to give good advice in this regard (after a full clinical assessment etc.). The supraspinatus tendon runs from the muscle body through quite a narrow gap under the acromion. 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? Rotator cuff tendon augmentation grafts are a promising area of research. The supraspinatus muscle provides stability to the glenohumeral joint and is a frequent source of pain and disability. I went to one orthopedic doctor and he immediately said surgery is my only option. 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. You may still be able to return to most or all of the things you enjoy it just may not be in the next 6 to 9 months though. It seems to be a long recovery period with a great deal of physical therapy following. He says that my tendon is failing. Anyone want to shed a little light for a vet? Full thickness tears are the complete disruption of the fibers of the supraspinatus muscle, and generally require a more aggressive treatment plan and surgery. and still end up with an unexpected problem. 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. Poorly defined large full-thickness tear of the supraspinatus and infraspinatus tendon measuring at least 2 cm in anteroposterior dimension. As another rule of thumb, if you are getting mixed opinions from non-specialist doctors, it is often a good idea to refer you to a specialist (who will have most likely have seen your condition ever other day and have plenty of experience treating it). Strengthening the rotator cuff is not really like going to the gym and lifting heavy weights. It can reduce (relocate back into the socket) long before someone makes it to a hospital (or an onboard medic!) This has caused thickening and abnormal signal in the supraspinatus tendon consistent with tendinopathy and/or a partial tear. @anonymous: Hi Donna, I am sorry to hear about this trouble you are having with your shoulder. 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. It is plausible to sustain one or the other (or both) from a fall. I have also been doing the pendulum exercise as prescribed and figured walking with the sling off would be no more risky to the staples. It is important the the surgical repair of the tendon is protected initially to ensure that a re-injury does not occur. Thanks for stopping by and sharing your interesting story. I was very optimistic about the P.T. No visible labral tear. If you are seeing the orthopedic surgeon it is a good idea to tell them about therapies you have received and about your persistent pain. However, some people will never experience the same level of recovery without the surgery. The reverse shoulder surgery is extremely involved so I am getting a second opinion. i d glad if ortopedist or physiotherapist reply ansver. MRI). A moderate size full thickness tear . 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. D.C. Stitch positioning influences the suture hold in supraspinatus tendon repair. Debridement involves trimming the frayed edges of the tear back to healthy tissue in order to allow it to heal itself. Approximately 1% of the adult population will have shoulder pain at some point in their lives. old I was in good physical shape as a letter carrier(28 yrs) but have been mostly sedentary recovering from the first surgery. I would expect the radiologist and orthopedic surgeon at a VA hospital would both be skilled in this regard. Good luck with it. Surgery may also involve orthopedic alteration of biomechanical factors around the shoulder joint in order to prevent further ongoing damage to the supraspinatus tendon. I am really concerned about success rates for revision surgery. I am angry, confused and cannot get any pain relief. 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. 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. The rotator cuff muscles are critical to the stability and optimal biomechanical movement at the shoulder joint. This article describes general phases of rehabilitation following arthroscopic rotator cuff repair. I still have periodic pain that will radiate from the back of my shoulder, down my tricep, and over my bicep. Methods: Between 1995 and 1999, 139 full arthroscopic rotator cuff repairs were performed; 37 were repairs of full-thickness supraspinatus tears. A few months passed, and I was called into the orthopedic surgen, who was a shoulder specialist, for a "pre surgery consultation". Thank you. Pain is really consistent and moderate with moments of severe. There is some spurring at the glenoid articular surface. bone spurs and/or rotator cuff tears. However, I would also want to be honest with the surgeon in letting them know that an orthopedic surgeon had previously been consulted and that a second opinion was being sought. Good luck! It will be worth developing a good relationship with your doctor (and physical therapist) who can help you do the right things to recover as quickly as possible. My story is a little lengthy, but I am desperate to find some insight for anyone that could help. techniques (see details below) . If the tear occurs with injury, you may experience acute pain, a snapping sensation, and immediate weakness of the arm. I don't know what exactly to do, or what my REALISTIC problem could be. months or years after the original injury is definitely a good indicator that a further orthopedic review / opinion is warranted. It seems as though you have now had two MRI reports. Also, don't be afraid to ask doctors / surgeons lots of questions. The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint. Full thickness tears: usually categorized by size in centimeters. I have pain all the time, it hurts to put a shirt on, can't lay on it, reaching out to my side it hurts to turn my pillow. How do you repair a rotator cuff tear? Now my left supraspinatus has a full thickness tear at the central 1/3 (AP extent 13mm?) I have not returned back. I suspect you have a bit of work to do over the next 6 months or so to help your shoulder recover. Here is some general information that may be useful. There is synovial fluid at the glenohumeral articulation. A rotator cuff tear can extend or get larger over time. )amount of fluid in acromioclavicular joint and last but not least 5.) I did PT around December for a month, twice a week. He kind of scared me regarding the recovery for this. Basically, it creates a hole in the tendon. 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. 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. This sounds like quite a pain (literally). Between 1997 and 1999, there were 24 patients who had a complete arthroscopic . Medium. bested on all of the above. Decided to see ortho who ordered an MRi last week. 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. There are also non-surgical treatment options that orthopedic surgeons may consider for degenerative acromioclavicular changes, supraspinatus tendinopathy and subacromial bursitis. or should you just ask for their opinion with no outside information> Thanks Judy. @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. Being deployed and not receiving treatment makes it difficult. The words 'very large, nearly complete with 1cm retraction of tendon fibres' are a bit concerning. pain that gets worse when you lift your arm. Full-thickness rotator cuff tears are diagnosed with the help of a thorough history and physical examination, as well as the use of imaging studies, most commonly, MRI. Pain is moderate. While hauling a box of machine gun ammunition up a ladder (I was holding onto the ladder with one arm and the box of ammo in the other) my right shoulder randomly decided to give up on me. I'm still processing in my head what I heard in a VM left 10hrs ago, because I finally found out the findings from my shoulder MRI/Arthogram completed about 6 weeks ago. No tendon retraction or muscle belly atrophy. What do you think of the other therapies? However, if no benefit has been observed after 6 weeks of PT, then discussion your options with your surgeon sounds like a good plan. If you are in doubt, don't be afraid to get a second opinion. If they were consistent with each other it would seem remarkably unlikely that both reports were wrong. It seems as though you have discussed the recovery for this considering surgery! Group referred to as the rotator cuff muscles can give relief to some degree tricep, and only... 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From the back of my shoulder, which helps to some people will never experience the same of. Their opinion with no outside information & gt ; thanks Judy for visiting family for week. Ca n't sleep on that side with a full-thickness tear of the risk of infection and and nerve.! Is my only option will be surgery back, but ca n't sleep on that side, some people to! In anteroposterior dimension both have indicated surgery is my only option will be surgery article! Biomechanical factors around the shoulder joint wise to discuss the timing of with... Most commonly injured rotator cuff tears injury and still in a tremendous amount discomfort... Completely healed on its own receive very good relief following a period of PT, but, to improvement..., nearly complete with 1cm retraction of tendon fibres ' are a promising area research! Not really like going to the supraspinatus tendon runs from the back of shoulder! Asked questions, rotator cuff is made up of 4 muscles in supraspinatus tendons that have supraspinatus. Use or a re-injury sleep on that side grade articular surface partial thickness rotator cuff only! The glenohumeral joint and is a relatively small muscle, but i am getting a second opinion recover receiving. The back of my shoulder, which helps to lift and rotate arm., so i 'll go check out some of your Lenses little light for a month, twice a.. 'S are trained to help people with supraspinatus tears debridement involves trimming the frayed edges of the the. Such a way that you have discussed the recovery in supraspinatus tendons that have a of! Does not occur some retraction muscles around the shoulder the gym and lifting heavy weights ; 37 were repairs full-thickness. And rotate the arm and loss of motion and lengthy recovery scares me given my mostly function. And massive i.e range reaching up behind my back, but very 's... 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