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Old 03-24-2015, 07:05 PM   #1
Alden Hingle
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Rotator Cuff and Biceps Tendon Tear?

Sorry for the long post. I am seeking advice on the correct rehab activities to follow. I saw an ortho on Monday; he diagnosed a rotator cuff and biceps tendon tear but he did not want to do an MRI since my symptoms were improving. He suggested some rehab exercises (medial and lateral rotation with bands) but I want to ensure they are appropriate for whatever I did to my shoulder.

I hurt my right shoulder two months ago while unloading a pickup truck. I reached over the side of the bed and yanked on a bag that was stuck (transverse adduction). I felt minor pain at that time and it got worse over a week or so. I immobilized the shoulder as much as I could but occasionally some movements would cause sharp pain in the shoulder. After about three-four weeks the sharp pains stopped and I began getting ROM back. I have continued to avoid any activities that cause discomfort.

My current symptoms are these:
- When massaged, my right front shoulder is tender in the area of the anterior deltoid and at the junction of the pec and the deltoid.
- When I use my shoulder in abduction, discomfort begins when my arm is at 90 degrees. I can take it higher if I move slowly but it is not comfortable.
- In flexion, the discomfort begins when my arm reaches about 45 degrees above parallel to the floor.
- Medial and lateral rotation with a very light band feel ok. They are not comfortable with a heavier band.
- I cannot tuck in my shirt behind my back with my right hand.

No other articulations of the shoulder hurt, nor does flexion of the arm (even with weight).

My questions are these:
Are the band exercises appropriate with the very light band?
Are there other exercises that would be appropriate with light weight (pull-downs, overhead press, etc.) or at low intensity (e.g. rowing) that would speed the healing?

I want to ensure that I do whatever I can to help the shoulder heal as quickly as possible so would appreciate any input in that regard.

Thanks!
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Old 03-25-2015, 03:41 AM   #2
Zach Long
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Re: Rotator Cuff and Biceps Tendon Tear?

Go to fitnesspainfree.com and contact Dan Pope. Physical therapist and CrossFitter. Probably has some good ideas of where to go for guided rehab which is going to be a much better bet than doing some random rotator cuff exercises your doc prescribed
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Old 03-27-2015, 10:26 AM   #3
Sean Rockett
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Re: Rotator Cuff and Biceps Tendon Tear?

So alot of this depends on your exam and strength testing, but there are rotator cuff exercises that can be done to try to strengthen the rotator cuff muscles. You mentioned getting it to heal as quickly as possible. Sometimes these do not heal if they are ripped or torn completely. A good sign is that you are feeling better and it sounds like your symptoms are quieting down. Unfortunately a rotator cuff complete tear is unlikely to reattach itself bacasue of the resting tension in it.
Quote:
Originally Posted by Alden Hingle View Post
Sorry for the long post. I am seeking advice on the correct rehab activities to follow. I saw an ortho on Monday; he diagnosed a rotator cuff and biceps tendon tear but he did not want to do an MRI since my symptoms were improving. He suggested some rehab exercises (medial and lateral rotation with bands) but I want to ensure they are appropriate for whatever I did to my shoulder.

I hurt my right shoulder two months ago while unloading a pickup truck. I reached over the side of the bed and yanked on a bag that was stuck (transverse adduction). I felt minor pain at that time and it got worse over a week or so. I immobilized the shoulder as much as I could but occasionally some movements would cause sharp pain in the shoulder. After about three-four weeks the sharp pains stopped and I began getting ROM back. I have continued to avoid any activities that cause discomfort.

My current symptoms are these:
- When massaged, my right front shoulder is tender in the area of the anterior deltoid and at the junction of the pec and the deltoid.
- When I use my shoulder in abduction, discomfort begins when my arm is at 90 degrees. I can take it higher if I move slowly but it is not comfortable.
- In flexion, the discomfort begins when my arm reaches about 45 degrees above parallel to the floor.
- Medial and lateral rotation with a very light band feel ok. They are not comfortable with a heavier band.
- I cannot tuck in my shirt behind my back with my right hand.

No other articulations of the shoulder hurt, nor does flexion of the arm (even with weight).

My questions are these:
Are the band exercises appropriate with the very light band?
Are there other exercises that would be appropriate with light weight (pull-downs, overhead press, etc.) or at low intensity (e.g. rowing) that would speed the healing?

I want to ensure that I do whatever I can to help the shoulder heal as quickly as possible so would appreciate any input in that regard.

Thanks!
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Old 03-27-2015, 03:50 PM   #4
Alden Hingle
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Re: Rotator Cuff and Biceps Tendon Tear?

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Originally Posted by Sean Rockett View Post
A good sign is that you are feeling better and it sounds like your symptoms are quieting down. Unfortunately a rotator cuff complete tear is unlikely to reattach itself bacasue of the resting tension in it.
Zach and Sean - thanks very much for the responses.

Sean - how would I know if it is a complete tear? Is there a function test that would confirm that? Or do I need to go in for an MRI to answer that question?
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Old 03-30-2015, 02:09 AM   #5
Richard Colon
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Re: Rotator Cuff and Biceps Tendon Tear?

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Originally Posted by Alden Hingle View Post
Sean - how would I know if it is a complete tear? Is there a function test that would confirm that? Or do I need to go in for an MRI to answer that question?
Had rotator cuff surgery in nov 2014 after over a year of generally being semi dumb. Just a lack of consistency with mobility and stabilizer strengthening and too much reliance on my overall strength and "its not bad, my shoulders are beefy, ignore the signs", etc...

The lead in to surgery was 2 to 3 months of appts, physical therapy 2-3x per week, xrays, mri's, doc meetings, 2nd opinions and internet research.

During the surgery the doc also identified a partial bicep tear. So to make a short story long, if i remember well, all of the experts during this whole humbling journey said that a full tear is a lot more than "i can do it but it really hurts." its more like total weakness and you cant do it at all. I dont think you are there.

Im a 200+ strict press guy. A 100+lb DB snatch guy. Im a 5'9" 225lb extremely broad shouldered dude with traps, neck and yoke to back it up.

1. Its not as bad as you think.
2. Listen to your body.
3. Respect a 2-3lb DB and simple therabands
And most importantly...be patient. Like months to a year patient.
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Old 03-30-2015, 02:11 AM   #6
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Re: Rotator Cuff and Biceps Tendon Tear?

phone typing double post nonsense. Sorry
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Old 04-05-2015, 05:53 PM   #7
Sean Rockett
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Re: Rotator Cuff and Biceps Tendon Tear?

a good exam can pick it up, it does depend on the size of the tear and how obvious it is. MRI can certainly show a full thickness tear also to confirm a physical exam. There is a sign called Codman's test where if you rub place your finger over a certain area on the patient's shoulder and rotate the arm you can feel a click which is a positive test signifying that the cuff is torn.
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Old 05-12-2015, 08:17 PM   #8
Alden Hingle
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Re: Rotator Cuff and Biceps Tendon Tear?

Due to a continued loss of ROM and pain in some positions, I asked for an MRI of my shoulder. Had an MRI two weeks ago and my ortho consult yesterday. MRI indicated:
1. Moderate supra- and infraspinatus tendinosis with a small 3mm articular-sided tear of the supraspinatus tendon. No propagation is present.
2. Multi-directional chronic SLAP tear with extension into the biceps anchor. The SLAP tear propagates posteriorly. The posterior labrum is grossly abnormal with tearing, hypertrophy and detachment.
3. Mild glenoid dysplasia with mild posterior sloping. Associated moderately advanced for age cartilage loss involves the glenohumeral joint, particularly at the posterior aspect of the glenoid.
4. Moderate joint effusion with a small amount of synovitis and intra-articular debris.
5. Moderate joint arthropathy.

My doctor recommends conservative treatment / physical therapy and indicated if I opted for surgery, he'd probably just remove the frayed material and clean up the arthritis and intra-articular debris. He then mentioned something about possibly releasing the biceps tendon and attaching things differently due to patients of my age having poor circulation in that area.

Couple of questions:
Is this something that will heal on its own (or at least become asymptomatic) with physical therapy? Or is surgery the only way I am going to get back to normal ROM and reasonable strength?
My ortho told me that I could resume normal activities (including lifting) and that I wasn't going to do more damage to myself as long as I avoided doing things that hurt when I did them and that I also did R/C rehab exercises. Is that a safe approach? As I said previously, I don't want to do any more damage to myself.

Thanks!
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Old 05-14-2015, 07:30 PM   #9
Sean Rockett
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Re: Rotator Cuff and Biceps Tendon Tear?

So some SLAP tears are painful and others are just present and seen on MRI. It depends on your exam and location of pain. If SLAP tears are fresh some can heal depending on size of tear and age of patient. Usually one gives something 3 months to try to heal and see if it is getting better on its own. The doctor is talking about biceps tenodesis. If you google my name I have a blog that talks about biceps/SLAP tears and biceps tenodesis and returning to CrossFit.
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Old 05-17-2015, 05:55 PM   #10
Alden Hingle
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Re: Rotator Cuff and Biceps Tendon Tear?

Sean - Thanks very much for the pointer to your blog. Now I understand what my doctor was describing. I'm already four months out from my injury and start physical therapy tomorrow so I'll see how it goes. I should have pushed for the MRI sooner just so I could get started. Do you want me to post the details and progress on your blog?

I learned today that one of my friends in our local motorcycle club and I share the same orthopedic surgeon and he had the tenodesis surgery 6 weeks ago. His recovery is going well and he is happy with the results. That friend also had a rotator cuff (other shoulder) repaired last year by the same surgeon with very good results. I can't think of a better endorsement.
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