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Old 01-06-11, 03:35 PM   #1
Yen
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Rotator cuff, part XXXIV: MRI results

After much anticipation I finally saw the sports ortho doc and got the MRI results this morning.

The verdict: Partial RC tear

Actually, he spoke of multiple small tears which he pointed out on the MRI; they are just below the acromion.

The doctor doesn't want to rush into surgery so he made the following recommendations, one stage at a time in the following order (below). I'll see him again in 5 weeks and he'll access my progress. If this plan doesn't work, then he will recommend other options (one of which is surgery).

1. work on improving pain with scapula function improvement first;
2. advance to rotator cuff activities once pain is reduced;
3. gradually advance to other activities including biking, gardening, gym, and rappelling

Notice that my favorite activities are last. This probably means being off the bike for a while, except for spin classes. I explained that I rode a metric century in the TdF in November without pain, and now I can't ride 10 miles without pain. He asked "I bet you ride a racing bike" (meaning, road bike). Yep -- and he said that's probably a contributing factor.

He gave me a new Rx for PT which begins next Monday, this time specifically to treat a partial RC tear. He also showed me a few things I can do with shoulder blades pinched (good posture) to improve scapular strength and function, taking some load off the RC.

Meanwhile I am working full time while overseeing my mom's care (about 50 minutes from home) while she is still in the hospital recovering from severe leg and hip pain. She has no idea about my shoulder and I won't tell her until she is independent once again, as that will cause her to worry and fret over me.


I am feeling the effects of not getting any decent amount of exercise for about 3 weeks, with the exception of climbing stairs at work, at the hospital, and at her home. I hope to get out and take a good walk this weekend.
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Old 01-06-11, 03:39 PM   #2
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Doctors rarely know what's going on. If I were you I'd get back out there and hit the road and gym hard. Work on your max bench press and just remember pain is weakness leaving the body.

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Old 01-06-11, 03:42 PM   #3
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Darn, Yen... that sucks. I know very well the affects of not riding; just ask my wife! There isn't anything you could wear to make it possible to ride the road bike without hurting the shoulder?
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Old 01-06-11, 03:49 PM   #4
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Try a spinning class.

Btw, here's an unusual rehab exercise that helped me

http://www.youtube.com/watch?v=zPa1i...eature=related
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Old 01-06-11, 04:16 PM   #5
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Are you sure this guy is a sports med doc?
Mine had me continue with my normal activities but added PT twice a week for 4 weeks to strengthen the shoulder/upper arm muscles. Then he did the surgery. I was off the bike for a week or two after the surgery. Once I could climb on the bike (on the trainer), with my arm in the sling, I was riding again. Two months or so after the surgery I was back to bike commuting to work, with a stop off for PT before work. That was fun.
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Old 01-06-11, 04:22 PM   #6
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That's too bad Yen :-( I don't know anything about RC tears, but is there a possibility that they could actually heal themselves? I hope the PT works out for you. In the meantime though, I wonder if you could ride a really upright bike without any pain.

Best wishes for your mom's recovery as well.
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Old 01-06-11, 04:49 PM   #7
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Yes, he is a sports ortho doc, a very reputable, highly-rated one who happens to specialize in shoulders, with a special interest in RC repairs. He takes a conservative approach with surgery being last resort, on a case-by-case basis.

His primary interest, I'm sure, is long-term restoration, not getting me on the bike as soon as I want to be (as much as I would like that). A small tear can turn into a bigger tear, requiring bigger surgery. The first goal is to strengthen the surrounding muscles to help the tears heal and pain subside; if we run out of non-surgical options, then he will do surgery. Surgery should be the last resort, to allow other more conservative options an opportunity to do their work.

Every person is different; one person's MRI might indicate a different treatment (and riding a bike OK), while mine may not.

I plan to do spinning classes, and I might be able to ride my Surly w/ the moustache bars (more upright) without pain. But as he pointed out, tiny tugs on a tiny tear creates bigger tears.
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Old 01-07-11, 12:08 AM   #8
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My experience with the RC was pretty much like Ron's and only surgery brought relief. But, as you say, cases may be different. My surgeon also found a labrum tear during surgery that did not show on the MRI so even that is not necessarily exact. Anyway, hang in there and good luck with it.
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Old 01-07-11, 05:27 AM   #9
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It's just gonna take time. All active people show the signs of wear and tear as they age. I bet an MRI of most athletes our age would indicate some RC damage. If you think about all we ask of our shoulders (and the how the joint is designed) it's no wonder. Good luck with your rehab.
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Old 01-07-11, 06:34 AM   #10
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I am two weeks removed from surgery on the left RC and bicep tear. Initially they said I would require the sling for 6 to 12 weeks, Doc said I can chuck it after a week, however, I need to wear it when I do my exercise (walking). Pt twice a week and daily exercises they gave me to do at home. Shoulder feels a lot better then it did last week and the folks at PT say I am way ahead of the game so hopefully I can get on the bike again in a month instead of the three months I was originally told. I will be so glad when or if I eventually get pain free. I miss being active.
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Old 01-07-11, 06:44 AM   #11
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Yen and rappelling..........I had not heard that one before!! I hope you plan to put that one last on the list of things to do after the RC feels better!

I know what you mean about not exercising. I'm working on a new career---I'm thinking I might make a good model for either the Blimp or the Michelin Tire man........

Seriously best of luck feeling better + Mom's challenges. (Don't tell her about the rappelling either!!!)
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Old 01-07-11, 07:40 PM   #12
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Actually, your report is a good one. The MRI would have disclosed any bone spurs which would mean no options, you go under the knife. Apparently your doc feels your current activities are stopping the muscles from repairing. Once repaired, you'll be able to go back to your favorite sports. Best of all, you can be back by the spring. If you had an operation, your recovery would be the same, maybe a little longer, but WAY more painful. Go with what your doc says. If it doesn't work, then you can listen to the nay sayers.
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Old 01-07-11, 07:51 PM   #13
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Yen, isn't your LHT set up with higher bars for a more upright riding position?
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Old 01-07-11, 11:13 PM   #14
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Well I am pretty bummed out as this is a big disruption of my plans and activities! But things could be worse... much worse.

It is tempting to just say "heck with it!" and go out and ride. However, I take RC tears very seriously because my brother's RC injuries were full-thickness tears, one of which could not be repaired. His left shoulder probably will never be good again --- he has always worked out (including riding a bike), gone to the gym, etc. My doctor yesterday demonstrated how gentle tugs on a weakened RC tendon create tiny tears, and tiny tugs on those (while reaching or pulling something, riding a bike, etc.) tear it further. Like sun exposure over the years, it is cumulative until, one day, it can't take the stress and the first pain develops after years of wear and tear. I don't want to totally screw up my shoulder by doing those things that might make the small tears into bigger tears.

He also explained that RC tears are common and many people are walking around with them and don't know it. He said the mystery is why some have pain, and some don't.

My Surly has a more upright position but not entirely. I called his office today to verify that he doesn't want me riding at all (though it is pretty much implied on the PT prescription). I'll resume PT on Monday to improve the scapular function. Apparently, shoulder stability (or, instability as the case may be) begins with good scapular function.
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Old 01-07-11, 11:17 PM   #15
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Joe: Rappelling is an activity I'm learning as a new volunteer on the Urban Search and Rescue (USAR) team at work. We are learning knots and started rappelling (on a slope, and a short building) just before the holidays.
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Old 01-08-11, 10:13 AM   #16
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I'm pretty sure I sustained some RC tears playing basketball fighting for rebounds, blocking shots etc while the arm was fully extended, in awkward positions and lots of force was applied to it. I continued to play well into my 40's and noticed that whenever I reached out there were times I didn't have the strength---and a lot more pain that I used to. Fortunately I guess stopping playing and going to a sedentary lifestyle helped to let it heal itself?????

USAR--that sounds pretty interesting. Be careful out there!
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Old 01-08-11, 11:02 AM   #17
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Joe -- I've been doing a lot of reading about rotator cuff injuries since my initial diagnosis (tendinitis). One point that comes up over and over again is that this type of injury is very common, but many people are free of pain ---- or, their pain is minimal and they chalk it up to getting older.

My pain occurs only when I raise my arm at a certain level in certain directions. For example, I can raise my left arm from the side to straight over my head without pain, but can't raise my right arm to 90 degrees without a lot of pain, and sometimes lower than that. It's not the pain itself that bothers me, but the potential for greater injury (and longer recovery) if I push past it. I am an avid gardener, but I can't stick a shovel in the ground without that pain. I'm watching planting season come and go, and not a thing getting done.

Like you, the pain subsides to almost nothing if I do nothing, but that's not where I want to go.

I hope you are feeling better and stronger every day, and really look forward to your first ride report when you are back on the bike.
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Old 01-09-11, 07:54 AM   #18
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Originally Posted by Yen View Post
Joe -- I've been doing a lot of reading about rotator cuff injuries since my initial diagnosis (tendinitis). One point that comes up over and over again is that this type of injury is very common, but many people are free of pain ---- or, their pain is minimal and they chalk it up to getting older.

My pain occurs only when I raise my arm at a certain level in certain directions. For example, I can raise my left arm from the side to straight over my head without pain, but can't raise my right arm to 90 degrees without a lot of pain, and sometimes lower than that. It's not the pain itself that bothers me, but the potential for greater injury (and longer recovery) if I push past it. I am an avid gardener, but I can't stick a shovel in the ground without that pain. I'm watching planting season come and go, and not a thing getting done.

Like you, the pain subsides to almost nothing if I do nothing, but that's not where I want to go.

I hope you are feeling better and stronger every day, and really look forward to your first ride report when you are back on the bike.
Those arm-lift symptoms are exactly what I had. I was able to ride a bike without pain, however. I wasn't always able to lift a water bottle while on the bike, however. For me, there's been no rappelling since college - it WAS a blast!

You may not be where you want to go, but you are where you are.

To my mind, and in my RC treatment with my PT, the goal of recovering was to minimize pain when doing what I want and need to and to regain the ability to pursue what I want to do without being susceptible to injury - for my shoulder to be fit for my purposes. If pain in certain activities is a sign of aggravating the injury, and you can't do these activities without causing that pain, you are not currently fit to pursue those activities in a healthful way. This isn't a place you are going, it's a place that you are now in. The solution is some sort of proper treatment that does not involve re-injuring yourself. Where you want to go is the right place, but don't confuse it with understanding where you now are.
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Old 01-09-11, 10:48 AM   #19
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I am an avid gardener, but I can't stick a shovel in the ground without that pain. I'm watching planting season come and go, and not a thing getting done.
As you might expect I can totally relate to not being able to do what you really enjoy doing!! I'm still searching for a good answer as well.
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Old 01-09-11, 03:15 PM   #20
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Those arm-lift symptoms are exactly what I had. I was able to ride a bike without pain, however. I wasn't always able to lift a water bottle while on the bike, however. For me, there's been no rappelling since college - it WAS a blast!

You may not be where you want to go, but you are where you are.

To my mind, and in my RC treatment with my PT, the goal of recovering was to minimize pain when doing what I want and need to and to regain the ability to pursue what I want to do without being susceptible to injury - for my shoulder to be fit for my purposes. If pain in certain activities is a sign of aggravating the injury, and you can't do these activities without causing that pain, you are not currently fit to pursue those activities in a healthful way. This isn't a place you are going, it's a place that you are now in. The solution is some sort of proper treatment that does not involve re-injuring yourself. Where you want to go is the right place, but don't confuse it with understanding where you now are.
Excellent! Thank you! Deep down this is what I tell myself; I know "this too will pass" and "it is what it is".

Spoke with my brother last night and told him all about this. He is 3-months post-op for full-thickness tear (which could not be repaired) and retracted tendon repair in his left shoulder. He can now do 2 push-ups and lift a little weight. He said pinching his shoulder blades enabled him to lift the affected arm all the way up even pre-op, and improving his scapular function was the priority post-op. For me, pinching the shoulder blades helps a little but not quite all the way yet.
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Old 01-09-11, 03:17 PM   #21
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As you might expect I can totally relate to not being able to do what you really enjoy doing!! I'm still searching for a good answer as well.
Yes, Joe, I think of you and your situation. I hope you are feeling at least a tiny bit of improvement each week... it must be a trial with many highs and lows. We're still here for you!
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