Shoulder pain due to subacromial impingement with tear of supraspinatus tendon


Q: I am 31 years old and have had pain in my left shoulder for 5-6 years. I recently (November 2010) had an arthrogram MRI and it showed the following, based upon the report: "There is mild degenerative change of the acromioclavicular joint. there is mild subacromial impingement. Tehre is a full thickness tear fo the supraspinatus fibers, with approximately 1.5cm of tendon retraction. There is trace contrast extending into the subacromial bursa. There is infraspinatus tendinosis with a partial thickness undersurface tear. There are tears involving the anterior and posterior labra. The superior and inferior labra appear intact. The biceps and subscapularis tendons are intact" I can perform most daily tasks, but have significant pain when throwing or lifting heavy weight above my shoulder and aching pain when bowlin. I have looked into PRP and stem cell therapies, as well as arthroscopic surgery. The last Ortho doctor I went to recommeneded surgery. Based upon the diagnosis from the MRI above, would you recommend that I have the surgery to mitigate any further damage to the shoulder?


A:    In your case possibly the surgical alternative might be considered in the view that the MRI showed a full thickness tear of the supraspinatus tendon, that should be repaired, also the infraspinatus tendon is being affected by the impingement of the rotator cuff. The rotator cuff is a group of tendons that support the shoulder. These tendons can be injured during lifting, when playing sports with a lot of throwing, after repetitive use over a long time or suffer degenerative changes with the aging process. Typically, presents with an activity related dull ache in the upper outer arm and shoulder. Activity is commonly more difficult and painful above the shoulder level (more than 90 degrees). There is little or no discomfort with below-shoulder-level activities (less than 90 degrees) such as golf, bowling, gardening, writing, or typing. But, tennis, baseball/softball, basketball, swimming, and painting are more problematic and painful. It is very important to complete an intensive and comprehensive Rehabilitation program after the surgery to ensure that you strengthen and balance the muscles around the shoulder joint giving  stability, improve range of motion, prevent scarring as the repaired tendons heal and teach you which movements and / or activities you should avoid.

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