[Andy W]

Has anyone any experience of this. I knew something was wrong, carried on regardless, climbing ok albeit with some discomfort and pain on certain moves. Anyhow got a diagnosis today of an 11mm x 6 mm full tear of my supraspinatus tendon. Online reading seems a bit bit gloomy, suggesting it won’t repair, even with physio, surgery sounds like recovery is long and not guaranteed. Anyone offer me any glimmer of hope. It’s day one and my wife is sick of my self analysis already 😕

[old cheese]

Hey Andy. What were your symptoms?

[webbo]

Has anyone any experience of this. I knew something was wrong, carried on regardless, climbing ok albeit with some discomfort and pain on certain moves. Anyhow got a diagnosis today of an 11mm x 6 mm full tear of my supraspinatus tendon. Online reading seems a bit bit gloomy, suggesting it won’t repair, even with physio, surgery sounds like recovery is long and not guaranteed. Anyone offer me any glimmer of hope. It’s day one and my wife is sick of my self analysis already 😕

I had a 21mm tear fixed 6 years ago which I gather is huge as when I saw the consultant who operated 2 weeks ago about my other shoulder. His words were “ you were the one with huge tear” I also had other tears in the other tendons plus a bone spur.
It was 6 weeks in a sling, then rehab very gentle at first but building up to weights then finger boarding. I had the op in March and climbing in again in August.
I might have to have my other shoulder done as I’ve a couple of small tears, osteoarthritis and my bicep tendon is out of place, this is from the ultrasound scan I had yesterday. I now need to go back and see the consultant to see what can be done.
I don’t where you are based but I’m seeing Simon Boyle in York, he also works in Leeds and Harrogate. Len Funk in Manchester is highly recommended by lots of people.

[ferret]

I had a partial tear, slap tear and bone spurs in both shoulders. Non surgical methods proved ineffective. Eventually got surgery full recovery.
5 weeks of immobilization and a month of light use with physio following surgery would recommend it

[Oldmanmatt]

I tore mine, with complete separation, right shoulder, around six years ago now. No surgical intervention as I was advised it was more likely to exacerbate and prolong recovery.
Obviously it has never repaired itself. However, I function quite well. I have bouts if pain, usually triggered by some innocuous movement, like pointing at something. Feels like something “clicks” (twangs, maybe) then I’ll have pain for a couple of days. Can be severe. Rarely has exercise or climbing triggered it, where it has, it’s been after a slip or sudden loading.
With the physio at the time and since,  I started to develop and maintain a very strong shoulder, keeping the muscles around the damage sufficiently strong to take the load off in all but the most specific positions. Mostly callisthenics, bar work and rings, distally unstable where possible.
Like the arthritis in my foot, I class it as minor disability and because it makes me nervous to pull in certain positions, it has drastically affected my climbing. Possibly I should have considered surgery, however getting back to work (which was climbing at the time) asap, seemed the right route.
Fucking ridiculous that I can hold an Iron Cross in the rings, but can end up almost in tears after reaching for a pen on my desk.

[Andy W]

Hey Andy. What were your symptoms?

It's been a few months with some initial bad pain after slapping for a hold at full overhead stretch. Initially very painful for a week or so, reaching for things, sleeping, pain reaching over head. I started some rehab my self based on thinking it was SIS. This definitely helped, I climbed conservatively for a month or so and felt things were on the mend. Then a few harder sessions climbing and a bad moment on a teliski/draglift, seem to set me back again. That prompted me to get the scan (echograph, in France, is that ultrasound, I think so) which showed the tear. I trained the day before the scan and to be honest I still think bouldering as long as I avoid slapping overhead, doesn't cause any pain.

[Andy W]

Has anyone any experience of this. I knew something was wrong, carried on regardless, climbing ok albeit with some discomfort and pain on certain moves. Anyhow got a diagnosis today of an 11mm x 6 mm full tear of my supraspinatus tendon. Online reading seems a bit bit gloomy, suggesting it won’t repair, even with physio, surgery sounds like recovery is long and not guaranteed. Anyone offer me any glimmer of hope. It’s day one and my wife is sick of my self analysis already 😕

I had a 21mm tear fixed 6 years ago which I gather is huge as when I saw the consultant who operated 2 weeks ago about my other shoulder. His words were “ you were the one with huge tear” I also had other tears in the other tendons plus a bone spur.
It was 6 weeks in a sling, then rehab very gentle at first but building up to weights then finger boarding. I had the op in March and climbing in again in August.
I might have to have my other shoulder done as I’ve a couple of small tears, osteoarthritis and my bicep tendon is out of place, this is from the ultrasound scan I had yesterday. I now need to go back and see the consultant to see what can be done.
I don’t where you are based but I’m seeing Simon Boyle in York, he also works in Leeds and Harrogate. Len Funk in Manchester is highly recommended by lots of people.

I live in the Arielle, so I need to find a good sports physio I think. Good luck with your treatment, like you my scan revealed a hots of other stuff...long head bicep tendinopathy, effusions etc.

[Andy W]

I tore mine, with complete separation, right shoulder, around six years ago now. No surgical intervention as I was advised it was more likely to exacerbate and prolong recovery.
Obviously it has never repaired itself. However, I function quite well. I have bouts if pain, usually triggered by some innocuous movement, like pointing at something. Feels like something “clicks” (twangs, maybe) then I’ll have pain for a couple of days. Can be severe. Rarely has exercise or climbing triggered it, where it has, it’s been after a slip or sudden loading.
With the physio at the time and since,  I started to develop and maintain a very strong shoulder, keeping the muscles around the damage sufficiently strong to take the load off in all but the most specific positions. Mostly callisthenics, bar work and rings, distally unstable where possible.
Like the arthritis in my foot, I class it as minor disability and because it makes me nervous to pull in certain positions, it has drastically affected my climbing. Possibly I should have considered surgery, however getting back to work (which was climbing at the time) asap, seemed the right route.
Fucking ridiculous that I can hold an Iron Cross in the rings, but can end up almost in tears after reaching for a pen on my desk.

Thanks for the details, it is weird because I am still bouldering at full strength without pain, unless i reach directly overhead, but that isn't as bad as pain I might get from reaching into a cupboard or reaching into the back seat of the car.

[duncan]

Full thickness tears are quite common in older people who don't have shoulder pain, which suggests that it's not always necessary to 'fix' the actual tear to have good function. Having said that, the older people in these studies are not decent standard boulderers. Studies comparing surgery with rehab. in sportspeople have slightly better outcomes for surgery overall but these average results conceal huge variations: some people do well with rehab. and others not at all. Likewise surgery.

In your shoes, I would try rehabbing it for 6 months or so with advice from a good specialist physio. and seeing where you were after that time before considering surgery. Perhaps in parallel with seeing a surgeon (though in France you'll probably not need to wait that long?). The downside of this is potentially wasting 6 months. The upside is potentially not wasting at least six months extra you'd spend recovering from the surgery.

Fucking ridiculous that I can hold an Iron Cross in the rings, but can end up almost in tears after reaching for a pen on my desk.

This sounds like the classic 'strong but slow' muscles. Like being able to hang big weights off a 20mm edge but lacking contact strength. Do you do any work that encourages speed of 'switching on' unpredictably? Throwing and catching? Crawling on all fours?

[Andy W]

Full thickness tears are quite common in older people who don't have shoulder pain, which suggests that it's not always necessary to 'fix' the actual tear to have good function. Having said that, the older people in these studies are not decent standard boulderers. Studies comparing surgery with rehab. in sportspeople have slightly better outcomes for surgery overall but these average results conceal huge variations: some people do well with rehab. and others not at all. Likewise surgery.

In your shoes, I would try rehabbing it for 6 months or so with advice from a good specialist physio. and seeing where you were after that time before considering surgery. Perhaps in parallel with seeing a surgeon (though in France you'll probably not need to wait that long?). The downside of this is potentially wasting 6 months. The upside is potentially not wasting at least six months extra you'd spend recovering from the surgery.

Fucking ridiculous that I can hold an Iron Cross in the rings, but can end up almost in tears after reaching for a pen on my desk.

This sounds like the classic 'strong but slow' muscles. Like being able to hang big weights off a 20mm edge but lacking contact strength. Do you do any work that encourages speed of 'switching on' unpredictably? Throwing and catching? Crawling on all fours?

Hi thanks for your reply. I just started translating the rest of the scan report, it looks like there are few other things wrong! But i imagine they all related and can't be separated, my guess is that they are all chronic, degenerative, with maybe a recentish acute phase. I do wonder if it is the bursitis that is actually causing the pain. I've pasted the translated report below.

"ULTRASOUND OF THE RIGHT SHOULDER

Tendon of the long portion of the biceps in place in its groove without effusion.

Subscapularis tendon difficult to visualize but appears correct.

Supraspinatus tendon of pathological appearance, thickened, heterogeneous with full-thickness fissure extending over 11 mm transversely, 6 mm anteroposteriorly

Correct infraspinatus tendon

Effusion of the bicipital groove intra-articularly and blade of effusion of the

subacromiodeltoid bursa.

Absence of significant acromioclavicular conflict To be compared with MRI"

[sheavi]

Hi

I'd take Duncan's advice and certainly note Matt's experience.  I've seen many patients post repair (months/years after) and the results are mixed.  Also re-tears post-surgery are quite common but appear not to cause symptoms necessarily. Far more important than any scan is how your function is. If you can boulder without pain except slapping - then perhaps surgery is unnecessary at present.  Instead a structured course of rehabilitation is first required. No doubt surgery does have its place and many people report positive outcomes.  The sceptic in me does wonder if that is always to do directly with the surgery or perhaps the time spent afterwards in rest and rehabilitation, not the mention the powerful effect of expectations/mind/placebo etc. that surgery can bring.

You mention that perhaps the bursa may be the source of symptoms which is touched on in the first link below.


Here's some links that may be useful.

https://www.thesports.physio/rotator-cuff-tears-cables-and-crescents/

https://www.thesports.physio/a-hole-in-the-blanket/

Good luck.

[Oldmanmatt]

This sounds like the classic 'strong but slow' muscles. Like being able to hang big weights off a 20mm edge but lacking contact strength. Do you do any work that encourages speed of 'switching on' unpredictably? Throwing and catching? Crawling on all fours?

This sounds like me… Strong but old and slow.
Short answer is no to not enough. I keep trying, but I’m prone to pushing too hard too quickly. I tried to take up TKD again, since I have a Dan grade mate here, who I trained with a couple of decades ago. I could keep up with the classes, but ended up injured again (MCL, recurrence). Again, not lacking power, but too slow to think about taking it seriously again. I have good flexibility, yet strangely restricted mobility. I perform well in floor exercises, and flexibility tests, then can’t get my legs up to kick or high step when climbing. So many old injuries that I can tweak or irritate, including a few I thought well and truly rehabbed. I can go run 10k through the desert carrying a 10-15kg bergan, do all kinds of tricks on a bar or rings, jump press ups on my knuckles, hang a 6mm edge; but I can’t pull for shit when actually climbing or twist and turn my body as I know I should. I know I have to start taking movement training seriously, but find it hard to motivate myself.
If I’m honest, I’m an old man who used to be able to do so much, quite easily/naturally and is sulking about time’s increasing limitations on that ease. I will snap out of it, I usually do.

[Ru]

I have a family member that has potentially torn their rotator cuff, probably the supraspinatus. Could anyone help me understand the terminology and anatomy?

My previous understanding was that the supraspinatus muscle attached to the humeral head via a tendon that could have a partial thickness or full thickness tear. I have read that a full thickness tear is one that goes all the way through the tendon. My lay understanding of this was that the tendon is like a rope and so a full thickness tear would be like completely severing a rope - i.e. there would be nothing holding the muscle onto the bone. The muscle would then retract like the bicep does when the long head bicep tendon is completely ruptured.

However, I have then read that a full thickness tear is like a "hole" that goes all the way through. The description of a "hole" in a tendon I find very confusing, as you wouldn't describe a completely severed rope as having a "hole" in it. I have also read that the hole would be like a hole in a sheet  - this gives me a mental picture of a flatter structure that is compromised, but the tendon around the hole is still intact.

So basically I have no real mental picture of what a full thickness tear is. If the supraspinatus muscle is completely detached that would seem to me to be a strong argument for surgery, but if the muscle is still functioning and attached, but compromised, that would seem to be a good reason to try to strengthen what's left initially. I doesn't help that different sources use terms interchangeably, resulting in terms like "full thickness partial tears", whereas other sources use "partial tear" to mean "not full thickness."

[sheavi]

I have a family member that has potentially torn their rotator cuff, probably the supraspinatus. Could anyone help me understand the terminology and anatomy?

My previous understanding was that the supraspinatus muscle attached to the humeral head via a tendon that could have a partial thickness or full thickness tear. I have read that a full thickness tear is one that goes all the way through the tendon. My lay understanding of this was that the tendon is like a rope and so a full thickness tear would be like completely severing a rope - i.e. there would be nothing holding the muscle onto the bone. The muscle would then retract like the bicep does when the long head bicep tendon is completely ruptured.

However, I have then read that a full thickness tear is like a "hole" that goes all the way through. The description of a "hole" in a tendon I find very confusing, as you wouldn't describe a completely severed rope as having a "hole" in it. I have also read that the hole would be like a hole in a sheet  - this gives me a mental picture of a flatter structure that is compromised, but the tendon around the hole is still intact.

So basically I have no real mental picture of what a full thickness tear is. If the supraspinatus muscle is completely detached that would seem to me to be a strong argument for surgery, but if the muscle is still functioning and attached, but compromised, that would seem to be a good reason to try to strengthen what's left initially. I doesn't help that different sources use terms interchangeably, resulting in terms like "full thickness partial tears", whereas other sources use "partial tear" to mean "not full thickness."

I'll have a go!  Tendons come in different shapes and sizes.  An achilles tendon is more rope-like but rotator cuff tendons are much flatter and more analogous to perhaps a bicycle inner tube or thicker cloth.  A partial tear is like a hole/fissure that doesn't go all the way through, where a full thickness tear does.  A full thickness tear can sometimes mean it has detached from the bone but this is usually called a rupture. I hope that makes sense.
https://www.thesports.physio/a-hole-in-the-blanket/

[mrjonathanr]

. I have also read that the hole would be like a hole in a sheet  - this gives me a mental picture of a flatter structure that is compromised, but the tendon around the hole is still intact.

Like you, I’m a layman, but that describes my understanding of it. I’m told the supraspinatus tendon is roughly flat, not round.

[Andy W]

Hi

I'd take Duncan's advice and certainly note Matt's experience.  I've seen many patients post repair (months/years after) and the results are mixed.  Also re-tears post-surgery are quite common but appear not to cause symptoms necessarily. Far more important than any scan is how your function is. If you can boulder without pain except slapping - then perhaps surgery is unnecessary at present.  Instead a structured course of rehabilitation is first required. No doubt surgery does have its place and many people report positive outcomes.  The sceptic in me does wonder if that is always to do directly with the surgery or perhaps the time spent afterwards in rest and rehabilitation, not the mention the powerful effect of expectations/mind/placebo etc. that surgery can bring.

You mention that perhaps the bursa may be the source of symptoms which is touched on in the first link below.


Here's some links that may be useful.

https://www.thesports.physio/rotator-cuff-tears-cables-and-crescents/

https://www.thesports.physio/a-hole-in-the-blanket/

Good luck.

Thanks for the reply. The links make for good reading and confirm a few thoughts I'd been having but couldn't really back up. The present shaped attachment of the tendon, makes sense. That would account why I have relatively good function still. The hole in the blanket metaphor is much more optimistic than the hanging on by a thread one. Strange how interpretation/perception can alter how we think of such things.

[Andy W]

Little update. After a particularly comic visit to a French Sports physio, he set me up with a TENS machine and an ice pack, after thirty mins he said next visit we will do some exercises...I said er I will call you.

I've spent a lot of time looking and trying different approaches and I think, going back to basic mobility has worked well, I focused too soon on strengthening and stretching. The upshot is I'm still climbing and nothing appears to getting worse.

I followed this chaps mobility stuff.....     https://www.youtube.com/@RehabScience