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Supraspinatus tendon tear

Updated on December 21, 2014

Supraspinatus tendon tear - what you need to know

Supraspinatus tendon tears are the most common tendon tear in the shoulder region. Tears of the supraspinatus tendon can be painful. They usually present as a sharp pain at the outside or front of the shoulder, particularly with arm elevation (raising arm to the side or front). Pain can also be brought on by laying on the side and a strong ache can persist after the injury has been irritated (this can cause difficulty sleeping). Supraspinatus tendon tears require specific rehabilitation of the rotator cuff and muscles that stabilize the shoulder blade. In some cases surgery to repair the tendon is also required. Surgery may also involve orthopedic alteration of biomechanical factors around the shoulder joint in order to prevent further ongoing damage to the supraspinatus tendon. This page starts with a general overview of supraspinatus tendon tears and then discusses shoulder impingement, rotator cuff rehabilitation exercises and surgical considerations relating to rotator cuff tears and the supraspinatus tendon in particular. There are several video examples to accompany the written explanation.

Supraspinatus tendon - what is it?

The supraspinatus muscle is a relatively small, but very important muscle. It plays a critical role in movements involving the shoulder joint, particularly arm elevation. The supraspinatus muscle body is located in the top portion of the back of the shoulder blade (superior posterior portion above the spine of the scapula) known as the supraspinatus fossa (top hollow part of the shoulder blade in the image on the right). This image is a left shoulder blade from the viewpoint of looking at it from behind (posterior view). The supraspinatus tendon runs from the muscle body through quite a narrow gap under the acromion (top left of shoulder blade in the image). Although not shown in this image, the acromion joins with the collar bone and attaches to the upper arm (humerus also not shown in this image). The acromion connects with the collar bone (clavicle) very close to the ball and socket (gleno-humeral) joint of the shoulder. The close proximity of the supraspinatus tendon to the acromion-clavicular arch is a common contributing factor in supraspinatus tears, particularly when the tendon becomes impinged between these bone structures with activities that require arm elevation.

Action of the supraspinatus

In addition to arm elevation, the action of the supraspinatus muscle has important role in pulling the head of humerus (the ball part of the ball and socket joint) into the glenoid (socket). Here is a three second video of the action of the supraspinatus muscle.

Supraspinatus tendon tears - underlying causes

There are at least three important factors that contribute to supraspinatus tendon tears. Some can be altered with conservative rehabilitation exercises in order to prevent further tearing and ongoing pain, while others cannot be altered without surgery.

These factors include:

1. Age related degeneration

The integrity of the supraspinatus tendon has a tendency to weaken with age and become prone to tendon tears. The majority of supraspinatus tendon tears occur amongst people over the age of 40 years. However, trauma (such as sporting injuries or motor vehicle accidents) can cause tears amongst people of any age.

2. Shoulder girdle structure

The individual shape of the bone structures (particularly the acromion) and soft tissues around the tendon will contribute to whether the tendon is able to move freely or becomes impinged between structures with arm elevation.

3. Biomechanics of shoulder movement

The supraspinatus is one of the four muscles that make up the rotator cuff group of muscles. The rotator cuff muscles are critical to stability and optimal biomechanical movement at the shoulder joint. 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 in the integrity of the supraspinatus tendon.

Traumatic causes of supraspinatus tendon tears

As mentioned above trauma is the cause of supraspinatus tendon tears in some cases. With the exception of motor vehicle accidents, this trauma usually occurs when the arm is elevated. Many professions require repetitive or heavy overhead work (roof plasterer etc.). People doing repetitive work above shoulder height may find themselves at higher risk of a supraspinatus tear. Players involved in sports requiring fast throwing actions (baseball) or overhead hitting (volleyball, tennis) may also sustain a traumatic injury to their rotator cuff, and the supraspinatus tendon in particular.

Explanation of rotator cuff injuries and 3 exercises to increase shoulder range of motion

At approximately 3 minute 40 second mark in this video there are 3 exercises to help increase the range of the movement in the shoulder. 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. After a formal assessment they will be able to prescribe a course of rehabilitative exercises (+ / - analgesic advice or possible recommendation for surgery if required).

Physical therapy exercises

Physical therapy exercises for supraspinatus tendon tears usually have one of three purposes:

1. Relieve pain

2. Increase shoulder range of movement

3. Strengthen rotator cuff muscles

Pendulum exercise (aka Codman's)

Here is a pendulum exercise demonstration. This exercise can be good for pain relief, and may also help increase the range of motion in the shoulder joint. It is noteworthy that you don't need to lean over as far as demonstrated in this video. For most people it is usually preferable to lean on a bench or table rather than the seat of a chair. This will help minimize the strain through the back.

Rotator cuff strengthening with theraband

Here are some common but very useful exercises to strengthen the rotator cuff muscles. There are some links below for cheap resistance tubing if you need to get a hold of some. Remember as you complete these exercises you are not aiming for speed, slow stead controlled movement is best. You should also not be feeling pain in the shoulder during the movement. As mentioned in the video, the aim of these resistance band exercises are not to increase your range of movement but strengthen the rotator cuff muscles which will help protect the integrity of the soft tissue structures around the shoulder in the long term. 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.

Surgery to repair a supraspinatus tendon tear and remove some bone to increase the space below the accromion

In many cases surgery is required. I could write a whole page on its own regarding shoulder surgery for rotator cuff tears (perhaps another day!). If the tendon has been completely ruptured (no longer attached) then surgery will definitely be required with some level of urgency if the tendon is to be successfully reattached. 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. When the supraspinatus tendon is torn but not completely ruptured, usually a period of conservative management with a physical therapy program will be trialled rather than rushing into surgery. Even if surgery is required, the physical therapy program can help strengthen the rotator cuff muscles before the surgery. The post-operative recovery period following a surgical rotator cuff repair will take some months and involve a specific program of range of motion and strengthening exercises that your surgeon will prescribe, often in conjunction with a physical therapist who will teach you the exercises and monitor your progression. Some surgeons will prescribe slightly different post-operative rehabilitation program dependent on the nature of the injury and precise surgery performed. Surgical repairs can be compromised when post-operative instructions are not followed, so if you have surgery make sure you know exactly what you should and should not do!

Share your comments or experiences here!

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      Scarbro 3 months ago

      Not too sure if this article is still active but I'll ask anyways. Im a bodybuilder for years but I'm getting old. Lol. I'm 43 and have been suffering from shoulder issues for over a year. Anyways, my appointment for surgery on my right shoulder is in 2 weeks.. Arthroscopic.. it use to ache and ache at night but recently its not so bad. It was a small rotator cuff tear. 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

      what or go ahead with the surgery??

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      mack 14 months ago

      hi drmike

      i have got partial thickness insertional tear in supraspinatus 9mm*5mm. have got bursal thickening as well and mild thickening of

      coracoacromial ligament. is surgery the only option?

      thnx

    • DrMikeM profile image
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      DrMikeM 2 years ago

      First, sorry for the delay in response. Second, I am sorry to hear about your fall and subsequent shoulder pain. It is not possible for me to give you any specific advice over the internet etc., but here are some general thoughts.

      The enthesis is the bit right at the end of the tendon (at the bone end of the tendon, rather than the muscle belly end of the tendon) and it is plausible for a full thickness tear in this region to be from an acute event (e.g. substantial trauma from a fall), or from repeated microtrauma (e.g due to biomechanics + / - age-associated changes). Generally speaking, for shoulder pain related to rotator cuff injuries following trauma, often the first strategy is to see whether the pain and other symptoms improve with non-surgical management approaches. However, in some cases, the better option may be to consider surgery sooner rather than later (e.g. perhaps if delay is likely to lead to a complete rupture that could be prevented with early surgery). The surgeon(s) who ordered the imaging are usually the best person to speak with regarding the pros and cons in any particular case. 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. pain management and physical therapy) may be the first choice to see if surgery can be avoided. 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.

      Of course, if you feel you cannot have an open and honest discussion about the pros and cons of surgery in your particular case with your surgeon, don’t be afraid to seek a second independent opinion from another specialist. 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.

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      Mkcary 2 years ago

      Hi Dr. Mike,

      I took a not so graceful fall on a sidewalk about 9 weeks ago and landed on my shoulder. List of pain and limited mobility for about a week. I have full range of motion and only occasional soreness now and again, but can't sleep on that side. Decided to see ortho who ordered an MRi last week. 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. No tendon retraction or muscle belly atrophy. Thoughts on surgery? I maybe take a few Advil a week with no loss of function at all. Taking on certain pain, loss of motion and lengthy recovery scares me given my mostly normal function. I am 55 and active, so I don't want to hurt my "golden" years, so I am not sure what to think. Sounds like no guarantee of 100% return to normal, and I'm about 95% now, not to mention a lengthy recovery. Thanks! Mary Kay

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      DrMikeM 3 years ago

      @will-nelson-790693: Hi Will, Thanks for stopping by and sharing your experience. I am glad that you noticed some relief after the surgery on your right shoulder and that the exercises for your left shoulder have already helped you get better quality sleep. While I can't give you specific advice over the internet, it sounds like you are doing a great job following the recommednations of your doctors. Don't be afraid to have an open discussion with your GP about whether or not a referral to a surgeon is the right way to go (or not) for your specific circumstance. I will congratulate you on actually doing your exercises! Some people will say that exercises didn't work for them, but it turns out actually doing the exercises (rather than just thinking about them) drastically increases the chance of them being effective! Let us know how things turn out for you. Good luck!

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      anonymous 4 years ago

      Full thickness tear of the anterior insertional fibers of the supraspinatus tendon with a 1cm retraction and no evidence of supraspinatus muscular atrophy. I also have an intermediate grade partial thickness tear of superior tendon bundle of Subscapularis without retraction or muscular atrophy. I also have no insurance and don't know about surgery. I work construction and am self employed. Can you help me out at all? Thanks

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      will-nelson-790693 3 years ago

      In September '12 I had surgery to reattach both the right rotator supra and infraspinatus with excellent results. I did PT around December for a month, twice a week. I slept in a recliner for about 2 1/2 months following surgery (I don't think I slept at all before surgery :) ). By June '13 I was better in many ways than before the injury. I have about 3" less range reaching up behind my back, but I think some pre-existing tears and arthritis were fixed. Now my left supraspinatus has a full thickness tear at the central 1/3 (AP extent 13mm?) and retracted 2 cm. This was caused by contact with another person and (I'm self diagnosing) some prior existing minor tendon tears. I have been saving up a couple months to cover my deductible expecting to schedule surgery. 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. I am disappointed not to have been referred to a surgeon, but I have to admit the exercises have already helped me sleep better. I would like to get the tendon fixed, the thought of advancing an existing tear makes me cringe. But shoulder exercises from now until I die.

    • DrMikeM profile image
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      DrMikeM 4 years ago

      @anonymous: Hi Donald, I'm sorry to hear about your shoulder trouble and insurance situation. Unfortunately I can't give you specific advice over the internet. Here is some general information that may be useful. 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). 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. These types of injuries seem quite common for people who work in construction and are often associated with doing work above shoulder height. Avoiding work above shoulder height can sometimes avoid aggravating the pain. Strengthening the rotator cuff muscles can give relief to some people wanting to avoid surgery. The rotator cuff exercises should not cause pain while the exercise is being performed. If pain is being caused, then there may be a problem with technique or a lower intensity may be required. Good luck with it!

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      anonymous 4 years ago

      Donald lee

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      DrMikeM 4 years ago

      @AussieAnnie LM: Thanks!

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      AussieAnnie LM 4 years ago

      great lens

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      DrMikeM 4 years ago

      @anonymous: Hi Bobby, Thanks for stopping by and leaving a comment. I'm sorry I can't give you specific advice about whether you will need surgery or not over the internet. Hopefully your doctor can give you specific advice in this regard. Some general information that may be useful to know is that some people who have similar pathology to that which you have described end up having surgery while other do not. Similarly, some benefit from conservative approaches (physical therapy / injections etc.), while others do not. So quite often the best treatment approach is not always immediately clear. 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). It is also worth knowing there are just some jobs that seem to take a heavy toll on shoulders / supraspinatus tendons (unfortunately I think painter / sheet rock installer / any occupation where you need to hold things up above shoulder or head height are right at the top of that list). So probably worthwhile having a chat with your doctor and seeing what they recommend as a first step. 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). Good luck!

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      anonymous 4 years ago

      Lou

      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? 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.

    • DrMikeM profile image
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      DrMikeM 4 years ago

      @anonymous: Hi Lou,

      Thanks for stopping by and leaving a comment. I've only got a couple of minutes, so I'll keep this short. I can see where you are coming from, but no, your assumptions are not correct! It sounds like you are not following your surgeons instructions! It would be much wiser to follow your surgeons instructions (which usually involve keeping arm in sling for 6+ weeks depending on surgery / surgeon etc. only taking out for prescribed exercises (e.g. pendulum), which should be undertaken ensuring correct technique). Surgical repairs of complete tendon tears from a traumatic event, like a car accident, can easily fail when surgeons instructions aren't followed. If you have any uncertainty around the need for your sling use, please call your surgeon's office today. It sounds like you may be putting yourself at unnecessary risk? If in doubt call your surgeons office. Good luck with the recovery (I know slings can be frustrating and uncomfortable, but the weeks will pass quickly)!

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      anonymous 4 years ago

      its been 5 months since my partialthickness tear of mysupraspinatus the the footplate..im 56 and also have degenerative change o the acromioclavicular joint impinging on the supraspinatus at the myotendinous junction...Narrowing of the acromiohumral distance...tenosynovitis of the lpng head of the biceps...will I need surgery???? im a painter/sheet rock installer...

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      DrMikeM 4 years ago

      @anonymous: Hi Elania, Thanks for stopping by and sharing. It is difficult for me to comment further based on this information. Nonetheless, it worth noting that as a general principle, synovial fluid is very important and helps lubricate the joint. 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. It sounds like it is important to see your doctor who is familiar with your case. They will be able to tell you the likelihood of a supraspinatus tear and adhesive capsulitis (or any other pathology), as well as the recommended course of action for your particular circumstance. Good luck!

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      anonymous 4 years ago

      In my reports say that I have less fluid and possible tear

    • DrMikeM profile image
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      DrMikeM 4 years ago

      @anonymous: Hi Kazikp, I am sorry I cannot give you advice over the internet but here is some general information you may find useful. The types of findings you have described are consistent with some quite substantial pathology in your shoulder. You have asked for information about potential options. 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. 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. Your orthopedic specialist will be able to give you advice about the best option for your circumstances. Some things to consider when you are discussing your options with a surgeon is the length of recovery time following surgery (likely to be months), consider time to return to work (also consider whether it it possible for you to return to light duties at work). On the other hand, you will also need to ask about the likelihood of decent recovery without surgery. There may also be insurance implications etc. if your initial injury was work related. Judging by the description of atrophy in your rotator cuff muscles, I am guessing it has already been some time since the incident occurred. It might be best to get an opinion from your orthopedic specialist sooner rather than later (if possible)! Good luck with it.

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      anonymous 4 years ago

      Dr Mike, Please help me understand what options I might have in my case of job relater incident. 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. There is supraspinatus muscular atrophy. The retracted margin of the tendon is at the level of the lateral and anterior margin of the anterior acromion. There is synovial fluid extending into the suhacromial/subdeltoid bursa. There is inhomogeneous and bulbous appearance of the distal .subscapularis tendon with tendinosis. There is fluid distending the long head of the biceps tendon sheath, representing tenosynovitis. Productive acromioclavicular joint changes are associated with an anterolaterally down sloping type II acromial configuration. There is compromise of the subacromial space with impression on the underlying torn supraspinatus. There is synovial fluid at the glenohumeral articulation. It extends slightly into the proximal subscapularis bursa. Subcortical reactive changes superiorly and laterally at the humeral head are present. There is some spurring at the glenoid articular surface. I here is incidental note made that the teres minor muscle is prominently atrophic. Examination otherwise demonstrates the osseous structures of the shoulder to be otherwise unremarkable in signal and morphology. Muscular and tendinous structures including remaining portions of the rotator cuff are also felt to remain otherwise unremarkable in signal and morphology. The glenoid labrum and bicipital tendon appear unremarkable in position and morphology.

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      DrMikeM 4 years ago

      @Reallmadhatter: No problem!

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      DrMikeM 4 years ago

      @Reallmadhatter: Good question. I don't think there is a clear answer to this one. On one hand, I want the second opinion to be formulated entirely based on my case information (not on what another surgeon did or did not recommend). 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. Although I probably wouldn't be forthcoming with the name of the first surgeon or advice given unless the surgeon actually asked about this directly. No black and white answer for this one I'm afraid.

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      DrMikeM 4 years ago

      @Reallmadhatter: Hi Judy,

      Thanks for stopping by and sharing your story. I'm sorry I can't give you specific advice over the internet, but hopefully you will find the following general information interesting.

      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.

      Your question regarding using a graft of some sort to help repair a rotator cuff tendon is an interesting one. Rotator cuff tendon augmentation grafts are a promising area of research. I say promising because work in basic science and animal studies have demonstrated some quite promising findings. However, to date, I am not aware of any rigorous large-scale clinical trials that have demonstrated effectiveness (or otherwise) in humans. There are some biomechanical and physiological attributes associated with the types of tendon injuries you have described that make them difficult to successfully repair. That being said, a surgeon's own experiences, skills and abilities (as well as risk tolerance) may factor into their decision as to whether a surgical repair (and the nature of the repair) is something they will advise. So a second opinion may not always yield the same advice (even though both surgeons may be giving appropriate advice based on their own circumstances and information). Risk of infection and nerve damage are worthy of consideration for any surgery, particularly one as involved as a reverse shoulder replacement. 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. It is certainly worth discussing a more conservative approach, such as seeing a physical therapist that specializes in shoulders, with your orthopedic surgeon; particularly if you feel you have noticed improvements previously. They will be able to give you information about the likelihood of a conservative approach being helpful in your specific case. Yes, also a good idea about discussing with your surgeon the potential risks or benefits from delaying surgery in your case. There are generally (at least) two main foci when considering whether to have surgery soon or to delay as long as possible. 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. Similarly pain and dysfunction in the shoulder may cause you to use it less, which may in turn lead to weaker muscles and tendons (which may lead to more difficulty during and after a subsequent surgery). 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. Again, because your case is not straightforward, seeking advice from your surgeon(s) in this regard is certainly wise.

      Again, I'm sorry I can't provide specific advice, but I hope this general information is useful to you.

      One thing that you may find encouraging is that often artists don't lift (elevate) their shoulders much when they create art (paint etc.). Shoulder muscles are very good for stabilizing the ball and socket joint and making large movements (to help lift things, throw objects etc.), but not so good with the finer movements (better performed by the muscles in the forearm and hand). I've seen musicians and artists with poor shoulder function be able to perform their art as well as they did before their injury; sometimes through making some adaptations, but other times almost no adaptation was required (depending on their technique / instrument / art etc.).

      Good luck with it!

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      Reallmadhatter 4 years ago

      P.S. sorry for the double posting, first time user. !!!

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      Reallmadhatter 4 years ago

      Dr. Mike. When getting a second opinion from another surgeon. Should you tell him what the other surgeons name is and what they advised. or should you just ask for their opinion with no outside information> Thanks Judy

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      Reallmadhatter 4 years ago

      Reallmadhatter Mar 14, 2013 @ 3:44 pm

      Judy 3/14/2013

      Dr Mike, Please help me understand what options I might have or questions to ask the surgeon about my full thickness rotator cuff tear.

      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.

      I have continued to have problems with my arm and initially was told that I had a partial tear of my rotator cuff. For awhile I was able to get my arm somewhat back to normal but wilh slight aching. A few months ago it seemed to hurt more and I had problems lifting my arm out or above my head. I can reach behind my back ok. I sleep fine as it does not hurt to lay on my back. I don't lay on the side of the hurt arm as I don't think it will be good for it. I have been seeing an orthopedic doctor for the past 18 months. and seemed to be doing ok with Cortisone shots.

      Because of the return of the recent pain, another MRI was ordered and the Radiologist wrote: "1. Poorly defined large full-thickness tear of the supraspinatus and infraspinatus tendon measuring at least 2 cm in anteroposterior dimension.

      2. Grade 1 strain of the lateral deltoid muscle and teres minor muscle

      3. Atrophic teres minor tendinosis.

      I was referred to a surgeon who stated that they could not repair the rotator cuff due to the size of the tear from a surgical standpoint. And overall her last resort for surgical intervention is a reverse total shoulder arthroplasty. But not result in a normal shoulder. but can get back fairly good motion about the shoulder . So my tear went from a near full thickness tear to a full thickness tear. The reverse shoulder surgery is extremely involved so I am getting a second opinion. My question to you is why can they not try to repair the rotator cuff using a graft of somesort. I do not want a metal shoulder. Because of the risk of infection and and nerve damage. Also can I try a more Conservative approach and see a phy therapist that specializes in shoulders before any surgery. Also an ex ray of my shoulder "Demonstrate my humeral head close to abutting my acromion. MRI does demonstrate a complete massive tear of my rotator cuff with retraction and severe atrophy. Overall my subscapularis does appear intact." I am 67 years old and am an artist and my left arm which is the one in question is my dominate arm.

      Also if I don eventually need surgery will it hurt to wait until I absolutely need it.

      I plan on asking the surgeon these questions, but wanted your expert opinion. I appreciate your thoughts on this matter.

      What little I have done has given me improvement.

    • profile image

      Reallmadhatter 4 years ago

      Reallmadhatter Mar 14, 2013 @ 3:44 pm

      Judy 3/14/2013

      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

      Judy 3/14/2013

      Dr Mike, Please help me understand what options I might have or questions to ask the surgeon about my full thickness rotator cuff tear.

      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.

      I have continued to have problems with my arm and initially was told that I had a partial tear of my rotator cuff. For awhile I was able to get my arm somewhat back to normal but wilh slight aching. A few months ago it seemed to hurt more and I had problems lifting my arm out or above my head. I can reach behind my back ok. I sleep fine as it does not hurt to lay on my back. I don't lay on the side of the hurt arm as I don't think it will be good for it. I have been seeing an orthopedic doctor for the past 18 months. and seemed to be doing ok with Cortisone shots.

      Because of the return of the recent pain, another MRI was ordered and the Radiologist wrote: "1. Poorly defined large full-thickness tear of the supraspinatus and infraspinatus tendon measuring at least 2 cm in anteroposterior dimension.

      2. Grade 1 strain of the lateral deltoid muscle and teres minor muscle

      3. Atrophic teres minor tendinosis.

      I was referred to a surgeon who stated that they could not repair the rotator cuff due to the size of the tear from a surgical standpoint. And overall her last resort for surgical intervention is a reverse total shoulder arthroplasty. But not result in a normal shoulder. but can get back fairly good motion about the shoulder . So my tear went from a near full thickness tear to a full thickness tear. The reverse shoulder surgery is extremely involved so I am getting a second opinion. My question to you is why can they not try to repair the rotator cuff using a graft of somesort. I do not want a metal shoulder. Because of the risk of infection and and nerve damage. Also can I try a more Conservative approach and see a phy therapist that specializes in shoulders before any surgery. Also an ex ray of my shoulder "Demonstrate my humeral head close to abutting my acromion. MRI does demonstrate a complete massive tear of my rotator cuff with retraction and severe atrophy. Overall my subscapularis does appear intact." I am 67 years old and am an artist and my left arm which is the one in question is my dominate arm.

      Also if I don eventually need surgery will it hurt to wait until I absolutely need it.

      I plan on asking the surgeon these questions, but wanted your expert opinion. I appreciate your thoughts on this matter.

      What little I have done has given me improvement.

      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.

      I have continued to have problems with my arm and initially was told that I had a partial tear of my rotator cuff. For awhile I was able to get my arm somewhat back to normal but wilh slight aching. A few months ago it seemed to hurt more and I had problems lifting my arm out or above my head. I can reach behind my back ok. I sleep fine as it does not hurt to lay on my back. I don't lay on the side of the hurt arm as I don't think it will be good for it. I have been seeing an orthopedic doctor for the past 18 months. and seemed to be doing ok with Cortisone shots.

      Because of the return of the recent pain, another MRI was ordered and the Radiologist wrote: "1. Poorly defined large full-thickness tear of the supraspinatus and infraspinatus tendon measuring at least 2 cm in anteroposterior dimension.

      2. Grade 1 strain of the lateral deltoid muscle and teres minor muscle

      3. Atrophic teres minor tendinosis.

      I was referred to a surgeon who stated that they could not repair the rotator cuff due to the size of the tear from a surgical standpoint. And overall her last resort for surgical intervention is a reverse total shoulder arthroplasty. But not result in a normal shoulder. but can get back fairly good motion about the shoulder . So my tear went from a near full thickness tear to a full thickness tear. The reverse shoulder surgery is extremely involved so I am getting a second opinion. My question to you is why can they not try to repair the rotator cuff using a graft of somesort. I do not want a metal shoulder. Because of the risk of infection and and nerve damage. Also can I try a more Conservative approach and see a phy therapist that specializes in shoulders before any surgery. Also an ex ray of my shoulder "Demonstrate my humeral head close to abutting my acromion. MRI does demonstrate a complete massive tear of my rotator cuff with retraction and severe atrophy. Overall my subscapularis does appear intact." I am 67 years old and am an artist and my left arm which is the one in question is my dominate arm.

      Also if I don eventually need surgery will it hurt to wait until I absolutely need it.

      I plan on asking the surgeon these questions, but wanted your expert opinion. I appreciate your thoughts on this matter.

      What little I have done has given me improvement.

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      DrMikeM 4 years ago

      @anonymous: Hi Bill,

      Sorry for the delay in response. Thanks for stopping by and sharing your story. The acriomioclavicular joint usually should have some fluid that helps lubricate the joint, but when it is specifically mentioned in an imaging report (like an MRI report), they are usually indicating that there are able to see more fluid then one might usually expect (in someone without any shoulder pathology). 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. Hope that helps!

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      Reallmadhatter 4 years ago

      @DrMikeM: Judy 3/14/2013

      Dr Mike, Please help me understand what options I might have or questions to ask the surgeon about my full thickness rotator cuff tear.

      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.

      I have continued to have problems with my arm and initially was told that I had a partial tear of my rotator cuff. For awhile I was able to get my arm somewhat back to normal but wilh slight aching. A few months ago it seemed to hurt more and I had problems lifting my arm out or above my head. I can reach behind my back ok. I sleep fine as it does not hurt to lay on my back. I don't lay on the side of the hurt arm as I don't think it will be good for it. I have been seeing an orthopedic doctor for the past 18 months. and seemed to be doing ok with Cortisone shots.

      Because of the return of the recent pain, a another MRI was ordered and the Radiologist wrote: "1. Poorly defined large full-thickness tear of the supraspinatus and infraspinatus tendon measuring at least 2 cm in anteroposterior dimension.

      2. Grade 1 strain of the lateral deltoid muscle and teres minor muscle

      3. Atrophic teres minor tendinosis.

      I was referred to a surgeon who stated that they could not repair the rotator cuff due to the size of the tear from a surgical standpoint. And overall her last resort for surgical intervention is a reverse total shoulder arthroplasty. But not result in a normal shoulder. but can get back fairly good motion about the shoulder . So my tear went from a near full thickness tear to a full thickness tear. The reverse shoulder surgery is extremely involved so I am getting a second opinion. My question to you is why can they not try and repair the rotator cuff using a graft of somesort. I do not want a metal shoulder. Because of the risk of infection and and nerve damage. Also can I try a more Conservative approach and see a phy therapist that specializes in shoulders before any surgery. Also an ex ray of my shoulder "Demonstrate my humeral head close to abutting my acromion. MRI does demonstrate a complete massive tear of my rotator cuff with retraction and severe atrophy. Overall my subscapularis does appear intact." I am 67 years old and am an artist and my left arm which is the one in question is my dominate arm.

      Also if I don eventually need surgery will it hurt to wait until I absolutely need it.

      I plan on asking the surgeon these questions, but wanted your expert opinion. I appreciate your thoughts on this matter.

      What little I have done has given me improvement.

      Left shoulder

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      anonymous 4 years ago

      Hey DrMikeM doin some research and came across your sight and thought I'd add my two cents. ,Been dealing with shoulder pain for about nine months now and thought I'd share my experience with you and other readers. As I said been dealing with this for about nine months and in that time have run the gamut of treatment.( x-ray, phys ther,corticosteroid inj. twice, second time relief only lasted 5 minutes) finally local doc ordered M.R.I. It was then I found out how messed up my shoulder actually is 1.)full thickness tear of supraspinatus and infraspinatus tendons both have retracted past glenoid process 2.) muscle atrophy of supraspinatus, infraspinatus, and subscapularis muscles, 3.) labra are not evaluated 4.)amount of fluid in acromioclavicular joint and last but not least 5.) Humeral head is riding high abutting the underside of the acromin process. I understand most of it but I was wondering is there supposed to be fluid in the acromioclavicular joint. If not what is this indictative of

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      DrMikeM 4 years ago

      @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. Good luck!

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      anonymous 4 years ago

      @anonymous: mike but not dr. mike. I am 72, I just got the mri with same partial tear. its been three months with some pt but no noticeable improvement. will consult surgeon next week

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      anonymous 4 years ago

      @DrMikeM: Dr Mike - as you rightly say I must wait to learn the actual facts of my case - and I have an appointment soon so I will learn then I hope. It's very good of you to reply so promptly and clearly though. Very much appreciated. I found it very helpful as I am sure all your other subscribers found it to be too. My best wishes go to all of them.

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      DrMikeM 4 years ago

      @anonymous: Hi Mike,

      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. Partial or full thickness tears that are not complete ruptures are generally far more common than complete ruptures (not common, but require surgery with some level of urgency). 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. Good luck with it.

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      anonymous 4 years ago

      Following an iltrasound scan I have been told I have a tear of the supraspinatus tendon and there is some retraction. Those words exactly. Does the fact that it mentions there is some retraction mean the tendon is completely torn or is it possible it is only partly torn. The technicians wont say more and nor will my doctor. Thankyou.

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      DrMikeM 4 years ago

      @anonymous: Hi Jackie,

      Thanks for stopping by and sharing. I think this is a common dilemma that people face. 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. 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.). Good luck with your decision!

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      anonymous 4 years ago

      Jackie. Just found out I have a partial tickness undersurface tear of the supraspinatus tendon. I am 60 years old and do not want surgery but if it helps to stop it getting worse as I get older I will have to. Good Luck to all the other guys, especially the deployed guy, my son has just returned.

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      DrMikeM 4 years ago

      @anonymous: Hi SSGtomn,

      Thanks for stopping by and leaving a comment. I'm sorry to hear of your shoulder trouble. 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.). However, there are certainly injuries and structures other than rotator cuff tears that can cause some of the symptoms Tim described above. Being deployed and not receiving treatment makes it difficult. I am sorry I can't provide you specific advice over the internet. I hope some of the general information I provided in my response to Tim's (or others) comment is useful. I'm not really sure how the whole army doctor situation works while you are on deployment, but I think if you have ongoing symptoms then it is worth making sure the appropriate people know. 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? Either way, I wish you all the best with it (and a safe deployment and return). Good luck!

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      DrMikeM 4 years ago

      @anonymous: Hi Tim,

      Sorry for the delay, I have been away. Thanks for sharing this detailed account with everyone. This sounds like quite a pain (literally). Unfortunately, I suspect that a whole bunch of people will read your account and hear bits and pieces that remind them of their own circumstance. I see this is true of SSGtomn who has left a comment already. Unfortunately I can't give you specific advice over the internet, without conducting a physical examination etc. However, I can just mention some general information that may be of interest. Sometimes, it is difficult to tell from people recalling what happened whether a shoulder has been dislocated. It can reduce (relocate back into the socket) long before someone makes it to a hospital (or an onboard medic!) for an examination, an x-ray or MRI, but other times soft tissue injuries can lead people to report similar symptoms even though no dislocation occurred. 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. Many people have seen sporting heroes dislocate a shoulder during a heavy contact, have a medic "pop" it back in, then continue on 15 minutes later. What we often don't see is the subsequent shoulder surgery and months of rehabilitation (sometimes in the off-season) to repair the damaged structures. 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 turns out, this management approach is not terribly effective in leading to a prompt repair of the damaged structures. 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). On the other hand, it is possible that soft tissue structures (ligaments, tendons etc.) can be damaged without a dislocation occurring at all, particularly when carry heavy items up ladders or performing repetitious activities. X-rays are often not very useful in diagnosing shoulder injuries. Unless the shoulder is actually dislocated at the time of the x-ray, or there is a noticeable bone abnormality (chipped or broken bone, bone spur that is visible on x-ray etc.), a shoulder x-ray may not reveal anything conclusive. Generally speaking, MRIs definitely help the surgeon to make a diagnosis and give them an idea of whether surgery will help. They do reveal most substantial soft tissue injuries, but they are only as useful as the person interpreting them is skilled. I would expect the radiologist and orthopedic surgeon at a VA hospital would both be skilled in this regard. 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). Communication between health professionals (such as PTs and surgeons) may not be as good as it could be. Ongoing serious pain influencing daily life, sleep etc. months or years after the original injury is definitely a good indicator that a further orthopedic review / opinion is warranted. Generally, if an injury is going to heal on it's own, it gets better over time, unless it is re-injured. 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. Also, don't be afraid to ask doctors / surgeons lots of questions. As far as general information goes, it is also worthwhile noting that chronic pain and inflammation at a joint can lead to secondary changes (weakening muscles, changes in the way the body processes pain etc.) that can be just as difficult to resolve as any structural injury.

      So in summary Tim, I would say I feel for you buddy. Based on the information you have provided above, I would say there are several structures that could potentially be causing this ongoing problem, of which a supraspinatus tendon tear is one (but is difficult to speculate without a physical examination / seeing the MRI etc. Either way, this kind of ongoing shoulder pain is not good. Don't be afraid to ask your surgeon about all your treatment options. Don't be afraid to say how you feel (no doubt you'd do this in a respectful way) about trying a whole bunch of non-surgical options, but not seeing any lasting results (as you have described for us above) and being keen to move forward toward some kind of resolution to the problem. The surgeon may (or may not) want to try arthroscopic surgery to repair any damage or structural problems they can identify on an MRI. If your surgeon does recommend surgery, be sure to ask about the likely recovery times and how long your arm movements will be restricted for. Keep in touch to let us know how you go. I am sure lots of people would like to hear how it turns out for you. Good luck!

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      DrMikeM 4 years ago

      @anonymous: Hi Jim,

      I'm sorry I can't give you specific advice over the internet about the best option for your situation. I can say though that PT's are trained to help people with painful ROM. Many people with supraspinatus tears receive very good relief following a period of PT, but others do not. It is also worth mentioning that not all PTs are created equal. Some will have more training, experience or ability in helping patients to overcome the biomechanical factors that can cause shoulder impingement and supraspinatus tears. 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). Strengthening the rotator cuff is not really like going to the gym and lifting heavy weights. Instead specific movements are required, these shouldn't cause pain while performing the exercise. If they do cause pain, then it is important to check with the PT that the technique and level of resistance is appropriate for your condition. Good luck!

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      anonymous 4 years ago

      @anonymous: Dude, I just did nearly the exact same thing. 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 don't want to experience what you've gone through, but I'm currently deployed and am not getting treated.

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      anonymous 4 years ago

      Tim W.

      I am really hoping to find some outside advice. My story is a little lengthy, but I am desperate to find some insight for anyone that could help.

      I served in the Navy for many years, and in April of 2010 I had a little mishap. 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 all of a sudden lost all my strength in my right arm and dropped the box. 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. One of the most painful experiences ever. My arm was nearly frozen for a period of about 10 minutes, but I slowly started regaining some ROM. 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. A few hours after the incident, I was able to seek some medical attention from our on board medic, who believed I had dislocated my shoulder, but was not overly concerned with my condition. I was instructed to ice pack my shoulder and take it easy. 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. I had periodic pain and tingling running all the way down my forearm. I decided to go to the local army medical hospital. 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. I did this as instructed, but, to little improvement.

      Time progressed, pain continued and my ROM slowly worsened. Come September of 2010 I chose not to re-enlist and returned home. I checked into my local VA hospital and initiated my disability claim. I explained of my ongoing problems since the incident, and once the claim was processed I was sent through a variety of medical departments for a full diagnostic. It was sometime in the early months of 2011 that I was sent off to have an MRI done. The results showed a "partial tear of the supraspinatus tendon, with large swelling and irritation". After an initial diagnosis from an Orthopedic specialist, the initial course of action was a steroid injection treatment into the "affected area" and a course of physical therapy. I received my first steroid injection treatment during the summer of 2011 and went through a lengthy 6 moth physical therapy treatment. I was very optimistic about the P.T. but unfortunately, the results were extremely minor. my ROM did increase a very small amount, but my pain and discomfort never went away. I was released from the P.T. program with a small packet of exercise instructions and told to continue them and to come back in a few months for an updated physical examination. Time passed. Pain continued and got worse. ROM decreased. Sleeping on my right side became impossible. Had periods of pain go from the back of my shoulder down my arm like before. Not all the time, but it was intermittent. I tried to figure out what the onset was, but could never figure it out, it just seemed completely random. In the beginning of 2012, I returned to the Orthopedic specialist at the VA, and the medical staff seemed very surprised that my god awful pain and discomfort was still going on. They decided to do a re examination of my MRI to see if there was something they were missing. Some days later, I was called back to the VA so they could tell me what they found. 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 told that they were now wanting to do surgery to actually go in and see what they might be able to do to repair some of the damage they thought they saw. In the mean time, I received another steroid injection treatment. A few months passed, and I was called into the orthopedic surgen, who was a shoulder specialist, for a "pre surgery consultation". 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. Needless to say, I started to feel like I was getting jerked around and not getting any realistic attention. That was July of 2011. I have not returned back. Since then, my pain has gotten to the point where its starting to take effect of my day to day life. I am in aching pain consistently. I wear an arm sling a lot to relieve weight from my shoulder, which helps to some degree. I have lost about 45+% of my ROM in my right arm. My arm is very weak. I am unable to carry any significant weight. To be as specific as I can, It feels like someone shoved a knife right into the top of my shoulder blade and right down inside my shoulder. I still have periodic pain that will radiate from the back of my shoulder, down my tricep, and over my bicep.

      I'm just about at the point of desperation here. I don't know what exactly to do, or what my REALISTIC problem could be.

      Anyone want to shed a little light for a vet?

      Sorry this is long.

      Thanks....

      Tim W,

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      anonymous 4 years ago

      Dr. Mike great info here thanks. I just had an MRI I have a tiny, focal intratendon tear of the supraspinatus fibers at the humeral insertion measuring 2mm with minor impingement changes are noted in the greater tuberosity of the humerus.

      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.

      bested on all of the above. is PT a good options. ROM hurts so I'm not sure.

      Thanks for the great info.

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      DrMikeM 4 years ago

      @flinnie lm: Hi Flinnie,

      Thanks for stopping by and leaving a comment!

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      Gloria Freeman 4 years ago from Alabama USA

      Hi lot of good info and tips here. Thanks for sharing.

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      DrMikeM 4 years ago

      @anonymous: Hi LB, Sorry for the delay, I have been away for visiting family for a week or so. I am sorry I can't give you specific advice but here is some general information that may be useful to you. I agree that shoulder pain for years, that has not resolved is definitely a good indicator that seeing a doctor is a good idea! If it hasn't resolved with time, then some kind of intervention (whether physical therapy, surgery etc.) is likely to be required if you want less shoulder pain. It is also worth noting that some conditions, particularly when joints are unstable or there is ongoing aggrevation, have better outcomes by being seen and receiving intervention sooner rather than later. You mention your shoulder makes a popping noise, generally speaking the sound a joint makes is not a good indicator of anything (particularly if the popping noise itself is not accompanied by pain). Popping noises can occur for a variety of reasons, the most common of which are completely normal. If the ball is popping out of the joint (dislocating), then that is a major concern (but this usually doesn't occur without trauma)! The popping may or may not be related to your shoulder pain (difficult for me to say without an examination etc.) 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). 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). What I think is more common, is two doctors not taking the time to explain something in normal everyday language and ensuring their patients have understood whatever it is they are trying to say (so lots of people feel like they are being told different things)! You mentioned rotator cuff and tendonosis like they were different things. It may be helpful to think of the rotator cuff as a group of muscles and each muscle is connected to the bone via a tendon. Tendonosis literally means chronic pathology without inflammation (i.e. damage to the tendon without swelling). This is possibly caused by microdamage to the tendon that is painful and can weaken it over time. The tendon that seems to be most commonly affected is the supraspinatus, although it could also easily be either infraspinatus, long head of biceps, subscapularis or teres minor tendons. So in other words, tendinosis is the condition and one of the rotator cuff tendons is probably the structure that was affected.

      Family is important, and I would not encourage people to discard their advice or offend their family and friends, but definitely weigh up advice on its merit. If a medical doctor (assuming they have nothing to personally gain by referring you to another health professional) suggests something may work based on their years of training, in depth understanding of anatomy, physiology, common pathology, research evidence and clinical experience with many patients, it is usually worth considering what a family or friend (albeit that they are usually well meaning) is basing their opinion on. 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. From my perspective, I have seen many patients with supraspinatus tendinosis who have benefited a great deal from physical therapy (but nothing is certain, and some patients may not receive great benefit and require a different intervention).

      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. A good doc should be able to assess your shoulder and give you some specific advice regarding the best next plan of attack. If it has been a while since the MRI, this may involve getting another one (as tendinosis can weaken the tendon, which may in turn lead to larger tears or even a complete rupture), it may also involve a trial of PT or a referral directly to an orthopedic surgeon. 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. Good luck with it and I hope you are feeling pain free sooner rather than later.

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      anonymous 4 years ago

      I have had shoulder pain for years and years. Visited many doctors and was always told it was nothing, the pain got unbearable and I saw yet another dr who was completely caught off guard my the loud pop my shoulder makes. She said she had never heard anything like that before and it was not my rotater cuff like everyone else believed. She did an MRI and said it was tendonosis, and suggested PT. working a full time job nd being a mother of three I could never fit it in my schedule but was also told by a family member that PT would not help. I have not lost any ROM I just have severe pain in my right shoulder. It gets weak and tired pretty quickly, I can't sleep on my side and it aches all the time. 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?

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      DrMikeM 4 years ago

      @anonymous: Hi Hans, Thanks for stopping by and sharing your story. 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. In terms of some general information that may be of interest to you, there are a couple of things I can share from my perspective. 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). I'm unable to say whether this has occurred in your case, however, the reason why this springs to mind is that I cannot recall ever seeing a true case of adhesive capsulitis (sometimes called frozen shoulder) that resolved in 6 weeks? Adhesive capsulitis will usually last at least 5 or 6 months (often considerably longer). 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? 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. Although very uncommon, it is possible that the report did contain an error. 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).

      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.

      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.

      It seems as though you have now had two MRI reports. If they were consistent with each other it would seem remarkably unlikely that both reports were wrong. Although the presence of a small tear visible on an MRI does not always mean that is the problem causing your shoulder pain. That is one of the reasons why surgeons will take a detailed history and conduct a physical examination to gather clinically relevant information.

      Good luck with it either way. If you get a chance please let us know how you go. I guarantee you will not be the last person to read this page wondering about a difference in doctor opinion or trying to figure out whether they have a supraspinatus tendon tear or adhesive capsulitis (or surgery versus no surgery). All the best.

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      anonymous 4 years ago

      dr mike,a i got an mri shoulder pain, the surgen said it was adhesive capsulitis and with about 6 weeks of pt it would be fine, but the mri report also said there was a tear, the doctor said the report was wrong, needless to say i got a second opinion, the next doctor ordered a new mri and he suggest surgery , i am at a loss, should i get a 3rd opinion just to be sure?

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      DrMikeM 4 years ago

      @anonymous: Hi Craig,

      Thanks for stopping by and leaving a comment. I'm sorry I can't give you specific advice on your case over the internet. In general terms of the types of MRI findings you have described, a combination of these types of pathology could require surgery; particularly if symptoms persisted after trying non-surgical interventions. 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. 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). I mention this, as this will often influence treatment decisions. When you speak to your doctor and discuss your plan for treatment, make sure you discuss any relevant work / sport related activities so you both know what to expect. Good luck!

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      anonymous 4 years ago

      Just got my MRI report back on right shoulder and wanted to know if you could shed some light on it. A-C joint is moderately to severely degenerative. Osteophytes and inferior capsular swelling indents the superior margin of the mytendinous junction of supraspinatus.

      There is a moderate amount of fluid distending the subdeltoid bursa maximal over the anterior aspect of supraspinatus and the rotator interval.

      Mild surface irregularity of the supraspinatus in keeping with scuffing-mild partial thickness bursal surface tearing. There is a small band of hyperintensity on the footprint attachment of the anterior aspect of supraspintus in keeping with tendinopathy -small unretracted intra-substance tear. It is possible this tear may communicate with the bursal surface anteriorly. Infraspinatus tendon is somewhat hetrogeneous in its deep attachment with what appears to be intra-substance tears down to enthesopathic change at footprint.

      Could this require surgery. Any advice would be appreciated thanks.

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      DrMikeM 4 years ago

      @anonymous: Hi Donna, I am sorry to hear about this trouble you are having with your shoulder. It sounds as though you know a little bit about your shoulder situation already, so I won't re-state details about the anatomy that is affected. I also can't give you specific advice about your situation over the internet etc. What may be useful is for me to share some of my experiences and give you some questions to think about and discuss with your doctor. 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. MRI). I have often seen these cases improve substantially after further surgery to repair these rotator cuff tears + post surgery rehabilitation therapies. It sounds like you may have already discussed the likelihood of success with your surgeon, if not, this would be a very wise thing to do. Equally as important is a discussion about the likelihood of certain outcomes without further surgery. This will help you figure out what you are deciding between. Sometimes the success rate of a second surgery is not as high as the success rate of the first surgery... but still much higher than any other alternative. 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. 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. 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. Good luck!

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      anonymous 4 years ago

      I had rotator cuff surgery in May for a Small(2mm) tear In the supraspinatus tendon. After 4 months of therapy and 3 injections I am unable to lift my right arm

      Above my shoulder or behind my back without pain. I had an arthogram-MRI which showed a 4 mm near full thickness u-shaped tear involving the supraspinatus tendon anteriorly near but not actually at the numeral attachment. This tear leaves only a very thin layer of intact cuff at the site, no impingement, labrum is intact. There is longitudinal split in the subscapularis tendon which extends from the humeral attachment to the musculotendinous junction. My doctor has told me I need to have arthroscopic revision rotator cuff repair. I am 55 yrs. old I was in good physical shape as a letter carrier(28 yrs) but have been mostly sedentary recovering from the first surgery. I am really concerned about success rates for revision surgery. I am worried I will not improve my ROM this time. Especially since my injury has gotten worse instead of better. I am close to retirement and I am afraid I will not be able to do the things I once enjoyed, outdoor activities. Any advice would be greatly appreciated.

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      DrMikeM 4 years ago

      @anonymous: Oh Tonia, I feel for you. This sounds like a difficult situation. 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. It is good that you have discussed the recovery with your surgeon already. From time to time tendons do rupture from a variety of causes, in your case it sounds like the surgeons description of rope fraying is a good one. 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). 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. That being said, contemporary surgical repairs and surgical re-attachments have relatively high rates of success (albeit after a difficult post-surgical recovery period) when performed in a timely manner. However, I think the most important thing you mentioned was falling pregnant. I would make sure your surgeon knows you are planning on falling pregnant within the next 12 months. Having the surgery sooner rather than later may help you to recover as much as possible by the time you fall pregnant. If your tendon were to completely rupture while you were pregnant, this may be very problematic. Your surgeon (and the anesthetist) will not want to perform elective orthopedic surgery while you are pregnant to re-attach the tendon. Waiting until after the delivery of your baby to re-attach the tendon may increase the chance of a poorer outcome (not to mention the difficulty nursing a newborn with only one functional arm). Additionally, you do not want to be dependent on strong medications to reduce pain while you are pregnant. On the other hand, if your surgeon thought your tendon would be able to endure pregnancy and nursing your baby without the need for strong medications or the need for surgery, then this may influence your decision on timing for surgery etc. Children are such a blessing and that time nursing your newborn is such a special and important time. Having pain and sub-optimal shoulder functioning while you are nursing would not be ideal. However, worse yet would be delaying in such a way that you miss out on falling pregnant or delivering a healthy baby. So I think it would be wise to discuss the timing of surgery with your surgeon in the context of wanting to fall pregnant. Thanks for the update and let us know how you go. If you have any follow up questions just post them here and I'll get back to them as soon as I'm able. Good luck!

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      anonymous 4 years ago

      I wrote a previous comment...saw my orthopedic surgeon this week. He says that my tendon is failing. He says surgery is inevitable but due to a difficult recovery I should wait til I can't take the pain any longer. To recap I have had debridement and subacromial decompression, am 34 years old and now have arthritis, bursitis, tendinitis and impingement. He says the tendon is fraying like a rope...that he would need to reattach to the bone. He kind of scared me regarding the recovery for this. Also not sure how long I should wait. He prescribed Vicodin and arthrotec for pain...but I would like to get pregnant within a year but would like to be fixed first for obvious reasons. Any thoughts? What does he mean by my tendon is failing?

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      DrMikeM 4 years ago

      @anonymous: Hi Mario,

      It sounds like you are on the right track with your surgeon and physical therapist. I think these are promising approaches for the types of pathology you described. Your physical therapist should be able to help you improve the strength and functioning of your rotator cuff muscles. This may not give immediate relief, but hopefully will show some benefit within 6 weeks. If not then, your surgeon will be able to give the likely benefits, risks and recovery time following surgery. There are other things your physical therapist may be able to help you with to give you some relief in the short term. Recovery after surgery can be quite drawn out, often requiring 6 months or more before functioning becomes similar to before the injury. However, if no benefit has been observed after 6 weeks of PT, then discussion your options with your surgeon sounds like a good plan. Let us know how you go. Good luck!

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      DrMikeM 4 years ago

      @anonymous: Hi Kausik,

      There is certainly good clinical research evidence indicating that arthroscopic surgery can help the types of injuries you described. 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. The recovery time after surgery is substantial (and may vary depending on the surgeon, and specific structures repaired). However, some people will never experience the same level of recovery without the surgery. 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. Your surgeon will be able to explain the potential risks and benefits (as well as if he thinks any alternatives are likely to be helpful). Good luck!

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      anonymous 4 years ago

      @DrMikeM: Hi Dr. Mike... Here I am 5 days post op. This surgery is no joke!! For anyone contemplating surgery, buy a recliner to sleep in after surgery. It will be your Godsend. Don't even think you won't need help, because you'll need help with even the most basic daily tasks. The pain is manageable if you stay on top of it with pain medication. Cold therapy cold therapy cold therapy!! I have a feeling this is going to be a long recovery!

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      anonymous 4 years ago

      @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...

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      anonymous 4 years ago

      Due to a fall and resulting shoulder pain my doctor prescribed to have an MRI, the findings were; moderate tendinitis in the supraspinatus. There is a delaminating tear of the supraspinatus myotendinous junction, measuring a thickness of about 2mm. There also is mild tendinosis of the infraspinatus at the footprint. Moderate subacromial/sub deltoid bursitis. Small to moderate glenohumeral joint effusion.

      Have been directed to work with a physical therapist and so far have not seen mprovement after two weeks but staying hopefull. The incident happened on Sept 25 and it is now Nov 10. Any suggestions and generally how long is the recovery period? The orthopedic said that after 6 weeks of PT if there is pain then we looka possible surgery, is there something else that I should do or look at? Thank you.

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      DrMikeM 4 years ago

      @anonymous: Hi Kausik,

      I am sorry I can't offer you specific advice over the internet regarding surgery or specific exercises. What I can say is that for anyone looking to return to unrestricted badminton following a partial thickness supraspinatus tendon tear and shoulder labrum tear (particularly a SLAP lesion) will not be quick or easy. Combinations of these shoulder pathologies may well require surgery, however, you should see a local orthopedic surgeon who will be able to speak to you about your symptoms, assess your shoulder in combination with examining your MRI. Rotator cuff exercises will usually be important for anyone looking to return to a racket sport following a supraspinatus tendon tear or shoulder labrum tear (or even someone looking to prevent those injuries). The difficulty with overhead racket sports (like badminton, squash or tennis) is that high level functioning of the rotator cuff muscles are required to stabilise the shoulder joint in what is naturally unstable positions (overhead, and with high speed movement). 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. They will be able to help you return to sport. Good luck!

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      anonymous 4 years ago

      sir i am a shuttle badminton player.. i got injury on my shoulder .. doc told to tke MRI scan.. after taking MRI scan these are the final impressions..

      1.partial tear in the supraspinatus tendon at the level of insertion in the greater tubersity for a length of about 15mm with intact insertion

      2 partial tear in the anterior superior labrum

      3 minimal joint space fluid in the right sholder..

      sir wat should i do to recover my sholder to a normal position...

      is surgery needed or general exercise is enough ,if exercise needed means plz guide me the exercise doc..i want to play again...

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      DrMikeM 4 years ago

      @anonymous: Hi Tonya,

      Thanks for stopping by and sharing your interesting story. I'm sorry I can't provide you with specific advice, rather I only provide some general information. 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. There are also non-surgical treatment options that orthopedic surgeons may consider for degenerative acromioclavicular changes, supraspinatus tendinopathy and subacromial bursitis. Exercise is important for many reasons (not the least of which are physical and mental health benefits). So don't give up on your ambition to participate in exercise. It may take a while to overcome your shoulder pain, and you may even need to modify the types of activities you do, but working hard to be able to return to exercise is definitely a worthwhile goal. Good luck!

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      DrMikeM 4 years ago

      @anonymous: Thanks for sharing you story Marcia. 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. Some general information you may find useful is that generally not a lot of people seem to have a full recovery following a SLAP lesion without surgery. 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. On the other hand, there is nothing speedy about recovery after surgery... but at least there usually is recovery (albeit slow). This is just general information of course. There are many sub-types of SLAP tears and varying severity. Your shoulder specialist will be able to provide you with specific advice regarding your chance of recovery without surgery, as well as what to expect if you do decide to go down the surgery path. Good luck!

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      anonymous 4 years ago

      I had subacromial decompression February 2010 a year after a motor vehicle injury (I am currently a 34 year old female). 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. I returned to the orthopedic surgeon at which point he did an x-ray which looked good and sent for a mri Monday. Results are as follows...study demonstrates degenerative arthritis around the acromioclavicular joint. This has caused thickening and abnormal signal in the supraspinatus tendon consistent with tendinopathy and/or a partial tear. Small area of subacromial bursitis present.

      I left out a bunch of other things that are normal. Any thoughts on treatment for this considering previous surgery? Follow up not til next Wednesday. Pain is really consistent and moderate with moments of severe.

      Sorry this is so long!

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      anonymous 4 years ago

      MRI states high grade articular surface partial thickness tear of the posterior spinatus tendon without retraction or atrophy. SLAP type tear of the superior labrum. Moderately large joint effusion.

      Had mild discomfort in shoulder for a few weeks in August. Went down a water slide on a mat head first arms supporting my body. Severe pain after. 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. Sought 2 nd opinion 3weeks later due to the server pain. Couldn't even lay down. Did MRI of neck 1st which showed degenerative disc disease in c5-6 and c7-t1. Have had physical therapy for 3 weeks with pain becoming worse so physical therapist suggested to dr. MRI of shoulder. Now I have these results stated above. Have been taking 800 mg Motrin tid. Also now taking Tylenol 500 with5 hydrocodone. Being referrfed to a shoulder specialist Tuesday. Is surgery my only option?

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      DrMikeM 4 years ago

      @anonymous: Hi Pamela,

      Thanks for stopping by and sharing your story. It sounds like you have several concerning symptoms there. I am sorry I am unable to provide any specific advice over the internet without conducting a physical examination etc. However, it sounds as though you must be under the care of a medical team in order to have received MRI results, which is a good thing. In terms of general information that may be useful to you, I am not sure I have seen any sound clinical research evidence indicating that prolotherapy is likely to provide long lasting benefits for people with MRI diagnosed supraspinatus tendon tears. I am aware than many clinicians who administer prolotherapy advocate for its benefits though. When supraspinatus tendon tear symptoms are chronic and severe, an orthopedic specialist will be able to provide good advice on likely recovery and treatment options, including the likelihood of successful recovery with or without surgery.

      Good luck!

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      anonymous 4 years ago

      Thanks to my hubby for finding this site. 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. It's a supraspinatus tendon tear with 50% thickness and no labral tear. 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. It's been very frustrating dealing with the chronic pain and reduction of normal activities in an attempt to adapt to my "new normal". 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. In the interim, physio, chiro, massage, taping were part of my pain management and ROM for all pain sites relating to MVA. I completed 6 treatments of prolotherapy approximately 9 months ago prior to this latest diagnosis. It did manage to decrease my overall pain but I still feel like I'm suffering unnecessarily. Am I destined for surgery in order to regain even 50% of what I've loss or should I try another round of prolotherapy?

      I was an elite athlete most of my life and have accepted that I will no longer be able to return to my sport 100%. 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.

      Thank you for the info posted on this page. It has been helpful.

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      DrMikeM 4 years ago

      @anonymous: Thanks for keeping us up to date. Yes, the surgery will be over very quickly, but it is the rest of the recovery that takes time and effort (and a fair bit of frustration being careful to keep within the movement restrictions).

      Good luck with the surgery Wendy!!!

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      anonymous 4 years ago

      @DrMikeM: Well, I'm 3 months post injury and still in a tremendous amount of discomfort and pain. I've met with 2 orthopedic surgeons and both have indicated surgery is my best option for recovery. That being said, I am scheduled for surgery on 6 Nov. I'm quite apprehensive and nervous about the surgery but more so about the recovery. It seems to be a long recovery period with a great deal of physical therapy following. I do so appreciate the advice and direction you have given to myself and others through this posting. Wish me luck!!! Thanks again Dr. Mike!!

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      DrMikeM 4 years ago

      @anonymous: Hi Ken,

      Thanks for stopping by and leaving a comment. Without seeing the scan or conducting a physical examination, I can only offer some general comments in response. There are a few interesting things worth noting here. The words 'very large, nearly complete... with 1cm retraction of tendon fibres' are a bit concerning. As a general principle, when soft tissues like tendons or ligaments are damaged (think sprain or strain), but are in very close proximity to one another (I don't consider 1cm retracted to be very close in this context), the structures can often heal and become as strong (or perhaps stronger) than they were before. Unfortunately, I think 1cm retractions of torn tendon fibres do not favor natural healing of those portions of the tendon (without surgery). 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. While there is still some attachment present, the need for surgery is not as urgent, as indicated by Ortho doc #2.

      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. This is a good example of why MRI's can be very valuable in cases like this. If in doubt, don't be afraid to ask Ortho doc #2 about any questions or concerns you might have. The rehabilitation after surgery is likely to take time.

      Let is know how it works out.

      Good luck!

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      anonymous 4 years ago

      i was recently diagnosed via MRI that i have a supraspinatus tendon tear. The MRI report says:

      1. very large, nearly complete tear of the supraspinatus tendon from the tendon insertion with 1cm retraction of tendon fibers

      2. mild labral degeneration. No visible labral tear.

      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 that helped in the short term and improved my left arm motion range, after i stopped the therapy the pain came back and reduced the range.

      Now, my Ortho doc #2 who recommended i do the MRI also reccomends a surgery to fix the tear. He did say that it can be done in the next few months and no urgent intervention required.

      i'm a long distance runner and in good fitness and the shoulder problem does not bother me during running. However it does bother me when i open the car door and my current range of left arm is restricted when i left up straight.

      I am wondering if I can recover without a surgery option.

      thank you for any advise

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      DrMikeM 4 years ago

      @anonymous: Hi Shirshendu,

      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.

      Some people will recover quickly without any treatment, other people will recover after commencing non-surgical interventions (such as physical therapy and rotator cuff exercises and / or receiving a steroid injection), while others will still have pain after many months and may require surgery.

      Most people with ongoing pain will usually try the conservative interventions before considering surgery. However, in some cases it is clear that surgery is likely to be the best option.

      Good luck with your recovery!

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      anonymous 4 years ago

      left supraspinatus tendon tear,so what the process of curing? feeling pain in hand,,,,

      S.kundu

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      DrMikeM 4 years ago

      @anonymous: Hi K9,

      That is some interesting advice you have received. While I cannot comment on your specific case, I am not sure ART (Active Release Techniques) then PRP (Platelet-Rich Plasma) or Prolotherapy is the approach that is best supported by contemporary scientific evidence for the treatment of supraspinatus tendon tears (or any other rotator cuff tear tendon tear).

      As I think you already suspect, an MRI is likely to have greater diagnostic accuracy for ruling out (or in) the involvement of other structures in your shoulder, such as the long head of Biceps Brachi. Your physician or orthopedic specialist should be able to give you specific advice about whether it is worth having an MRI in your specific case.

      If you are in doubt, don't be afraid to get a second opinion. Good luck!

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      anonymous 4 years ago

      I have been diagnosed with a tear of the supraspinatus tendon by exam and u/s. My pain is mostly in the bicep area and I do not have trouble lifting the arm but bringing it back down and also bringing the lower arm down when the upper arm is at 90 degrees. Must also have to bring the arm back with my other arm if I am lying and have the arm overhead...which now longer will lie flat on the floor if it is overhead.It has been recommende to do ART then PRP and possibly prolotherapy. Should this shoulder have an MRI? What do you think of the other therapies?

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      DrMikeM 4 years ago

      @anonymous: Hi Wendy,

      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. 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. Make sure you ask the orthopedic surgeon about what to expect after the surgery and the likely recovery time. That way you can make an informed decision in consultation with advice from your doctor. Good luck!

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      anonymous 4 years ago

      @DrMikeM: Thank you Dr. Mike for answering my question. It sounds like the damage is fairly minor in my shoulder yet I have a great deal of discomfort and limited ROM 2 1/2 months after my fall. I went to one orthopedic doctor and he immediately said surgery is my only option. I have a second opinion on Monday. Generally speaking, do small tears need surgical repair?

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      DrMikeM 4 years ago

      @anonymous: Hi Shelley,

      I am sorry I can't give you any specific advice over the internet, but here are some thoughts that may be useful to you. People who have partial thickness supraspinatus tendon tears following a fall or mechanical trauma often report similar symptoms to people with whiplash associated disorders (aka whiplash). It is plausible to sustain one or the other (or both) from a fall.

      Whiplash is more difficult to detect with common imaging approaches, like an MRI, than supraspinatus tendon tears. Hopefully your orthopedic surgeon conducted a physical examination to help determine the relative contribution of the partial thickness supraspinatus tendon tear versus whiplash. Some simple tests during a physical examination should enable your doctor to determine whether your symptoms are likely to improved with a surgical repair of the tendon.

      It is also worth noting that whiplash associated disorders are complex. Most people who I have seen with whiplash (albeit usually from motor vehicle accidents more than falls) tend to notice a great deal of improvement over the first few weeks, but some have symptoms that persist. 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).

      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. 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. This can be one of the most frustrating things for people who have whiplash associated disorders. The soft tissues in their neck that were affected by the initial trauma may actually have healed, but they may still be feeling discomfort. 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).

      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. Just be aware that even in the best cases, the recovery time following surgery requires months (not weeks) so if you go ahead with the surgery don't be discouraged if you still have some pain in the first weeks after the surgery.

      If you have concerns, you could ask the surgeon when you next see him whether he thinks your symptoms are from the tendon tear and rotator cuff dysfunction or whiplash? Then follow up by asking him about any risks associated with the surgery in your particular case (your surgeon should know your particular circumstances in detail and be able to provide you with specific advice about options available to you).

      Good luck! If you get a chance drop by again and let us know how you went.

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      anonymous 5 years ago

      Hi there. I had a fall at my workplace and was suffering neck and shoulder pain. I saw doctor initially who said physiotherapy will help it. I worked closely with a physiotherapist for a good four months and pain got worse. 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. I then went to see another orthopaedic surgeon who said I have whiplash. I now am having surgery but is it safe to have with whiplash symptoms. The pain is mostly in neck and shoulder blade and collar. I am angry, confused and cannot get any pain relief. Advice welcomed.

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      DrMikeM 5 years ago

      @anonymous: Hi Shannon,

      Thanks for stopping by and sharing your story with everyone! I can't comment on the nature of care you have received, but I can say that you are not alone in this type of experience!

      There is some really good information in what you have said. Particularly about what many people are likely to experience during the often long road to recovery. Lots of people express feeling useless, frustrated, and angry at times. You are also right that many people often don't understand that you are not 'putting on an act'. People tend to expect recovery after surgery will take a few weeks. Surgery to repair tendons generally involves a long recovery period. It is important the the surgical repair of the tendon is protected initially to ensure that a re-injury does not occur. The recovery after surgical tendon repairs often takes longer than recovering from broken bones. It is also worth noting that sometimes you can do everything right (good surgery, follow instructions etc.) and still end up with an unexpected problem.

      Getting a second opinion when you are not sure about your first is also often a good idea.

      Good luck with your next round of surgery or therapies! Let us know how you go!

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      DrMikeM 5 years ago

      @anonymous: Hi Luis,

      Thanks for stopping by, you have raised some very good questions. Here is some general information which I hope is useful for you:

      1. I'm not sure whether the doctor you mentioned is a family physician / general practitioner or an orthopedic consultant / surgeon. If you have only seen your family physician or general practitioner so far it would be a good idea to ask them about a referral to an orthopedic specialist who primarily treats patients with shoulder conditions. 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. Make sure you understand their explanation of what problems are occurring around you shoulder and what treatment options are available to you. 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).

      2. I am sorry, I can't give you specific advice over the internet about whether you will need surgery or not. 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.

      3. It can be difficult to find good information on the web for specific rehabilitation following surgery. This is partly because rehabilitation following surgery will depend on the surgical technique used. I get asked about this a lot, perhaps I should write a page on rehabilitation following surgical repair of supraspinatus tendon tears! Here is a link to a recent academic journal article on the topic that should be free to access. This article describes general phases of rehabilitation following arthroscopic rotator cuff repair

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC332563...

      Good luck!

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      anonymous 5 years ago

      I had surgery in Mar 2012 for decompression,near full thickness bursa tear and a near full thickness supraspinatus tear with degeneration and general multi-directional laxity of the shoulder capsule.I know the work I have preformed and physical activities over the past 20yrs haven't helped but it was an acute injury that ended it.Since surgery I have been to a physiotherapist but after a few sessions I was experiencing a spot of pain (hot spot) which the physio dismissed as surgery related pain.To make a long story short, gym didn't go well to which I was told by my physio that I was overdoing it (I followed the program to the letter) anyway a second opinion found I have got a high grade partial tear and possible partial full thickness tear and bursa thickening and bunching on adduction. 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! I'm only 38 and am not willing to give up everything I love doing and from what I read there are many more options available. 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! 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! 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! Wish me well for the next round surgery or not.... I will surf again!

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      anonymous 5 years ago

      I received today my results of a CT Scan from my right shoulder, which I had an accident like 5 months ago. I received several therapies, but still the pain ... The CT impression read like this:

      â¢High-grade partial tear of the supraspinatus tendon at its insertion (rim rent tear)

      â¢Degeneration of the infraspinatus tendon with bursa side fraying.

      â¢Tendinosis of the spraspinatus tendon.

      Questions: 1. When I visit my DR. what are the thing I need to be aware for the diagnostic?; 2. Do I will need surgery?; 3; Where can I found documentation in the web for the rehabilitation?

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      DrMikeM 5 years ago

      @anonymous: Hi Kimee,

      I am sorry I can't offer you specific advice over the internet about whether you should or should not have surgery. However, given that you already have an MRI it sounds like you are already under the care of your doctor, which is great. Your doctor should be able to explain your options and potential expected outcomes. Don't be afraid to ask lots of questions about what is likely to happen if you do or don't have surgery. Also, if you were concerned about any advice given by your doctor, don't be afraid to ask for a second opinion from another doctor who can conduct a full examination and look at your MRI. 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)! It must have been quite a knock, there is some quite serious damage there. I think it would be wise to listed to the advice from your doctor on this one! Good luck with it. I wish you a speedy and full recovery. I suspect you have a bit of work to do over the next 6 months or so to help your shoulder recover. 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. If you get a chance, drop by and let us know how you go with your recovery!

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      anonymous 5 years ago

      DrMikeM

      I experienced a fall on August 31, 2012. I have experienced some soreness and very limited ROM of my affected L shoulder/arm. My MRI impression reads: suggestive of a full thickness, obliquely oriented tear through the supraspinatus insertion. Glenohumeral joint effusion and finding may signify capsulosynovitis or perhaps capsular strain. Fluid signal anterior to the proximal humerus as well as within the sucoracoid bursa. Mild AC arthropathy. In your opinion, do I have any other option other than surgery?

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      DrMikeM 5 years ago

      @anonymous: Hi Dick,

      Thanks for stopping by. From the information you have provided it is difficult to say whether surgery will be needed. Starting with Physio treatment is a good idea. Many people will recover after receiving treatment from a physiotherapist (or physical therapist in USA). Hopefully your physio can set you up with an exercise program to strengthen your rotator cuff and improve the biomechanics at your shoulder joint. Massage may give you some short term relief, but I'm not sure massage on its own will have long term benefit that is additional to natural healing. However, improving rotator cuff functioning is usually a good idea and your physio should be able to assess your current situation and provide you with a suitable tailored program of exercises as they see fit.

      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. Overall, it will often take 6 months or more before the shoulder is completely back to normal.

      If you are seeing a physio for this condition, they should be able to provide you some good information about the post-surgery protocols that surgeons in your local area will be likely to prescribe.

      Good luck!

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      anonymous 5 years ago

      there is minimal AC arthrosis. there is a small full thickness insertional tear identified relating to the posterior supraspinatus. the defect measures approximately 1cm anterior to posterior and medial to lateral. there is no focal atrophy or fatty infiltration.that is my M.R. I. report .This happen 9 weeks ago , my shoulder is still sores I am going for phisio, messages and still no progess,does that mean I will need surgery,or will it heel by it self. If I need surgery,what is the recovry time..

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      DrMikeM 5 years ago

      @anonymous: Hi Kym,

      Thanks for stopping by and sharing your story. Sometimes in cases like this your surgeon may want to try an injection. These injections usually include an anti-inflammatory that can last for a couple months delivered directly to the problem area(s) and a local anesthetic that will work for the first few days until the anti-inflammatory starts to give relief. 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.

      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. Most people who do have surgery experience acute pain during the first few days (although the acute pain medications usually help with this). The speed of recovery after surgery will depend on the type of surgery and following the surgeon's recommended protocol. Following the post-surgery protocol will help minimize the chance of a poor outcome and further problems. If your doctor does end up recommending surgery, make sure you have a good chat about what to expect after the specific surgery they are planning. If they repair the tendon surgically, this will probably involve wearing a sling and not using that shoulder actively for at least 4-6 weeks and then quite slow gradual progression for the weeks / months after that. The specific post-surgery rehabilitation is often differs between surgeons in different regions (depending on the specific techniques they use). Good luck!

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      DrMikeM 5 years ago

      @anonymous: Hi Wendy,

      Thanks for posting your question. 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).

      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.

      Hope that helps. If you want any further clarification just post any follow up question. Good luck with it!

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      DrMikeM 5 years ago

      @anonymous: Hi Janice,

      No, it may not be too late to get relief. Best to have a chat with your doctor. 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. This may give you relief, even if you have been getting symptoms for a few years. Good luck!

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      anonymous 5 years ago

      I just found out this week that I have Bursitis, and a tear in my Supraspinatus. I have had this problem with my shoulder/arm for about 6 months maybe. I take anti-inflammatory meds for a long time for other problems, but it sure has not helped my arm. I hope I have not waited to long for having this checked, and the only option will be surgery. I have a referral to a specialist and hopefully I will have some answers soon. I have spoke with people that have had surgery on their shoulder and they say that is a very painful surgery, and they still have problems from time to time with their shoulder. I hope I will not follow suit!

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      anonymous 5 years ago

      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. Remaining tendons of the rotator cuff are normal in signal and morphology.

      Impression: moderate supraspinatus tendinosis with a small full thickness footplate tear.

      What does all that mean in simple layman terms?

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      anonymous 5 years ago

      Hi, I have had a partial supraspintus tear for 3 years now, and am wondering if it's too late to anything about it?

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      DrMikeM 5 years ago

      @anonymous: Hi Vicki, I'm glad the information was useful to you. It is difficult to know whether your husband will need surgery based on this information alone. Of course, I am sure his orthopedic surgeon will be able to give good advice in this regard (after a full clinical assessment etc.). However, it is worth noting a common misconception about full thickness tears. A full thickness tear is not usually a complete rupture. 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). A full rupture will require surgery (usually quite urgently). The tendon will usually retract if a full rupture has occurred. In the case of a non-retracted full thickness supraspinatus tear and acromioclavicular degeneration, surgery may well be the best option to maximize the long term outcome. However, there are a variety of factors that will need to be considered. Your doctor may also advise a trial of physical therapy to see if that can bring relief to his symptoms. Sorry we are unable to give specific advice over the internet, but I hope this general information is helpful!

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      anonymous 5 years ago

      I found the information good. My husband just had and MRI and it showed a Nonretracted small insertion full-thickness tear of the supraspinatus tendon. Acromioclavicular joint degenerative changes, which means nothing to me. I guess my question is does this always require surgery?

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      DrMikeM 5 years ago

      @brando87: Thanks brando87, that's what I aim for! I'll go check out some of your lenses now.

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      DrMikeM 5 years ago

      @pawpaw911: Hi Pawpaw911, thanks for dropping by. I have always found the anatomy of the shoulder to be very interesting. 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)! I'll go check out some of your Lenses.

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      DrMikeM 5 years ago

      @anonymous: Hi Les, I am glad you found this information helpful. I hope your shoulder has now recovered!

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      DrMikeM 5 years ago

      @anonymous: Hi Onder,

      Rotator cuff exercises are often prescribed for people with a partial tear of the supraspinatus tendon. I am not aware of any studies that have shown rotator cuff exercises impair healing in supraspinatus tendons that have a partial thickness tear. 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). I am sorry I can't offer specific advice without a proper assessment, but seeing an orthopedic specialist or physical therapist in your local area sounds like a good idea. All the best with it.

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      anonymous 5 years ago

      hi

      i d glad if ortopedist or physiotherapist reply ansver.

      my MRI result come out that supraspinant tendom has partial tear.

      so, my question is if i make physical strengt evercises to improve rotory cuff at this level-now,isn't it bad to heal the particular supraspinat muscle.

      thank you for your considiration and helle from Turkey:-)