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Thread: Rotator Cuff Tear any advice please

  1. #1

    Rotator Cuff Tear any advice please

    I have a slight tear in my left shoulder and attached the results in a word document, I cannot get to see a P.T. for about 5 weeks but would like some advise on which exercises i should or should not do to strengthen my left shoulder. I have full range of motion with pain at times and cannot sleep on that shoulder as it keeps me awake, I do not and will not have surgery due to loosing my independence,I would be great full for any advice........................
    Attached Files Attached Files

  2. #2
    Sorry for got to add, Im a 54 year old incomplete Para T4 Para in really good health except for neuro pain. I have been in a chair now for 38 years...............

  3. #3
    According to the Ultrasound , you have a partial tear of the supraspinatus muscle tendon. This muscle is responsible for the first 15-30 degrees of shoulder abduction (raising your arms from your sides to make "airplane wings" ) The tear is at the tendon footprint which means its right near where the tendon attaches to the upper arm bone. Be careful.

    http://www.naric.com/?q=en/content/h...sing-theraband

    In this link, the woman is using Theraband which is readily available to purchase on Amazon and other websites. She's using red Theraband which is medium resistance and may be too much to start. Light resistance Theraband ( tan or yellow ) might be a better first choice option.

    Theraband resistance is explained here:
    http://www.thera-band.com/faqs_consumer.php#faq_1


    Here's another illustrated guide to wheelchair shoulder Theraband exercises:
    https://ahc.aurorahealthcare.org/fyw...e/x15159bc.pdf
    Again, the blue Theraband the model is using is even more stiff than the red and is probably way to much resistance to start out.

    The American Academy of Orthopedic Surgeons has this guide for exercises not requiring Theraband. You may be able to adapt the basics from then to use in a wheelchair and while in bed.
    http://orthoinfo.aaos.org/PDFs/Rehab_Shoulder_5.pdf
    Last edited by 2drwhofans; 09-09-2015 at 08:10 PM.

  4. #4
    Remember RICE
    Rest Ice Compression Elevation

    http://www.uptodate.com/contents/rot...ond-the-basics

    pbr

  5. #5
    Thanks everyone for your advice, Will this injury heal with the proper treatment as I am getting conflicting views on this from my G.P.and online advice?
    Also is this a serious injury?

  6. #6
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    I swear I have what you describe and ultrasound. I refuse for same reasons. Thing does hurt a lot every day. I lift weights 5 days/week and seems ok there. Does it hurt if arm is doing activity? My hurting seems far greater if just sitting there doing nothing. Keeping arm active seems to "hide" the hurt, but have no idea if I am damaging more.

  7. #7
    There was a short news item in New Mobility magazine a couple of issues ago about a new non-surgical method
    of healing rotator cuff tears, based on a decades-old knee repair method.
    As best as I recall, your own blood is drawn and spun out in a centrifuge to distill your own body's growth hormone.
    This is then injected in tissues near the torn cuff, which causes the torn tissue to heal faster and better than
    with surgery. It sounded promising. Maybe you can search NM online, I have to go out now but will try to find it for you later.

  8. #8
    Here's the link & excerpt to the NM item about non-surgical repair of a rotator cuff tear:
    http://www.newmobility.com/2015/07/non-surgical-option-for-shoulder-repair/

    I was told I can try physical therapy, but am likely facing shoulder surgery. I dread spending two to three months in a nursing home with my arm in a sling. A friend told me about a new technique to fix rotator cuff tears where they take some of your blood and spin it down to a concentrate, then inject the concentrated blood into the tear, which enables it to heal without surgery. It sounds almost too good to be true. Is there such a procedure? If so, how long does it take and does insurance cover it?
    — Chip
    A. The procedure your friend is referring to is called platelet rich plasma therapy. PRP was developed in the 1950s to aid jaw healing during dental procedures. It started to be used in orthopedics and sports medicine about 10 years ago and is often used by professional athletes, notably major league pitchers, to speed healing and avoid season-ending surgery.
    To get a handle on how PRP works, I turned to Dr. Victor Ibrahim, a physiatrist, sports medicine doctor and director of the Performance and Musculoskeletal Regeneration Center in Washington, D.C. Ibrahim, having treated over 5,000 people with PRP, explains that blood platelets contain nutrients and growth factors that start and speed up the process of tissue repair and regeneration, and “they are very potent.” A 2008 article on PRP in Current Reviews in Musculoskeletal Medicine says while the average person’s blood is made up of 6 percent platelets, PRP increases platelet count to 94 percent. The concentrated nutrient and growth factor-rich PRP is injected directly into a damaged tendon or ligament and stimulates healing.
    PRP therapy is generally done in a doctor’s office and takes about 45 minutes. About an ounce of the patient’s own blood is drawn and placed in a centrifuge to isolate the platelet-rich plasma, which is then loaded into a syringe. Ibrahim says a key to successful PRP treatment is using an ultrasound probe to see the exact location of the tear in real time so the PRP can be injected directly into the damaged area. Most partial tears require between one and three treatments. A waiting period of four to six weeks is used to determine if an additional treatment is needed.
    Ibrahim says he has treated a number of wheelchair users. In 2010 he received a grant from the Sam Schmidt Paralysis Foundation for a pilot study that followed eight people with SCI who had PRP to successfully treat shoulder tears at the bicep.
    One of those people is Chris Waddell, 46, a winter and summer Paralympic medalist, speaker and author in his 27th year as a T10-11 complete para. In 2010 Waddell hurt his left shoulder by trying to get back in shape too quickly and was in constant pain. In 2012 the shoulder gave out during a complex transfer. An MRI showed a slight tear in his rotator cuff, but a physical examination showed significantly more shoulder weakness than the MRI suggested. “Transfers were painful, and I had to give up mono-skiing,” says Waddell. An orthopedic surgeon looked at the MRI and recommended surgery. Waddell resigned himself to surgery and a long stay in a nursing home during recovery, with no guarantee of success.
    Then he heard about Ibrahim through a friend. When Ibrahim examined him, using an ultra sound, he found partial tears in Waddell’s bicep tendon, anterior and posterior labrum (area around the socket), deltoid, and rotator cuff. In 2013 Waddell had three PRP procedures, one in February, March and May. “It worked!” he says. “My shoulder started to feel better in a couple of weeks. Now the shoulder pain is completely gone, and with physical therapy and steady working out, my shoulder strength is at 95 percent and I’ve returned to my active lifestyle.”
    If you are thinking there must be a catch, there is — most insurers, including Medicare, won’t pay for it. Ibrahim says that although there are many studies showing the efficacy of using PRP in minimally invasive injections, the studies are small. And because PRP is FDA approved with no patents, there isn’t any money to fund the large size studies that insurers want to see. In addition, there are studies that confuse the issue by looking at the wrong application — specifically using PRP in conjunction with surgical repair. Surgery, when warranted, causes a great deal of inflammation to the injured area, which overwhelms the healing response of PRP, says Ibrahim.
    According to AboutHealth.com, PRP treatments cost between $500 to $1,000 per injection, and costs can vary widely upwards. Ibrahim says his clinic charges $1,000 for the complete treatment — on a sliding scale. “We have never turned anyone away due to lack of money,” he says.
    One physician who recently learned how to do PRP is Dr. Jerome Stenehjem, medical director of Sharp Alison deRose Rehabilitation Center in San Diego. “PRP does work,” he says. “The science makes sense, and in the right hands it can be effective. Shoulders are one of the better joints to inject. I have been gearing up and plan to do PRP injections on an older patient of mine with paraplegia and shoulder degenerative joint disease.”
    Another PRP recipient is Paul Erway, 57, a wheelchair racer in his 35th year as a T4 para. In 2013 Erway hurt his right shoulder. An MRI diagnosed three partial tears and a complete tear on the top of the shoulder. “I was in a lot of pain and went to see the sports doctor for the University of Kentucky men’s basketball team. He mentioned PRP therapy, saying he had 10 papers on his desk about PRP, and suggested I look into it.”
    Erway located Dr. Steven Johnson, medical director for Evergreen Medical Center in Jefferson, Ind. “He used a hand-guided ultrasound to inject the PRP right into the tears,” says Erway, whose shoulder felt better in about a month — meaning he had no pain and could slowly, carefully start physical therapy. “The partial tears healed, but the complete tear had pulled apart, so it didn’t heal, which only affects my ability to lift my arm over my head. I built my strength back up and the following year did 50 wheelchair marathons in 50 weeks.”
    As with any medical procedure, it is important to choose a doctor who is well-versed in the specific therapy. Currently there are about 200 physicians in the United States who do PRP, according to Ibrahim. He says it is important to find a physician who does a competent evaluation and uses some sort of guidance, like an ultrasound device, to inject the PRP exactly to the injury. And steer clear of someone who is just experimenting or trying to supplement their practice. Try and get a feel if they are committed to the science.
    Over the years I’ve learned that rest and ice are the first line of defense for a sore shoulder. I now use a SmartDrive power unit on my manual chair, which enables me to rest and rehab my shoulders. I’m hoping it helps me avoid shoulder breakdown. When the soreness doesn’t go away, a visit to my primary care physician and physical therapy has done the job. However, if my shoulders ever get to the point of needing surgery and PRP looks like an option, for me it would be well-worth the out-of-pocket cost to avoid spending months in a nursing home.
    Chip, I hope this has given you the information you need to investigate further. Keep us posted.
    If you have a health question, contact Bob Vogel at rhvshark@mac.com.
    Resources
    • Performance and Musculoskeletal Regeneration Center, 202/681-PMRI; info@pmrcenter.org, pmrcenter.org
    • “Shouldering the Load,” www.newmobility.com/2005/09/shouldering-the-load/
    • SmartDrive, 800/637-2989; max-mobility.com
    • Use of Platelet Rich Plasma for the Treatment of Bicipital Tendinopathy in Spinal Cord Injury: A Pilot Study, www.ncbi.nlm.nih.gov/pubmed/23459023
    • 50 Marathons in 50 Days, www.50abilitymarathons.com/featured-athletes/paul-erway/



  9. #9
    It won't go completely back to the way it was before. You should get an opinion from the Orthopedic surgeon for sure.

    One thing you will need to do is change the way you transfer and modify any repetitive movements that aggravate that shoulder. Repetitive movements will continue to aggravate that shoulder. Get honest information from a Physical therapist who is familiar with treating spinal cord injured persons on transfers.

    pbr

  10. #10
    Never an guarantees with shoulder surgery. I know more that have gone bad with in a few years than those that haven't. Once you're cut from surgery there is never any going back.

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