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recovering from a torn rotator cuff

post #1 of 17
Thread Starter 

Hi all,

 

Monday night I tore my rotator cuff. I was skiing in low visibility down a powder run when I hit an invisible kicker and landed shoulder-first on a cattrack below. I could raise my arm to "ski pole height", but no higher. Couldn't raise it laterally. My physio, who I saw the next day, wasn't really able to do the full range of tests due to swelling (despite all the icing and ibuprofen). He noticed my collar bone is now sticking up an extra half inch on the injured side. (It hasn't really dropped since...) The physio prescribed a set of exercises for range of motion and said that in a couple of weeks if all goes well I should be able to ski gently, and go back to normal skiing in a month. However, he saw the look of horror/"oh my god" and I'm worried I might have unintentionally pushed him into giving me a better date... 

 

Now I'm on day 3 of rehab and can extend my elbow in front of my chest to around chest level without pain or popping while supporting the arm with a bar. Laterally I can extend (using a bar) out to armpit height.

 

Is this progress typical for a minor tear?

What are other people's experiences recovering from a rotator cuff tear? 

Any recovery suggestions, like diet or supplements?

I understand that tendons can't heal--once they're severed, they're severed and the only way to reattach is through surgery. Is that true?

The physio was concerned that if I ski and my pole snags, my arm will get pulled behind my body and bad things will ensue. Would this typically be a long-term risk now?

post #2 of 17

Hi Metaphor!

 

Hope that you are doing okay with your shoulder. I can't really offer you any advice as I'm not really sure how you know that you tore your rotator cuff, or if you did. Were diagnostic tests done (other than the physical tests which your physio did)?

 

Yesterday I just had a (probably very) small tear repaired under arthroscopy. I also had a small spur removed, which is likely what caused the tear. So mine wasn't due to any accident, and judging from symptoms, was probably existent or getting sawed away at by the spur for years. As we age, particularly if there are things maybe slightly out-of-whack (and most of us are slightly out-of-what, to a certain extent, I believe), and/or we abuse our shoulders a lot with sports/lifting/whatever . . . we can have problems. My shoulder surgeon said that something like 90+% of us have some type of rotator cuff tear in our lifetimes. Most of them heal by themselves and in a year are all better, or maybe sooner, or some maybe need surgical repair. I guess it depends on how bad it is, and how/if it heals.

 

Anyway, a few years ago I had MRIs on both shoulders, and both of them showed small tears in several places. At the time, I was 53 years old, and years of sports probably didn't help. I had one shoulder "cleaned out" at that time, and had to wait for this one until now due to other injuries and getting time off work. But I did okay with the unrepaired shoulder, with pain coming and going, and a few cortisone injections (but you don't want too many). I have had to avoid swimming any stroke where my hands come out of the water (and I have designed a creative way of still swimming freestyle with an underwater arm recovery stroke!). And sometimes it would really bother me, such as when I had to use crutches for two weeks, and or I would fall on it skiing or whatever, and sometimes just using a computer mouse too much (yeah.).  And I probably have had at least four or more courses of physical therapy over the last 20 years for my shoulder issues, working on stabilization and such. But I think that I am just one of those people doomed to have bad shoulders (and other joints), and, um, I'm getting old.

 

Actually, when my former surgeon (since I have changed insurance, had to change surgeons) cleaned out my first shoulder two years ago, he didn't even sew up the tears - he cleaned out the joint so that the bursitis would allow the cuff to sit back down where it needed to to heal itself, as the bursitis had been holding the cuff up too high and the tear could not heal (called a lift-off lesion). It has been pretty good since then, though he had warned me that the bursitis might recur, and lately it has been a little annoying at times.

 

So good for you, that you are working on therapy, and I hope that it helps. I am not sure that a tear can really be diagnosed without an MRI or going into the joint with a scope. But maybe the therapy will help you get back in shape without surgery (last resort, though arthoscopy isn't too bad if it is just a tiny tear like mine). It might just need to heal. IF that's what it is. I don't know much about the Canadian healthcare system - is a physio a sports doctor? For some reason, I thought that they were physical therapists. Anyway, most of the shoulder exercises which have been prescribed for me over the years have involved a lot of internal and external rotation exercises, and one doctor told me that rule of thumb is to never do any exercise where you cannot visualize your hands either directly or in your peripheral vision. So no behind-the-back pull-downs, stuff like that. And he also told me "no push-ups, ever". You'll get all kinds of advice from different practitioners. See what works, and allow things to heal. And if your doctor doesn't seem sure and/or you're not getting better, maybe get some diagnostic tests done (xrays, which don't always show much in the way of tears, or better yet, MRI) so that you know what you are dealing with, or get a second or third opinion.

 

I've been taking glucosamine/chondroitin for years (so does my cat with a repaired ACL, ha ha!), and I don't know if it helps at all. It is more for general joint issues, not a torn cuff. So not sure that it will help you specifically for your problem. I suspect that the physio told you to ice it a lot to allow the inflammation to go down? It would seem to me that you would not want to be lifting the shoulder up too much - not letting your elbow leave your side much - until the tear heals.

 

Best of luck to you!

Kitty

post #3 of 17
Thread Starter 

Thanks for the kind words Kitty. Physios can run some physical tests to identify torn tendons, along with the grade. In Canada I'll be waiting a long time to get an MRI for something not life threatening. That said I will be getting an ultrasound pretty soon to check for bone spurs etc. 

 

It turns out the tear is very minor. With any luck I'll be rehabilitated in time for the coach level 2 course at the end of the month. (I've already been cleared to freeski, so long as I don't use poles and stay on groomers.)

post #4 of 17
Quote:
Originally Posted by Metaphor_ View Post

Hi all,

 

Monday night I tore my rotator cuff. I was skiing in low visibility down a powder run when I hit an invisible kicker and landed shoulder-first on a cattrack below. I could raise my arm to "ski pole height", but no higher. Couldn't raise it laterally. My physio, who I saw the next day, wasn't really able to do the full range of tests due to swelling (despite all the icing and ibuprofen). He noticed my collar bone is now sticking up an extra half inch on the injured side. (It hasn't really dropped since...) The physio prescribed a set of exercises for range of motion and said that in a couple of weeks if all goes well I should be able to ski gently, and go back to normal skiing in a month. However, he saw the look of horror/"oh my god" and I'm worried I might have unintentionally pushed him into giving me a better date... 

 

Now I'm on day 3 of rehab and can extend my elbow in front of my chest to around chest level without pain or popping while supporting the arm with a bar. Laterally I can extend (using a bar) out to armpit height.

 

Is this progress typical for a minor tear?

What are other people's experiences recovering from a rotator cuff tear? 

Any recovery suggestions, like diet or supplements?

I understand that tendons can't heal--once they're severed, they're severed and the only way to reattach is through surgery. Is that true?

The physio was concerned that if I ski and my pole snags, my arm will get pulled behind my body and bad things will ensue. Would this typically be a long-term risk now?

a)  doesn't sound like (just) a rotator cuff tear; go see a doctor - not a "physio";

b)  for me (partial tear); it was 4-5 years of drugs, including steroid injections, and physical therapy; not "one month";

c)  yes, completely severed/torn tendons do not "heal" or "reattach" (to where they are supposed to be); a partially torn tendon can actually "heal", or at least become functional with monitored rest/physical therapy

d)  poles don't typically "snag" and pull arms behind the body while skiing;  your "physio" doesn't seem to have a clue.

 

Go see a real doctor.

post #5 of 17

Metaphor,

Everyone is different, every injury is different and everyone heals differently.  However...

 

One of the biggest mistakes I did in my life was not take care of my shoulder when I originally hurt in '88.  I sucked it up and kept going.  It bothered me here and there but I was able to deal with it (was in the Marines at the time).  Fast forward several years and by the late '90's I'm just starting to baby it but I don't even realize I'm doing it and by the early 2000's I am babying it and have started doing more things left handed (right shoulder was injured).  2006 finally went to the doc for it (18 years later).  A couple shots and physical therapy.  After a couple months I'm much better and the chronic pain is mostly gone.  By time I went to the doc's in 2006, I could no longer throw a ball over hand and was babying it so much, at PT, they thought I was left handed because of the strength test.

 

That lasted a while but it would always flare up and I would have to go through a series of exercises but it was always there.  In 2009 I said enough and went back to the docs (different one this time).  I couldn't even hold a coffee cup without being in pain.  I was constantly trying to find a position that wasn't painful (dull ache). Still got the shot and PT, but he also told me my tendons had degenerated (did an MRI) pretty badly and after a few visits the plan is to do a sub-acromial decompression surgery (at the end of ski season of course - 2010).  In the mean time, I fell skiing and because my shoulder is in such bad shape, I tore my RTC 90% (found out during SAD surgery which turned into RTC repair surgery).  I fell in February but had become so accustomed to the pain, that it didn't seem much worse (pain wise not functional movement wise) so I kept skiing the rest of the season.  I was already in PT getting ready for surgery.  End of March I had the surgery.

 

I was 28 when I first injured it, 46 when I went to the docs the first time and 50 when I went in for surgery.  When I was 28, I probably didn't need surgery but I did need something beyond Motrin.  I'm not implying that you are being as stupid as I was.  You are doing something.  My point of all of this, is your goal should be to make your shoulder perfect and not good enough.  Good enough means constant work and daily therapy to keep it healthy - for the rest of your life.  Each time I would slack on the PT, the pain came back.

 

After surgery and all the drugs wore off, it was the first time I was pain free in several years.  Without a doubt the recovery was long.  You get to about 90% in a year and 100% is 18 to 24 months.  But what I didn't realize, was that all that babying of the shoulder that snuck up on me (was like watching the grass grow), changed other parts of my body too.  My upper back became very tight and I was constantly getting stiff necks.  Sleeping through the night was the holy grail.  It wasn't until after the surgery and I was fully recovered that I started connecting the dots and realized all the side effects my shoulder caused.

 

Having the RTC surgery was one of the best things to happen to me.  Once recovered, I would recommend doing a Functional Movement test to see if anything new creeped in while you were distracted by your shoulder.  It really does become quite debilitating if not corrected.

 

I have lots of suggestions on post surgery recovery.  I think I might have even posted them here back in 2010.

 

Ken

post #6 of 17

I am a repeat offender with rotator cuff tears, the most recent one fixed last October.  My other one was eight years before.  I'm now 56.  Both were surgically repaired.

 

As others have suggested, you need to see a doctor for a full assessment of  the damage.  Only an MRI can properly show the extent of tissue/tendon damage.  My latest one I tore in Dec 2011 while skiing.  Having been thru the process before, a few months earlier I could tell the shoulder was weakening, and discomfort, especially at night, was becoming more common.  I saw the surgeon who had repaired my other one, and he diagnosed it as tendonitis and gave me a cortisone shot.  A few weeks later I was skiing, hit an ice patch, put my arm down to regain balance, and it tore.  Didn't take much.  I could tell immediately because the symptoms were the same as 7 years earlier.

 

I skied the rest of the season with the torn rotator.  Only problem was I could not fully extend my left arm to pole properly, but it was not a deal breaker.  I also had to make accommodations for carrying skis and other gear.

 

I waited almost a year before getting it repaired because I was living in Europe at the time and did not want to miss out on my final Alps ski season.  The consequence was that the tendon retracted over an inch, so the surgeon had to pull it back to reattach, or what doctors call anchor, the tendon to the shoulder bone.  If you have a complete tear, the muscle will contract over time.  Sometimes a surgeon can not pull it back far enough.  In that case you are just SOL and have to regain the best ROM and strength you can through PT.

 

I was lucky with both surgeries; did not need any post-operative pain medication, but I'm just lucky, have good pain management genes.  Most need some for post-op and PT.

 

For both surgeries the process was: arm in sling for one month, then 2-3 months of PT.  After that I was about 75-80%, then just have to work on your own for full strength, about 6-7 months after surgery. It did take about a year before I forgot I ever had a tear.

 

I agree with L&AirC and others that you should strive to regain full functionality for your shoulder. If you're young (i.e. under 50) and active, you don't want to spend the rest of your life with a limitation that could be fixed.  The inconvenience of surgery and a few months of PT is a small price to pay  for being able to actively participate in the sports and activities you love to do.

 

Best of luck with it and hope all goes well, whatever it turns out to be.   -  Buster22181

post #7 of 17
Just go to a doc now, that's why we have free health care.
post #8 of 17

Just one quick post:

 

You don't necessarily require surgery with a partial tear, and surgery for this type of injury is - well - not 100% successful to say the least, successful for some, partially successful for others, unsuccessful for some others, and some are worse off with the surgery than before.  It depends on alot of factors, and it is biological tissue.  If there is a decent chance that you could get through it with only physical therapy (no surgery, no steroids), then that is probably what your doctor will recommend first.  If your MRI shows your RCF is toast, or you are not showing strengthr/range/pain reduction improvement with physical therapy (and steroids, if necessary), over some reasonable time (month-years, depending on the specifics of your case), then surgery may be suggested. 

 

My rotator cuff (partial tear), as long as it took to get over the problems (without surgery), is fully functional with no issues in at least 12 years since recovery.

post #9 of 17

I'm also a repeat offender.

In an unscheduled motorcycle dismount I manged to break a few bones in one shoulder, and didn't realize the other had been dislocated until I tried to reach up to pull down a projector screen.

 

When I was learning how to do sweep blocks many years ago, I managed to sweep a sidekick into my shoulder and neck and was so into my sparring, that I just shrugged off the shoulder injury and changed stances, and substituted right kick for right punch.  Later, I was so concerned about my neck that I didn't notice the shoulder dislocation again until I was washing my armpit in the shower.

 

I  fell skiing and injured my shoulder skiing.  I believe the medical term for the injury is "discomboomerated"; I can't say for sure because the medical treatment I have experienced consists of a lot of wasted time taking X-rays and consulting physisians who end up prescribing rest, and at most a sling for a few weeks.  I already know the physio.  

 

Just when I was beginning to be able to lift my arm above my shoulder I hit an unseen hole doing about 35-40 mph and didn't stop quite as fast as my skis did.  I had the good sense to fall on my other shoulder.   I believe the term for that injury was "schmucked" . Even with two arms it was very painful lifting the chair-lift bar.

 

Since I try not to ski on my shoulders, I don't stop skiing just because I have a shoulder injury I just ski without poles.   I may make the occasional sudden movement that is painful, but other than that (and lifting the chair bar if you have two shoulder injuries), there's no problem skiing.

 

From my experience with discomboomerated and schmucked  shoulders, recovery time to using poles again is generally 3 to 6 weeks.  Time to doing full-power punches on a heavy bag (or a dirtbag ;)  ) without hurting the shoulder is about 6 months to a year.

post #10 of 17
Quote:
Originally Posted by stevescho View Post

Just one quick post:

 

You don't necessarily require surgery with a partial tear, and surgery for this type of injury is - well - not 100% successful to say the least, successful for some, partially successful for others, unsuccessful for some others, and some are worse off with the surgery than before.  It depends on alot of factors, and it is biological tissue.  If there is a decent chance that you could get through it with only physical therapy (no surgery, no steroids), then that is probably what your doctor will recommend first.  If your MRI shows your RCF is toast, or you are not showing strengthr/range/pain reduction improvement with physical therapy (and steroids, if necessary), over some reasonable time (month-years, depending on the specifics of your case), then surgery may be suggested. 

 

My rotator cuff (partial tear), as long as it took to get over the problems (without surgery), is fully functional with no issues in at least 12 years since recovery.

 

 My surgeon told me there is nothing surgery can't make worse.

post #11 of 17

Just kind of re-opening this post and looking for some insight.  I have recently been diagnosed through MRI with a full thickness tare of my Rotator(approx 2mm) cuff, tendonitis, impingement and all that good stuff going on. I am a self employed Landscaper and work by myself at the present time. First opinion from one Doc was not even a hesitation, get surgery within a month or you could lose functionality of your shoulder. At 46 I am not ready for that but I am in the process of getting a second opinion to maybe prolong the surgery if absolutely necessary til after Turkey Day. Anyone with any experience in this field or type of injury with an opinion I would be glad to hear about it.  Thanks,      Dave

post #12 of 17

Well, if the doc is saying get it done right away or lose functionality, seems like that is what you should do.  However, you also ought to inquiry about the rehab time.

 

I've had 4 shoulder dislocations, 3 in one and 1 in the other.  I'm a candidate for surgery, but I've put it off until I feel I can't live with the situation.  But I don't think I've got a tear that is as bad as yours -- it isn't really affecting me at the moment.

 

My spouse, on the other hand, had to have both shoulders repaired for rotator cuff injuries.  The rehab and recovery was pretty long and painful.  Literally months before she could return to anything like normal activity.  So best to inquire about the rehab and recovery expectations...

 

Mike

post #13 of 17

That is my problem at present, If I don't work I don't get paid and lose clients, etc. I am wondering if anyone has had this situation and had to prolong surgery til a certain point. Thanks for your response

post #14 of 17
post #15 of 17

I highly recommend you get one of these icing machines and use it overnight: http://www.dme-direct.com/breg-polar-care-kodiak-cold-therapy-unit

 

That icing machine worked wonders after my wife's shoulder surgery.  She now occasionally uses it on her other shoulder when it flares up due to the same bone spurs surgically removed from the other side.  Ice works magic on the body.  Plus Advil or Aleve, of course.

 

She knew surgery was the only option after lots of PT and she still couldn't sleep lying down due to the pain.   Recovery was tough.  I think the docs downplay it.  You have to stay (and sleep) upright, and you'll have a hard time getting off your couch or recliner for at least a week.  You'll need someone to take care of you and feed your icing machine for the first few days, at a minimum.   Narcotics are very necessary, but the icing machine allows you to use less and get off them quicker.

 

If you have shoulder issues don't raise your hands above your shoulders unless specifically given exercises by a PT.  Watch the video in the last post and you'll see why.


Edited by tball - 6/4/13 at 8:32pm
post #16 of 17

it really depends A LOT on what kind of damage and what techniques are being used on the repairs. Dave, is that a full or partial tear? its sounds more like you are saying a partial 2mm tear?  Thats a grade 1 I believe. the other issue not discussed here is shoulder instability. This is much different from a rotator cuff tear but if you are experiencing looseness in the shoulder and have a lot of pain in the surrounding muscles or repeated dislocations or subluxations you may need to have this addressed.  You should find a OS who is using up to date techniques as it will have a bearing on recovery time for sure.  

post #17 of 17

You are probably looking at 4-6 weeks in a sling. Followed by another 6-8 weeks of re-hab(depending on how bad things are in there)

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