My orthopedist recommended surgery for me. He disagreed with the radiologist report that I have a 50% thickness tear in the supraspinatus. The orthopedist, when reading the MRI, believes its a full thickness tear. Yet I’m not getting pain when pressing or when he tested my arm in a variety of movements. I can reach overhead with no pain. He says there’s no pain since the other muscles are overcompensating for the supraspinatus. Since I adjusted my workouts and started PT, the pain has gotten better. The orthopedists stated “its only a matter of time before it needs to fixed via surgery.” I don’t get the difference in opinion between him and the radiologist and him advocating surgery, which is Pandora’s box in my opinion. We did align on getting PRP into shoulder but holding off on surgery. He wants to take another MRI in 6 months and see if its progressed. My MRI report is below. I’m just confused. Any comments are welcome.
ROTATOR CUFF REGION
CUFF TENDONS: A thin linear partial-thickness partial width bursal surface tear of the anterior insertional
supraspinatus tendon measures 9 mm in AP dimension, involving approximately 50% of the tendon thickness.
There is mild surrounding supraspinatus tendinosis. The remaining cuff tendons are normal in appearance.
CUFF MUSCLES: Normal appearing muscles.
CUFF GOUTALLIER STAGE: Stage 0: Normal muscle without fat.
DELTOID: Normal. No significant atrophy or tear.
LONG BICEPS TENDON: Normal. No abnormal signal, attrition, or tear.
LABRUM/BICEPS ANCHOR
SUPERIOR: Normal. No visible labral tear or biceps anchor pathology.
ANTERIOR/INFERIOR: Normal. No visible tear or attrition.
POSTERIOR: Normal. No posterior labrum abnormality.
CAPSULE
ANTERIOR/INFERIOR: Normal. No visible capsular laxity or thickening.
POSTERIOR: Normal. No visible capsular laxity or thickening.
AC JOINT REGION
AC JOINT: Mild degenerative change.
From what I recall you would be a borderline case for surgery. Something like over 50% is surgical but that’s usually accompanied by pain and discomfort. I’ve had partial tears twice and did PT for recovery. Mine were not as bad as yours. If the pain and inflammation is not bad, I’m not sure why your choice to wait and see is a problem with the doc. Just don’t overdo a thing and give it time to heal.
Here’s a current update. The original physician, when performing the ultrasound for the PRP injection into the supraspinatus, stated after I asked him, “the supraspinatus is not fully torn.” He later backpedaled on surgery and said “I have a long runway if before any surgery.” Fortunately, the ultrasound and PRP was conducted so he could see this.
I saw a 2nd ortho and he was unequivocal that I didn’t need surgery. He made sure not to criticize the other physician.
Question: I had PRP on the shoulder. I’m not lifting, if at all. Can I do rehab? The original physician gave me no limits. This is concerning. I did some rows and external rotations but for the most part, not lifting anything significantly. Can I do rehab? Can I do some moderate rows?
Did the provider who injected you not give you any instructions for what to do following the injection? I have had both stem cell and PRP shots. I received detailed instructions following the stem cell procedure. My recollection is that when I had a follow up PRP shot, I was told I could do whatever I wanted as soon as I wanted. What I don’t know though is if this was because I’d already had the stem cell procedure done and the PRP shot was a follow up to that. Bottom line: I’d ask the provider who gave you the PRP shot what you should be doing now that you’ve had the shot. And if you aren’t doing physical therapy, you probably should be.
I’d follow up with his/her office to see if they have a rehab protocol they want you to follow or if they can send you to physical therapy. PT did wonders for my shoulder.