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Old 12-16-10, 02:10 PM   #1
Yen
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Rotator cuff tendinitis, part 2

I'm wrapping up my 3rd week of PT, 2x/week, for what's probably rotator cuff tendinosis (NOT tendinitis as previously thought). The PT also suspects a partial tear of the RC. I have not had an MRI; the doctor said he will order one if there is no improvement after 12 PT sessions. PT consists of several different exercises including gentle stretches and using a resistance band. This facility places an emphasis on sports-injury recovery using the latest techniques, and I am confident in their knowledge and skills.

This question is for those of you who had RC tendinosis and found recovery through PT exercises:

How long did it take before you noticed significant improvement? It's going on 3 weeks and there is not much improvement, maybe 5-10%. Riding my bike did NOT hurt prior to PT, but it hurts now after about 20 miles; the PT thinks the exercises may have opened a can of worms but he did not discourage me from riding.

In the first week of PT, the therapist said I should feel 50% better after 2 weeks. He and the techs are perplexed over why my shoulder/arm don't feel better by now. I am seriously considering getting an MRI before the end of the year while my insurance deductible has already been met.
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Old 12-16-10, 03:17 PM   #2
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I'd get the MRI. I've had rotator cuff issues twice, got an MRI the second time. Even though I had no structural damage, it took about two years each time for the pain to go away. I bet I couldn't throw a baseball thirty feet now.
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Old 12-16-10, 03:30 PM   #3
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TWL: thanks. The only reason I hesitate is because MRIs are expensive and I'm not trying to rule out cancer or some other deadly disease. However, I'd like to know exactly what we're dealing with.
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Old 12-16-10, 03:36 PM   #4
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I missed part 1, but I'm going through something similar right now. I've only had x rays done. Some say I had a broken collar bone, if so it was at birth. One doctor said it was a bone spur. Another doctor just gives me a cortisone shots when it bothers me. I think it was caused in service on a jump where I bounced off the side of a plane. I just put up with the pain until it goes away. It doe's go away, but it comes back once or twice a year. I may go for an MRI, but I pretty much put up with it. It doe's set you back at times, but I seem to recover. Good luck with yours and if you have success, maybe I'll try something similar.
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Old 12-16-10, 05:32 PM   #5
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Get the MRI! Why wait for 12 PT sessions to find out if you have a serious problem if insurance is going to pay for it? The sooner you find out the sooner you can start treatment and the sooner you'll get it resolved.
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Old 12-16-10, 05:49 PM   #6
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There are two reasons to get the MRI. One, if it will identify the problem so that PT will be better able to plan a program to help you recover or two, you are willing to undergo surgery to correct a problem. Thing is, usually simple range of motion/strength tests can nail down the issue. There may be a partial tear or some impingement but most do not require surgery. Even so, if the injury was on the margin, surgery should be a last resort IMO. Last resort being a significant tear which limits usefulness.

These injuries take time to get over. In my case that is well over a year, close to two years from the time of onset. Give it some time would be my advice.
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Old 12-16-10, 06:09 PM   #7
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I got the book I referenced in part one. I've done all of three sessions of the intermediate-level exercises. When those are pain-free, you go to the advanced. Irrespective of the actual cuff damage, the exercises are all the same.

According to the book, my symptoms match with a torn tendon which is what I had repaired originally (and the offending bone shaved) some 15 years ago. It apparently can be healed by the exercises or not. It takes about 6-weeks. I have not studied the book much yet, just jumped into the exercises.

Far less pain at night and during weight training. Never has bothered me on the bike. I'm above a hundred pounds again on upright-rows having had to live around 60 over the past few months. Part of that was the discovery on Google that I had my hands too close on the bar which puts more strain on the cuffs.

Up to 30 sec on kneeling side planks with little pain which is a big improvement.

More than half the exercises are stretches. The author sites studies which indicates that one set of stretches per day is as good as more and holding the stretch for 30-seconds is far more effective than 15 and as effective as more than 30. Time and effort required are therefore low since you are only doing about 8 exercises with only one set for each of the light weight exercises of 10 to 20 reps. No warm ups required.

I'm not into stretching, so I appreciate quick and dirty. However, I just learned that as us old folk's age,our tendons get dryer which makes them stiff. That explains why I noticed that I've had more problems reaching down to put my socks on just in the last few months. So now I've added some leg stretches using the quick and dirty 30 sec. once per day. Only three days, but a significant improvement.
Al

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Old 12-16-10, 06:15 PM   #8
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Get the MRI

I had an MRI on my left shoulder last Wednesday and got the results from the ortho doc this morning. Major tear not only to the cuff but to some of the shoulder muscle also. Surgery this Tuesday. He said the MRI showed a very large tear but was not sure if it was all new or some of it may be older, he will know when he gets in there. Arthroscopic is planned but he said the tear is so large they may need to cut. I dumped the bike in September and knew it was not good. My shoulders have hurt for years, especially trying to do any weight training specifically on my shoulders, so some of it may be an old injury. He said recovery will consist of PT for 3-6 months starting two days after the procedure. I Will be in a sling for six weeks, hopefully not longer.(daughter's wedding is the 5th of Feb). No riding he said for sure. A stationary bike is ok but nothing else. At least I will be able to walk to hopefully sustain my weight loss.

So yesterday I set my new Cannondale CAAD 7 up against the inside of the garage door to take a photo to post and also send to my brother a copy. I forget about it. Three hours later I am outbound to get the mountain bike for a quick 13 mile ride. I hit the garage door opener and see my new CAAD caught on the door as it is rising. OMG! I run and grab the bike with my right hand (good shoulder) lift quickly, and save the bike from damage and place it gently on the floor. I then bend over from the pain shooting through my Right shoulder (again the previously mentioned "good" shoulder) that now hurts worse then the left. Life is good. I am still riding tomorrow.
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Old 12-16-10, 06:18 PM   #9
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Yen
I have, luckily, not had this painful injury. From other injuries I have had in my spine I second (third, forth?) going ahead with the MRI. Get it diagnosed a soon as you can so they can tailor your treatment in total to what they find. No need in an avid, healthy cyclist putting up with pain that will effect your enjoyment.

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Old 12-16-10, 08:47 PM   #10
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Thanks everyone.
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Old 12-16-10, 09:00 PM   #11
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Interesting you mentioned kneeling side planks.

On the first day of PT, one of the exercises I was shown was kneeling side planks. I said "no can do" because I had already tried and with a lot of pain (prior to this injury, I was doing side planks from my feet for 1 full minute, pain free). When the PT heard I can't do one at all, he said I have "a lot of work to do". Every appointment after that, I was asked "can you do a kneeling sideways plank yet?", and always my answer was "no". On the 4th visit, the PT asked me to try them at home by positioning my shoulder until I find a comfortable spot. When I tried that, it worked and now I do a kneeling plank for 20-30 seconds with minimal pain.

When I told him I was able to do a side plank from my feet for 1 full minute before the injury, he said that is "phenomenal for a person over 50". He must see a lot of weak 50+ folks.

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...

Up to 30 sec on kneeling side planks with little pain which is a big improvement.

...
Al
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Old 12-17-10, 07:20 AM   #12
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Interesting you mentioned kneeling side planks.

When I told him I was able to do a side plank from my feet for 1 full minute before the injury, he said that is "phenomenal for a person over 50". He must see a lot of weak 50+ folks.


Your therapist needs to do some study. There are a lot of folks over 50, 60 even 70 who can do that sort of stuff.


Actually, I've tried full side planks for a few years but couldn't do over 15 seconds due to the pain. Your post in the previous thread gave me the idea of a kneeling plank. So tried one. Managed about 10 seconds due to the pain.

My present kneeling 30-sec is not pain limited. I'm trying to build up the cuff slowly and not push the pain.

I'm going to wait a while before I try non-kneeling again.

Al
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Old 12-17-10, 07:55 PM   #13
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How long did it take before you noticed significant improvement? It's going on 3 weeks and there is not much improvement, maybe 5-10%.
I was probably about the same after 3 weeks. After 6 months I was probably 60% and after a year I hardly notice it. The time I do notice it is when I stick my arm straight out to signal a turn. I have a "significant partial tear".
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Old 12-17-10, 08:57 PM   #14
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Here is my experience ... typed one handed three days post shoulder surgery. Last May I experienced pain and limited range of motion after some weight work in the gym. I let it rest a few weeks and returned to the gym workout and things were not better. After a few weeks more rest, the same experience was repeated. I made an appointment with a local orthopod known for his shoulder expertise. He first suggested using bands to do some rehab. I did that for a few weeks with some modest improvement, but I still could not throw a ball other than under handed. The next step was an MRI, which was not at all definitive. The doc suggested that MRIs may or may not be helpful in identifying the problem and in my case it was not at all helpful. He then suggested a cortisone shot and that worked well for about three or four weeks, then I was back to pain and limited range of motion. The next step was surgery to repair whatever he found ... it was a torn bicep tendon and required some pins or something like that to repair. The surgery was a breeze, the recovery is very painful and I will be in a sling for six weeks. I am hopeful the short term loss of road biking will have long term payoffs.

Up untill the surgery I kept riding with some days and rides more painful than others. I guess the short version is that there is no one answer since each injury is different and how it is treated depends on your doc and your preferences and tolerances.

Good luck
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Old 12-17-10, 11:13 PM   #15
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I was probably about the same after 3 weeks. After 6 months I was probably 60% and after a year I hardly notice it. The time I do notice it is when I stick my arm straight out to signal a turn. I have a "significant partial tear".
Ken, where was the tear, and wear was your pain? Did you get an MRI?
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Old 12-17-10, 11:18 PM   #16
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metalheart44: Your experience explains why I am reluctant to get an MRI. I got one for one of my wrists, and found nothing; when the bill arrived, I wished I'd declined the MRI since it was not done to rule out a serious or life-threatening condition. And knowing an MRI is not always conclusive, there's the chance of getting a "negative" report when in fact the MRI doesn't pick up something really there.
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Old 12-18-10, 08:01 AM   #17
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metalheart44: Your experience explains why I am reluctant to get an MRI. I got one for one of my wrists, and found nothing; when the bill arrived, I wished I'd declined the MRI since it was not done to rule out a serious or life-threatening condition. And knowing an MRI is not always conclusive, there's the chance of getting a "negative" report when in fact the MRI doesn't pick up something really there.
Possibly relevant to the issue. I've been reading in the book. It appears that there have been several trials each consisting of three groups: operated on, therapy (both professional and at home) and do nothing. There was no difference in recovery rates in any of the trials between those operated on and those who did therapy either at home or professionally.

The conclusion was that those cases/injuries that have the need for surgery are rare. That reminds me of a back surgeon who wrote the book a few decades ago who made the case that 98% of back surgeries were unnecessary.

You might consider the book, it's short and very informative. Then too you can do some Google Scholar searches for trials on the subject.

As mentioned before, I had planned to see about an MRI. I decided to drop it unless things get really bad as it was 15 years ago. With my Medicare and supplemental it's free, but I hate to waste resources. Besides, I seem to be markedly improving.

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Old 12-18-10, 08:10 AM   #18
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metalheart44: Your experience explains why I am reluctant to get an MRI. I got one for one of my wrists, and found nothing; when the bill arrived, I wished I'd declined the MRI since it was not done to rule out a serious or life-threatening condition. And knowing an MRI is not always conclusive, there's the chance of getting a "negative" report when in fact the MRI doesn't pick up something really there.
MRIs can be financially painful but at least there is no radiation to worry about.
Correct that diagnostic exams don't always result in a diagnosis.
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Old 12-18-10, 11:27 AM   #19
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I was expecting the MRI to offer more of a go/no go answer to surgery and the results were not clear enough and did not predict the injury found during surgery. While an MRI may be diagnostic, it is worth noting that it may also result in essentially little new information to help sort out what to do next. If there is any hope of a non-surgical solution for you, then try hard at that ....

Good luck
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Old 12-21-10, 07:52 AM   #20
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Ken, where was the tear, and wear was your pain? Did you get an MRI?
Yen, I don't know exactly where the tear is. I had an ultrasound, not an MRI. I believe that this was done by a special kind of ultrasound because it was done in a hospital clinic, not the lab where I once had ultrasound for a different condition. I suspect it is cheaper than MRI (we don't pay for either under our health system in Canada) but I guess it could have been selected for another reason. (shorter wait time? more conclusive? better for the body? I don't know)
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Old 12-21-10, 08:43 AM   #21
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+1 to the "get the MRI" group. In my experience (2008 rotator cuff and labrum surgery) all the PT prior to MRI was a waste of time.
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Old 12-21-10, 09:45 AM   #22
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Bill how long was the recovery time after the surgery? When were you on a bike again? I have my surgery in about 5 hours.
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Old 12-21-10, 11:45 AM   #23
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Hoping the best for you... keep us posted on your recovery.

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Bill how long was the recovery time after the surgery? When were you on a bike again? I have my surgery in about 5 hours.
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Old 12-21-10, 12:27 PM   #24
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Bill how long was the recovery time after the surgery? When were you on a bike again? I have my surgery in about 5 hours.
It was about a month or maybe five weeks before I could ride my bike again. Then it was just some easy cruises on my hybrid. You can probably pedal a trainer or spin bike pretty soon after surgery if they are set upright for you. Full recovery was probably ten weeks or so....but it is a gradual and subtle process near the end. After six weeks you should feel pretty good but you just don't want to shock or overuse the shoulder. Good luck on the surgery.
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Old 12-21-10, 12:29 PM   #25
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+1 to the "get the MRI" group. In my experience (2008 rotator cuff and labrum surgery) all the PT prior to MRI was a waste of time.
I've already called the doc to schedule one before Jan 1 --- awaiting the call back to tell me where and when. I requested either contrast or no contrast, or ultrasound... whichever he feels gives the best results.
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