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supraspinatus tear-recovery

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  • supraspinatus tear-recovery

    I have a question.

    When you tear a supraspinatus tendon (about 2cm but still partial thickness) , does the infraspinatus muscle (or some muscle in that area) lose most (around 80%) of its strength?

    I've noticed that after some months of physio and a cortisone shot that other muscles seem not too bad now but the infraspinatus is doing nothing. Is this common?

    I've been to the ortho who has been managing conservatively, in conjunction with his physio, but has recommended a surgical repair. I've wanted to see if any further improvement happens before making a decision. He's agreed to my current decision and has ramped up the physio to see if I can get back to activities without op.

    Feeling scared about possible op, disappointed that I still can't do sport I want to do after nearly 6 months, and unsure whether lost strength is likely to return with physio alone.

    Anyone had any opinion frm your experience.

  • #2
    Hi there,

    I know exactly how you feel and I am experiencing the same thing with my injury. I did a tear of the rotator cuff almost two years ago and another one about a year ago at the front of my shoulder.

    I started physio 6 months ago and noticed significant muscle development but there is one muscle which still remains very weak and underdeveloped. I suspect that it may be common in that not all the muscles will redevelop at the same time because so many of the other muscles are used to overworking so the small muscles don't get the chance to redevelop as quickly. I'm trying acupuncture and moxibustion to try to increase the blood flow to the shoulder girdle and hope that this will help the muscles reactivate and start working again. But you have to realise that each treatment is unique to each person and that it may not be helpful for many. Acupuncture for me has helped a great deal. I think though as far as I have read in the research on rehabv that you can regain your strength but may just not be as good as it was before.

    I am also in the same position as you are in the scary thought of surgery. I am seeing a shoulder surgeon in 3 weeks time and have been managing my injury conservatively for about 6 months with the physio. I can say that my shoulder is better than what it was 6 months ago but not perfect. I think that it just takes a long time to heal and that requires patients which is something which I am not very good at. I too am hoping that I can manage it conservatively so that I do not have surgery. Since my shoulder injury is quite old, I don't think that I will regain full range of motion. I think really though, that to regain your strength after surgery is really up to you in pushing through with doing your rehab and taking every opportunity to do it. I have a friend at work who had a total shoulder reconstruction and tore her pec muscles and after surgery and intensive physio therapy along with doing her exercises at home every day she has 98% of her range of motion back.

    So really there is a light t the end of the tunnel. I feel scared too about the possibility of surgery but you know you have to think positive. That's the only thing that gets me through it all.

    Take it easy, talk more to your physio and your sports doc about your concerns and I think that it is a positive thing that your surgeon has agreed to your decision to ramp physio up and then see how you go. I think this is a very wise decision and hope that my surgeon has the exact same idea for me too.


    • #3
      Hi Ah-Oh,

      I can't comment specifically on your injury as I have a different shoulder injury. However, I can comment on physio and surgery.

      Like you I was very keen to avoid any surgery on my shoulder. I did physio for a good couple of years and also tried clinical pilates but my muscles weren't doing much. Initially my shoulder surgeon managed me conservatively but decided in the end that with more physio I was going to become increasingly frustrated, so was my physio.

      I had the surgery just over 6 weeks ago and my shoulder is already so much better. My muscles are working much better now and was the best decision I made to have the surgery done. At least I can see light at the end of the tunnel now. I should be able to play sport about 6 months after the surgery.

      If you aren't already seeing a sports physician I'd recommend going to see someone good to see if they may have other conservative ideas. Surgeons often only think about physio or surgery. Whereabouts are you based ? If you're in Melbourne I know of some good sports physicians. Make sure the physio you are seeing also specialises in shoulders. It makes a huge difference.

      Good luck with what you decide.


      • #4

        'Sorry to hear about your shoulder problem.

        A couple of comments / suggestions:

        1. has an injury to infraspinatus (or surrounding structures) been ruled out?

        2. While some people who read this forum don?t like to hear the recommendation to see a sports physician, I completely agree with KJ (also about the need to ensure that your physio is top notch with shoulder injuries). Sports physicians often see the bigger picture and are able to offer a broader range of treatment options. Perhaps a recent experience of mine will help illustrate the point. I have been having problems with my knee for the last eighteen months and had two ?scopes last year. At the beginning of this year my orthopod (one of Sydney?s best knee surgeons) told me that there was nothing further he could do and that the pain I had was caused by the Grade 3 chondral defects and early onset arthritis in my knee and I pretty much just had to live with and manage it. Being totally sick of being on the medical merry-go-round (I had a shoulder problem similar to yours immediately prior to the knee problem) and with a few other things on my plate, I begrudgingly accepted this and got on with my life. Just recently, however, I went to see the sports physician who assisted at both my ?scopes last year. He told me that he thought the bulk of my knee pain was not from the defects/arthritis but from fat pad impingement and that this could be addressed. (He also said that orthopods often don't recognise this). He got me in to see a physio who specialises in patellafemoral pain (lucky for me a world leader in the area) within a week (if I?d rung myself I wouldn?t have got in to see her until August). She confirmed that I had ?a horribly inflamed fat pad? and in the first session ? a bit of testing and a bit of taping ? reduced my pain by 95%. For the first time in eighteen months I can walk without a limp (almost) and ride a bike without pain and my knee no longer feels like a rusty gate. I am stoked!

        The morale to the story ? don?t assume your surgeon knows everything, ensure you are seeing an excellent surgeon and an excellent shoulder physio and go and see a sports physician who specialises in shoulders for another opinion. If the final conclusion is to have the surgery, then go ahead and have it (I got a small full thickness tear in my suprasinatus tendon nearly three years ago and was on the borderline for surgical repair. We decided to manage it conservatively but I sometimes wonder whether I should have gone for the surgery, the shoulder still gives me grief)


        • #5
          I also agree with KJs and Jelly beans comments in that it is important to see a good sports doc who specialises in shoulders and also physio who works with people with shoulder injuries.

          JB welcome back haven't seen u around for ages.


          • #6
            Thanks for replies. It's all really helpful.

            I am in Sydney so a couple of good (shoulder) sports physician contacts would be good. You can send me a private message if preferred - I don't really like mentioning names myself on this ste (although I find it really interesting seeing what other people have said when they do mention names).

            Jellybean, the physio I'm seeing works with a couple of shoulder orthos and I've heard good reports of both ortho and physio.

            I'll check the MRI report but am pretty sure the infrasp.. was ruled out which was why I was initially curious about the total lack of strength in that muscle.

            I'm tending to think that the improvement has sort of stopped now that the cortisone has run out and hence my quandries for long term outcomes.

            Ortho has said that if I was 70 he would recommend it be managed conservatively. However, given I'm still reasonably young-ish (40's) and like to compete in a couple of sports, long term management/outcome should be better with a repair (given statistics, his experience, and the recovery I've made to date doing physio - ie not as much as he'd hoped). Similarly to you kjwilkin, my ortho also mentioned the reality of ad infinitum physio in management of my injury and outcomes.

            Even if I'm not able to compete, I'd like to be able to continue an active life - I've got a good 25-30 years at least (I hope) doing these sports (obviously at increasingly punter level) - we're an outdoors family and I want to be able to actually still do stuff.

            I'm quite willing to look at other sports if I can't continue my preferred ones (water based needing upper body function). But like many others on this site, I've got another chronic injury (back) which I manage daily with specific exercises. This is long-term management that has worked really well but does cut out running/high impact type activities unfortunately.

            Have another appointment to see ortho in about 4 or 5 weeks. So will see. Won't do anything until the ski trip has come and gone though - cross country - so hopefully no heroic stacks but will have to see if range of movement allows for happy skiing - should be OK I think will take it easy.



            • #7

              'Apologies for the delay in replying ....a little bit busy!

              Angie - thanks for the welcome back! Lots of reasons for not being around - things are crazy with work, travelling alot and was a bit over everything medical - needed a break for a while. Will PM you.

              Ah oh - I'll also PM you the details of the sports physician I saw in Sydney (Crows Nest) - I found him excellent and will have no hesitation in going back to him. [I can appreciate that everyone's different but I think it's unfortunate that alot of people have stopped publicly naming who they see and providing contact details - it provided a quick and easy way of identifying people to see. Forum visitors who, for whatever reason, don't like to post or send PMs now don't see that info. But c'est la vie].

              Re your infraspinatus (or whatever is not functioning) - have you asked your OS or physio about this? MRI's don't always tell the full story. (I know both of my knee MRIs last year understated the real damage).

              'Know what you're saying about maintaining an active life - I'm also early 40's and normally very active. I now have to avoid any upper body based exercise because of my shoulder but there's plenty of other options! No matter what injury or injuries you have, there'll always something you can do to keep active (my challenge last year was finding some useful activity with a shoulder and knee injury. Until I could get back on the bike, I found swimming - using a kickboard and fins, no arms - kept me active).

              Consider another opinion and see what your OS says at your next visit. Enjoy the ski trip! Wisely or unwisely I am also hoping to go skiing (downhill) later in the season.

              Good luck!




              • #8
                Its Great Reading That You Are Back Leading A Near To Norm Life After The Injury You Had. I Am 47 And Still Think That Keeping Active Is Really Import For Mind And Well As Body . Can Hardly Wait To Get To The Same Stage As You Are. My Susp Tendon Is Hesitant N Moving With Hand Upside Down Just Hope It Improves With Time. That Is The Way I Had My Hand When I Sustained The Injry Just Hope It Frees Up With Time. Your Post Gives Me Confidence That Things Can Get Back Near To Norm


                • #9
                  Hi All, I haven't posted for a while either..due to work and just dealing with the pain of a frozen shoulder. I have been to the sports physican everyone recommends on this site and he's confirmed SLAP tear and then frozen shoulder. I had a cortisone injection and the results lasted for two weeks..then I was in constant pain. Now taking oxycodeine and MS contin... nightmare. Anti inflamatories do nothing. Just wondering if anyone else with frozen shoulder has any ideas on pain relief. I am doing gives some limited relief and phsyio, the guy who specialises in shoulders in north sydney oval... it's moved some..but the pain is still intense. If anyone has any pain remedies I'd be all ears.


                  • #10
                    Had a frozen shoulder about 4 years ago and found bowen freed it up quicker than accupuncture = but everyone is different. You have to get a bowen therapist that just doesn't pussy foot around though. Mine went on 18 month leave once and I tried 3 others who didn't achieve a thing. I have this treatment every 2 to 4 month even if I feel ok because modern medicine and me dont mix. I was so pleased when he returned. Also try hydrotherapy pool. Its amazing how much lighter shoulder fells under water. Good luck. If you want the name of bowen therapy man let me know. I have been going for 12 years now and only had 3 days off work unil my shoulder injury spoilt my record and added 6 months onto that. Hope it is improving!