Rotator cuff tendinosis, possible tear

Hello,

I'm an active woman in my mid-50s. I'm a cyclist and go to the gym (weight room, treadmill, spin classes, etc.) 3-4 days/week. I'm a typical middle-age woman just trying to get stronger and stay in shape.

In mid-Sept. I lifted my arm to the side to open a cupboard in the kitchen, and suddenly noticed a moderate pain about 4 inches below the top of my right shoulder (I'm right-handed). I did not feel or hear any snapping or any ripping/tearing pain at that time.

I stopped doing any arm weights at the gym and rested it for a month.

After 1 month of no improvement I went to an ortho doc who took x-rays and did ROM tests, then told me I have RC Tendinitis. He said to take anti-inflammatory 2x/day, don't lift my arm to the side or do anything that causes pain, and return in 1 month.

After another month (now 2 months after onset), I felt no improvement and asked for a referral to PT. I began PT in late November doing gentle stretches and resistence bands or no weight at all. After 8 weeks of PT 2x/week + exercises at home, there is still no improvement.

The PT believes I have tendinosis (NOT tendinitis) and an RC tear. I'm waiting for an MRI appointment next week, and scheduled an appt. for a second opinion with another ortho doc (shoulder specialist) in early January.

The pain occurs mostly when lifting my arm, occasionally (a little) during sleep, and feels tender just below the bulge formed by the deltoid muscle at the top of my arm. When I press on it, it feels like a large internal bruise (however, there is no bruising visible). When I lift my arm in front of me or to the side, the pain is sharp and at times feels like a tearing pain. After days of rest, the pain subsides and feels duller, but then any activity (including the PT exercises I do at home) seems to aggravate it again. It usually doesn't hurt while I am at rest except for an occasional throb.

Meanwhile I have observed the following:

• There is NO improvement after 8 PT sessions which include heat and deep massage.
• I feel much less pain after skipping the exercises for 1 or more days.
• The exercises (any exercise or activity that uses the arm at all) aggravates it and causes more pain, not less.

I am trying to schedule an MRI next week. Meanwhile, we are still going on the initial diagnosis, but without the MRI we don't really know what we're working with. The PT is as perplexed and concerned as I am.

Do these symptoms and the pattern sound familiar to anyone?

If there is tendinotis there is an inflammation and anti inflammatory drugs and rest will make you feel better. If there is tear of RC then doing exercise or doing massage and heat will not do anything.
and if there is tear, which will cause inflamations and you do not want to heal it or doing massage. those will make it worse. you need to ice it if there is inflammation.

you might have a partial rupture

I would like to hear from you after the first MRI appointment.

Thank you very much for your reply.

That explains why I have much more pain after doing the exercises, no matter how gently I do them. Taking a few days off (actually, forgetting about them during Christmas and other things going on) I noticed the pain is much less. It still does hurt a LOT to lift my arm in certain directions, or to lift things with that arm, and I feel more frequent pain in the upper regions of the arm now (the primary pain site is about 4 inches below the top of my arm).

I was given a DVD of the MRI to give to my referring doctor. But first, we viewed it on our home computer --- of course can't determine anything with our untrained eyes, but I noticed numerous white spots around the joint.

If I have a partial rupture, wouldn't I have pain ALL the time?

Not necessarily, you may only feel pain when you use or try to use the muscle / tendon that is injured. The tendon may have many micro tears, due to overuse and unfortunately occurs more to those mature in age ! (sorry!)

Do you have trouble sleeping on that side ? Pain sleeping on the affected side indicates a RC tear (supraspinatus muscle, responsible for initial lifting of the arm up to the side). This muscle attaches on the arm (at the area where you complain of pain).

Tendinosis of the supraspinatus muscle is very common, there are exercises to help (called eccentric exercises) however they are aimed to cause an inflammatory effect (ie pain, swelling etc) but research and evidence shows that this is actually productive. It causes an increase in cell activity which actually aids recovery.

I was shown....and used this technique on a patient with severe OA recently. The exercises caused him slight pain but only while we did them. Within a week he could lift his arm and was pain free (in a community hospital in UK with daily PT).

I can't say that this is the same injury you have.....as it's almost impossible to diagnose injuries without doing a physical examination. Just thought you might be interested.

Be careful with doing eccentric exercise without being properly diagnosed

she says, pain A LOT and that means unusual. I originally thought she has a pain while resting.... but she doesnt? still it can have a partial rupture and not have pain at rest.

By the way, have you ever stretched the area you have pain? does it get worse right after stretch or after 30 min? if it get worse, there is inflammation going on.
if it does not get worse after 30min or so, rather improves, there is a chance that specific stretch can reduce pains. if there is no tendon, labrum issue, you can get better in few visits. and you will know that treatment is working on the spot. heat and deep massage can stimulate receptors and sometimes you feel better on the spot but pains come back quickly ,meanioung that treatment is not working. or do you get worse on the spot right after heat and massage?
by the way, can you use your unaffected side of arm to raise or move your affected side and not to have pains?
i do not recommend to do any painful exercise without having properly diagnosis is done.

Taiger111,

If you had read the bottom of my post I stated -

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I can't say that this is the same injury you have.....as it's almost impossible to diagnose injuries without doing a physical examination. Just thought you might be interested.

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I wasn't recommending RiderJen to do the exercises (I'm a 2nd year student so my experience is very limited).....merely trying to be helpful by explaining rehab options and what I have personally seen.

Thank you all for the replies. I'll reply later with more details when I have a few more minutes.

OK, this is what I have heard and read (including here) over the past weeks:

I could have tendinosis, a partial tear, a full tear, or partial rupture. Exercises may help by strengthening the muscles to allow the tendon to heal; or they may hinder and impair healing. Inflammation is good, and it is bad. Massage is good, or not good.:eek:

I'll clarify things a little -- I don't expect you to diagnose it for me. :)

-- The primary pain site (about 4 inches below the top of my shoulder) has not improved at all since day 1; in fact it is a little worse, and I think the type of pain has gone from dull to sharp/tearing at times.

-- The primary pain site almost never hurts at rest, but occasionally throbs at rest.

-- It hurts a little when I sleep on it; I am not supposed to sleep on it but if I roll onto it in my sleep, I think it wakes me up after an unknown period of time, though the pain is not very bad.

-- I also now have noticeable new pain in the front of the shoulder.

-- Starting a couple of weeks ago, I've noticed some popping in the shoulder when I sometimes move it

-- Deep massage is very painful

-- By "A LOT" of pain, I mean when when I lift my arm to the side or a couple of other directions, it is very painful. When at rest, I feel only minor throbs in different places of the upper arm and shoulder.

Hope this helps. ;)

ok..... i am not gonna diagnose but...... Doing any exercise or Deep massage wouldnt make any senses to me. Poping sound indicates that shoulder is unstable and shoulder is supported by RC or capsule.
Pain like throb is indicative of a rupture of muscle, tendon, labrum in which case surgery is required. I have my friend going through surgery that orthopedic recommends after having seen MRI.
In MRI it was not clear that rupture or labrum damage. During surgery it was found that he had a partial rupture of bicep tendons and labrum tear. All of things that i have read through comments from others and yourself, isnt it better to rest(no exercise or deep massage) until you meet several ortho? ALso, A very good Active Release Techniques Provider(pin point stretch) who is in Sport chiropractic field can diagnose it. They deal with sport injuries alot and have their ortho physicians to refer out to rule out any conditions such as this. If you allow me I will post your comments on ART website.
thanks

Sure, go ahead and post on ART site - I'm open to any input.

I believe the PT exercises and deep massage were based on the diagnosis (from my referring ortho doc) of "rotator cuff tendinitis". The PT and I believe it is at least tendinosis since it hasn't healed, and he believes there is a tear -- but he is following the orders of my referring doc.

The PT referred me to a sports ortho doc whom I will see on Thursday.

Meanwhile, I am caring for my mom (age 80) who is in the hospital with a bulging L3 disk and has a lot of pain in her hip and leg (Spinal Stenosis with radiculopathy). She's improving every day and hopes to go home later this week. I haven't told her about my shoulder (since I don't know the MRI results) and I'm sure this additional activity isn't helping, but caring for her is my priority at this time.

And thank you again for all of your input! This has been very interesting.

Coincidently, my brother is recovering from rotator cuff repair surgery done in Oct. He had a full-thickness tear that could not be fixed; he also had a retracted tendon (fixed), tendinosis (fixed), bone spurs (fixed). He's still doing PT and wearing the sling. He's 1 year younger than I.

Oh, also.... it's hard for me to believe that even a partial rupture wouldn't have a LOT of pain ALL the time, even at rest. Just expressing my thoughts, not disagreeing with anyone. :)

A very interesting discussion here - and a typical shoulder case - very difficult to diagnose. We don't really have any specific test for the different lesions of the shoulder. The testing we have cery often test for two or more lesions. Your frustration is understandable. You must have at RC lesion ++ - even a partial lesion will have improved after what you have done to it. Spontaneous lesions like this happens, but are very difficult to isolate. The white spots you describe on the MRI could be liquid as a sign of inflamation. If you have a lesion, you also have an inflamation. You most likely will need some kind of reconstruction. Good luck

Thank you. Yikes. By "RC lesion ++", do you mean multiple RC lesions? And by lesion, do you mean tear? When I see the word lesion I think "growth". One more day to wait --- tomorrow I'll get the MRI results.

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Originally Posted by Perbast

A very interesting discussion here - and a typical shoulder case - very difficult to diagnose. We don't really have any specific test for the different lesions of the shoulder. The testing we have cery often test for two or more lesions. Your frustration is understandable. You must have at RC lesion ++ - even a partial lesion will have improved after what you have done to it. Spontaneous lesions like this happens, but are very difficult to isolate. The white spots you describe on the MRI could be liquid as a sign of inflamation. If you have a lesion, you also have an inflamation. You most likely will need some kind of reconstruction. Good luck

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Quote:

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Originally Posted by RiderJen

Thank you. Yikes. By "RC lesion ++", do you mean multiple RC lesions? And by lesion, do you mean tear? When I see the word lesion I think "growth". One more day to wait --- tomorrow I'll get the MRI results.

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No - I did mean that chances are that you do have a lesion - having said that, isolated lesion are rare. I prefer to paint a realistic picture and have you discover different with the MRI - good luck today

I have a "blister" or ball underneath my skin, just behind my clavicle, after a rotator cuff tear. Does anyone know what this is? Will it clear up?
Thanks

Hi, I am new to this forum and was hoping to find someone who suffered from tendinosis of the shoulder. I had a labral repair nearly two years ago, followed by manipulation under anesthesia (three months afterwards) and 12 months later had a third surgery because the surgical achor had come out of the labrum and caused some damage to surrounding tissue.

My shoulder only had normal surgical pain for the first 4 weeks and then I developed severe gnawing/aching pain in the shoulderblade area and ungodly shooting pains down my biceps all the way through to my wrist. The removal of the loose surgical anchor relieved the shooting pains, but I still have gnawing pain of a "4-9" on any given day.

The MRI done about a year ago (before the final surgery) showed I had tendinosis of the infraspinatus and supraspinatus. I quit my job as an ICU nurse and rested 6 months, I even stopped doing aggressive PT and only did light stretching and minimal PT (on advice from MD/PT). I generally do not experience "pain" when performing my excercises, but after I stop the pain becomes intense. The pain also might be described as how a bad rug burn feels about 30 seconds after the initial ripping off of skin.

This whole experience has been very frustrating for me. I have had to change jobs and alter my very active athletic lifestyle due to the pain. I have done intensive therapy for almost a year straight and now I have rested for almost 6 months and seem to have nothing to show for it except my left shoulder is now impinged. I have started PT for both shoulders.

I don't feel like my shoulder should be this painful. I am assuming it is caused from the tendinosis? If anyone has any thoughts, or been through something similar, I would appreciate hearing what you have to say.