T Nation

Full-Thickness Suprasinatus Tear - Avoiding Surgery?


#1

I had an MRI done on my left shoulder last week and it turns out, to my surprise, that I have a full-thickness supraspinatus tear.

Quick story on me: I'm 41, male, 5'11", 205. Always been natural. For most of my life I trained with bodybuilding-style workouts 4 or 5 days per week. LOTS of heavy benching, etc. over the years, but not really in recent year, as my shoulders got cranky. I've had some degree of shoulder impingement, etc. in one shoulder or the other at various times (though never this badly injured) over the years, though mostly in the right shoulder.

For the past three years I've been doing muay thai training 3-4 days per week (hitting pads and sparring), and lifting only twice a week, and haven't even been doing heavy chest/shoulder work in recent years because my shoulders are generally cranky to some degree, but I can go heavy on rows, deadlifts, weighted pullups, and (until recently) weighted dips, etc.

In March of this year (5 months ago) I was doing weighted dips with 120 pounds, which I'd done many times before with no problem. At the bottom of one rep I felt a pretty clear pop in the left shoulder. Not major pain, but felt a pop. That night it started hurting like hell (and did for the next few days), and I saw a very good (non-surgeon) orthopedist the very next day.

The doctor did an X-ray, did a bunch of mobility and range of motion tests, and said it doesn't seem like I tore anything but I just "pissed off" the biceps tendon and the bursa, so things are inflamed. He prescribed an anti-inflammatory, physical therapy and ice, and once things calmed down to try to gradually get back to my activities. Quote "You be you!"

The severe pain went away after a few days (anti-inflammatory probably helped a lot), and things got about 20 or 30 percent better, but I still had nagging pain in the front of the shoulder (biceps tendon area). I did about 4 rehab sessions and then took the PT's lesson plan and applied that for a few more weeks. I got back to doing muay thai (though would limit things like throwing hard left hooks or hard clinching work), but that pain was still annoying, especially at night.

A few weeks after the first doctor's visit I returned for a cortisone shot. He did the injection using ultrasound and even showed me the tendon on the screen as he did it. He said ultrasound is "like a poor man's MRI," and that the supraspinatus looked intact. The cortisone shot really only helped for about a week -- then, back to the plateaued point I had been at.

For a long time I mulled getting PRP injections, which my doc offers, but they're $1,000 / shot, so I held off.

4 weeks ago I was doing some light clinching work in muay thai, the other guy trapped my arm too hard, and I felt some pain. I was able to continue training a minute later, but that night it hurt quite a bit, and has been set back two steps pain-wise ever since. Definitely frequently bothers me at night now. I've laid off muay thai for the past few weeks, and only recently started doing a few pushups as far as upper body strength work (along with now very diligently doing rehab work on my own, i.e. external rotation, scapula work, etc).

A week ago I saw a different orthopedist for a second opinion. He ordered an MRI. (He initially suspected a labral tear, after doing some mobility tests). Turns out there's a full-thickness tear of my supraspinatus. Balls! He said that, especially at my young age and activity level, surgery is probably what I should do. (Arthroscopic surgery.)

Just today I saw a THIRD doc for another opinion -- a very highly regarded guy at the Hospital for Special Surgery here in NYC, who has done 800 to 1,000 RC surgeries. He did some mobility drills, said things seemed reasonably strong, but then looked at the MRI and the X-ray and confirmed the full-thickness tear. He said that surgery is probably the ideal way to go, as I'm so active and young, and that it could get worse over time (the muscle could atrophy, the tendon could retract, etc). He said I don't need to do it right away or anything, and I can try doing some rehab for a while and see if I can work with it. He said as far as muay thai, lifting, etc. to do what doesn't hurt and let pain be my guide. He said it's hard to predict who can just live with it without surgery and who can't, but that the tear of course won't fully heal on its own (without surgery).

It annoys me at night, and there is certainly impingement in certain more extreme angles of arm movement, but given the scary-sounding diagnosis, I'm not in any extreme pain, or constant pain or anything. I'm fine when I'm just going about my day and such and not doing anything really physical/exerting with it. (But the nighttime pain is annoying.) But I also certainly can't do much upper body pressing of any kind, and can't really go all-out in muay thai training without having to worry about it.

So I'm initially going to try committing myself like all hell to rehab, getting some regular ART work done, icing it frequently when needed, using anti-inflammatories on occasion if needed, and he said maybe get an MRI in 6 months and see if the tear has at least not worsened.

QUESTION: Has anyone here had a full-thickness suprasinatus tear and NOT gotten surgery, and been ok, i.e. gotten back to a pretty high level of physical activity? Can I somehow avoid the surgery? Recovery/rehab from the surgery is a BITCH.

Thanks in advance!


#2

Anybody? I’d love any input . . . .


#3

It looks as though surgery would be the primary option. Yes, you can get past the surgery, but the recovery is a bitch. Expect 6-12 months of rehab after surgery, beginning with baby steps. Progress will be incremental. Passive range of motion in limited planes in the beginning, then gentle stretching and strengthening. Google protocol for rotator cuff repair rehab. Ice will be your best friend for a while. The hardest part is going to be holding back, and feeling as though you are not progressing. Sense of perspective is key. Think roller-coaster ride, not linear progress, for the first few months. It would not surprise me if the MD pulled a few bone spurs out during surgery, either. A partial tear may not need surgery, as there are many pitchers still active with partial thickness tears, and screwed up labrums, but they have adapted. Full thickness is different. I hope you weigh all options, and end up with the best decision for you. Good luck.


#4

[quote]BennyHayes wrote:
It looks as though surgery would be the primary option. Yes, you can get past the surgery, but the recovery is a bitch. Expect 6-12 months of rehab after surgery, beginning with baby steps. Progress will be incremental. Passive range of motion in limited planes in the beginning, then gentle stretching and strengthening. Google protocol for rotator cuff repair rehab. Ice will be your best friend for a while. The hardest part is going to be holding back, and feeling as though you are not progressing. Sense of perspective is key. Think roller-coaster ride, not linear progress, for the first few months. It would not surprise me if the MD pulled a few bone spurs out during surgery, either. A partial tear may not need surgery, as there are many pitchers still active with partial thickness tears, and screwed up labrums, but they have adapted. Full thickness is different. I hope you weigh all options, and end up with the best decision for you. Good luck.[/quote]

Thanks for your input. Yeah, (sigh), that’s pretty much what I’ve heard. The ironic thing is, it’s not like I’m in some constant pain or anything. It’s annoying at times, and definitely during the night, but I’m so fine in 85% of things it’s just . . . weird. A lot to digest.


#5

It is possible to have the tear and not need surgery but the question is, does it affect your quality of life?
If you want to keep working out, lifting, martial arts, if will affect your ‘quality of life’ and you will need it fixed or be miserable.

The pain while laying down will stay unfortunately, I don’t know the mechanics behind it.

I had pain in my left shoulder for 20 years, I put it down to wear and tear from my martial arts background and strongman training. Had to lay a certain way to sleep, couldn’t cuddle with that arm for long without awkward feelings and pain. Competing in an event I tore my right shoulder, full-thickness supraspinatus tear. Had surgery. I told him about my left, he did an MRI, to my shock, full-thickness supraspinatus tear. 3 months after my right surgery we did my left.

I’m not going to lie, it sucks, recovery sucks, you have to sleep in a recliner for months because laying down hurts. You will start exercises with 1lb and move up. But to be honest I’m glad I did it and I’m starting to get use to what being pain free (from the decades of left tear).

Bear in mind the muscle will atrophy, my left re-tore a couple of months into rehab because of the tissue quality.

I am at 7 months out from the re-do of my left. I’m allowed to pull as much as I want (as long as pain free), squat with SSB (arm range of motion is a battle to get back). Hit 30lb dumbbells for 10 reps on floor press pain free, 25lb on overhead. Far cry from my PR of 250 for 2. No deadlift allowed yet.

IMO get it fixed


#6

If you are sure you don’t want surgery. Band pull aparts and lots of them! My friend is a PT and when I had my right shoulder issue(didn’t know it was torn) he had me do 500 of them each workout. The pain left(still bad at night) and I could still do all the strongman events with my regular poundage’s. The night pain just got too much.


#7

If you do surgery, you can do fairly well within 6-12 months. Functional, everyday things, but not near the weights you were handling at your best. It may take up to two years post-op to reach those levels. That is so true about sleeping in a recliner for a while.


#8

Yikes.

JH, did you have arthroscopic surgery or open surgery? How did you manage to re-tear the left after surgery? Were you going really heavy too soon?

BH, TWO YEARS to get back to full strength? DAMN. What do you think the likely time frame is for getting back to things like martial arts, i.e. being able to punch with full force and such?

My doctor is making the recovery sound a little less daunting than you guys are, but I’m not aware of any massive improvements in the process in recent years or anything so . . . I don’t know. (SIGH.)


#9

[quote]Damici wrote:
Yikes.

JH, did you have arthroscopic surgery or open surgery? How did you manage to re-tear the left after surgery? Were you going really heavy too soon?
[/quote]

I had arthroscopic. It just re-tore in a new place, tissue wasn’t very good quality from being detached for so long. That’s why I think if you believe you might end up going for surgery to do it sooner than later (bear in mine was tore for 20+ years, few months toying with it may not make much difference overall) I’d talk it over with your doctor if you are not comfortable tho.


#10

I tore my supraspinatus off the bone benching at a meet. Not having the surgery wasn’t an option for me in terms of pain and mobility. It’s a long recovery. My OHP never came back. And I am definitely still weaker on my repaired side with certain movements. But I am pain-free and was able to return to competing. Good luck.


#11

Thanks everyone for the info and feedback.

Though heavy upper-body pressing work is out for at least now, I can’t believe how minor a problem things seem at the moment given the diagnosis and how awful “full-thickness tear” sounds. Last night I actually slept pain-free for the first time in a long time! Going to try to do some muay thai bag work in a few days and see what I can and can’t do, and if I can do a decent training session without much trouble.

Totally, totally on the fence right now, but I don’t think I’m having surgery very soon, that’s for sure. Going to get LOTS of opinions, and see what’s deal-able and what’s not, as far as my condition.

The thing is, even after the 6 months of rehab, only THEN can I START getting back into shape (if I have the surgery)! Jeezus.


#12

FYI, I’ve been doing a ton of research. I’m very likely going to get stem cell treatment (Regenexx). It’s damn pricey but for a tear of my size (not very big), it seems to have a very high likelihood of treating it quite well. And surgery is not very appealing to me. I’ll update once I’ve gone in for the needle (probably a few weeks down the road).


#13

Please keep us updated on your progress! I’m very curious how this pans out.

Myself: I’ve been struggling with a supraspinatus tendinopathy (chronic degeneration of the tendon, no inflammation present) for two years.

About 2 months ago I had had enough of training on and off and going one step forward and two steps back. Couldn’t even ride a bike anymore, because leaning on the steering wheel hurt too much.

Took off two weeks of ALL physical activity besides walking and kept the arm in a brace, then began rehab 7 days a week, focusing on eccentric movement. Rotator cuff stuff mostly, then as I improved more scapular stability exercises.

I’ve come a long way, but it is getting slowly better. Currently in week 9 of my rehab. No other forms of lifting weights, besides some light (135 lbs) squats once a week. Other than that it’s walking, cycling (able to do that again, as long as I don’t mountain bike) and jogging.

Constant pain has subsided, making very slow progress though. Seeing my physical therapist tonight.

I’d look into eccentric training. There’s been a lot of research concerning the achilles tendon (of course much thicker than the rotator cuff tendons) and patella tendon, and it is one of the few forms of therapy that has a high success rate in improving symptoms and improving tendon regeneration.

If you Google (if you haven’t already) “Alfredson eccentric achilles” you will come across a whole lot of info concerning the protocol (basically 2x a day 3x15 eccentric only reps. I am doing it only once a day though).


#14

Just got cleared by my surgeon to start lifting again, after finishing PT on my second shoulder repair. #1 was in 2009, open shoulder repair not arthroscopic (subscap tendon reattachmemnt and biceps tendon). Primary incision was about 5" long.

Fast fwd to this April 28th when I had surgery on the other shoulder. The MRI showed significant subscap damage along with biceps tendon being out of its proper location. What it FAILED to show was all the supraspinatus damage! So, I awoke in post-op to the happy news that I had yet another open shoulder surgery. Luckily this one was a much smaller incision!

Maybe I am weird, but I slept in my own bed from the day of surgery. I learned back in 2009 how to sleep in the pillow and sling combo, and learned I couldn’t roll over at night. I slept fine. It worked best for me to sleep on top of the covers so that my husband didn’t disturb the covers on me when he would roll over. I used a light Woobie for my blanket.

While I did not lift weights until we started with the light stuff in PT, now that I have finished therapy and been cleared by my surgeon, I have started lifting again. Total was 4mo of essentially no/minimal lifting ( but I do cycle regularly). I am doing a complete reset on all weights and concentrating on form over weight. I plan to work back into it slowly, and intelligently, so I do NOT re-injure myself.

Honestly, I only took the T4 pain pills for less than a week. I found a heating pad worked better for me than ice packs. It is not a requirement that you sleep in a recliner for days on end, though I am told most folks do. I find I sleep better in my own bed, period. My surgeon asked me at around a month post op if I was sleeping in my bed yet. I looked at him, puzzled, and said, “Doc I have been sleeping in my own bed since I got home the day of surgery!” He just shook his head and said I was weird. I prefer to think I’m blessed.

BTW according to my PT folks, I have 100% ROM back, and only limited pain in that range. Most of that pain should go away over the next 8months. Already, light OHP does not hurt like it did before the surgery. Yes my left side is weaker than it was. I expected that. I will get back, stronger than before. It just takes some time. But already, I am glad I had the surgery done. I feel BETTER. FWIW, I’m almost 52, and female.