supraspinatus tear

I'm confused, after having an ultrasound and an x-ray, I was told that I have a complete tear of my supraspinatus, but I have good rotation, and good ROM with very little pain, it's more a deep acke then a pain, with alot of swelling in the front shoulder/chest area, that my colar bone is not seen
(due to swelling). I have been receiving therapy from the first day I felt the pain ,at that time I had no ROM. It is 8 months later. Should' nt I still be having great pain ROM and have little to no rotation. I just had an MRI awaiting results. I do have aching/pain in the shoulder joint, along the top of my shoulder and down my arn to my elbow. I also have some discomfort in the back of my neck.

HI ;

I think in case of complete tear there will be no pain or little that is true . The supraspinatus is more for abduction motion ,and rotation could share in it more than one muscle .

Why the Orthopedist whom assessed you did not choose to deal surgically .

Cheers
Emad

If you are not an active individual then you might be able to live your life without the use of your supraspinatus. But, since evey individual is an athlete you should at least visit another orthopedic surgeon for a second opinion and find out about surgical options. In the mean time, physiotherapy and manual work will reduce the amount of scar tissue build up allowing a better result with surgery and quicker rehabilitation. But why you waited 8 months after the initial diagnosis I'm not sure of.

Good luck

Is it a "complete rupture" or merely a "full thickness tear" ?

Thanks for the info... To give a litle history,
I was involved in a car accident in June 2006, that's when I injured my shoulder. Waiting 8 months is the waiting time. After complaining of the discomfort/pain, an X-ray was done pretty quickly (about 3 weeks). It was identified that there was a seperation/tear/ and clavical displacement. All this time I had been going to physio and receiving treatment. Finally after much complaining of not getting any better with the ache/pain an ultrasound was ordered this took about 6 weeks to get. It was then seen that the tear involved the supraspinatus. I was told that it was a complete tear, then I was referred to a surgon. This took 4 months to get the initial appointment, the surgon felt that an MRI was necessary. This took 3 weeks to get. So now here I am 8 months later with nothing done to repair the injury, and waiting for the second visit to the surgon for him to tell me what was seen on the MRI and hopefully to schedual the surgery. MRI was on Feb. 21/07. I will not get a recall visit for at least 3 weeks after the MRI.
Our medical system SUCKS!

The swelling and chest pain is due to the clavical separation. I wonder if you had a fracture that was missed. A bone scan would be able to pick that up. The pain that you describe in your arm and neck are typical of rotator cuff injuries. You will need the tendon repaired if possible - it may be complicated by the clavical displacement.

Although the Supraspinatus is an integral part of the rotator cuff in its role in initiating movement, you can function with a full tear. However most commonly I find a lot of people then suffer secondary symptoms where the surrounding muscles start to give a little too much of themselves and trigger points develop and effective shortening of the muscles occur. The Upper Trapezius fibres and Pectorals tend to be prone to this. After some time pain and shoulder complex dysfunction come into play.

If I was your Physio I'd start by dealing with any trigger points in all the prime suspects (and there are a few!). There are several effective techniques, such as acupunture, TP release, myofascial release. Posture correction is appropriate as is ensuring good Scapula control. Then you can start to look at (cautious) strengthening. If you're into doing weights I'd also be careful in not overloading the muscles you've had released. Loss of form and technique, and early fatigue in the shoulder are good pointers.

Ultimately it could be a stop gap and surgery might be the only answer. Have a look shirtless in the mirror. Does your shoulder roll forward or does it look like the 'ball' of the joint has dropped? They both [I]could[I] be an indication of bad the situation is.

All the best with your future treatment,

Sweens

Hello sweens,
"TP release???" Sorry, but I am not familiar with that abbreviation. Could you please explain what it is?
many thanks!

Why are we going to use trigger point release therapy inspite of no pain ? He says very little pain meaning no active triggers there . What are we going to release ?

Cheers
Emad

The complainant did say he had no joint pain but did mention aching in the muscles surrounding the shoulder complex as well as some referred pain into the lower arm. This could be caused by inflammation in the joint granted, but it could indicate some active trigger pts not already assessed or found. Personally I would be surprised if there were none as he/she mentioned the injury is now 4-5 months old.

I just think ruling out all objective findings would be the way to go. My comments were based on the importance of a thorough subjective and objective assessment.

Sweens

hi sweens ;

I think the issue of Trigger point therapy still needs research to support ,sometimes i see triggers as just sensitive neural areas/spots .Just my view .
As for this current shoulder case , i think practical assessing of this case is important ,because we can NOT assess the passive abduction if it is available or not to conclude the tear hypothesis ,because pain sometimes may be severe around shoulder that the motion could be thought of as paralysis or tear .

Cheers
Emad

hi its high time u r going for MRI after 8 long months.its ok then, u said x-ray shows clavicle separation. ur symptoms & x-ray corelation shows u hav AC JOINT SEPARATION. just check with ur ortho surgeon to rule out it.
there r diff grades 1,2 ,3. urs may possibly maybe 2 r 3. even if its 2 r 3 dont worry it can be made alright.do reply after MRI result ;)

In youngers, in case of complete tear of supraspinatous operation should usually be undertaken to suture the rent in tendon. Thereafter, passive movements may be begun within few days but attempts to lift arm actively should be deferred for four weeks (sometimes for 6-8 weeks). The results of operation are not uniformly satisfactory, probably because of the poor quality of degenerate tendon.

In olders operation should usually be avoided because degenrate state of tendon make satisfactory repair impracticable. The disability tend to become less noticeable, and indeed the power of abduction (by deltoid alone) may sometimes be regained despite the persistence of large tear.