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Old 08-01-2009, 01:09 PM   #1
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Smile rotator cuff surgery necessary? please help

I'm a 65, fit, active woman. Last Jan. I felt shoulder pain, when working with personal trainer. Thought it was tendinitis, rested, iced, etc. for a month. Went to ortho, sent me to PT for 10 weeks, finally got an MRI that indicated a small tear. He said live with the discomfort, or get surgery, but wasn't specific about the MRI other than that. At first I had trouble putting 1/2 gallon of milk in frig with R arm, bowls on shelf, but that has improved. My shoulder does ache, can have sharp pain down right arm to elbow depending on what I'm doing. I have not done any heavy lifting, ie. putting bike or kayak on racks, moving furniture, etc. so my activities have been very compromised. It has improved after PT but there is general discomfort, and my activities have been low key, no furniture refinishing, painting of walls etc. I have a 2nd opinion the middle of Sept. with a top shoulder doctor. I'll be better informed as to what decision to make then hopefully. I've read many posts about how tough the rehab is. I want to stay active and continue doing things so wonder how my quality of life will be with/without the surgery as I age. I also live alone, have a dog, and am wondering if I can manage post surgery on my own re: passive exercises that can be done with another person or with the useful arm. I'm not concerned about the day to day things, as I have done a lot of caregiving, and know how to adapt, etc. but want to be sure I can handle the home PT on my own. Any experiences you can share would be wonderful, thanks so much! * email address removed by hb-mod, moderator *

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Old 08-02-2009, 05:57 AM   #2
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Re: rotator cuff surgery necessary? please help

were there any other significant findings that showed up in that MRI besides one small tear? was this in that very top tendon(supraspinatus)? thats just the most commonly torn one of all of them. this is what i did have a smaller tear in at one time but just did not know that for many years til it completely snapped on me. not every rotator surgery or the post op rehab is the same by any means. it all comes down to how bad the damage actually is and what needs to be fixed actually. the thing here is, once that tear occurs at all, if you stay as active as it sounds like you are, it WILL tear completely on you at some point along the way. it just progresses if it is not repaired when it is much smaller?

considering the fact that you are just very active and want to continue to be so? i would actually go get that tear fixed while it is still small and not wait til it completely snaps and the pain and loss of ROM are much more impactful. not to mention how simple it would be now vs later to just get it done. if i had had the MRI BEFORE that morning my supra snapped and actually saw what was going on, i would have gotten it sewen back up then. i had some pretty extensive damage in mine when i had my repairs done and the pain and rehab were much more painful and PT was also mandatory and lengthy. it would not be that way for what you only have going on right now.

at this point, if this is the only issue that needs to be fixed, it would be a pretty quick type of procedure that just involves more of an arthroscopic approach. if it completely tears on you at some point, trust me, it is much much more involved and painful at that point. this is of course my own opinion having gone thru more extensive repairs. but right now, its not too big of a deal, later, it would more than likely be. i would just get it done and over and get back to your life without the pain and losses you are feeling right now. simply catching a small tear now will keep it from progressing into the type of mess i had to deal with.

i wish you luck with this city. please keep me posted. FB
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Old 08-02-2009, 05:28 PM   #3
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Re: rotator cuff surgery necessary? please help

I've had both shoulders operated on although only had a rotator cuff repair along with it. Osteoarthritis can cause a lot of pain and difficulty with movement from OA in the acromioclavicular joint...the joint on top of the shoulder area where the collar bone and shoulder blade come together and often the pain comes from there, not the rotator cuff. the surgery to fix it is very simple in that they cut off about 1/2 inch of the end of the collar bone. this is done by scope. While in there, they can fix a torn rotator cuff. There are 4 tendons that make up the rotator cuff and as Marcia said, the most commonly torn is the supraspinatus. This can also be fixed through a scope so that all you end up with is 4-5 1/2 inch incisions. Day surgery. My surgeon does nothing but shoulders so it was fast and easy. He used both a nerve block and a light general and I needed no pain meds after surgery.

Rehab has changed drastically in the past few years and if your surgeon is up on the latest techniques, you'll know by his approach to rehab. They used to have you in PT the same week working the arm. No more. Now, it's rest the arm and let it heal for at least 3 months before even starting strengthening. You may have PT to keep the range of motion going so the exercises are all passive but no lifting or doing cords or anything else for 3 months to let the tendons heal. A rehab that begins too fast is the #1 cause of a re-tear. So let that guide you in choosing a doc.

I get a quarterly report from a major orthopedic hospital and their last issue just had all the new recommendations(no stress for 3 months) and why(healing) that I went through 5 years ago. And it went very well. Not much pain, and strength is better than before. And I had the AC joint excision along with it.

Any questions, please ask. I can't believe that people are still going through these huge open shoulder surgeries where a scope can do just about anything in the right hands. and then the people I saw in rehab pushing these newly attached tendons!!!! Met 1 guy who re-tore the same tendon 8 times and kept going back to the same doc who blamed the patient instead of his technique. Poor guy! Best to know in advance what is now the best procedure before you end up being butchered.

gentle hugs...............Jenny

 
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Old 08-04-2009, 04:35 AM   #4
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Re: rotator cuff surgery necessary? please help

Couldn't agree more about starting rehab too soon. I had arthroscopic rotator cuff surgery in March and started PT shortly thereafter. The PT guy kept subtly admonishing me for not pushing through the pain more. When my surgeon saw I was regressing rather than progressing he stopped all PT, which helped. But it is now 5 months post surgery and I still have a problem with that arm "catching" on certain movement. I recently tried light weights, which my surgeon suggested, but that only exacerbated the problem. The surgery was partially successful as I couldn't use that arm at all prior to it, but I do wonder if I'll ever move into fuller recovery.

Jen

 
Old 08-04-2009, 07:14 AM   #5
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Re: rotator cuff surgery necessary? please help

i would imagine considering that long of a wait before even starting hands on would create a much higher incidence of the basic frozen shoulder wouldn't it? i know with mine, i used that CPM machine which ONLY moves that joint without involving any of the tendons or muscle for about two and a half weeks? it was not til about a month post op that i went thru the standard hands on and that was very subtle at the beginning and just progressed upon MY timetable and not an actual set standard type of thing? that really is the key here, whatever you had done and YOUR actual healing course considered too. i had my myofascial therepist doing my rehab and he was also helping by slipping in my usual myo release therepy too,that helped tons with the muscle tendon tightening crap.everything went really smooth with my shoulder. i am back to full ROM on that side too now and have been for quite some time.

while i do agree there HAS to be that down time with the key excecises to keep that joint moving(the pendulum stuff?) i just cannot fathom why three full months would be considered just based upon how quickly that shoulder joint can freeze up without movement for that long. once that joint starts to encapsulate and build those nasty adhesions, well its a tough one to rehab from. what occurs within that joint jenny? thats just such a very long time with no movement ya know? it seems like that wait could actually 'create" more problems than it would solve, to me anyways. i just remember vividly when i had reached that degree mark my surgeon had set for me and that chair got picked up? after that, i really started to feel everything tighten back up(with more pain back again too) and some ROM i had gained i just could not 'do" anymore til i was in the hands on.

i do think the way my surgeon did my post op course really went rather well considering. i never went 'backwards" at all, only kept progressing. it really IS interesting how certain surgeons will do things. my ortho is one of the best here in MN. tho he did my two knee surgeries, his main specialty which i did not actually know til my rotator tore is shoulders. i am lucky to even have this particular ortho who actually understands RSD and chronic pain too. i AM blessed there just with that since most are unfortunetly for us, truely clueless on both things.

that three month thing tho, this is the first i have even heard about that long of a wait before even beginning to rehab that stuff. how much actual joint excercises does this reqire while that healing takes place? i would think that THAT part would have to be almost mandatory with that? interesting. FB
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3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
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Old 08-04-2009, 07:52 AM   #6
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Re: rotator cuff surgery necessary? please help

What my surgeon had me do was once he had done the first post-op check, I was to let my arm hang down with me bent over and I did small circles in both directions. I did that several times a day to keep the joint lose. Then at 6 weeks post-op I began PT with range of motion exercises that were totally passive. The therapist moved everything and I did nothing and we slowly built up to my doing range of motion by myself with no weight and some challenge exercises were he provided the resistance and I had to keep my arm straight. That was for 3-4 weeks. Then we took a short break to allow for healing and I re-started PT with strengthening exercises..weights, cords, you name it at 3 months post-op. So PT is begun at 3 weeks to keep from getting a frozen shoulder but no strengthening. Everything was aimed at keeping the range of motion good and slowly increased but no "pushing through the pain" to strengthen. That's what causes problems.

Tendons have a very poor blood supply and with post-op swelling, it's even worse. So you need to keep the joint lose but not stress the tendon at all until some healing has begun. Tendons can take up to a full year to heal just as muscles take up to 8 months. I get partial tendon tears in my hands all the time and it takes forever to heal. And I have a partial tear in the rotator cuff tendon in my left shoulder but will wait for it to tear completely before going through all of that again. It's not at all painful but it is time consuming.

If I gave the impression that no rehab is done, that is not what I meant to convey...just the weights and cords and strengthening stuff that is delayed for 3 months. Range of motion is still done from 3 weeks on and I think I actually began it a little before that as I was healing well.

But the old treatment was to start doing strengthening within a week after surgery. I saw guys there doing this with their stitches still in. The theory was that tendons would heal faster if worked. They used to think the same with muscles. Now, they wait a lot longer so you don't re-tear the muscles.

I remember the days when they operate on a shoulder and put you in a cast for 6-8 weeks then you'd come out with a frozen shoulder and they had to break up all the adhesions then work the tendon. So it swung the other way to work it as soon as possible to avoid frozen shoulder and what happened was the tendons re-ruptured. So now they have found a sensible medium. Do ROM exercise for the first 2-3 months and then start the strengthening. I was 3 months due to my older age. A younger male who works out regularly might start strengthening a little earlier but from what my doc told me..his philosophy is ...no! Let it heal.

Does this make more sense?

Jenny

 
Old 08-04-2009, 03:55 PM   #7
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Re: rotator cuff surgery necessary? please help

Thanks for the responses, I am just continuing the exercises I learned in PT, until I have my appt. in Sept. for 2nd opinion, and will make a decision about what to do then. Will let you know how things go.

 
Old 08-05-2009, 05:58 AM   #8
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Re: rotator cuff surgery necessary? please help

sounds like a good plan city,and DO let us know what the plan is. good luck.

jenny, you just described pretty much what my therepist did, but the strengthening did not start til after about six weeks and it was very slow,and at my comfort level too with no "pushing thru" crap. i do believe i did the pullys tho before anything else? the joint excercises are really really crucial. my only problem with this as having to use my knees/hips to just do the swinging stuff and even the little circles too? i have RSD in my right knee so this stuff just sent THAT over the top big time. so doing the shoulder swings sucked for me but i did do them only with my knee braced. that helped some. i do agree that not doing ANYTHING at all is what would be the biggest problem. they kind of did this with my sisters knee injury where they had her completely immobilized and using crutches for like ever and it really messed up her knee permanently. this was wayy back in the early 90s? its still screwed up today now. with my knee surgeries i was up on that thing the very next morning weight bearing and getting PT, subtle but doing it. that joint is much easier to rehab since it really only moves in one direction, up and down. things were VERY different with that shoulder tho. marcia
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3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 08-05-2009, 07:43 PM   #9
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Re: rotator cuff surgery necessary? please help

I had rotator cuff surgery a few years ago (age 40) and I'm extremely happy I did it. I didn't have a ton of pain prior to surgery, but the little things just kept adding up and annoying me, so I took the plunge. My only regret was waiting so long. I also had a tear in my labrum, so I'm sure that figured in my pain a bit.

I started therapy about a week after the surgery and followed their plan. I was fine with it. After two weeks I was doing just about everything, in fact it was hard for me not to push myself because it felt so good. Within three months I was back in the gym doing brazilian jiu jitsu.

For me, it was worth it. I tried the PT first, and had some shots, but they didn't give me anywhere near the relief the surgery did. Good luck

 
Old 08-07-2009, 10:55 AM   #10
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Re: rotator cuff surgery necessary? please help

My thanks to all of you. I got my tear on March 11, 09. Had a heck of a time with the area clinics where I live. Finally went to larger town to a Bone and Joint doctor. They took MRI, said it was big tear, and he wanted me to meet a surgeon. I said I needed time to think about it. I had read on the Mayo Clinic site that they do repair themselves...so then on May 18 I fell. Of course I fell into the front of my computer chair and hit the arm of the chair with my right shoulder....the bad one! I just sat there and cried. Was going to PT and had to go that afternoon. Could not finish PT. Went back to dr and met surgeon, very nice and am still on the thinking mode. Going to be 70 next month, have had open heart, herina, gall bladder, stint, etc. All in the past 4 years. Just do not want anymore! Truthfully the arm does seem to be getting better. I also live alone and have a small dog. Can't do everything I used to do, but slowly making it work.
Sandy

 
Old 08-08-2009, 07:13 AM   #11
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Re: rotator cuff surgery necessary? please help

wow now that sounds just insane to have all that occur. the one thing i wanted to mention to you? while certain problems can repair themselves unfortunetly there are many many more that simply will not/cannot without being reattached to each other so they just can even reattach at all? once you fully snap any tendon, since it is under strain and usually pulled on to begin with(just tension there actually) like with my complete tear, as soon as it snapped on me that morning, both ends pulled back and retracted? on one end, it actually retracted a full 11 mms. in cases like that, there will not be any recovering/repair going on til those ends are simply sewen back together. alot of what can occur with or without surgical intervention depends pretty much on just what is actually damaged in that rotator cuff itself. as long as your pain and overall functions are not being severely impacted yet, at your age, for alot of reasons ,it may just be best to leave it all alone, ya know what i mean? it all comes down pretty much to YOUR overall quality of life and if the pain is managable or too much to handle anymore. if the pain starts to get too bad for you, seeking out a good pain managemnt clinic may help alot with that. they can simply offer you many different ways to even try and manage even the worst of the worst types of pain. certain types of blocks and other injections like steriods can also really help with that type of injury too. just a thought for you if you should decide to forgo any surgery. hope all stays stable for you. FB
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9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 08-29-2009, 08:37 PM   #12
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Re: rotator cuff surgery necessary? please help

need to ask a very important question. I fell a couple months ago. Contrary to most beliefs I did not suffer much damage until a couple weeks later. I was up on a desk top dusting, fell about 5 ft., did a summer-sault and landed on the floor with my head on a stack of pictures and frames i had removed for dusting the shelf. I had a knot on my head and a large bruise on my shoulder. I am a nurse so feeling like I knew how to watch for signs of a concussion I let me neighbor know but I stayed at home. No problem for exacthly three weeks. On the third week on our way to the lake I suddendly became nauseated, started having a seizure, and threw up everywhere. Never had I felt this way before. I was trembling and felt like I was not even sure where I was. Went to doctor and to make a long story short was admitted. I had aspiration pneumonia in both lobes from aspirating the vomitus, a slow brain bleed, and a concussion in the lower occipital part of the brain. My shoulder was giving me tremendous pain but that was put on the back burner to take care of all of this. massive dosages of antibiotics were given to nip the pneumonia and that caused pseudo-colitis. I had blood in my stools....conoloscopy was normal. Upper endoscopy was normal. Cat scan showed slow brain bleed and concussion. Never in my nursing career had I heard of something happening like this three weeks after a fall. Now, I am doing well from all the other and my question is? I am supposed to have a rotator cuff surgery which tore when I fell on t he shoulder. I understand the recovery is not that short. Yet I have a small 8 mo. old. I have been picking him up and down and downing what I need by holding my right arm flush with my side. Will I still be able to handle him after the surgery or will maybe just 2 weeks or help be what I need. I desperately need to know this question. Thanks.

Last edited by badfeet51; 08-29-2009 at 08:47 PM. Reason: moved to another board

 
Old 09-01-2009, 02:53 AM   #13
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Re: rotator cuff surgery necessary? please help

I know not all people respond to surgery/recovery the same, but for me I have had 3 surgeries on my left shoulder and the last one has been since Feb. and I am still have problems. I was told that I waited too long and the first doctor did damage it by scraping the bone too much. I wish you the best of luck and I will say some prayers for you.

 
Old 09-01-2009, 06:29 AM   #14
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Re: rotator cuff surgery necessary? please help

(ART) Active Release Technique I have used it for my neck/shoulders: disc bulges at c3-4 and c6-7, central spinal stenosis at c6-7 level and some end plate spurring. Along with stretches and exercise.
Interesting info:

Quote:
Rotator cuff tears or strains are very common in powerlifters, especially those who specialize in the bench press. It has been my experience that heavy bench pressing does lead to premature degenerative changes in most shoulders, and this is a perfect example of that category. Conservative care can be used to manage these types of injuries if one can coordinate with a qualified practitioner.

Active release technique (ART) is a patented, state-of-the-art soft tissue system/movement based on a massage technique that treats problems with muscles, tendons, ligaments, fascia, and nerves. These conditions all have one important thing in common—they are a result of overused muscles. This can lead to acute conditions such as a supraspinatus strain or the accumulation of small tears due to repetitive microtrauma. This in turn will cause the tissue to undergo hypoxia, which means that the tissue is not getting enough oxygen. These factors can cause the body to produce tough, dense, scar tissue in the effected area. This is very common in weight lifters. This scar tissue binds up and ties down tissues that need to move freely. As this scar tissue builds up, muscles become shorter and weaker, tension on tendons can cause tendonitis, and nerves can become trapped. This can cause reduced ROM, loss of strength, and pain. If a nerve is trapped, the patient may also feel tingling, numbness, and weakness.
Good luck and good health.

 
Old 09-10-2009, 04:52 PM   #15
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Re: rotator cuff surgery necessary? please help

i had 3 on my left shoulder 4 years ago and i am doing fine alot has to do with the doctor you use the frist doc did it twice did not fix it the last one fixed it

 
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