[Jenn]

Hi everyone.

I know that shoulder problems come up a lot on here, but I was specifically after info on rotator cuff surgery.

After two years of being in pain I went for an MRI arthrogram and it turns out that I have a small partial thickness tear of my rotator cuff induced by trauma as shown in the red circle here:



The reason I had it for so long without having a full investigation is that I was pretty much able to manage the pain with physio, however I was never 100% and shortly after stopping physio my pain came back worse than ever.

Not surprisingly my surgeon is recommending surgery. I’m in two minds as it would require 3-6 months off of climbing... however I can’t exactly do physio exercises for the rest of my life, also the tear can get worse if it isn't fixed.

Anyone been through similar?

[tobym]

Jenn,

you mentioned 'your' physio, so I'm guessing you've had a fairly comprehensive course of physiotherapy, which didn't give lasting resolution of symptoms. Unfortunately, you appear to have a reasonably significant(I'm only a GP, so haven't seen many-GCW will know more) supraspinatus tear, and I'm not really aware of any treatment other than surgery that will fix it: it hasn't resolved in 2 years, maybe resting for long enough,  'might' allow it to repair itself, but I thought you were trying to avoid long layoffs from activity/climbing.

If you continue, as you are, there is a high risk of rupture, and then surgery would be the only solution,if possible, and probably a longer recovery.
Without supraspinatus, you would have great difficulty in initiating abduction at the shoulder, and the shoulder would be very unstable, potentially leading to more long-term problems.

It might be worth waiting for advice from people with a more orthopaedic/musculoskeletal background than myself.

Not sure if any effective solution is going to give you everything you want

Hope that helps,

Toby

[Jenn]

Thanks for your reply.

I should have been more specific... Yes, I did supervised physio exercises for 4 months and continued on my own for a total of 8 months. I had a significant reduction in pain but I was never ‘normal’; for example I never felt able to go back to campusing since I had this feeling like something might pop and I always had some residual pain. I started an MSc course last October and climbing (and my physio exercises) fell by the wayside. I started climbing again regularly in June and by August my shoulder pain came back worse than ever. It was a struggle to do daily tasks and I was constantly in pain. Because of this my GP referred me to a surgeon.

I agree - there is no solution that gives me everything I want. I really don't want to take more time off of climbing, however, I don't want to be in pain for the rest of my life and I certainly don't want to make it worse. I was just interested in people's thoughts / experiences.

Thanks again.

[GCW]

I'm only a GP, so haven't seen many-GCW will know more

I'm only a GP trainee!

That one image is very pretty, but on its own doesn't help much.
Basically you have 3 options.
1.  Stay as you are, it's likely that things will continue the same and not improve.
2.  Arthroscopic RC repair.  In the right hands a pretty good success rate, but nothing is guarunteed.  Worst outcome is you are no better but have a stiffer shoulder.
3.  Open repair.  Some people prefer this to arthroscopic repair.  Basically results are much the same, but complications (and scar) are a little higher.

To put in context, I dislocated my shoulder years ago and it's still unstable.  But I've learned to avoid things that tend to sublux/dislocate it, which usually means I can't catch slaps/dynos with my left arm.  It's a pain in the arse sometimes, but not enough for me to have a repair.

But that's me, and you are you.  It's a personal choice I'm afraid.  Only you know how bad it is as the moment.

[fatdoc]

GCW is fast gaining a level of respect for appropriate www. responses that frankly I'm totally totally impressed by.

I agree.

i have a 2 penneth.

Though frowned upon by some.. proper rest ( you mention campusing.. that would be like 9 months after proper rest and slow rehab  IM book) after an expert steroid injection... can really sort out the cycle of inflammation / pain / swelling leading to impingment leading to swelling   *repeat* hence injection and the enforced rest..

you seriously want to avoid surgery, I've seen the best.. and it's impressive.. BUT

you still wanna avoid.


I have rotator cuffs that are on clinical exam normal.. but oh my on occasion they hurt.. rest (change of sport deliberate into downhill MTB every 4 months) and just keepin fit works.. there again I'm old, dont redpoint and climb for simple release these days.

If you want to see a shoulder surgeon that appreciates these issues either private or on the NHS I have a name in sheff that I'd let inject / operate on me or my wife.. he knows the score in climbers terms..

either way, cross training is my final advice, get interested in something else for 6 months.. you will heal by default!! ( just as quick as post op rehab.. )

[Jenn]

Thanks a lot GCW and fatdoc.

So far everyone has been positive about surgery - I'm not so sure. The rehab sounds horrible (arm in a sling for a month). Plus it might not even work...

The pain is horrible if I climb and don't do physio. Also, I work in a lab, so I don't know how much I can possibly avoid using my shoulder - though it's not exactly like having to do heavy lifting.

I just recently got into MTB; maybe that's the way forward, though come to think of it, that bothers my shoulder as well.

Thanks again for the advice - I do agree though, surgery is something that I want to avoid at all costs. Maybe a second opinion is in order?

[Carnage]

So far everyone has been positive about surgery - I'm not so sure. The rehab sounds horrible (arm in a sling for a month). Plus it might not even work...

Yeah - The month in the sling absolutely sucks balls (esp trying to sleep). I was under the knife for a different injury to my shoulder and unless you have no other choice, I wouldn't recommend it. Get a couple of opinions from specialists and exhaust all your options before taking the plunge.
Good luck.

[GCW]

Expectation is a huge part of this.

Case 1- 60 year old man with severe arthritis in his hip, chronic pain, poor mobility.  Has a hip replacement and is pain free, but the hip is very stiff and he needs a stick to walk.

Case 2- 60 year old man, fell runner, does 4 minute miles.  Falls, breaks hip- subsequently fixed surgically and heals perfectly well.  Full movements but often has pain when running and is not able to break through 5 minute miles.

Who is more likely to be disappointed?


If you are significantly disabled by your shoulder, and you expect to get a bit better but NOT back to normal- if surgery is successful you will doubtless be happy.
If you are expecting to be back to a normal shoulder with no pain, even if it's 80% successful you may be disappointed.

Best thing is to speak to a dedicated shoulder surgeon, as we can only give general advise on here.  Hope you get it clear though.

[SA Chris]

Jenn, I am no expert, but what did you do?

I damaged a rotor cuff (spinatus I think) early in the year (I think the damage was actually done by a wave closing on me when surfing, and getting "washing machined" in early Feb). I went to physio for quite bit, who did various treatments as well as got me onto a daily theraband routine which helped tremendously and it is pretty much back to strength with the added benefit of sorting out loads of shoulder instabilities I had neglected. I would never consider campusing on it yet though, as it is still not 100%, and would be looking for trouble. Depends what level you climb/ed at.

What treatments has your physio been doing with you?

[galpinos]

Hi Jenn,

I'm not pro surgery but.....

Have had surgery on my shoulder due to recurrent dislocations, the last one of which did considerable damage. I was forced into surgery as my shoulder had become so unstable I not only couldn't climb but it was affecting day to day life.

The recovery time is shite, but in reality not that bad. I didn't even think about climbing for 6 months and concentrated on other stuff. The month in a sling left me pretty down but in retrospect I've now got a fully working shoulder with a very slight restriction of movement and a lovely big scar so it was worth it. What more could you want!

Taking 6 months out, be it rest and rehab or enforced post surgery time out, is not the end of the world and if it leaves you with a decent shoulder for the rest of your life, then surely it's worth doing?

[tobym]

I'm only a GP, so haven't seen many-GCW will know more

I'm only a GP trainee!

Ahh, I read this in another of your posts, but also read that you were a 'knuckle-dragger' in a previous life, and interpreted that as meaning an orthopod of some grade or other!This was also backed up by your impressive musculokeletal knowledge/common sense

[GCW]

I may have done some bone grating in the past, but that was in a past life

[tobym]

Glad to hear you've seen the light , sorry for the thread drift, Jenn

[Carnage]

I've now got a fully working shoulder with a very slight restriction of movement and a lovely big scar so it was worth it. What more could you want!

This pretty much my experience although I don't have the nice big scar (it looks more someone attacked me with a stapler). I reckon I've probably got 95% ROM which really isn't that bad when I consider the state I was in before. Its not all doom and gloom but be prepared to deal with a shoulder that feels like someone poured concrete in it, for quite a few months as you slowly regain mobility.

[nik at work]

Ahh, I read this in another of your posts, but also read that you were a 'knuckle-dragger' in a previous life, and interpreted that as meaning an orthopod of some grade or other!This was also backed up by your impressive musculokeletal knowledge/common sense

Get GCW to explain his "Skeletal Theory for the Impossibility of the use of The Egyptian in Climbing" and you will soon realise he knows naff all about the form and function of bones n shit

[GCW]

Egyptians are easier if your hips are flexible.
Not exactly rocket science, shorty.

[SA Chris]

If your hips aren't flexible, then make your hips more flexible? It aint exactly nuclear physics.

[Jenn]

Hey guys,

Thanks again for all of your input. I really appreciate it. I have to make quite a difficult decision and I want to make sure that I consider all aspects.

For example, was under the impression that I could get 100% function back... it doesn't seem so. I need to talk to my dr's about this one.

Speaking of which - I'm in London and I've been dealing with these people - all dedicated shoulder / elbow people: http://www.shoulderunit.co.uk/ However, I'm not overly impressed thus far and I need to speak to some other dr's.

As for my physio, I did the usual rotator cuff exercises starting with Therabands and working up to free weights. The exercises did work fairly well, as I said I got about an 80-90 % pain reduction even after climbing, but I never felt like I could push it. I don't boulder hard (about Font 6cish), but I always thought I could do better. With the injury I didn't feel like I could do proper training (eg. campusing), if that makes sense?

As for what happened the dr said that it was induced by trauma. I don't however recall one specific event (however I did have my boyfriend fall onto my shoulder from about 6m when I should have been spotting him...). I think it might just be general wear and tear, but I'm not too sure. My left shoulder often bothers me as well, but never to the same degree leading me to suspect that it was more of a overuse injury.

Though I guess it does make a difference going forward. I wonder if it can be prevented from happening again.

I'm starting to think more and more that I might try physio again.

Sorry for rambling. I had my MSc viva yesterday and my brain has been reduced to jelly.

[GCW]

For example, was under the impression that I could get 100% function back... it doesn't seem so. I need to talk to my dr's about this one.

You can get full function back, but it isn't a guaruntee.  All I'm saying is that you need to be aware you may well get better, but you could stay the same or even get worse after surgery.  Cuff repairs are pretty good, but it depends how bad you are to start with (see above).

I don't know the London guys, and it wouldn't be right to comment if I did.  However, if you feel you need to discuss things more you need to do so before going under the knife.

[SA Chris]

Although it's not a polite question to ask a lady, age can be a factor too, but fair to assume if you are just completing Msc you are still relatively young. Hope the viva went OK.

[Jenn]

I'm 32 - not young, but not old.

Viva went well, thanks. I got a distinction in my project 

[GCW]

In under 50s, arthroscopic cuff repair is pretty successful. 
Most studies show that 90ish% of people say their result is "good" or "excellent".  About 5% are disatisfied due to stiffness, long term.

Your potential surgeon should be able to provide you with their figures for outcomes.

[fatdoc]

May I ask this thread to be Stickyed... as it is all encompassing and will avoid GCW having to repeat himself?

[GCW]

Doesn't really cover all aspect of RC problems, that would need a while website.
I don't mind repeating myself:

Go and see someone that knows.

[nik at work]

Nothing can stop GCW repeating himself.

"easier for the short easier for the short easier for the short......"