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Thread: Any older sci patients out there dealing with partial rotator cuff tear

  1. #1

    Any older sci patients out there dealing with partial rotator cuff tear

    I have had a partial rotator cuff tear for about 6 months now and was wondering if anyone else has advice on managing the injury. Cotizone shots are out for me as I had a bad reaction when I had one for my injured thumb a few years ago, it sent me weird in the head for some reason and my doctor said I reacted to the steroid component which made me very moody almost aggressive . I am a incomplete T4 38 years post transverse myelitis with chronic neuro pain to add to my joys. I saw a physio once every 2 weeks for treatment and do my rehab exercises at home now as acupuncture didn't do much good

  2. #2
    Time to go with a power assist or full power chair. Also refine your transfer techniques and other shoulder stressors. At 61 years post injury with about 55 of them pushing a manual wheelchair my rotator cuffs are mostly scar tissue. Taking the stress off the shoulders will reduce the pain some. Click on the following link for a good guide to dealing with the major wheeler problem. http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf
    Last edited by SCIfor55+yrs.; 02-15-2016 at 12:40 PM.
    You will find a guide to preserving shoulder function @
    http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

    See my personal webpage @
    http://cccforum55.freehostia.com/

  3. #3
    My Dad is a 73 year old para, and has a partial tear of his right rotator cuff. He did physical therapy for months (twice a week), with gradual stabilization and improvement in strength. His tear was an exacerbation of an old injury, mostly likely done by overdoing it with weight training + age related/overuse changes.

    Surprisingly, he had no pain with his injury. Just a sudden loss of strength that has been very slow to recover. He was told that sometimes older patients can have these gradual tears that develop slowly over time with less pain.

    So, is pain your main issue? Who is advising you now how to manage it? Are you on anti-inflammatories other than steroids? There are also anti-inflammatory creams/patches and sometimes other molecules you can inject to help with pain. I've also heard of people who take a medicine to stabilize their mood when they get their steroid treatment, just briefly, to prevent the side effect you describe. A very experienced doc who uses steroids may know about this (maybe a rheumatologist?), but I suspect that most orthopedic surgeon types might not.

    My father was quite panicked about his injury for months. This is quite a horrible complication, as you know. He already takes a lot of pain medication for his long standing chronic pain (gabapentin 800mg 4x per day, Cymbalta 60, tramadol 50 2x per day and as needed), so we used to wonder if this might have masked some pain/discomfort from his shoulder tear.

    Totally agree on watching how you transfer. My Dad also was reaching back with his arm overhead to pull things which is a big no-no. He used to do this in bed a lot and we watch it now.

  4. #4
    I can endorse what hlh said about overhead lifting. This is one reason we have banned overhead trapezes on our beds, and won't order them for use at home. Pulling yourself up into a truck to transfer by grabbing onto the "sissy bar" is also a good way to do this. Suggest you see a good physiatrist who is knowledgeable about SCI for a shoulder evaluation, and start working on a more regular basis with a PT or OT who can teach you more shoulder friendly mobility and self-care skills...you may have several bad habits that are making this worse. I would also endorse going with power mobility, and perhaps even a mechanical lift for transfers. As you get older, you no only have the repetitive stress of years of using your shoulders for what they are not designed for, but your collagen in your joints, tendons, and ligaments becomes more brittle. This can much more easily result in tears rather than strains or sprains.

    Also recommend you download and read this helpful booklet. It is really about prevention, but once you have the tear, using these principles can help it from getting worse:

    Preservation of Upper Limb Function Following Spinal Cord Injury: What You Should Know

    http://www.pva.org/site/apps/ka/ec/p...oductID=883954

    (KLD)

  5. #5
    I already have just received some power Assist wheels (TWIONS POWER ASSIST) which are great but I live in a rural area in Australia so finding a PT with spinal chord injury knowledge is impossible.
    I am really after something for the pain on bad days like cortisone that is not steroid based or is hard on the liver like most anti-inflammatories?

  6. #6
    You may need to take an opioid for this type of musculoskeletal pain. Avoid excessive use of most NSAIDS as these are hard on your liver and on your kidneys. Analgesic creams or lotions may be helpful. Lidocaine skin patches have helped some. Ask your physician about salicylates (not ASA or aspirin) as well.

    Any PT or OT should be able to guide you on modifications of your mobility and ADL skills commiserate with the Clinical Practice Guidelines. They should download and consult the professional version of the document I linked above:

    http://www.pva.org/site/apps/ka/ec/p...oductID=883861

    (KLD)

  7. #7
    Senior Member
    Join Date
    Mar 2012
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    Hampstead NC
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    I have tears in both shoulders described in the MRI report as "massive" this plus other sundry issues. However, since the unbearable pain I was having in my shoulder/arm area's and at the insistence of one of my son's, I had the orthopedic doctors take a look at my neck. Sure enough my spinal discs were all tipped on way and the other. "I" made sure I actually saw what the problem was myself C-2 through T-1 were a mess. The spinal chord, which was quite visible in the MRI was squished and shaped like a snake running through the discs. Since the procedure was going to be through the neck from the front he fused and replaced discs from C-3 to C-4, C-4 to C-5 and C-5 to C-6. The way this was explained to me was doing work on C-2 to C-3 and any work below C-6 had to be done from the back of my neck. He was very hesitant to do C-5, to C-6 but he did it because it was so necessary.

    Believe it or not, much of the pain has gone. I have been able to cease my use of opioids, but I still use Gabbapentin 3 x 600 per day. Now I am certainly not without some pain, but it has been relieved to a point where it is bearable. I am physically and mentally able to drive, I even took and passed a driving test, but the DMV took my driving privileges away anyway, due to my prescribed use of opioids. I was taking these opioids when I was driving tested, in heavy traffic etc. and passed comfortably. I do however, enjoy life better without the partial fog of the "dope". All of which I was quite unaware of, while using the prescribed amounts.

    When I did explore having repairs done to my shoulders, the suggested solution was "reverse shoulder replacement" and several months of convalescing, which at my age of 76 could be the rest of my life. And since I have partial paralysis in my legs, lower back spinal problems, I use my arms pushing up, and from all indications I would not be able use my arms and shoulders this way any longer with such a "reverse shoulder replacement" The cure available is worse than the physical problem !!!! Cortisone shots have always made the pain from my shoulders worse, they do not seem to be an answer. Any type of manual wheelchair is out of the question, I have no power with my arms spread apart.

    I really have NO IDEA how I damaged my neck, of course I have fallen many times and even got momentarily knocked out that I recall, but nothing that I can directly remember that affected my neck or cervical area of my body. Was it somehow caused by the Bends/Caissons Disease? Most of the associated pain and everything else can be contributing getting its start way back then. It simply has all gotten worse with age.

  8. #8
    Senior Member
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    Mar 2012
    Location
    Hampstead NC
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    1,099
    SCI Nurse, the most effective pain killer for me was "Viiox" which I used for a couple of years around year 2000 +/- but that made my ankles swell and uncomfortable, so I convinced my GP doctor to do something else. We now know the effects of that medication. But it did work for my overall pain relief, and leg spasms. A short time after I stopped taking Viiox it was removed from the market.

  9. #9
    Once a leading prescription pain-relief medication worldwide, Vioxx (rofecoxib) and its manufacturer, Merck, fell from grace when scientists discovered the drug caused heart attacks, strokes and death.

    (KLD)

  10. #10
    A little late for that now.....as in meaning anybody confined to a wheelchair for life should have a power chair from the start.
    I don't want to hear the bullshit that you need the exercise either. You get more than you need just taking care of yourself.
    After 12 years my shoulder started to bother me and my SC Doctor said time for a power chair. With power chair I could do way more things also without all the wear and tear on your shoulders. Mine hurt like hell now with 40 years as a SCI. Why most SCI people as they age end up in nursing homes. The Gov. must think it is cheaper or some bean counter hoping you won't make it 30 to 40 years.
    Art

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