Tendonitis And Stiff Shoulder

[jettyflamingo]

understand your agony fully....have same type of problem for one full year and still have it...been on prednisona....soma...declofonaca you name it....still have sholder pain.....when raising my arm.....i have been told that it can take a year to slowly heal......i tried the swiming route but only made it worse....sleeping corectly seems to be a recurring problem...tried using head pillows.....soft pillows....hard pillows again not much luck...anyway guess we just have to put up with it (am 78) so i apparently am being punished for my past evil ways....god luck

[goodgenie4u]

I will be in Chiang Mai for 3 weeks starting Feb 8. I'm 64 years old and my shoulders rotor and arms off and on "tighten up" and this interferes with various arm positions, like my left arm when playing the guitar or trying to scratch my back!

I think it is tension and weak muscles requiring therapy and an exercise regimen (passive type). Where can i find in the old city or around Central department store a physiotherapist that will undertake the therapy. My insurance company says the therapist has to be a member of a recognized Thai professional association.

Thanks

[camerata]

Well, I did regain pretty much full range of motion except for putting my arm up my back but then, incredibly, I tore the rotator cuff tendon on the other shoulder. The MRI report says it's a grade 1 partial thickness tear, bursal surface, of supraspinatus tendon. No improvement over the past 4 months and I'll see the surgeon again soon about arthroscopic surgery.

I wonder why a fairly small tear would not heal, given the care I've taken not to aggravate it? But I certainly don't want to go on forever with restricted movement and some pain. The American Academy of orthopoedic Surgeons suggests that around 90% of patients who have keyhole surgery are satisfied and that it's the only way to regain strength in the shoulder, but I wonder how long I should wait before making a decision? The site also suggests that if there is no improvement over 6-12 months, there probably never will be. On the other hand, some sites say it's bad to wait too long before surgery.

[camerata]

It turns out that with a partial tear, all that's needed is to get in and "polish" it (a bone spur, I assume), but if it develops into a full tear it will need sutures and the cost goes up by 100,000 baht. So it isn't a good idea to wait a long time unless there is a definite improvement.

[Sheryl]

Yes, I think from the soubnds of it the sooner the better. Is it Dr Mason you are seeing? He is very well qualified & I'd trust his advice.

[camerata]

My physical medicine doctor sent me to Dr Panya. Both of these doctors seem to be going out of their way not to appear to be pushing me into having the operation. However, now it's clear that I'm not making progress after several months and putting off an operation could result in much longer recovery time and greater expense, I think it's time to go for it. Apparently, it involves a one-night stay at the hospital.

[moe666]

i have been recovering from a torn rotator cuff the MRI showed a quarter in. tear in the tendon and a frayed biceps tendon. Whe I went to see the ortho. Dr. he was not in a hurry to do surgery. I only have pain when i make a stupid move or keep arm in the same position without support for a extended period. The Docs. position was you have no problem sleeping no surgery.

I started a physical therapy program using rubber bands and light weights. I have recovered strength in arm and pain has become less I have also returned to the gym and started out with light weights working the arms, chest, and back, I consulted with the physical therapist on what I could do and not do as well.

My Docs commets to me about shoulder surgery is to relieve pain number one and the shoulder will never be as good as new.

Please keep us informed about your outcome and good luck to you wishing you the best

[camerata]

Thanks. I was hoping my case would be like this, but I can only sleep in one position now and simple motions like reaching for something are painful. I cannot continue like this and have a normal life, so time to consider the operation.

[moe666]

Thanks. I was hoping my case would be like this, but I can only sleep in one position now and simple motions like reaching for something are painful. I cannot continue like this and have a normal life, so time to consider the operation.

Yes I feel your pain. I guess I am lucky not to have as much pain as other folks. Good luck and hope all goes well, please keep us informed how it goes.

[camerata]

I saw my physical medicine doctor yesterday and asked what she would do in my position. She said she would try conservative treatment for awhile before considering an operation. In the past I've had "dry needling" to get rid of trigger points causing muscular pain, but in my experience it only works about half the time, and usually the trigger point comes back again later because the primary cause of the problem remains. Also, it's often painful without anaesthetic. So now I'm getting massage and ultrasound, plus some passive range-of-motion exercises.

One thing I should mention is that about 10 days ago I discovered that sleeping with my arm supported by a cushion does not work for this problem (it was ideal for the stiff shoulder last year). Having finally found a sleeping position that works (I cannot sleep on my back), all the twinges of pain during everyday movements are disappearing. Now it's more like if I move my arm to a certain extent in a certain direction it will hurt, otherwise it won't, i.e. the pain is predictable. If you can't sleep on your back, your precise sleeping position is very important with rotator cuff tears.

The main points I got from the doctor were:

1. Having the operation to smooth the bone but with no sutures will only require your arm to be in a sling for 7-10 days and your partial tear will then heal itself to some extent.

2. If sutures are involved, for a full tear or perhaps a large partial tear, the recovery is long and hard and probably never 100%.

3. The surgeon never knows for sure if he'll need to suture until he opens up your shoulder. The MRI is a guide, but can't be relied on 100%.

[Sheryl]

Due to the last 2 points you mention, no doctor is going to want to take responsibility for telling you to have surgery. You are going to have to decide that for yourself and tell them.

Having already given conservative management 4 months, it would not be unreasonable to decide on surgery now. Also not unreasonable to go ahead and wait another month or two if the pain is manageable.

However from what you say it seems like the procedure needed now would be fairly simple and that there may be a risk of needing more extensive surgery if you delay and sustain any further tears. Need to take this into account.

[FBN]

It is important to know as accurately as possible what the surgery would be and what the probable outcome would be. Usually, the older the patient, the less invasive or agressive the surgery would be. If pain relief, for a rotator cuff tear, even a cortisone injection locally may become an option. Cortisone is usually combined with a long acting local anaesthetic and should give pain relief almost immediately; pain return after the local has worn off and it takes a while before the steroid starts to work but if the pain is relieved, it is usually a good indication that the injection had been given in the correct area and that the steroid should work.

For joint capsule integrity studies, injection of the joint with a radio opaque material and MRI is usually combined. Leakage from the joint confirms extent of tear..

Again, the older the patient, the less successful the outcome of surgery would be..

Good Luck!

[camerata]

However from what you say it seems like the procedure needed now would be fairly simple and that there may be a risk of needing more extensive surgery if you delay and sustain any further tears. Need to take this into account.

I put it to her like that, but she kind of pulled a face. Not sure if she didn't get my logic or there was some other reason. It seems to me a reasonable gamble that if I don't need sutures during the op the result will be much better than doing nothing. If I do need sutures during the op the tear is probably bad enough that if left alone it would have been a problem in the future. She did mention that any decision depends on quality of life, but I guess that differs from person to person. Right now I'd say I can arrange my life so there is no real pain, but that means avoiding some shoulder motions/positions completely. A dodgy shoulder is not exactly enhancing my love-life, and I wouldn't be able to swim unless it was doggy paddle.

[camerata]

It is important to know as accurately as possible what the surgery would be and what the probable outcome would be.

Well, this is what they can't tell me. The surgeon said it would be arthroscopic surgery and that a partial tear wouldn't require sutures. The physiatrist told me that the tear shown on the MRI was not distinct and that a large partial tear might need sutures. So they won't know until they get in and see the tendon. The MRI is now 2 months old and the tear may have got worse. No one has mentioned injecting the joint before an MRI. As for the outcome, with no sutures it sounds pretty good, with the tear at least partially healing itself. With sutures I was told that basically every case is different and a lot depends on the patient and the rehabilitation process.

I suppose I could ask for another MRI and then ask the surgeon if he can give me a good idea of whether it will require sutures or not.

I have a bit of a time limit here as my right to partial reimbursement from my employer will end early next year.

[FBN]

An arthroscopic procedure would be the least invasive and may offer the best option at the moment as it is both diagnostic and can be definitive treatment as well depending on the findings during the procedure but this would still depend on the age of the patient. Good option for an active 60yo but not so good for a frail 70-80yo... Even then, golf and tennis would probably be out; it will probably also not ensure a full range of motion required for freestyle swimming..

The rotator cuff is not a single anatomic structure but made up of fibres from the muscles covering the shoulder joint. remember the shoulder (upper extremity) is "suspended" from the upper body by muscles in contrast to the lower extremity that has a weight bearing link to the skeletal system. This means more stress on the relatively flimsy structures anchoring the upper extremity which is prone to deteriorate with age and offers much less physical structure to work with during surgery which is one of the main reasons for such generally poor outcomes.

The period of immobilisation after surgery is also critical; the older the patient, the least period of immobilisation will give better outcomes so there is a fine balance between the invasiveness of the surgery and ensuring early mobilisation.

[ignoramus]

Camerata, You will probably accept this info witha grain of salt, but here goes anyway. A long-term broadcaster on radio here in Sydney was told by 2 doctors that he would need an operation on his shoulder. He couldn't don a jacket without help. Lyprinol 'saved' him. Can't vouch for it myself, but I do trust this chap. He took the Blackmore brand but I imagine any brand would do.

[camerata]

Thanks. I'm not opposed to supplements in principle as I already take some for my knees. Do you know what condition the broadcaster had? Frozen shoulder?

[Digitalbanana]

Good luck, I had similar experience to you with Samitivej when I turned up already with frozen shoulder and a rotator cuff inflammation, they wanted to do arthroscopic surgery on my first doctors appointment. Never went back. I have been seeing Dr Panya at Bumrungrad since and he had me on phsyio for first 2 months which was painful but when left to my own afterward I have been able to get back to 99% full normality. I go to see Dr Panya now every quarter for a review and hopefully soon won't need to go back again. Was very happy with the service there.

[camerata]

That's good to know. I just checked the dates and in fact this happened about a week into June. Since I didn't realize it was a tear, I didn't see a doctor until early July. Then one month of dry needling and one month of no treatment. It's only this month that the loss of range of motion has become very obvious and I've started physio. So in fact not that much real treatment so far, and I've read that 6 months' physio is common.

Were you given anti-inflammatories? I had them last year for synovitis but this year I was told no need since I'm not in any pain.

[ignoramus]

I don't think frozen shoulder was mentioned, but will try to find out.

[Digitalbanana]

That's good to know. I just checked the dates and in fact this happened about a week into June. Since I didn't realize it was a tear, I didn't see a doctor until early July. Then one month of dry needling and one month of no treatment. It's only this month that the loss of range of motion has become very obvious and I've started physio. So in fact not that much real treatment so far, and I've read that 6 months' physio is common.

Were you given anti-inflammatories? I had them last year for synovitis but this year I was told no need since I'm not in any pain.

I was given anti-inflammatories for first ten days, then not needed again as pain was no longer continuous but just when I moved in certain positions - which I stopped doing unless during physio. I was told it could take up to 12-18 months, so needs a lot of patience.