Might Not Work (rotator cuff surgery)

by Sharon

I've been told that I have a torn rotator cuff. I will be starting on my second set of PT within the next few days. The first PT was under the impression that all that I had was a sore and stretched out bicep.


Now I'm told, after having an MRI, that there is a tear. I'm to have 4-6 weeks of PT, and if there is no improvement then they want to do surgery. Thing is, I've been told that the surgery might not work. I'm curious on what you can tell me about this? Everything I've read seems to say that recovery is very possible, though time consuming.

I was injured in a fall back in October of 2007. The first set of PT was in December. That lasted for 8 weeks. I'd had an x-ray in November but did not get an MRI, until April of 2008.

Could you explain to me why you think the surgery might not work? Also, why do you think they waited so long before having the MRI?

I've got a consultation with my doctor next week, but I'm curious and want information now. I hope you can help me.

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Jun 14, 2008
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Think Positive!
by: Bart - SII

Great questions! First off, who has told you that the surgery might now work? Your physician, your PT, friends? I only ask because many times doctors will give the "worst case" scenario - ie. the surgery may not help - so that you are prepared for any result. With that said, rotator cuff repairs are generally successful, although there are a lot of different things that help to determine their success.

The size of the tear is usually the primary determining factor of how well a repair works.

Rotator cuff tears are classified as full thickness or partial thickness...this means that the cuff is either torn partially through, or all the way through as you go from top to bottom. In addition to full thickness vs. partial thickness tears is the size of the tear...this is usually measured in centimeters - tears less than 2cm are generally repaired successfully - as the size of the tear goes up, the success rate goes down - but not substantially.

Other factors that will contribute to the success of the surgery include how closely the post-operative protocol is followed - did the arm remain immobilized for a proper amount of time; was rehab progressed appropriately to allow the tissue to heal; was attention paid to the surrounding shoulder muscles and scapular stabilizers during rehabilittion.

Your activity levels after surgery are also a factor. Are you trying to get back to lots of overhead lifting or throwing, or just normal daily activities - the higher the demand, the more likely you will notice some impairments.

Overall, rotator cuff repair can be successful if your surgeon is experienced with this type of surgery, if the rehabilitation program is followed all the way through, and you are patient with your recovery.

I always like to give my patients the "best case" scenario based on my evaluation, and then tell them all of the things they MUST do in order to achieve that success. Other clinicians will give the worst case.

The majority of rotator cuff repairs that I have seen have had a very good recovery.

As far as why they waited for the MRI - it is standard practice to attempt conservative treatment for rotator cuff tears before surgery, unless there is a significant loss of function or extreme pain - typically 3 months of rehabilitation is undertaken before surgery is considered...this is especially true with partial thickness tears.


Jun 14, 2008
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Continued response
by: Bart - SII

So, upon your initial injury in November, your physician sent you for rehabilitation to see how you responded. You didn't progress, so the next step is to order an MRI (most of the time they will try to avoid an MRI because of its expense). I wouldn't fault your physician for not ordering it sooner - rotator cuff tears can often be mistaken for other types of injuries - the shoulder is a very complicated joint.

Make sure you discuss all of your options with your doctor when you see them - some things to ask about include:

Did the MRI show how large the tear was - partial or full thickness?

Do they do rotator cuff repairs as an open or arthroscopic procedure?

Will they use a pain catheter for post-operative pain modulation?

How long in a sling?

How long before returning to work?

When to start rehabilitation?

Normal time for a full recovery?

These are just a few questions you may want to have answered.

Hope this helps - please comment back if you have other questions.


Jun 14, 2008
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answers
by: Anonymous

An answer to your questions. The Ortho doctor told me the surgery might not work. If I remember the reason it was due to the muscles being atropied in the shoulder, along with fat moved into the space. I'm thinking that my age might have something to do with this. I'm 50 yrs old, and female and obese.

I have to admit, for my age and weight, I'm pretty strong, and I know how to lift and do a controlled drop. They didn't give me much info on the tear.

While I was going PT the first time,the therapists were puzzled on my injury, as I was able to do most of what they asked. They felt it was in the bicep and not the rotator cuff. They were really puzzled about the way the arm would lock up when the elbow was held tight to my side and cocked to do an over head lift, with as little as 2 pounds.

I'm wanting to get back to as much of my activity level as possible.That means,lifting over head, or from the ground. It's only in that one particular position of my arm is when I can not lift.

Thanks for the information on the MRI. I was concerned about doctor or even myself with negligent follow thru.

I've written down all the questions you've given me and I will be sure to ask the doctor when I go next week. Big thanks, you've taken a load off my mind. I was seriously concerned about negligent care from the doctor or from where I work or even from myself, for maybe not pushing for the appts. with the doctor, being so far apart. Also that I MIGHT not have been serious about doing my home rehab.

Now I need to discuss with my job to see if they want a second opinion, how they are going to handle my recovery if I DO get the surgery, if I'm even able to work while I'm doing the rehab.

That's a big problem. I currently have weight restrictions at my job. Yet, it's almost impossible to do my work, without going over the weight limit. Which by the way is only 15 lbs. I DID work while doing the previous Rehab, but now that we know what's exactly wrong, they might want to handle things differently. Also, if there's any chance of reinjurying myself, then of course I don't want to, or they aren't going to want me to continue with that line of work. Which is a bummer in of itself, as I enjoy working at this job.

Which by the way is a country store at a dairy farm. Finding me something else to do, would probably mean a loss in pay, or other responsibiites.

I do enjoy handling the visitors to the dairy. We do have an ice cream bar, but what's funny about that, is this type of work, ACTUALLY makes my arm hurt more than the lifting I was doing in the store. Funny ha ha. Who'd think scooping ice cream would make the shoulder or bicep area of my arm HURT!

Big thanks for all your answers and the questions I should be asking my doctor, and also ones that I should be asking my job.

Thank you for your time.

Jun 15, 2008
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Be encouraged! You have alot to do with how successful your surgery is!
by: Anonymous

I first injured my shoulder in July of 2007. When I got to where I could not lift over my head, had difficulty getting dressed or combing my hair. I finally went to the doctor. I was in severe pain all of the time. My doctor did an MRI right away but I think this is because I could pinpoint exactly when I injured it and how I injured it...by lifting something at an odd angle.

Because the shoulder can't be frozed for surgery, he ordered 3 months of physical therapy first. The therapy is the key in my opinion. They were able to get my shoulder unfrozen so that I didn't require a manipulation to unfreeze it before they fixed the problem surgically. My doctor actually waited another 3 months before doing the surgery (because I was still recovering from chemotherapy).

The surgery was done in March and of course, another 3 months of therapy began almost immediately. My shoulder has not felt this good in almost a year. Therapy by the therapist is no longer required. I have about 90% of my range of motion back and my arm is very weak. But I keep doing my at-home exercises daily and I can tell it is getting stronger and my range of motion is improving. My therapist recommended I continue the at-home therapy for a year if I wanted to get the full function back which I will do. I can only lift up to 1 lb with my left arm, though with certain strengthening exercises, I'm told I'm getting up to 25 lbs of pressure. Though I could never do that much with just my left arm. So be careful about the lifting, because if you reinjure it, they may or may not be able to fix it.

Mine was a near full thickness tear of the supraspinatus with just a few fibers clinging to the bone. I have osteoporosis and the first anchor they put in fell out during surgery so they had to reanchor it with a larger anchor. All that and I am doing great! Well on my way to a full recovery!

If I can do it, I know you can too. Good Luck!

Aug 18, 2008
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more update on might not work.
by:

well,

I'd lost the link to this forum, so wasn't able to get back and inform what's been going on.

I've had the reavaluation from the second doctor. The doctor felt that this was an OLD, tear, and that surgery won't work. They also feel that the only alternative is physical therapy. I just found out this information over the telephone and need to call the evaluating doctor tomorrow.

I've read that rotator cuff problems can sometimes NOT be repaired. Yet, how can all of this pain be from something that's supposed to be from an OLD TEAR? I've had very little pain before the bad fall. I know, I know, I've also read that you can go for years and not know that you've got a tear. Yet, what's causing all my pain and weakness now?

Guess I'll have to wait to hear what the new doctor has to say tomorrow. Now I'm concerned that workmans comp isn't going to pay for this. No doubt that I got hurt on the job, but can a prexisting conditon be exempt?


Aug 18, 2008
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update on might not work
by: Sharon

oops, forgot to ask,

ok,

if they won't do the surgery and the therapy doesn't work.

WHAT THEN?



Aug 18, 2008
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Sorry to hear...
by: Bart - SII

Sorry to hear about your recent evaluation - it is true that the older the tear, the less likely it can be repaired successfully - but, it still seems to me that there could be something done surgically to try to alleviate your pain.

As far as why you are having so much trouble...
The rotator cuff is there to help keep the humerus centered within the socket when you move your shoulder - without these muscles working properly, you get excessive movement of the humeral head, which leads to impingement, pain, and loss of function. So, since your cuff is torn, it means it is unable to do its job. The goal of therapy will be to train the surrounding muscles to take over the job of the rotator cuff to help keep your humerus centered and reduce your impingement and pain.

If therapy doesn't work, then surgery may still be an option, perhaps not to repair the cuff, but to clean out the shoulder and try to get it as close to normal as possible. And it is possible that the tear could be repaired - you can't know for sure until you get inside and see the extent of the tear.

Cortizone injections are another option, which you may have already had done, I am not sure. These can sometimes eliminate pain and allow for improved function, but often their benefits are short lived - several weeks to several months.

Keep us updated on how your visit with your doctor goes.

Bart

Aug 19, 2008
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update on might not work
by: Sharon

Thanks Bart for the quick response.


it's a real bummer that they're saying they can't do surgery. Not that I'm begging to have surgery. Yet again, I know that my arm has gotten worse, over the last 10 months. This is what I can't figure, why now the pain and problems?

Yeah I know, tears can happen and you don't know it, but again, this seems kind of strange I have 2 bad falls in less than a year and NOW I'm having problems? I guess it could happen.

I do remember having a dog walk pull my arm around the back of my head, and it was a minor ouchie, nothing like I'm having now.

Well first thing in the morning I'm calling this doctor, to hear exactly how large and old they think this tear is. Also, why they don't think surgery would work. All I remember beeing told my the middle person, was that it was a large tear, muscles had athropied, and fatty tissue had invaded the area. Guess the original doctor was correct. I had my doubts about them, as they wre the local young medical doctors that were only at the hospital for a short time. That's the only kind of insurance I can afford. One that's based on your income on a sliding scale.

I was concerned, since I'd never met this doctos that's doing the evaluation, that he might not be a qualified doctor. Yes, the owner of the place where I work is a plastic surgeon and has access to all sorts of people. So I was thinking that this doctor just might be doing him a favor, and blowing me off. That way they don't have to pay any more medical bills.

I did some research on him, and he's credentials are very high. So I really doubt that he'd do something off the records like what I was thinking.

Aug 19, 2008
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another thought
by: Sharon

just another thought.

I am concerned about making this tear worse. This is something I'm going to address to the doctor when I talk to them.

I need to know how careful I need to be the rest of my life? What things can I do or NOT DO?


I am all the time asked to do things, picking things up, going up laddes, or just general every day things. Some are not what a normal woman would do, but I'm know to do it anyway. Hey, all it takes is a little muscle.

Also, with the job I have, do you think I should do MORE RESTRICTIONS?
Right now I'm on a 15 pound weight limit. Yet, know at certain points of lifting, I'm not even able to do 2-3 pounds without the arm locking up. Yet, without the weight, I'm able to move the arm freely.

Thanks for taking the time to answers my questions and please excuse any tying or spelling errors.


Aug 19, 2008
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Surgery Works
by: Anonymous

You did not mention what type of tear the MRI revealed. If it is a rotator cuff tear (likely a supraspinatus tear) or a biceps tendon tear, surgery has a high degree of success (assuming you have a good surgeon who has a history of good surgical outcomes).

I am a Physical Therapist and have seen many, many patients post op from these surgeries and all have done very well. I, myself, have had rotator cuff surgery and have had no problems since. (I am a bodybuilder so my workouts are more extreme than most.)

I will tell you (as I tell my patients) IT CAN, AND USUALLY DOES, TAKE UP TO ONE YEAR TO FULLY RECOVER FROM SURGERY. So, if you decide to have suregry, be patient--and go to physical therapy!

Aug 19, 2008
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update on information
by: Sharon

I'm sorry,

I was told that the MRI, showed a large tear in the rotator cuff. They said nothing about bicep. They also said it was an old tear, that had fatty tissue invading it, and the muscles were atrofied (sp) I don't know how old they feel the tear might be. I guess this doesn't matter.

I did have the owner of where I work, who is also a full time plastic surgeon, look at everything involved and he said I'd really messed up my shoulder. His words not mine.
He hadn't looked at the MRI, at that time. This owner is a well known plastic surgeon, who does more than comestic.

I had an MRI done, about 15 years ago because of some ulnar and carpel tunnel problems. NO mention of rotator cuff problems then. That doctor, went into detail of the things they did find, but NEVER mentioned rotator cuff or any type of tear.

So when this tear could have happened, is unknown. I guess this is common.


Is there anyway that they could be thinking and considering that the tear that I have, is OLD, even though my 2 bad falls I'd had were about 10 months ago? That this tear could possibly be from that time? I guess I'm just trying to narrow down when and where this happened. Which I know can't always be done.

I go to speak to the evaluating doctor on Sept. 8th, I will also be staring PT on the same day.

Is it possible, to tell how old an injury is by looking at an MRI?

Also, is it possible to tell if the surgery will work just by looking at an MRI?

Another thing, I've had people tell me that HAVING the surgery can actually makes things WORSE.

Is this true?

Yet, not having the surgery, and dealing with my every day life, is probably going to make the tear worse. All it takes is ONE TIME and things happen.

Any ideaa on what I should do about this?

Nov 18, 2008
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Rotator Cuff Surgery
by: Anonymous

I had rotator cuff surgery for the second time this past March. I went through 6 months of recovery, following the physical therapist's orders and exercises regularly. After the six months, I was still hurting and they had me go in for a test that they shot my shoulder with a dye and took another MRI. The doctor stated that the part in the back of my shoulder that he had stapled had seepage. He told me to keep exercising, but don't go past the pain and we would recheck to see if it heals itself after the first of the year. Well, the pain is there when I try to lift my arm, and it is constant and more sore in the cold.
My question to you is this. Should I go back to this doctor for another repair on the back side, and is the bill on him. Also, can it heal on it's own like he was hoping for. Thank you for any help. This hurts!

Dec 04, 2008
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Rotator cuff surgury number 3
by: Kriesea

I tore my shoulder iin Aug of 2006. By Feb of 2007 I had my first operation, the second was followed on May 11, 2007, and through a series of Return to Work 5 week sessions I was able to tear my shoulder worse than before.

I have headaches everyday, when I wake up and go to bed. It is bad today because it is cold, but more because of the laptop computer I carry in and to work, and because I had a wonderful spasm yesterday afternoon. Something of which I have not experienced before.

I can take Hydro-morphine, Baclofen, Flexerol, and need a sleeping pill to fall asleep, other wise I am awake all night.

I am about ready, and have been since May 2007 to put a noose around my neck.

My last operation was in October, I was off work for 6 months, lost my job, and unable to find decent work in the trade I picked because of my new found inability.

I am seeking to sue, or get the health centre that made me this way, and help pay for the pills I am now living on.

Should you get rotator cuff surgey? Which headache do you prefer more?

Dec 04, 2008
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comment
by: Sharon

I'm sorry to heat that you're having so much trouble.

I guess I should consider myself lucky. I have pain, but it can be controled.

My shoulder can't be repaired, but I'm still able to do a lot of things.

I am in the process of applying for SSI disability, and I'm soon to get my settlement from the Workers Compensation.

Not that I'm getting very much, but it seems like it's going to be a quick settlement. Even though my injury was Oct. 2007. I was able to work for quite some time.

Sadly, I too can not find a job, and I'm curious about some retraining.

Yet, who'd want to hire a 51 year old woman, with shoulder problems and Fibromalygia?


Dec 06, 2008
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sharron
by: kriesea

depends where you are.. in Canada we have something called "second career" in which they will help you find the next career you are looking at.

You can also go through workers compensation for retraining.

My shrink once said that many women become successful after 50, because their responsiblities are gone. Kids gone, husband etc..

Have you considered opening your own company?
Email me.. I have an idea for you

2b.abee at gmail.com

Chris

Dec 06, 2008
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workers compensation
by: sharon

I've talked to the insurance carrier who's handling the workers compensation. From what they've said, I'm capable of doing customer service work, as long as it's not a physical job.

They felt that with the training I already have, I do not need any other type.

yeah right.


I agree, that it's possible to start over at the age of 50, and I've got some ideas with the settlement money, but gosh darn it, I truly liked this darn job.
Yet, no way, will they even allow me to come back, in any position.

I was told they are afraid I'd hurt myself again!

argh!

times are hard, so even the healthy young people are having trouble finding a job.

Even ones they DON'T LIKE.

Apr 16, 2009
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I wish I was Curt Shilling
by: Robbie

Ihad an accident on Thanksgiving 2007 at work. I didn't know I tore my left rotator cuff until March 2008. I took cortisone shots against my cardiologist orders but my bone dr. said they were the bovine kind. I had surgery in June of 2008 at 11am. At 4.30pm when I was brought home wearing a cryocuff(a sling with a med catheder and ice) what I thought was the ice melting was blood dripping all over my couch due to a small pin-prick of a hole next to the incision. I went back to the hospital emergency room waited 2 hrs dripping blood on those comfy chairs before my name was called. The staff doctor couldn't stop the bleeding so he bandaged me up like a mummy and sent me home with a whopping bill. My surgeon denied it was blood just ooze and started me on PT the following day. When the theropist raised my arm blood spurted out like a monty python movie. PT was then cancelled. All the doctors do 4 MRI's saying a bloodclot during surgery tore all the tendons and all they do is prescribe painkillers. I can't even button my shirt but I worked 2 jobs and can't get any disability because I still work just using my right arm to carry and distribute mail. I had to leave my other job. I go to work in pain(wife thinks we will lose the house on disabilty pay)my attorney says I'm gonna permantly maime myself if I keep this up. I want out of this marriage and I can't handle the pain every freakin' day. Thanks for the session.P.S. The bleeding continued until July 4,2008 and that bill was even higher. I wonder if Nick Drake felt this way before he went to bed.

Apr 20, 2009
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my shoulder
by: Anonymous

I am scheduled shoulder surgery on my left shoulder ihave had 3 previous surgeries on the same shoulder. this time however i have torn everything possible in my shoulder andam not promised a full recovery not that i have had that previously. I have had the acromium process taken out already. the bicep tendon is torn as well. after surgery and rehab on the left shoulder my right shoulder has a full thickness massive tear inthere and a torn bicep tendon as well. on the left shoulder the glenoid labrom is a mess as well.anybody got an idea of what kind of use i will have of my left shoulder? am on disability as well

Oct 12, 2010
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Shoulder Surgery
by: Anonymous

I had surgery in January and now, 9 months later have terrible pain. I did the physical therapy as perscribed and went back to work after 4 months. My job is very physical and I was afraid of reinjuring my shoulder, but figured the doctor knew best. Since returning to work, I have had a slow but constatant downward spiral. My shoulder is not in so much pain that I don't know how I am going to go to work tomorrow. The headaches make it even worse. Just made an appointment to see the dr who did my surgery next week. I hope that I have not reinjured my shoulder. this is a work related injury and really don't want to have to go through all the crap again.

Mar 22, 2012
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ROTATOR CUFF INJURY STORIES NEW
by: Anonymous

I WANT TO SHARE THIS SITE FOR INFO OF THE SUFFERING OF HAVING ROTATOR CUFF SURGERY/ INJURY. NOBODY KNOWS THE SUFFERING EXCEPT THE PATIENT.

Sep 10, 2012
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rotator surgery NEW
by: same shape

hi, im writing because i fell over a flatbed at work in 2009,could not use my arm for about a month. went back to work. worked until 9-2011, would get sharp pain constantly, i didnt know why.eventually as time went by , i was slowly losing my ability to lift my arm. i then blamed it on the tricor meds i was taking because i heard they could make your muscles hurt and limit mobility. i talked to doctor, he said it wasnt the pills because it would not be limited to one arm. it got to the point i couldnt use the arm.anyway after the years of pain, i found out it was my cuff. i had surgery 4-2012,went for a manipulation 9-12,and back in therapy. i still dont see a change.so whats up with that? any ideas?

Sep 10, 2012
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rotator surgery NEW
by: same shape

hi, im writing because i fell over a flatbed at work in 2009,could not use my arm for about a month. went back to work. worked until 9-2011, would get sharp pain constantly, i didnt know why.eventually as time went by , i was slowly losing my ability to lift my arm. i then blamed it on the tricor meds i was taking because i heard they could make your muscles hurt and limit mobility. i talked to doctor, he said it wasnt the pills because it would not be limited to one arm. it got to the point i couldnt use the arm.anyway after the years of pain, i found out it was my cuff. i had surgery 4-2012,went for a manipulation 9-12,and back in therapy. i still dont see a change.so whats up with that? any ideas?

Sep 10, 2012
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rotator surgery NEW
by: same shape

hi, im writing because i fell over a flatbed at work in 2009,could not use my arm for about a month. went back to work. worked until 9-2011, would get sharp pain constantly, i didnt know why.eventually as time went by , i was slowly losing my ability to lift my arm. i then blamed it on the tricor meds i was taking because i heard they could make your muscles hurt and limit mobility. i talked to doctor, he said it wasnt the pills because it would not be limited to one arm. it got to the point i couldnt use the arm.anyway after the years of pain, i found out it was my cuff. i had surgery 4-2012,went for a manipulation 9-12,and back in therapy. i still dont see a change.so whats up with that? any ideas?

Oct 19, 2015
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