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Torn Rotator Cuff: Should I wait it out or get the minimally invasive surgery?

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  • Torn Rotator Cuff: Should I wait it out or get the minimally invasive surgery?

    I know athletes are more prone to this injury. I don't know why I got it, but I made it worse doing crew/rowing this summer. I've had quite a bit of pain on and off; two rounds of therapy, two cortisone injects, which certainly lessened the pain. But the medico says this will not heal itself. Has anyone had experience, especially doing Primal, that you can indeed get the tear to heal? I have become such a skeptic about medical procedures, even while being very grateful for them. I had spinal surgery ten years ago that was a great success. Still......I'm ditherng on this one, and find I will have as much or more recuperation time as I did with a major back surgery.

    I look forward to hearing about any of your experiences with torn rotator cuff--sounds like a GTO malfunction.
    This time, like all times, is a very good one, if we but know what to do with it. Ralph Waldo Emerson

    Any given day you are surrounded by 10,000 idiots.
    Lao Tsu, founder of Taoism

  • #2
    I had my rc surgically fixed in July. I tore it putting away Halloween decorations last November and was in so much pain I *welcomed* surgery. Unfortunately, I tore my ACL in December, so had to have that fixed first. By the time I'd rehabbed from the ACL enough to stand the thought of another surgery, it was July. Between November and July I tried rest (i.e. no activity whatsoever), PT exercises of various modalities, pretending nothing was wrong and trying to exercise normally (yeah, that lasted one session LOL). Nothing helped. Nothing. I won't do cortisone because I firmly believe that for ME, it causes more problems than it solves. The inflammation was just part of the problem.

    I won't lie to you. The rehab sucks major canal water through a straw. I am just now able to really work out without pain or intense soreness (beyond normal soreness, I mean... the kind that makes you wonder if you injured something) and it's six months later. But OMG, it was so worth it. I can now do crazy things like put on a coat or reach back to get my seatbelt without intense pain. I am even doing pullups with the woodyband at crossfit and very slowly regaining my strength (just before I tore my shoulder, I finised the 100 pushups protocol - real hand/foot pushups... now, I can do about five "real" pushups, then I have to switch to hands/knees and I can do about ten more.)

    I highly recommend the surgery if you want to be active into your old age LOL. I'm 45 and the thought of having that pain for the rest of my life made it a no-brainer for me.

    And, btw, total or partial tears will NOT heal on their own past a certain point (I forget what that is... but you can google it)... it's just not how the body works.

    Good luck to you. If you decide to go through the surgery, I can give you some pointers on what to set up in advance so you can (somewhat) function post surgery. I was lucky and in the sling for a short time only... many people are slinged up for months. Just depends on your surgery, your surgeon and your body.

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    • #3
      I've torn mine twice, never had the surgery. I did therapy. Both were partial tears; one was "borderline" according to the doc and the MRI, doc said it was my call. My understanding is that the post-surgery period is an absolute b*tch. So I put it off and put it off and eventually (nearly a year later) it healed. From what I've read, the jury's still out on whether or not you can get complete healing without surgery. My guess is, it's yet another of those situations where the answer is "it depends". And you don't necessarily get to know all of the factors upon which "it depends". (agh! that's life!)

      Do watch out for "frozen shoulder" (aka "adhesive encapsulation", you can google it). It can accompany any shoulder injury, sets in for no apparent reason -- that is to say, sometimes someone gets it, while someone else with exact same injury does not -- and it is truly the most aggravating and painful thing I've ever experienced (include 5 natural childbirths, a knee rebuild/rehab, a finger rebuild/rehab with three surgeries, and abdominal surgery in my list). Frozen shoulder can take up to a year to heal, and there does not seem to be a whole lot you can do in the meantime to get relief. I did see an extremely good massage therapist (not the "rub you down" kind, but the actual therapeutic kind) who gently-yet-painfully pulled my shoulder apart twice a week for six months. I also went to physical therapy during this time. I cannot speak to the efficacy of these measures, since the possibility exists that my frozen shoulder would have cleared up on its own during this same period of time.

      Good luck!

      eta: one additional data point -- my friend also tore hers twice, did not have surgery the first time, but did the second time; Doc told her that her second tear was due to her not really healing properly after the first tear. Something to think about and ask the Doc about.

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      • #4
        Originally posted by JBGrokerty View Post
        I've torn mine twice, never had the surgery. I did therapy. Both were partial tears; one was "borderline" according to the doc and the MRI, doc said it was my call. My understanding is that the post-surgery period is an absolute b*tch. So I put it off and put it off and eventually (nearly a year later) it healed. From what I've read, the jury's still out on whether or not you can get complete healing without surgery. My guess is, it's yet another of those situations where the answer is "it depends". And you don't necessarily get to know all of the factors upon which "it depends". (agh! that's life!)

        Do watch out for "frozen shoulder" (aka "adhesive encapsulation", you can google it). It can accompany any shoulder injury, sets in for no apparent reason -- that is to say, sometimes someone gets it, while someone else with exact same injury does not -- and it is truly the most aggravating and painful thing I've ever experienced (include 5 natural childbirths, a knee rebuild/rehab, a finger rebuild/rehab with three surgeries, and abdominal surgery in my list). Frozen shoulder can take up to a year to heal, and there does not seem to be a whole lot you can do in the meantime to get relief. I did see an extremely good massage therapist (not the "rub you down" kind, but the actual therapeutic kind) who gently-yet-painfully pulled my shoulder apart twice a week for six months. I also went to physical therapy during this time. I cannot speak to the efficacy of these measures, since the possibility exists that my frozen shoulder would have cleared up on its own during this same period of time.

        Good luck!

        eta: one additional data point -- my friend also tore hers twice, did not have surgery the first time, but did the second time; Doc told her that her second tear was due to her not really healing properly after the first tear. Something to think about and ask the Doc about.
        I second the thoughts on frozen shoulder. Not a fun ride and long time to dissipate. I suspect keeping a range of motion is important to avoid a frozen shoulder, but am not certain of how that plays against healing an rotator cuff tear.

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        • #5
          Thank you for your experiences. i have spent a good bit of time on the internet, which sometimes is too much info. I saw surgeries, etc, have read the good, the bad, the ugly. I feel overwhelmed by so much information. Yes, I am worried about frozen shoulder. I've been faithful in the stretches, and take Aleve to keep inflamation in check. I had an episode the year before which was deemed Impingement Syndrome, which I now wonder was the beginning of the tear. If it weren't for the long recuperation, I think I would be more willing.
          Lolov: please do share what you did presurgery. I was looking in my closet at how much is up on shelves that would have to come down, just as one instance.
          I like everything about being in my 60s except the body parts showing the wear and tear. C'est la vie!
          This time, like all times, is a very good one, if we but know what to do with it. Ralph Waldo Emerson

          Any given day you are surrounded by 10,000 idiots.
          Lao Tsu, founder of Taoism

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          • #6
            Pre-surgery I did the following:

            Took everything (and I mean EVERYthing) that I need on a daily/weekly basis (and that I didn't want to have to ask anyone to get for me...) out and put it within easy reach (ie. at about countertop level)

            Bought a bunch of front SNAP (not button.. god, buttons are impossible with one hand!) shirts a few sizes too big.

            Bought (and practiced putting on one-handed) a front closure bra (I am too "big" to go without comfortably.)

            Got out a bunch of sweat pants (no zippers, buttons, etc. frankly, I bought these for when I had the knee done, but they were handy!)

            Cooked up a month's worth of food (casserole type meals, i.e. chili, soup, etc. and stuff like browned a ton of ground beef and put it all into meal size containers, labeled it and froze it.) Keep in mind, I have two kids and no one to help, so I was on my own to get meals for all but the first couple of days. If you have someone to help, this might not be necessary.

            Made a list of foods I enjoy, that are Primal and that my kids like so I didn't have to think.

            Brought in a freezer full of ice for the ice cuff thingy so I didn't have to drive to the store and figure out how to haul 20 lbs of ice from the store to my car, my car to my house and from downstairs to upstairs.

            I set up a "station" downstairs in case it was more comfy to sleep in the recliner (most people seem to find this the case... I was fine in bed with a wedge pillow). Also, it was where I spent the bulk of my daytime hours the first week. Next to this chair I had my phone charger, my kindle and charger, lip balm, pens, pencils, paper, tape, postits, magazines, ipod and earphones, pain meds (get the prescription filled BEFORE surgery if possible), kleenex and books.

            Remember to keep stuff on the side opposite your surgical side... it's a beyotch to reach across yourself to try and get something for a while.

            That's all I remember at the moment.. I'll add more as I remember... seriously, I've blotted a lot of it out. The ACL wasn't so bad... but the RC six months later was a real PITA. You don't realize how much you use that hand until you can't!! And mine was on my non-dominant side!

            Best of luck... I am 45, so no spring chicken when it comes to recovery, but my doc and PT were amazed at how fast I regained ROM, etc. Still.. it wasn't fast enough for my brain if you kwim.

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            • #7
              Great foresight! I am saving your list, which is triggering ideas for my situation. Snaps are brilliant idea!
              This time, like all times, is a very good one, if we but know what to do with it. Ralph Waldo Emerson

              Any given day you are surrounded by 10,000 idiots.
              Lao Tsu, founder of Taoism

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              • #8
                It won't heal by itself, go for the surgery. In my case the rehab was not bad but be sure you have a great and convenient physical therapist as you'll be going 2-3 x a week and can't drive for weeks until you are off of the pain meds. The recliner is essential for the first week then hopefully you can transition back to bed. Good luck. If you are in or near Alabama I recommend Dr. Lemak, senior, who is the physician for the PGA and the king of shoulder surgery.

                Note - my injury was pre-primal days but I don't think it would have made a difference.
                Last edited by Adrianag; 01-08-2011, 03:07 AM.

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                • #9
                  totally depends upon the kind of tear, to be honest.

                  i would recommend a second/third opinion on it. surgery might be the right option, in which case it is worth doing.

                  post facto, whatever you decide, you need to work on full range of motion exercises for the shoulders. after physical therapy and what not, make sure you are maintaining the whole joint's health.

                  i also recommend massage in this process. it does help free up scar tissue and promote full range of motion. feldenkrais will also help.

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                  • #10
                    Ahhh... Massage; the one bright spot in the recovery. I'm going to get a second opinion on the surgery. Thank you.
                    This time, like all times, is a very good one, if we but know what to do with it. Ralph Waldo Emerson

                    Any given day you are surrounded by 10,000 idiots.
                    Lao Tsu, founder of Taoism

                    Comment


                    • #11
                      As a few others have said, the decision to have surgery or not totally depends on the degree of the tear and what you want to do with your shoulder once recovered.

                      If the tear is a partial thickness compared to a full thickness tear then there is a relatively good chance of it healing on its own, provided you give it the proper rest are relatively healthy, and work with a good therapist. A full thickness tear most often will need surgery to repair itself unless it is fairly small.

                      Did the doctor tell you what percentage the tear was? The biggest concern with putting off surgery is that depending on your age, or overall health. Overtime the tendon can retract, and degenerate and then the surgeon is unable to repair it. That most often occurs in older patients who hurt their shoulder then go a long time without seeing anybody about it then its too late.

                      Rotator cuff surgery is a very successful surgery, and there are very few risks too worry about. The standard surgical risk apply, but if they do it arthoscopically, then the risks of infection etc are decreased dramatically as opposed to an open procedure. The first six weeks of rehab are the worst, and then it gets better from there.

                      As far as cause I am concerned, I have never read any evidence that specifically identifies the GTO as the culprit. GTO's are going to be guilty in instances of spontaneous rupture. (i.e. a weightlifter rupturing the biceps while doing a deadlift, an athlete rupturing the patellar tendon etc) RTC tears most often occur from overuse, chronic degeneration, poor scapular kinematics causing rubbing/fraying, shoulder impingement etc. Though it can occur from falling on your shoulder.

                      Hope that all helps in making your decision, basically my advice would be that if the Doctor says the tear is beyond 50%, I would get them to repair it otherwise you could potentially consider going through therapy and allowing it heal on its own. Just find a good sports medicine orthopedist to perform the surgery and not a general (do everything) orthopedic surgeon.

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                      • #12
                        Stu: well you learn something new every day! I was making a poor joke in saying the torn rotator cuff sounded like a GTO malfunction. I was meaning the old muscle car, pontiac GTO. My spouse had one in our 60s college days; I used to say you had to rest after driving it. Anyway, I looked up the gto as you interpreted and was enlighted. Thanks for your thoughts and suggestions. I did not learn the percentage the thing is torn, and will follow up on that.
                        Last edited by Digby; 01-08-2011, 09:46 AM. Reason: Typing gaff
                        This time, like all times, is a very good one, if we but know what to do with it. Ralph Waldo Emerson

                        Any given day you are surrounded by 10,000 idiots.
                        Lao Tsu, founder of Taoism

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                        • #13
                          No worries, I feel equally stupid for being young and completely missing the joke. Oh well! Anyways glad you learned something. Hope you get your shoulder taken care of.

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                          • #14
                            the only thing I have to add is that it seems that you can go from a shoulder/RC injury to a frozen shoulder quickly and that is a real bitch. 1 year on and I'm still in pain. so if you can avoid that, all good. I hope you heal naturally and fast.

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                            • #15
                              Digby, I have no experience with this injury, but I have a chronic hip problem (not arthritic, mine is nerve damage problem) which sometimes flares up if I overdo things. When it does I use Voltaren gel for reducing the inflammation and managing the pain. It is not recommended for hips (or shoulders) but works a treat for me on the hip area. Sometimes I can't get out of bed without it, the pain is so bad.

                              It may be of use to you in reducing inflammation and pain too, you could check with your doctor. I can buy it over the counter here without a script, and my doctor has said it is Ok to use it for my occasional flare ups. You do have to be careful though, not to overdo it again when it reduces the pain, it is easy to exacerbate an injury when the pain is masked.
                              Odille
                              F 58 / 170cms / SW 131.5 kgs / Current 112.4/ GW 65
                              following Primal Lifestyle and swimming my way to health

                              My Primal Blog / Photo Blog / RedBubble shop / My Calendars / My Facebook

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