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Old 09-08-2013, 09:55 PM   #1
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massive tear, retracted muscle, no surgery?

So, I have been diagnosed via MRI with a massive cuff tear of the supraspinatus. The Dr. says the muscle has retracted back so far that surgery is not an option. He said it had been torn for years, even though the pain only started after some certain movements I was doing. He has me doing PT (not helping) and wants me to wait "as long as I can" then have shoulder replacement. Is he a quack or is it really that bad? I have asked my workers comp rep to send me to the Andrews Clinic in Birmingham, AL for 2nd opinion. Waiting for an answer.

edit, I have a bone spur too, he said a pretty big one. I have a cd of the MRI but dont know how to get the images off it to show anyone

Last edited by sginn; 09-08-2013 at 09:59 PM.

 
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Old 09-09-2013, 01:09 AM   #2
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Re: massive tear, retracted muscle, no surgery?

Do you have pain now? All the time? Can you sleep? How is your range of motion?
If you have a massive tear, the only replacement you can get is a reverse. Believe me, you do not want that.

 
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Old 09-09-2013, 05:15 PM   #3
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Re: massive tear, retracted muscle, no surgery?

Hey, thanks for your reply. I see by reading some threads you have really been through alot. Thanks for any feedback you can give.

I have an impingement too which really sets me off right at the 90 degree mark. Had that happen today doing exercise at PT. Hurts so bad I get nauseated. I don't sleep well because I roll over on my shoulder. It goes numb too and I have to take my other arm to pull my bad arm out from under me.This is my dominant shoulder too.

Pain is always present but worse at certain movements and after a days work of opening and closing car doors and pushing and pulling, my tricep and bicep feel like they will explode. My arm is twice the size of my other arm and I noticed yesterday looking in the mirror, my shoulder is drooping significantly lower than the left side. I am taking Loratab that another Dr. gave me, (my ortho doc hasn't given me anything), and I still feel like I have rubber bands inside me and something in my shoulder blade at all times. If I cant learn the rest of my processes at work, then my opportunity to move up in the company or move to other areas is jeopardized.

After the pain today at PT, my tricep area is so sore I can barely touch it.

I am almost 52 years old and have been post menopausal since 1992 after a complete hysterectomy. Bone loss is a concern too. I've worked very physical jobs since I was 20-ish. Been in one wreck that may have been the culprit of the tear. I don't remember a specific time that I felt anything. Just started hurting after pulling up on (very tight)parking brakes at work

Last edited by sginn; 09-09-2013 at 05:17 PM.

 
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Old 09-09-2013, 05:56 PM   #4
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Re: massive tear, retracted muscle, no surgery?

I am 57 and yes, been through the wringer. I had an injury, and went through the surgical route. Believe me, if I had to do it over, I would NEVER EVER have shoulder surgery.

If you have pain, consider therapy, reiki, or even a suprascapular nerve block. If I had known about the block, I would have tried that. I have gone through trials, but it does not block the areas where I have pain now. But it would have worked for my cuff tear.

I am sorry to say that you will probably have pain till you stop stressing your shoulder with work. Time to consider your future. Surgery probably will not be the answer you seek. Yes I am in pain management, but that is no real answer either. That is a whole other hell. I didn't have a physical job but still have long term disability now as my right dominant arm is done.

 
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Old 09-09-2013, 06:21 PM   #5
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Re: massive tear, retracted muscle, no surgery?

yes, I have some friends who are urging me to go the disability route. Not sure if I would get it, plus I am in workers comp situation right now. I don't know how this all will pan out. I just want to be out of pain and be able to make my bills.

I cringe at the thought of the reverse replacement, so it isn't something I want to do. I will inquire about the nerve block, but I still want another opinion. This Dr. has literally offered me nothing but PT to strengthen the deltoid. He says " the muscle has pulled back to far to pull over , so you basically have a hole in there" ...... :/

 
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Old 09-09-2013, 06:59 PM   #6
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Re: massive tear, retracted muscle, no surgery?

He may be right. The reverse is very serious. You will not be able to work a physically demanding job again. Granted, mine was a revision situation which is way more debilitating but you cannot expect to work after a reverse if there is any stress on the arm.

 
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Old 09-21-2013, 12:27 PM   #7
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Re: massive tear, retracted muscle, no surgery?

Find orthopedic surgeon that specializes in shoulder reconstruction and other surgeries of the shoulder. My uncle had the same problem, he waited too long so repair was not possible. The surgeon that fixed him did a transplant as well as removing some of his muscle. With hard work with a Physical Therapist and keeping at it for months he can move it pretty good now.

 
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Old 09-21-2013, 02:02 PM   #8
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Re: massive tear, retracted muscle, no surgery?

They can do muscle and tendon transfers, but the conditions have to be right. It is not for everyone as each situation is different. Irreparable cuff tears are a problem that cannot be solved 100% unfortunately.

 
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Old 09-21-2013, 02:11 PM   #9
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Cool Re: massive tear, retracted muscle, no surgery?

Better posture during sleeping may be helpful (using pillows and rolled blankets as padding to 'prop' up your arm to lessen pulling at your shoulder, for example). You may wish seek a second opinion about the MRI results and outlook. You may be able to learn to do much of your activities with your non-dominant arm.

I imagine the 'delay' in replacement has to do with the likelihood of the replacement not lasting very long (20 years?), so if you "tough it out" now for ten or fifteen years, you'd only need to have replacement done once (with a normal life expectancy). If that were the doctor's line of reasoning, you might have some thoughts on just how desireable that sort of logic is for you.

sf

Last edited by SoundsFamiliar; 09-21-2013 at 02:13 PM.

 
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Old 09-21-2013, 02:50 PM   #10
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Re: massive tear, retracted muscle, no surgery?

yeah, he only wants me to have it done once if I can wait. I am doing much of my job with my left arm now, and have been sleeping different too. I have pretty good movement but the impingement hits at many different angles and puts me in tears and hurts for hours afterwards. My bicep is pooched out, looks like I lift weights, and it spasms a lot. All my muscles surrounding the shoulder and up my neck are in constant knots.

I have talked to HR at work and a job move is probably imminent, since much of my job is forward pushing and pulling movements. I'm already on "no above the shoulder" restrictions.

As bad as I would like this "fixed", I believe I am going to have to just wait until I am older, my conditions worsens to a point of really unbearable, and technology will hopefully be more advanced.

I am still going to seek a 2nd opinion though. If only to create a contact for future help.

I'll keep you all updated. Thanks for all the feedback.

 
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Old 09-21-2013, 02:52 PM   #11
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Re: massive tear, retracted muscle, no surgery?

Dont worry about the images. No one here is qualified to interpret them I dont think! Everyone has a unique situation so it is hard to offer good advice but to go to a shoulder surgeon with lots of experience and one you trust.

 
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Old 09-21-2013, 03:01 PM   #12
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Re: massive tear, retracted muscle, no surgery?

well, I did talk to my regular Dr. about it. My ortho didn't tell me how far the muscle has pulled back. It's 30 mm ...a long way.. My other concern is I am post menopausal due to having a hysterectomy and I worry about bone loss. It's already grinding and popping. How bad does he want it to get?

It's hard not to get discouraged, especially when I leave work in so much pain that I wanna slap someone. I mean, he hasn't even offered pain meds, shots or anything. I don't think he realizes how bad it hurts

 
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Old 09-21-2013, 03:19 PM   #13
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Re: massive tear, retracted muscle, no surgery?

You wont get pain meds from the orthopod or gp. Actually 30mm is 3 cm and that isn't too terrible. What matters is the state of the muscle. If there is too much fatty infiltration then the tendon cannot be pulled back. Fat indicates that the tear is old.
Your best bet is to find a pain management doc. Rules and regs have really put the kabosh on pain treatment.

I am sorry to say this is a very difficult situation. You have my sympathy!

Last edited by galalena; 09-21-2013 at 03:46 PM.

 
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Old 09-21-2013, 03:58 PM   #14
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Cool Re: massive tear, retracted muscle, no surgery?

Quote:
Originally Posted by sginn View Post
... I worry about bone loss.
Well, (a) I hope you're taking the maximum level of recommended supplements to discourage bone loss (e.g. 1,000 i.u. Vit. D/day, 3x 500mg calcium equivalent taken at mealtimes [eg. 1 regular and 1 extra-strength TUMS = 500mg], wouldn't hurt to take some magnesium supplement, too; and (b), I'd wonder about your likelihood of becoming arthritic in that area (not sure who'd you'd ask about that, perhaps a rheumatologist?).

Which, might be a good argument for using an anti-inflammatory salve such as diclofenac in a transdermal gel [there's a 1% OTC version called Voltaren, prescription versions may be 10%); diclofenac is a respectable painkiller in its own right, but not everyone's stomach/body can tolerate anti-inflammatories well or all that safely.

sf

 
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