Differences in male/female recovery from rotator cuff injuries

[sickshoulder30]

I'm a 30 year-old female, recreational athlete. About a year ago, in March 2012, I took an awkward spill and messed up shoulder pretty badly. I tripped while doing sprints and was airborne before I landed arm-pit first and hyperextended my left (nondominant) shoulder. Luckily, I think only one person saw from across the street.

Luckily, nothing was broken. The results of my MRI arthrogram with contrast from July 2012 showed:
1) Partial thickness tear of the supraspinatus tendon
2) Rotator cuff tendinopathy
3) Humeral avulsion of the inferior glenohumeral ligament (HAGL) with a note that this diagnosis was unclear, because the contrast leaked which may have been due to a vigorous injection (A.K.A. a mistake by the postdoc fellow who gave the injection) that would mimic the appearance of HAGL.

So far I've tried rest, ice, ibuprofen, 3 months of physiotherapy (PT), and cortisone. After I finished PT in June, the pain was way down and I had made a lot of progress. Then I overexerted myself doing a lot of heavy lifting when I moved to a new apartment, which lead to the MRI and cortisone injection in July. All of those methods provided a decent amount of relief up to a point. I still do my PT exercises 2-3 times per week and I've regained a good amount of strength and range of motion, but I stopped making progress a couple of months ago.

After the MRI, the orthopedist said he wasn't recommending surgery because the tear in my tendon was small and he didn't feel I had significant instability. He said the pain I was feeling was from inflammation due to overexerting myself. He was confident that I had gotten everything I could out of 3 months of PT and could go back to my normal activities. He said that by the time the cortisone wore off, the inflammation would have resolved, which ended up being accurate. He didn't suspect that I had the HAGL lesion because it's a common false positive in MRI's, it's an uncommon lesion, and would be unlikely based on my age and physical exam.

I can do pretty much everything at the gym and yoga that I was doing before my injury without pain (even 3 sets of 3 pull-ups). The things that continue to hurt are minor tasks: putting a purse strap on my injured shoulder; folding my arms across my chest; reaching forward or down with my left arm; and leaning on my elbow, shoulder, or scapula of the bad side. I frequently feel like my shoulder blade isn't connected properly. Sometimes my bad arm will just give out or stop working, but I don't feel any pain when this happens. It's very easy to aggravate my shoulder if I overexert myself and then I have to rest and ice for 1-2 weeks. I don't really trust my shoulder, which leads me to hold back on certain things, like holding babies after a close call with my 2-month old nephew.

The last time I saw the doctor was 8 months ago and I feel like I have a greater understanding of what's going on with my shoulder now, so I'm anxiously waiting for my next appointment in 2 weeks. At first I was impressed by my orthopedist's credentials, he's a shoulder specialist and team doctor for a local professional sports team. Now I'm wondering if he's the best choice for me since I'm being compared to male pro athletes. I imagine that men who make a living from overhand throwing could present with pretty severe instability compared to a clumsy female who hurt her shoulder falling. Wouldn't a woman of average height, weighing 54 kg, have a smaller tendon than a 90kg+ male, professional athlete? Relative to the size of my tendon and my muscle mass, I would think that a <3mm tear and "minor" instability might have a greater impact on my activities of daily living.

Does anyone have any advice for questions I should ask at my next appointment? Can anyone recommend some good resources for reading about recovery from traumatic rotator cuff injuries that are specific to adult, female, non-professional athletes? I'd be especially interested in reading things from the physiotherapy perspective. I'd also like to hear from people who have had experiences with both conservative and surgical treatments for traumatic rotator cuff issues to help me come up with my own list of pros and cons. How did you make the decision? How did you feel with the outcome? Should I give it more time to heal before considering surgery? Would another round of cortisone and physical therapy make a long-term difference or will I probably end up getting surgery anyway? Should I learn to accept my shoulder the way it is? The orthopedist still hasn't recommended surgery, so am I just thinking of the worst-case scenario?

Thank you in advance!

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[physiobob]

Interesting that your diagnosis included

2) Rotator cuff tendinopathy

which is a chronic condition, probably something that has gradually been creeping up on your for yrs. The injury and subsequent MRI should be assessed for what is 'Fresh' and what is likely to have been there already. It does should though that your AC joint might need some tweaking and possible the next to get some more long term resolution of symptoms. A partial tear though with associated tendinopathy is not something I would have injected at all. In my opinion that is likely to result in further degradation to the tissue and less likely to assist tissue healing.

Rotator cuff injuries take a long time to heal, especially supraspinatus ones. This could take 12-18 months for full pain free, non-restricted range to return. Forcing it or heaving working out when that is not the case is something I would avoid. As they say in the UK, 'Keep Clam and Carry On'! :-)