Joe A Shaw PA-C - 11/8/2011

Question
I'm 55 years old and last December I fractured my humerus and had multiple fractures to the humerus head as a result of a fall. I had surgery where a plate and pins were inserted into the humerus and the humerus head.  I have been having physiotherapy twice weekly for more than 7 months and, whilst I can now raise my arm to around 160 degrees whilst laying down, when standing I can only raise my arm to 45 degrees.  If I physically lift my arm using my other hand it will raise to 160 degrees. I have had an EMG which ruled out any nerve damage and also an MRI to check for tendon damage.  My orthopedic consultant told me that the MRI report suggested there was no tendon damage but the consultant in charge of the physiotherapy department disagrees.  He said the report was guesswork as it wasn't possible to view the tendon because the plate in my arm obstructs the view.  

Is there anything else which could be causing difficulty in lifting my arm unaided or, in your opinion, do you think the problem could be tendon related?

Answer
Lynn,
It seems you should be able to maintain your ROM standing if you have that same ROM lying supine?It could be weakness of the muscles of the rotator cuff as a cause but after 7 mos of PT??you should have good muscle strength to at least do that? Could be the supraspinatus tendon/muscle which an MRI is usually good at detecting tears,you may have to undergo arthroscopic evaluation to get a more definite answer.