rotator cuff surgery necessary? please help

W

whoaaitsbecky

New member
Thanks everyone for your responses. I had a 2nd opinion at the Shoulder Institute at MGH here in Boston with a top doctor for this injury and have decided to go ahead with surgery on 11/4. I am very active, just returned from a 2 week cycling trip in Europe, and certainly felt the difference in pain level after doing more activities and pulling luggage. Prior to that I was taking it easy and doing PT, which helped, but my recreation activites were severely compromised and I want to continue being active.

Since I live alone, but have terrific neighbors, I am trying to get ready for my return home after surgery. Any suggestions about clothing etc.? I have done a lot of reading online, and think I'm in tune with what I need to do. I also have a 20 pound dog, and I think I will kennel him for the first few days, and perhaps get a dog walker for the first week after that. Can anyone give me an idea about how much discomfort and limitation I will have the first couple of weeks, so I will know if this makes sense. I realize everyone is different, but it would be helpful to know other people's experiences. Thanks, once again.
 
Hello Citycyclegal,
I'm 48 yrs and I had the same problems you posted. I had an ex-ray, MRI done. After that I went to PT which made matters worse, after that my Orthopedic Surgeon gave me injections, which only gave me temp relief. Well, after dealing with this pain for over 1 yr. I requested to have surgery. On Nov. 13, 2009 I had Rotator Cuff Surgery, and I realize it's been a few days and I can say I'm in alot of pain. The doc gave me a script for Percocet and also On-Q Pump Pain Relief, which was completed yesterday, and I removed the catheter myself, and it was helpful. I go this Thurs for my first post-op. I hope and pray that this surgery resolves my problem, and I wish you all the best in the decision you make to prepare for surgery. Please keep in touch, and if there's any questions you may have, feel free to let me know.
Take care and Have A Great-Day!

DolphinLuver
 
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
 
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
 
I agree with Feelbad. I am very happy I had my surgery which also involved the biceps tendon. You should really consult an orthopedic shoulder specialist and learn more about your injury, as well as what it would entail if you should postpone it. At our age, it is more wear and tear on something that is already troublesome and I wanted to prevent any more damage, and be able to resume all my activities as usual.
 
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 *
 
Hi, Vintagetwin,
I am very glad I had the surgery. The major surgery was a biceps tenodesis, where they cut the tendon and then reattached it, takes a long time to heal. I did have the nerveblock which was great, went home with oxycontin 2x a day am and pm, and then oxycontin every 4-6 hours as needed. Sleeping sitting up wasn't fun, but doable, and of course could be uncomfortable that first week. I am still doing strengthening, and probably will continue PT until the middle of March, and then be on my own to continue necessary exercises. My doctor said I wouldn't be able to put my bike on the rack until June or so. Right now, lifting a half gallon of milk up onto the shelf in frig is finally doable, but some effort. It just takes time, and continuing the strengthening. I highly recommend being prepared ahead of time, if you are on your own, and have someone stay with you the first couple of days. If you have specific questions, please ask. I think having the right medication going home was key for pain. I talked to someone else that just had tylenol with codeine, and was in a lot of pain. Be sure to discuss your options for pain meds. Quality of my life is important, and I am glad that I had it done, and by summer I will be all set. No discomfort now. Any questions, please ask, and good luck with your decision. Sheila
 
Citycyclegal,
Very anxious to hear how you made out. I'm in the same boat. Very active, not much discomfort, partial tear but I haven't been able to do any of the activities I love for the last 4 months while I try rehab. I might be slightly better now but it's not very significant and don't want to to wait too long to get the surgery done if I'm going to do it. I've got virtually full range of motion but still get soreness on light use. Need to make a decision soon. I'd love to hear from you. Thanks
 
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.
 
Thank you very much for your response. I talked with my Dr.'s nurse on Monday, with questions in hand, and have decided to go ahead with the surgery. I was in shock when I went to the Dr. for the results of the MRI and he said I needed surgery,thought I would just have to have a shot. I was totally unprepared for surgery, I barely heard what he said. Two days later is when I decided to check the internet. . Thank again.
 
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.
 
Oops, just noticed that I posted 2x and reread. Meds were oxycontin 2x at the start, and then oxycodone every 4-6 hours the first week.
 
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
 
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.
 
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
 
just having gone thru this myself vintage only AFTER what was only a partial tear that i did not know i had actually snapped in half one morning,i would very highly recommend that you just get this tear fixed NOW vs waiting and it tearing little bits along the way to a full complete tear? its just a huge huge difference in the level of real surgery involved when its only a partial vs a full complete? the procedure for what you have would be more than likely done by only a scope vs the other when its torn which would require a cut into the shoulder area and surgery done inside with much more overall trauma done to the area which of course would be much more painful too post op and thru the required rehab?

honestly, if i had actually known just how badly my tendon was torn before it did that to me i most defintiely would have had it fixed when it was "only' a tear. i knew i had a 'shoulder issue' of some kind but not what actually showed up on my MRI. i just didn't realize how really crucial it was then when it just 'hurt" or burned once in a while it would have been to just even obtain that MRI. i also had another partial tear in the one directly beneath the snapped one too. other things also needed some smaller repairs as well. bone spurs are also something that need to be cleared if you have any within that joint? but most of this was done with the scope and tiny little tools that get inserted along with a tiny camera so they can see what they are doing in there. if i had not snapped the very top tendon, the incision would not have been needed and bone would not have any anchor pins in it now either. its just a really really painful surgery to have once that tendon fully goes vs being partially torn. i really would do this now since quite honestly all it can take in some cases to fully tear a partial is one really sudden lift you do that you are not expecting or ready for or having 'something' that you suddenly have to stop from like falling that is really heavy? these kinds of stupid moves are what can create either a much larger tear or a complete in a freaking heartbeat in some cases. i do hope things get done sooner vs later for ya. it IS soo much less painful to just 'do' now. please let me know how things are going. FB
 
Hi, Vintagetwin,
I am very glad I had the surgery. The major surgery was a biceps tenodesis, where they cut the tendon and then reattached it, takes a long time to heal. I did have the nerveblock which was great, went home with oxycontin 2x a day am and pm, and then oxycontin every 4-6 hours as needed. Sleeping sitting up wasn't fun, but doable, and of course could be uncomfortable that first week. I am still doing strengthening, and probably will continue PT until the middle of March, and then be on my own to continue necessary exercises. My doctor said I wouldn't be able to put my bike on the rack until June or so. Right now, lifting a half gallon of milk up onto the shelf in frig is finally doable, but some effort. It just takes time, and continuing the strengthening. I highly recommend being prepared ahead of time, if you are on your own, and have someone stay with you the first couple of days. If you have specific questions, please ask. I think having the right medication going home was key for pain. I talked to someone else that just had tylenol with codeine, and was in a lot of pain. Be sure to discuss your options for pain meds. Quality of my life is important, and I am glad that I had it done, and by summer I will be all set. No discomfort now. Any questions, please ask, and good luck with your decision. Sheila
 
Dear Feelbad,

Thank you for your response, it was very helpful and confirmed what the nurse told me on Monday. I was shocked when I went to my Dr. for the result of the MRI, I was sure all I would need was a shot. When he told me I needed surgery, I barely heard what he said. Two days later is when I decided to check the internet. On Monday I called his nurse, with questions in hand and decided to have the surgery in a couple of weeks. Thanks again for your response.
 
(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:



Good luck and good health. :)
 
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