Muscle Rupture

[Celsius]

Not me, but my wife's father who is 75 years old.

 

He just got back from a MRI scan and from reading it it looks like a total (Category III) muscle rupture.

 

Some most important text from the scan:

 

"FINDINGS: The study reveals supraspinatus tendinosis with full thickness full width tear at tendon insertion with medial tendon retraction to level of humeral head, measured about 3.0 cm in transverse diameter and 1.4 cm in AP diameter. Mild atrophy of supraspinatus muscle is noted (Goutalliers grade II). There is subscapularis tendinosis with low grade partial thickness tear involved the articular surface at tendon insertion, measured about 0.9 cm in transverse diameter and 0.6 cm in vertical diameter. There is infraspinatus tendinosis with low grade partial thickness tear involved the articular surface at tendon insertion, measured about 1.6 cm in transverse diameter and 0.7 cm in AP diameter. The teres minor tendons show normal size and signal intensity."

 

The hospital (Bangpakok) quoted him 300k for the what I think is keyhole surgery. This will be out of pocket. He managed ,to get MRI scan paid for by using his accident insurance, but they will not cover the surgery as it is over budget. So, today they are going to try and use a 30 baht scheme, but I don't think this is going to work or that it will be free.

 

In any case I did some amateur research even here on Asean now and read some replies by Sheryl. However, some replies got me worried about the surgery as it seems that when it is done on older people it may make things worse or/and the tear might come back. Some suggested that surgery, even for total rapture is not necessary. I found this article which it seems to support this:

 

https://pubmed.ncbi.nlm.nih.gov/29433644/

 

 

I just want what is best for the old man.

 

 

[Lacessit]

The key factor in recovery from surgery is the amount of rehabilitation undertaken. It is very important to find a good physiotherapist who is experienced in rehab.

Unless your wife's father is willing and able to work on the rehab, he may be better off doing nothing. It also depends on how much pain he has now.

[Sheryl]

It's rupture, not rapture. And of tendon, not muscle.

 

Every case is different in terms of best management and there is no substitute for a review by a top shoulder specialist.

 

I suggest your father-in-law consult Prof. Mason Poramathikun who can be seen at Vajira Hospital on Mondays morning and on Tuesday afternoons  https://www.vajira.ac.th/content/6477421adf48cb66bbf8445c

 

Prof. Mason can also be seen at Bumrungrad but will cost more there

 

The "30 baht" scheme will be free and will work eventually, but will take some time to work his way up the system, they will likely try to fob him off with anti-inflammatories first before referring him to a specialist. If Prof. Mason believes surgery is indicated It might be possible to get a letter from him to that effect asking your FIL's 30 baht hospital to provide a referral to Vajira. No guarantee but worth a try and if possible to get, it would expedite things.

 

 

 

 

[Tom H]

No one needs to suffer from pain these days. Pain management with related medicine is a way out. 

[Celsius]

Would it be able to change the thread title so I don't look like an idiot for future generations googling this topic.

[oobar]

On 8/10/2023 at 10:02 AM, Sheryl said:

It's rupture, not rapture. And of tendon, not muscle.

 

Every case is different in terms of best management and there is no substitute for a review by a top shoulder specialist.

 

I suggest your father-in-law consult Prof. Mason Poramathikun who can be seen at Vajira Hospital on Mondays morning and on Tuesday afternoons  https://www.vajira.ac.th/content/6477421adf48cb66bbf8445c

 

Prof. Mason can also be seen at Bumrungrad but will cost more there

 

The "30 baht" scheme will be free and will work eventually, but will take some time to work his way up the system, they will likely try to fob him off with anti-inflammatories first before referring him to a specialist. If Prof. Mason believes surgery is indicated It might be possible to get a letter from him to that effect asking your FIL's 30 baht hospital to provide a referral to Vajira. No guarantee but worth a try and if possible to get, it would expedite things.

 

 

 

 

It is indeed possible to have a tear in any of the four muscles that essentially become tendons at points of attachment in the rotator cuff.  I have a rotator cuff tear, am 78 years old and have elected not to have surgery.  The article about the results of not doing so was encouraging.  While painful, I plan to tough this one out -- adding it to a few other infirmities I'm already toughing out.

[Albaby]

On 8/10/2023 at 9:42 AM, Celsius said:

Not me, but my wife's father who is 75 years old.

 

He just got back from a MRI scan and from reading it it looks like a total (Category III) muscle rupture.

 

Some most important text from the scan:

 

"FINDINGS: The study reveals supraspinatus tendinosis with full thickness full width tear at tendon insertion with medial tendon retraction to level of humeral head, measured about 3.0 cm in transverse diameter and 1.4 cm in AP diameter. Mild atrophy of supraspinatus muscle is noted (Goutalliers grade II). There is subscapularis tendinosis with low grade partial thickness tear involved the articular surface at tendon insertion, measured about 0.9 cm in transverse diameter and 0.6 cm in vertical diameter. There is infraspinatus tendinosis with low grade partial thickness tear involved the articular surface at tendon insertion, measured about 1.6 cm in transverse diameter and 0.7 cm in AP diameter. The teres minor tendons show normal size and signal intensity."

 

The hospital (Bangpakok) quoted him 300k for the what I think is keyhole surgery. This will be out of pocket. He managed ,to get MRI scan paid for by using his accident insurance, but they will not cover the surgery as it is over budget. So, today they are going to try and use a 30 baht scheme, but I don't think this is going to work or that it will be free.

 

In any case I did some amateur research even here on Asean now and read some replies by Sheryl. However, some replies got me worried about the surgery as it seems that when it is done on older people it may make things worse or/and the tear might come back. Some suggested that surgery, even for total rapture is not necessary. I found this article which it seems to support this:

 

https://pubmed.ncbi.nlm.nih.gov/29433644/

 

 

I just want what is best for the old man.

 

 

At his age ,there is no way imo he should be considering an op. The failure rate is huge, esp at his at his age.Youtube has heaps of exercises for this problem, at 75, resistant bands and gentle exercise are the go. Big plus if you can find a decent physio but not essential. Tore my Rotator Cuff completely  10 years ago, decided against surgery and I'm good as gold . Weights 5 times a week + cardio, no problems. I still do the resistance band exercises. Good luck.

[swm59nj]

Every individual recovers from surgical procedures differently.  Especially orthopedic type injuries. 
He has a massive tear also. With some other issues. These types for the most part require surgical intervention. 
A qualified orthopedic specialist should be consulted . 
You should consider Sheryl’s recommendation 

[Albaby]

21 hours ago, swm59nj said:

Every individual recovers from surgical procedures differently.  Especially orthopedic type injuries. 
He has a massive tear also. With some other issues. These types for the most part require surgical intervention. 
A qualified orthopedic specialist should be consulted . 
You should consider Sheryl’s recommendation 

Rubbish, I've been there, have you? The surgical success rate at his age is circa 30%.  He goes to see a surgeon, surgery will be recommended. $$$$

[bignok]

6 minutes ago, Albaby said:

Rubbish, I've been there, have you? The surgical success rate at his age is circa 30%.  He goes to see a surgeon, surgery will be recommended. $$$$

True. Its $$$$$. Not care.

 

Id get a few opinions at least. Get on protein powder plus magnesium.

 

 

[Sheryl]

On 8/14/2023 at 9:55 AM, Albaby said:

Rubbish, I've been there, have you? The surgical success rate at his age is circa 30%.  He goes to see a surgeon, surgery will be recommended. $$$$

I can assure you that orthopedic surgeons do not always -- or even usually -- recommend surgery. 

[Celsius]

The thing is old guy is stubborn and if the surgery is involved he will certainly not follow the required phisio. He still works and he won't even put a compression.

 

I am afraid it will be money down the drain.

 

He says he is not in a lot of pain.

[Sheryl]

12 hours ago, Celsius said:

The thing is old guy is stubborn and if the surgery is involved he will certainly not follow the required phisio. He still works and he won't even put a compression.

 

I am afraid it will be money down the drain.

 

He says he is not in a lot of pain.

No reason to assume surgery is required. There may be other options. Some as simple as exercises he can do at home andoral medication. . 

 

As already stated  needs to see a good shoulder specialist. Prof. Mason will not recommend surgery unless absolutely needed. If he has not much pain and his range of motion is not too currtailed then likely it is not. Please disregard ill-informed comments claiming surgton will always want to operate. Not at all the case with reputable orthos. 

[Albaby]

On 8/15/2023 at 10:06 AM, Sheryl said:

I can assure you that orthopedic surgeons do not always -- or even usually -- recommend surgery. 

So. you are an ortho? The two I saw were eager to open me up.

[Albaby]

On 8/15/2023 at 1:06 PM, Sheryl said:

I can assure you that orthopedic surgeons do not always -- or even usually -- recommend surgery. 

I've got a bridge  I want to sell. Very cheap.

[Celsius]

Ok, in the end he opted for the surgery.

 

It will be done under 30 baht scheme and I am surprised he already has an appointment this month.

 

He will be paying around 15k baht and this is mostly for upgraded room and a nurse. He was supposed to do it at his local assigned hospital, but the hospital did not have the equipment and they wrote some letter stating that, so he got transferred to Siriraj Hospital which I understand is very good. If the hospital did not issue a letter the surgery would cost  100,000

 

As far as I am concerned he got faster service than in Canada.

Edited September 17, 2023 by Celsius

[Sheryl]

11 minutes ago, Celsius said:

Ok, in the end he opted for the surgery.

 

It will be done under 30 baht scheme and I am surprised he already has an appointment this month.

 

He will be paying around 15k baht and this is mostly for upgraded room and a nurse. He was supposed to do it at his local assigned hospital, but the hospital did not have the equipment and they wrote some letter stating that, so he got transferred to Siriraj Hospital which I understand is very good. If the hospital did not issue a letter the surgery would cost  100,000

 

As far as I am concerned he got faster service than in Canada.

Glad to hear it and yes, Siriraj is excellent.