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torn rotator cuff - experiential counsel

post #1 of 39
Thread Starter 

I fell now 3 weeks ago, right shoulder hurt, pain started on rear of neck down to shoulder, that night pain in shoulder (the ball just around and below the rotator cuff ) was unbelievable. Have trouble abducting arm away from side in bent or straight position. doc appointment next week, hoping its not torn but pain has not gone away. Its 3 weeks now. Hope fading. Is surgery the quickest recovery option? Need/desire to keep skiing and am taking son on ski vacation during easter. Again, if these are symptoms of something else, any guidance, ski docs, patrollers, am resident of new york city.

 

thanks

 

post #2 of 39

Have you had an x-ray?

 

Assuming you don't have a humerus fracture (surgical neck or greater tuberosity) your symptoms are absolutely consistent with a significant cuff tear (supraspinatus).

post #3 of 39
Thread Starter 

doc apptmt on Tues, no x-ray yet, its painful, hard to say better or worse, but i think its better, on some days feel little until abduction of arm attempted, odd thing is forward extension or bent forward movement and rear, same movements no problem, vertical raise, no problem, its abduction away from shoulder, especially with bent elbow, and getting arm to be perpendicular to the side is the most painful. deeply worried since season not over and am taking my son to austria to ski! got to find a solution. 

 

these potential fractures are news to me. please elaborate if possibe. thank

post #4 of 39

You have some type of supraspinatus dysfunction:  either significant partial tear, complete tear, or disruption of its anchor (i.e. greater tuberosity fracture).  You need an xray, assessment, physio, +/- cortisone injection for pain/inflammation, +/- surgical assessment if complete rupture of the cuff tendon.

post #5 of 39
Thread Starter 

Thanks much, did some more research. What a pain, just from a fall, on hardpack though!

post #6 of 39
Thread Starter 

X-rays taken, no breaks, Doc not a skiier (he said he skis with trepidation so gave it up! ) in fact, he thinks no rotator cuff tear either but prescribed MRI too to be sure. fyi - pain has not gone away, got worse this morning...

post #7 of 39

Sticking with my initial impression.  Glad to hear nothing's broken :)

post #8 of 39

well - symptoms and length of time with pain suggest some issue, could be rotator cuff, but perhaps something else close to it.  Fact that doctor thinks it's not a rotator cuff is good - these are not a simple issue to rehabilitate or a sure surgical fix either.  The other fact that he prescribed an MRI is of concern; these are expensive procedures/equipment - and despite what you may listen to on ESPN re: pro athletes, HMO's don't give MRI's out like aspirin ("to make sure", as you put it) - it is being done for a legitimate reason.  What I don't know.

 

Wait for the test results, and report any improvement or lack thereof in function, pain to your doctor.

post #9 of 39
Thread Starter 

Thanks JD and Steve - am concerned especially the duration of pain, so MRI it will have to be but also going to see a Doc reputed;y more focused on sports injuries, referred by active pals, since not sure, this could require someone who has seen all this before.

post #10 of 39

Feel your pain. I went splat doing warp 9 down a flat groomer yesterday in new cut-up heavy wet snow. The doc-in-a box thinks I have a torn rotator, says to start with physical therapy and take it from there. All I know is that I cannot move my right arm without excruciating pain.  This on the first day in weeks we here in the PNW finally get some significant snowfall.  Keep us posted.

post #11 of 39

get the MRI, thats about they only way to see what's going on. Find a dr. who is a real specialist and understands that you a skier. Most will treat you like Joe-couch-potato so don't let them just give you the standard rehab or surgical options. Having had many sports related surgeries and injuries, including 2 shoulder surgeries and a partial rotator tear, take this advice to heart.

post #12 of 39

An MRI can be useful in the case of diagnostic uncertainty, or for pre-operative planning, but the most important 'test' is to have someone experienced examine you

post #13 of 39
Thread Starter 

Appreciate the informative and experienced observations (an experience one wishes on no one!) - waiting for MRI but have appointment with sports med expert in NYC on Monday, comes highly recommended by other wounded aging warriors who are avid skiiers. Pain is weird, does'nt go away, have stopped the Advil/Aleve intake to see how it feels - sounds crazy but am going to hit the slopes tomorrow, will try to focus on technique on gentle slopes - son skiing, and can't resist..i think you folks empathize on the final sentiment amongst others

post #14 of 39
Thread Starter 

interesting cutter, first doc did not want to advise any therapy until MRI, and of course his office staff asleep at the switch, not heard from them about appointment for MRI, also he did say, no breaks in shoulder from X-ray, and was encouraging in that he didnt think rotator cuff torn but said could be have aggravated weakened shoulder, since I play (used to, its off the menu for now) tennis at least 3 times/week and serving arm, right one often felt sore. Just curious, where is PNW, we ski at Catamount, kind of home mountain - in upstate NY, since its close and they treat my boy great, he learned there and is now considered the best kid, beyond school called Mountain Cats, started him at 3 1/2 hears and he took to it like a dolphin takes to the seas, amusing since parents not native skiiers but Dad working hard to learn, and keep up. My focus is purely technical and on improvement, no great risks, but as I have learnt, am so much better in a year, that as the speeds get higher, the risk curve is rising at a faster rate .. pretty logical

post #15 of 39

PNW = Pacific North West,

post #16 of 39
Thread Starter 

ok, MRI done, ski specialist Doc prior to MRI thought either break, or rotator cuff tear, my regular doc (ortho specialist) has to get back to me, now the MRI films are with them - waiting but here is what the written report summarizes:

1. Fraying of the bursal margin of the supraspinatus tendon

2. partial supraspinatus tear.

 

Explanations anyone - appreciated.

Thanks

 

post #17 of 39

Yup.  You have a partial thickness cuff tear.  Most of these are managed with a cortisone injection (for pain), rest/time/gentle mobilizing, and then a cuff strengthening program.  Very few get operated on, and the indications for doing so are 1) chronic pain, 2) mechanical impingement of the cuff that poses a risk for further cuff damage.

 

You should ask your ortho (and/or radiologist) to confirm that you have a 'type 1 acromion'.

 

Lastly, in our neck of the woods (Canada) most of these are managed clinically, i.e. usually the diagnosis and treatment decisions are done sans MRI .

post #18 of 39

I've had full thickness labrum and rotator cuff tears on both shoulders (I was a gymnast) and when it was time for rehab, the key for me was strengthening my upper back. Most of the muscles in the shoulder insert on your scapula (chicken-wing) so doing lots of exercises to stabilize your scapulas can do a lot to provide a steady base for your ailing rotator cuff muscles. (right side is the rear view where the rotator cuff muscles insert into the scapula)

 

 

Maybe since you don't have a full tear, some of those stabilization exercises would be beneficial now. The primary one that I did 3 sets of 15 every other day using a theraband:

 

  1. Stretch the theraband out with both hands in front of you parallel to the ground
  2. Pull back with both hands so your elbows go straight out and you make 90 degree angles with both elbows. You should feel like your trying to squeeze a piece of paper between your scapulas
  3. While holding the squeeze in the back, rotate your forearms upward so that your forearms are now perpendicular to the ground while keeping the 90 degree elbow bend (maybe even go a bit past)
  4. Slowly rotate back to the 90 degree bend, parallel to the ground position
  5. Slowly release back to both arms in front of you
  6. Repeat.

 

There are lots of other good rotator exercises, but if you're hurt, maybe the best thing is to work the muscles around it a bit for better support. Hope that's somewhat helpful...good luck out there

post #19 of 39
Thread Starter 

Thanks for the interpretation. I am waiting for the Docs. I take counsel seriously on avoiding surgery. Weirdest thing, this morning arm was so damned painful while past few days was much better. Could also be as markets sink into oblivion!

Will take note of exercises. Right now trying to keep it with minimal movement, not easy but trying.

post #20 of 39
Thread Starter 

more medical jargon on condition:

medial subluxation of the biceps; type II acromion present.

along with original partial subscapularis tear

 

post #21 of 39

I've had rotator cuff problems twice now, once in each shoulder. Both times falling snowboarding onto hardpack. What has helped me rehabilitate more than anything else has been working with a punchbag. I know this sounds weird and it felt completely ridiculous when it was first suggested to me. I asked a specialist for an explanation and it went something like this: the pain is caused by a muscle group (the one attached to the damaged cuff) tensing and pulling on the tear. In turn the pain makes the muscle tense and you get a vicious circle. When you punch it's a sharp, anaerobic jolt which makes every muscle group inte whole shoulder contract and then relax. Doing this rhythmically can get the tense muscles to fall into line with all the other muscle groups - i.e. it relaxes. Once you've got it to relax the pain goes down and the vicious circle is broken. I wondered why the force of the punches didn't cause further damage and the answer was that because ALL the muscles work together the load on the tear is not that high, in fact lower than doing a stretching exercise which is targeted towards a particular muscle group (so long as you punch with only moderate force, not all-out KO punches).

 

Anyway it has worked for me.

 

Mark

 

Mark

post #22 of 39
Thread Starter 

Folks, based on two ortho docs counsel, had surgery-arthoscopic, thursday. repair of cuff and reattachment of bicep tendon. its painful and arm pretty immobile for certain movements. thanks for good counsel on this board.

 

 

post #23 of 39
Thread Starter 

Post surgery update: its May 24, surgery to repair rotator cuff tear and detached bicep tendon was on april 30. simple warning to all, arm hurts ALL the time, going to physical therapy 3 times/week, guy is good too, focuses on pain management; laying off the percy's - i actually dont like them, but the things that work like advil are NOT GOOD for you, i.e. inhibits recovery..i'll say this, my chest was cut open twice in 10 years (Scuba diving accidents) and the recovery was MUCH faster, I FELT BETTER within days of leaving the hospital post serious chest surgery..this is ridiculous. And my Doc is a real attentive guy. 

 

Therefore to anyone considering Rotator Cuff surgery, be forewarned, its a serious b*tch..no ifs and buts.. 

post #24 of 39

I know it's of no consolation to you, but I've been through it twice.

 

Sleeping in a chair for weeks etc. Advice, do your exercises and follow the Therapists instructions.

 

You'll be as good as new in six months.

post #25 of 39

"Therefore to anyone considering Rotator Cuff surgery, be forewarned, its a serious b*tch..no ifs and buts.. "

 

dustyfog,

 

This is why I'm trying to build up my upper back and shoulders.  Trying to avoid surgery as long as possible.  So far it's working.  Works better than Vitamin M (Motrin).

 

Actually the jury is still out as to what the problem is.  Never had an MRI, just X-rays.  The OS said she didn't think it was torn but come back in 6 months if PT doesn't help.  Did the PT and it helped.  It's now three years later and it's been killing me.  MD said I have classic torn rotator cuff symptoms.  The PT I had said my chest was more developed than my back and was causing my shoulders to rotate forward and use of the shoulder irritates it.

 

All I know is that I can't throw a ball over hand, put both hands behind my back without wincing, and picking up anything heavy is out of the question.  It is always sore.

 

15-20 minutes on the bowflex almost everyday makes it feel better and I can feel my shoulders being pulled back to were they should be.

 

So for now I ride the stationary bike for my knee, then work my back and shoulders for the shoulder.  Eventually I'll have enough wrong with me that I'll be in great shape!   I've also been doing yoga on the Wii.  Mainly because with my messed up back (not related to the shoulder) I could use better posture and the balance (for skiing of course).

 

Hope you have a speedy recovery,

 

Ken
 

post #26 of 39
Thread Starter 

thanks lars and l*r, right wish i had avoided it- the surgery that is, right now anyway.

but l&r your condition sounds pretty iffy! wow!

 

lars, you'd better be right..kind of strange to not be playing tennis 3-4 times a week right now, not to mention the daily agonizing over how the f--- am i going to be able to make the esa trip with dan egan to valle nevado(well got earn a bit to afford that too!)

 

glad i did our austria trip with shredded shoulder before surgery..

 

post #27 of 39

Dustyfog, I know what you are going through. Yeah, the PT is your only salvation now, stick with it.

Half a lifetime ago I tore a shoulder tendon going over the handlebars on Claire's @ Hunta, also had a nice hyper extension. The Docs suggested rest for 16 weeks, pretty tough for a 27 y.o.Funny part was that to do my hair I would have to raise the bad arm using my good arm, but I could hold it over my head, just couldn't lift it. Lucky though, I only had pain when lifting it, not 24/7, just kind of a dead feeling.

 

You mentioned diving. About three yeas ago I had a "dive accident", class I DCS. Didn't do any chamber time, but boy did my other shoulder ache.

About a year later I started losing my golf swing, which happens, but my whole swing was going south. A few more months go by and now I have pain and can't even reach into the fridge without almost going down.

Pain was so bad and constant, that I couldn't sleep, just naps. I'm sure you have been experiencing that as well. Seems to be problematic with shoulders from what i've been told by my Orthoman.

Turns out I have necrosis of the rotator tissue and bone surface, a flat spot.

Doc says that when I want the surgery to grind the ball round again and Ti cap it, the PT will be SIX MONTHS. I am managing the pain these days, a year and a half later.

 

I take it your fall was just a simple fall, or was it a arm-out to side 'stick'? Just curious.

Oh yeah, I have given up golf and surfing due to the limited range I now enjoy. It doesn't effect my aim when spearfishing though.

I did ski with the torn tendon that winter, and it did heal up nicely.

Good luck and PT for a full recovery, Shoulders are more complex than I ever imagined!

Al

 

 


Edited by snokat - 5/27/2009 at 10:21 am GMT


Edited by snokat - 5/27/2009 at 02:09 pm GMT


Edited by snokat - 5/27/2009 at 02:12 pm GMT


Edited by snokat - 5/27/2009 at 02:15 pm GMT
post #28 of 39
Thread Starter 

hilariously positive post snokat; it was a fall, trying to avoid 10yr olds flying in to my starboard side, and trying to stop themselves, radically out of control on a mini-ridge before a steep dip, i as skiing with poles-behind-back drill, fell hard on hard pack and was p(((ed off..well rest is history.

 

spearfishing huh, is'nt that like abalone hunting, favorite carcharodon carcarias appetizer, no?

post #29 of 39
Thread Starter 
 Its now almost 3 months since repair of rotator cuff and bicep tendon. Recovery has been quite painful, first 6 to 8 weeks, was in pain constantly. Now can find positions where i feel no pain, and movement is returning quite a bit but not 100%. Yes go to physical therapy now 2x week, and move arm around and at home or at work too. Here are some questions :
1. How long till this ridiculous sensation of the right arm being an appendage goes away, its been almost 3 months?
2. When will motion of right arm return completely - can move arm as follows : swing forward and above head to almost vertical, say from arms at side, about 160degs, and this is standing, and on its on, lying down more - cannot rotate arm at full length through a 360deg circuit, weird as can rotate bent arm forward or backwards in shoulder socket
3. Cannot serve in tennis, or for that matter not sure able to hit a shot with ball coming at velocity, forehand nor backhand; Or for that matter, when sitting with both arms acting as forelimbs with weight on the ground, right wrist feels weaker than the left.
4. lifting heavy objects (often necessary or i forget) leads to pain in shoulder socket and where cuff pain was and in scar tissue knots under skin, pretty painful, avoiding painkillers now, for last 2 to 3 weeks. that's a good part as son has noticed and observes improvement, and he noticed, i lifted him out of the shower..and he encouragingly notes the recovery...great kid.
5. When will this become normal..driving me nuts, this surgery is really ridiculous?
6. The paranoia of ripping it again, have i done it, who knows, i mean, arm is kind of stiff when i wake up in the morning, not slept on it yet, but the few times i forgot to use supporting pillow, arm first thing when crawling out of bed felt like relatively painful and useless appendage and this is in the past week. How can we tell if torn again, since the pain is already there when certain movements arm does not yet like occur?
7. What are the odds of being able to go ski with Dan Egan and crew on Aug 21, 09 in Valle Nevado?

Any counsel, experience would be helpful, thanks.
post #30 of 39
More PT!!! I've been shooting hoops and passing a medicine ball, also back in the gym, did first weight workouts last week with no latent pain. I did do a 5-week boot camp to analyze my ROM.

Fog, let your Doc and PT know about your concerns. Keep the faith, December is still a long ways off.

I have  friend who busted his humurous in a freak waterskiing accident a while back. After PT he wasn't happy with his range of motion so he went and got accupuncture done. He is 100% now and heading to the World Judo Championships in Atlanta in a month, he is in his early 50s.
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