Rotator cuff injury, disatisfied with Dr's reaction.

Posted , 3 users are following.

Hi. I'm in Canada and I'm 46 yrs old male. Roughly 15-17 years ago I injured my shoulder playing rugby (practice). In a walk-thru I was setting a maul and received the other player with my arms stretched out in front of me, jarring the right shoulder backwards. Since then I've had decreasing mobility and increased pain, especially with rotator cuff motions (throwing, reaching, sleeping on it).

My GP sent me for xray and ultrasound ahead of an orthopedic consult. The important points of the report are below:

Mild synovitis of the biceps tendon and sheath is seen.

A partial thickness tear is seen at the subscapularis tendon insertion measuring 4 x 7 x 13mm.

A partial thickness tear is seen at the insertion of the supraspinatus tendon measuring 0.4 x 1.1 x 1.1cm and there is 9mm calcification.

There is no impingment.

There is degeneration of the AC joint with extension of the joint capsule.

Now I'm no doctor but I see 1cm tears in 2 different tendons and think there's something fairly odd going on.

Today the orthopedic surgeon ran me through some basic mobility tests and said the report referred to some tendinitis, thinning of the muscles but no holes, nothing major. He didn't seem to think there was anything to worry about and agreed to MY suggestion that a cortisone injection might help. This was my best-case scenario, but I'm still dissatisfied with the consult.

So my question is: Am I overreacting to the report (1cm tears) or is the doctor's opinion on track with other ultrasound reports? I'm asking because the pain is frustrating and restricts my activities, and I'd like some opinions before I ask my GP for a second opinion. I don't want to anger Dr.s by asking for second opinions but this is a decade old and isn't getting any better.

Thanks for you time!

B.

 

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8 Replies

  • Posted

    Hi, I am in Canada too. I've read a lot over the last year due to my own three surgeries and complications, and I believe partial tears are usually treated conservatively first. Have you done 3 months of solid physio to build up the rotator cuff strength? I recommend getting a very good manual PT and go twice a week for three months. If you aren't happy after that take another step. Surgery is very debilitating... it is 16 solid weeks of pain and sleepless nights each time for me!

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  • Posted

    I think it would be worth getting a second opinion. If you have already endured a decade with this, it's not urgent. Don't know your age or occupation, but if you are going to have surgery you shoule be certain that is the right path. Although certainty  is hard to come by 100% under any circumstances. I had a cortisone injection 10 weeks after my injury and my range improved and pain decreased by there was still weakness and obvios muscle wasting. But some people get considerable improvement with the cortion and physical therapy. I would have loved to avoid surgery. It's not been a picnic and I still don't know the end result. Even with full thickness tear of 2 tendons over 3 cm and 3 cm retracted I still hesitated and dragged my feet. But the Dr was pretty clear that surgery was my best option and an "investment in my future." It's a very personal decision. Ask questions...try therapy...all the conservative measures available, get second opinion. Wish you the best.

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  • Posted

    I have had tears on both my shoulders, one was clearly diagnosed as needing surgery the other more conservative treatment, cortisone and physio. I was dubious to the effectiveness of this but given I was already recovering from one surgery agreed and committed to programme. I found there was little improvement early on but perservered with physio and I have seen steady improvement to the point where I feel more confident that I might avoid surgery.

    My physio told me that 80% of RC tears can be treated this way successfully, don't know how true this is but he is a good guy!

    I need to do excercise everyday to improve and maintain my arm but following the initial exstreme pain, I am now virtually pain free, unless I do something stupid. I am hoping for a good recovery.

    Hope this was helpful as it is simply my experience.

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  • Posted

    Thanks for the replies, very helpful. Hearing that surgery was the only option for larger tears (and full thickness) is reassuring. From what I can discern, subscap & supraspinatus are roughly 12mm thick, so I'm sitting at 1/3 thickness, approximately. It hurts like the dickens, but it looks like I'm half way gone (or half way good?), so perhaps I'll look more seriously at physio. I know surgery is rough, especially so in the shoulder (my ACL reconstruction was a dream compared to some of the stories I've read for shoulders), so I'd like to avoid it if possible, but sometimes, oh boy!

    LessrTuberosity, what do you consider "manual" PT? I did see a sports therapy guy for a bit, it seemed a lot like range of motion and some serious thumb-work on the scar tissue, usually for about 30-45 minutes per visit weekly. Once I felt better I stopped (of course). Is that the kind of PT you're talking about? I wasn't ever sent home with "homework" between visits (I was given "homework" during my ACL recovery).

    Thanks again for the responses!

    B.

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    • Posted

      Hi again

      I attended physio weekly initially to reinforce the exercise regime I do at home. My workout is done soley with elastic bands of varying strength. Advised that lower bands but more repetitions is for the best initially in that don't rush it, as small tendons anything more strenuous and you are using other groups of muscles ( not sure I have described that very well!). Following workout at physio I am shattered but no pain in arm! Feel it a bit the next day but it seems to be working. If you check online there is advice on these kinds of exercises. I now only attend monthly and that is to ensure I am doing the exercises correctly.

      As I said I was dubious as to the chances of avoiding another surgery but I am distinctly more positive.

      Good luck

      C

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  • Posted

    Just an FYI on "manual therapy" which can encompass many different techniques and styles. Generally, friction massage for 30-40 min over a scar sounds excessive. There is mobilization, which is usually gentle manual manipulation of the joing in order to lossen a tight joint capsule...which may be cause of pain and restricted range of motion. There is manual stretching (long, slow, static is best) of the tendons and muscles around the joint also to improve range and decrease pain. there is myofascial release (which is a type of manual therapy) good to release restrictions, including scar tissue and rebalance structure thus improving range and regaining strength...and there is good old fashion massage....which could be deep tissue or more superficial. strengthening should follow stretching and should begin light another poster pointed out you are working at strengthening muscles that are small initially and don't want to recruit the larger muscles that can substitute and takeover for the smaller rotation muscles. I hope you are able to avoid the surgery.

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  • Posted

    Sorry to read your story.  Frustrating for sure.  There is a lot of information on the internet.  One that I have found helpful is titled Arthroscopic Rotator Cuff Repair Frequently Asked Questions.  The article is current (2016) through Brigham and Womens' Hospital in Boston, Massachusetts.  The article is 34 pages in length.  User-friendly written, extremely informative with photographs.  I am in the ninth week out of my surgery and wish I had read the article three months ago.  I would have done a few things differently based on the information.  Good luck and keep us posted.    

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    • Posted

      One other thought is physical therapy or athletic trainer support.  In Canada do you need a doctor's referral to have an evaluation for PT or AT?  You may want to schedule an evaluation and go from there.  GOOD LUCK!

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