Hello. I am a longtime reader of T-nation. This may be my first post in a forum, but not entirely certain about that. Anyway, here goes . . . .
I have come to the realization that my left rotator cuff is “probably” torn. No, I have not had an official diagnosis, not yet anyway, but that is forthcoming. IF it is actually torn, what are your thoughts on surgery? A few other points:
42 years old. The first symptom occurred in May of 2020, when I was 40.
Since that time, the pain has been “on and off,” rarely “severe” but mostly tolerable.
In the last couple of months, there has been a noticeable discomfort in this shoulder while sleeping. Especially when the left side isn’t elevated. It is a deep ache, cramp, etc…
Have been trying ice, cold compresses, an average of 3-5 times a day (20-30 minutes each), for the last 2 months.
Yes, I am still lifting. A “TRT assisted” (cypionate/pro.) noncompeting bodybuilder. Push, Pull, Legs regimens have been my “go to” since reading CT’s “The Best Damn Natural Bodybuliding Plan,” or whatever the official title is, back in 2016.
Hammer Strength pressing movements, and even seated barbell overhead presses, are generally fine. If there is any pain while performing these, it is minimal and tolerable.
HOWEVER, dips (one of the best pec & delt developers for me, personally) have been 100% off-limits lately. The last time I tried to dip (week 1 of December, 2022), it felt like Freddy Krueger had mutilated those shoulder joints & ligaments with his glove!
All “pulling” movements (back, bi’s, etc.) have been fine. In fact, yesterday was a Pull training session and a good one, at that. No noticeable aggravation of the shoulder aftewards.
Final notes: I began supplementing with collagen peptides after the injury first occurred. (Flat bench DB presses, with only a moderate poundage at the time, but my left arm just suddenly went sideways during a late concentric rep, and I spent about 6 weeks not training any upper body at all. I had assumed that it had “healed” via rest, but the problem has been an “on-and-off” one since the summer of 2020.)
As for the collagen supplementation, I feel that it has been beneficial but obviously is has not been a cure.
Okay, after having stated all of this, please provide any comments and thoughts on whether surgery is advisable, IF it turns out that the rotator cuff is diagnosed as torn. I am almost assured that any ortho clinic I visit will recommend the surgery. (After all, more profit for them.) But, I really (1) want to avoid it, and (2) continue to train, if there are other options to alleviate and/or manage such an injury.
I think if it was fully torn you would be more than off and on pain. I had fraying of the muscle or micro tears. My ortho and I decided against surgery so I started rehab work with bands and prescription strength anti inflammatory medicines. It took almost a year to feel fully better. I’m now 95% better and even benching again with caution. See the ortho, get an MRI and then decide.
It is a wealth of biomechanical understanding and discusses in-depth the decision-making process of how to treat the shoulder and how to rehab it. Go to Page 32 if you want to jump ahead to the question you are asking.
Yes, it discusses using interventional ortho-biologics, but it is free, and you will learn a lot, and help you in your decision-making process. I can vouch for its effectiveness under the right physician.
Shoulders are wonderfully complicated joints. Likewise, they can be b*!?* to deal with!
Surgery is not recommended as primary management for degenerative rotator cuff tears (especially in those aged over 40) even if they are full-thickness
RC repair is not recommended as primary management because of the huge rate of asymptomatic tears in healthy shoulders, as people age
Up to 40% of pain-free individuals may have cuff tears. Therefore it is very challenging to conclude that, should someone have a degenerative cuff tear, fixing the tear will have any affect on symptoms. Often, it does not when directly compared to physical therapy / exercise rehabilitation
This does change however with more acute/traumatic tears, especially in younger individuals, since there can be higher certainty the cuff tear is associated with shoulder symptoms
Something as that could be a torn labrum. If you have even a partial RC tear, surgery may not be necessary. I have seen some good results with PRP (your own plasma) injections, with partial tears. MRI’s can be done pretty cheaply, at least here in the Atlanta area. On a similar note, Dan John is a big devotee of hanging to fix a lot of shoulder issues.
I’m 46 and just had shoulder surgery 3 weeks ago on the left side. I was having intense pain trying to do cable raises and finally went in to have it checked out. Ended up getting an MRI and I had bone (essentially a spur) digging into the rotator. Two years ago I had the same going on with the right side, but this presented with pain trying to do bench press movements.
In both cases I had surgery to remove/grind out the bone spur, and grind the bone in the acromioclavicular (AC) joint. The current left side surgery they weren’t sure if the rotator cuff was going to need repair or not from the MRI. It showed some damage but once they got in they found it was small enough to leave alone.
Two years ago, they showed me pictures from the right side surgery and you could actually see the divot and bruise the bone was creating on the rotator cuff. Awaiting to see the left side pics at my follow up appointment next week. I haven’t regretted having the right side done, as I was able to start pressing again. Fortunately, I think my recovery on the left is going a bit faster than on the right it took months for me to be able to lay on the right side (side sleeper) but I have been cautiously been able to lay on the left in the past couple days.
I would recommend at least having it checked out. They will likely have you start with physical therapy and see how that goes. If that helps, you will hopefully avoid the surgery. Just be sure to do the recommended home exercises that the therapist prescribes, it makes a difference on outcome and recovery.