Patient: Two months ago I was about to fall and my brother pulled me from my shoulder in order to prevent it. At that time I felt pain in my right bicep. The pain initially was there but in 10 days it subsided maybe 20% and has been the same ever since. Had an MRI last week. The report says rotator cuff tear, bicep tendon tear. Attaching the report and hoping that you guys go over it and explain me what is going in simpler terms rather than the terminology that is used in the report.
Symptoms: My forearm hurts when I lift my arm at a certain angle.
Doctor: Hi.Thanks for your query and an elucidate history.Read your history carefully and the reports you have provided.The history dates back to 2 months and must have been a sudden pull that is without any preparation or time to react as the fall must have been eminent. You felt pain only in biceps -MRI last week – I am trying to explain as you have asked for, feel free to ask further if you need to or if you feel that there is a gap of communication, I shall be very happy to assist your.Basics: The rotator cuff- as the name suggests is called rotator as you may be knowing that shoulder joint is one of the joint which has the maximum movements including that of rotation.This is needed for the life.This is made possible by a classical arrangements of the muscles, tendons and other structures that allow the rotation at the same time stabilizing it during the process.The rotator cuff is a group of tendons and muscles in the shoulder, connecting the upper arm (humerus) to the shoulder blade (scapula). The rotator cuff tendons provide stability to the shoulder; the muscles allow the shoulder to rotate.The muscles in the rotator cuff include:Teres minorInfraspinatusSupraspinatusSubscapularisEach muscle of the rotator cuff inserts at the scapula, and has a tendon that attaches to the humerus (arm bone). Together, the tendons and other tissues form a cuff around the humerus. When there is injury, these structures are partially or completely tore off.As your report says: I will try to explain as per the points as numbered in the section under Impression of your report for easy correlation for you to make:1. The muscles coming from the scapula, (the flat bone behind) and getting inserted into the humerus are tore away. There is full thickness tearing means there is complete disruption.Tendinosis means inflammation of the tendons.Upper part of the long bone humerus is migrated as the support pattern has changes.Cut muscles hence no action hence they atrophy (thin out).2. Subscapularis muscle coming from the front part of the scapula too have the changes of tear – hence the part which is not in continuity gets retracted – pulled away.3. Biceps- arm muscle tendon is also tore, hence the retraction and collection of fluid as a reaction to trauma. not yet reabsorbed.4. The joint fluid increased in quantity due to reaction to trauma as a natural process of healing andSynovitis is inflammation of the lining of the joint which supplies fluid to the joint5. Impingment is pushed in – of the structured below the acromion.I hope this helps.
Comments / Follow Ups
Patient: Testing posting a comment
Doctor: yes please……………
Patient: Ok, so as a follow-up question here is what I would like to ask:
1. Is what I have the same as the commonly referred rotator cuff tear, or I have a rotator cuff tear and othef tears associated tears?
2. If I don’t want to operate on it, what are the drawbacks. What can happen? Will the condition get worse over time or after some time it will become even less bothersome qnd I can continue to live with it?
Doctor: You have rotator cuff tear as discussed above.
Not operating will weaken up the movements of the shoulder joint, can limit movement and cause pain, swelling, reduced power in particular movements. In long run if you do not take proper aftercare the other nearby muscles also start get muscle atrophy due to reduced use.
Ultimate decision can be taken only after a clinical evaluation, actual physical examination by an orthopedic surgeon and correlation with the reports.
Patient: Thank you. Looks like I’m going to have to do the surgery (seeing a surgeon on Friday). My question now is the following: Does it matter when I do the surgery? Meaning if I do it now or 3 months from now what will be the difference? My symptoms have subsided and I do not face major mobility issues.
Doctor: 3rd and last follow-up:
You are most welcome.
Nice to know that your all the doubts will be more clear on Friday.
It does matter when do you get the surgery done. It is already 2 months late, I think if indicated go for surgery at the earliest. I am sure you will be enlightened more on Friday. It is always better to follow the advise of your Consulting Doctor.
Wishing you all the best and have great recovery.