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Rotator Cuff Injuries

post #1 of 15
Thread Starter 
Doing a search, it seems these are less common skiing than I would have thought. I've posted the same questions on a few other forums with some good replies, but I'm trying to get as much information as I can.

Last season, in early March, I tried running gates for the first time at a local hill. After a few laps, the course got icy and rutted out. To the best of my knowledge, I hit a rut and dug my tips in causing a release. (it was on video, but I haven't seen it) I fell hard with outstretched arms and tore up my left shoulder. Even though I could barely move that arm, I managed to ski the rest of the day.

I talked with different doctors, all encouraged me to try various exercises and PT before opting for surgery. Fortunately I have a family member that is an AT and she was able to help me out. 7 months later, I have full range of motion, but the injured shoulder is very weak. The pain still keeps me up at night, and any work done with my arm above shoulder height causes more pain. Hard to escape this being a firefighter / emt.

I know I need to go back to the ortho doc, however I am reluctant to try cortisone shots due to the risk of further damage to the tissue, and surgery is not an option until May. This is due to a paramedic class, not the ski season. I am not able to stay off the shoulder until class is over.

To people who have been in the same situation, at what point did you decide surgery was the only option left? I know this injury can take a very long time to heal, one doc told me up to a year. Am I just being impatient?

To any medical professionals on the board, am I at risk causing more injury to the shoulder by waiting for definitive treatment? Is there anything I can do this ski season to reduce the risk of worsening the tear? (Short of not falling, or tuck-and-roll..)

Thanks in advance.
post #2 of 15
I have a similar injury. Just wish mine was fun related like yours instead of job related. lol
The best results I've gotten is just imobilizing as often and as long as possible. I'm no FF but having a 4 year old boy alone probably comes close.

What prompted my reply was the shots. It might be sensationalist but I wouldn't look at that as any less serious as surgury. I have a dear older friend right now that has been undergoing shots for her back. The shots somehow caused her to get a staff infection. She's now hospitalized and occationaly on a ventilator. Just be really careful.

good luck to ya.
post #3 of 15
Thread Starter 
Thanks for the reply - I'd prefer to not get shots or surgery. The ortho clinic covered by my insurance tries PT, shots, surgery, in that order. The shots carry high enough risk considering they don't address the root problem, only reducing inflammation caused by the tear.

I'm open to "alternative" treatments as well.

staff infection from the shots, MRSA? all too common in the hospital, I feel bad for her. That's going to be a rough recovery.
post #4 of 15
Quote:
Originally Posted by emtnate View Post
Thanks for the reply - I'd prefer to not get shots or surgery. The ortho clinic covered by my insurance tries PT, shots, surgery, in that order. The shots carry high enough risk considering they don't address the root problem, only reducing inflammation caused by the tear.

I'm open to "alternative" treatments as well.

staff infection from the shots, MRSA? all too common in the hospital, I feel bad for her. That's going to be a rough recovery.
Your clinic is suggesting the right order of treatment. There is virtually no risk with a cortisone shot - IMO you are being silly by avoiding it, especially when you have pain. The point is to reduce inflammation and pain so that you can rehab effectively. There is no evidence for so called 'alternative' treatments. Lastly, you should have a dynamic ultrasound done (better than MRI) to assess the extent of your partial tear (if you can lift you arm over your head you don't have a complete tear).

If you post such a query online, you're going to get all kinds of ridiculous stories about "cortisone did this and that". IMO, listen to your docs & physios.

FYI, the only indications for surgery are either a complete tear or persistent pain. Weakness (with a partial tear) is not part of the criteria, since surgery has not been shown to improve this.
post #5 of 15
Quote:
Originally Posted by emtnate View Post
Doing a search, it seems these are less common skiing than I would have thought. I've posted the same questions on a few other forums with some good replies, but I'm trying to get as much information as I can.

Last season, in early March, I tried running gates for the first time at a local hill. After a few laps, the course got icy and rutted out. To the best of my knowledge, I hit a rut and dug my tips in causing a release. (it was on video, but I haven't seen it) I fell hard with outstretched arms and tore up my left shoulder. Even though I could barely move that arm, I managed to ski the rest of the day.

I talked with different doctors, all encouraged me to try various exercises and PT before opting for surgery. Fortunately I have a family member that is an AT and she was able to help me out. 7 months later, I have full range of motion, but the injured shoulder is very weak. The pain still keeps me up at night, and any work done with my arm above shoulder height causes more pain. Hard to escape this being a firefighter / emt.

I know I need to go back to the ortho doc, however I am reluctant to try cortisone shots due to the risk of further damage to the tissue, and surgery is not an option until May. This is due to a paramedic class, not the ski season. I am not able to stay off the shoulder until class is over.

To people who have been in the same situation, at what point did you decide surgery was the only option left? I know this injury can take a very long time to heal, one doc told me up to a year. Am I just being impatient?

To any medical professionals on the board, am I at risk causing more injury to the shoulder by waiting for definitive treatment? Is there anything I can do this ski season to reduce the risk of worsening the tear? (Short of not falling, or tuck-and-roll..)

Thanks in advance.
- avoid whatever it is you are doing with the arm over your head that is causing the pain, don't rationalize it ("hard to escape"); stop doing it.

- concur with your doctors, about the PT. 7 months is not a long time. keep up the PT.

- look - this talk about staph infections from an injection, you "rathering not", and someone else talking about (unspecified) "high risks" with respect to cortisone is cause for concern in itself; and so is the idea of "immobilizing as often and long as possible" - that's probably the opposite of what you want to do to heal an injured rotator cuff, the worst possible advice imaginable. Don't do that.

The ONLY one you should be listening to with respect to PT, and especially cortisone or other prescribed substances is your doctor; this is not a substance you should be "deciding" (or decline, if it is advised) without consultation with your physician, and the "risk damage to tissue" comment suggests some misinformation or misunderstanding. It does have risks such as you feeling like superman and not listening to your doctor to lay off after the injection, and causing more injury to the shoulder; there is an association with cataracts later in life, some other things. It is done with a large needle and there is some mild pain associated with the injection - - - not something you will want to look at while its happening if you are squeamish. It might not work. But it isn't going to cause a staph infection or turn your shoulder into Jello.

- By the way, I did have a serious rotator cuff tear injury. The point at which I decided whether or not to do surgery (I chose not), was after 3 years of physical therapy, 2 cortisone injections, continued pain, and an MRI confirming the condition of the ligament (tear). As in your case, there was some improvement, with some weakness and residual pain, which was aggravated by the above the shoulder movements. After consultation with my doctor, I had a 3rd cortisone injection (and final, that is all the doctor would allow in my lifetime in that shoulder); and continue with a 4th year of physical therapy. It worked - - - I have had no pain in the 7 years since - - 100% mobility and strength, that I did not have in the preceding 4 years. Without surgery.
post #6 of 15
Thread Starter 
4 years, that's a long time. The PT definitely helps, like I said, my docs don't want to do surgery any more than I want to be cut. The persistent pain when I try to sleep is becoming very troublesome.

About not putting my arm above me head, yes, I try to avoid it as much as possible. Common sense tells me to not do things that hurt. However as a medic / firefighter, it is pretty much impossible unless I don't work or go to class. Again, not an option. For the most part I go about my day like normal. I do the exercises that have been suggested and do my job as best I can.

I'm not concerned about infection at the injection site, if I notice the doc is not practicing sterile techniques, then I won't let him give me the injection. Needles don't really bother me, even large ones. I'm not going to let someone put a 16 ga IV catheter in my hand or cephalic again, but thats about it. My only concern was the potential for tissue damage, and I do understand that has more to do with repeat injections in the same site than just one or 2 treatments.



(I still haven't made an appointment with the ortho clinic..) How long were you advised to take it easy after cortisone treatments?
post #7 of 15
I've had major reconstruction of both shoulders. One from damage caused by many years of playing Hockey. The other was from a fall while on Patrol. I've got 4 inch scars on both shoulders to prove it. I'm a building contractor who needs full range of motion for work so after many months of pain and medicine along with cortizone injections, I decided to get it fixed. The surgery and immediate recovery was one of the most painful things I've ever gone through. Especially the rehab and therapy. I was off work for 8 weeks on that one and full strenth in 12 weeks. My right shoulder gave me no choice. The fall tore all the major ligaments and tissue off my scapula and socket. Therapy wasn't an option. I was off work for 3 months with that one before I could even think about swinging a hammer, and full strenth took another 3 months. I only have 40% range of motion in my right shoulder.

So, if you can improve your range of motion through therapy, I suggest you do so. Cortisone injections are a tempory fix and a waste of money. Surgery is the permanent fix but painful and time consuming. The choice is yours and good luck.
post #8 of 15
Wow.
post #9 of 15
Quote:
Originally Posted by emtnate View Post
4 years, that's a long time. The PT definitely helps, like I said, my docs don't want to do surgery any more than I want to be cut. The persistent pain when I try to sleep is becoming very troublesome.

About not putting my arm above me head, yes, I try to avoid it as much as possible. Common sense tells me to not do things that hurt. However as a medic / firefighter, it is pretty much impossible unless I don't work or go to class. Again, not an option. For the most part I go about my day like normal. I do the exercises that have been suggested and do my job as best I can.

I'm not concerned about infection at the injection site, if I notice the doc is not practicing sterile techniques, then I won't let him give me the injection. Needles don't really bother me, even large ones. I'm not going to let someone put a 16 ga IV catheter in my hand or cephalic again, but thats about it. My only concern was the potential for tissue damage, and I do understand that has more to do with repeat injections in the same site than just one or 2 treatments.



(I still haven't made an appointment with the ortho clinic..) How long were you advised to take it easy after cortisone treatments?
I was told to lay off for about 5-7 days after cortisone, if I remember correctly, before resuming PT; and don't try any new overhead activities either. Try to get over any fear of needles; you won't feel it anyway (topical anesthetic is used). Certain types of imaging will involve a catheter with dye also.

As far as sleeplessness/residual pain is concerned, your docs will give you some advice on this (ibuprofen, "deal with it - its nothing to worry about", "you're improving", "get used to it")
post #10 of 15
Thread Starter 
Quote:
Originally Posted by stevescho View Post
... your docs will give you some advice on this (ibuprofen, "deal with it - its nothing to worry about", "you're improving", "get used to it")

Pretty much the advice I've been given, I'm just getting impatient. And about the needles - not a problem. 16 gauge catheters are HUGE, about the size of a pencil lead. They're not too bad in your AC (elbow) but really hurt the thin skin on your hand. Besides for imaging, the dye goes in the AC anyways.

Being an EMT student and having your fellow classmates start IVs and give saline shots on you for practice gets rid of any fear of needles you might have.

5-7 days, I might be able to live with that without getting too far behind in class. I'll have to ask my partner at work if I can just drive that week. Thanks for the information.
post #11 of 15
I had rotator cuff surgery on my right sholder several years ago. It hurts alot for the first month and when you go to rehab it hurts alot again. No fun at all but well worth it to have my sholder back and a good nights sleep. My father let his go to far and they could'nt repair it. My suggestion is to get it over with after your class ends.

Bryan
post #12 of 15
Quote:
Originally Posted by jdistefa View Post
Your clinic is suggesting the right order of treatment. There is virtually no risk with a cortisone shot - IMO you are being silly by avoiding it, especially when you have pain. The point is to reduce inflammation and pain so that you can rehab effectively. There is no evidence for so called 'alternative' treatments. Lastly, you should have a dynamic ultrasound done (better than MRI) to assess the extent of your partial tear (if you can lift you arm over your head you don't have a complete tear).

If you post such a query online, you're going to get all kinds of ridiculous stories about "cortisone did this and that". IMO, listen to your docs & physios.

FYI, the only indications for surgery are either a complete tear or persistent pain. Weakness (with a partial tear) is not part of the criteria, since surgery has not been shown to improve this.
This is sound advice.
I've been thru shoulder issues in the past ,including surgery.
I've had numerous cort.injections.You need them for the exact reasons jdistefa says.
What are you doing in parimedic class that would not allow you to get surgery?
post #13 of 15
I have had a partial tear for at least 10 yrs now, along with a bunch of other miscellaneous wear and tear damage. I still consider surgery sometimes when it becomes aggravating, but for the most part it is stable. I have found that taking a single Aleve tablet every morning, whether it is hurting or not, makes a significant difference in my quality of life and significantly improves my ability to lift weights, ski, drive, sleep, etc. Everyone could stand a little less inflammation in their lives, and I am content to continue this way for the forseeable future. Surgery is a risky thing and I've had both good outcomes and bad in the past. You roll the dice and take yer chance. It is a personal decision.
post #14 of 15
Thread Starter 
Quote:
Originally Posted by loboskis View Post
What are you doing in parimedic class that would not allow you to get surgery?
Lifting and moving patients, lifting the cot into the truck, performing CPR, the list goes on. The class work is not the problem, but we have to spend time in various departments of the hospital and ride along time with another paramedic. We spend more hours on the trucks than we do in class. If I had a weight restriction for 6 weeks after a surgery, I would get behind in this part of my class.

There is so much time we are required to put in, it would be impossible to catch back up. Starting the class over will not be an option. Any other paramedics here will agree that once is enough with the class.

I spoke with a doc yesterday, he is still optimistic about not needing surgery. He didn't seem too concerned about waiting so long and still thinks I'm getting enough improvement with PT.
post #15 of 15
Quote:
Originally Posted by emtnate View Post
Lifting and moving patients, lifting the cot into the truck, performing CPR, the list goes on. The class work is not the problem, but we have to spend time in various departments of the hospital and ride along time with another paramedic. We spend more hours on the trucks than we do in class. If I had a weight restriction for 6 weeks after a surgery, I would get behind in this part of my class.

There is so much time we are required to put in, it would be impossible to catch back up. Starting the class over will not be an option. Any other paramedics here will agree that once is enough with the class.

I spoke with a doc yesterday, he is still optimistic about not needing surgery. He didn't seem too concerned about waiting so long and still thinks I'm getting enough improvement with PT.
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