Question
Dear Doctor,

I returned from my general practicioners this morning with the news that I have a torn rotator cuff and biceps tear  his words were, "your shoulder is a mess."  This after he had reviewed an MRI I had last week.  He recommended and I set an appointment with an orthopadic specialist.

I am 50 years old and have lifted weights and done cardio training for years.  I did have had rotator cuff problems in the past, about 18 years ago when I was given a cortisone injection which help to clear up the problem.  Up unitl 3 weeks ago when I heard my shoulder pop and a tinge in my biceps muscle while doing incline dumbell lifts, I have not had any real problems.

My doctor indicated that the MRI showed no bleeding or bruising of the bicep, which he said was a little unusual.

My question is and I will find out more when I meet with the specialist, do you believe these types of tears will require surgery. I realize you don't have the MRI in front of you and are going based on this e-mail. I have read a number of different things and it sounds like there may be some options other than surgery, which I would like to avoid.

I have discomfort in lifting my arm over my head with the rotator cuff and it affects my sleep.  The bicep tear has not given me any problems.  Any feedback prior to my appointment will be appreciate.

Marshall Sneen, Jr.
Franklin, WI

Answer
Dear Mr. Sneen,

The good news for you is that there are other options for care in consideration of the rotator cuff tear and the bicep tendon tear.  Both of these injuries can be managed with physical therapy and rehabilitative exercises as long as the tears are not full thickness, and you will generally not experience much loss of strength after rehab has been completed.

With that being said, it is really up to your orthopedic surgeon to evaluate the amount of tearing you have experienced, and your current level of function in regards to the injury.  With his recommendation, you will ultimately have to make the decision about your care.  

Concerning the bicep tear, even if it is a full thickness tear, many times it will still not be surgically repaired because the remaining biceps tendon and muscle is strong enough to compensate for the loss of the injured tendon.  If you were a professional athlete, there would be no question...you would have it repaired immediately...but your not.  Your current activity levels and competitive level of sporting activities must be evaluated to make a conclusion on surgical repair, and what benefit you will receive from it.  

Now concerning the rotator cuff, from what you have described it sounds like the problem is the supraspinatus tendon, which is consequently the most frequently injured rotator cuff muscle.  If this tear is significant, although not full thickness, then your chances for surgery are pretty good.  The shoulder is an inherently unstable joint due to its great freedom of motion as well as the decreased amount of bony stability...it is literally held together by ligaments and muscle.  Therefore, if it is unstable, then surgery is appropriate to reduce the probability of further injury.

Again having explained the above, most rotator cuff tears can be rehabbed with exercises and stability work and do not need surgical repair.  The MRI and your functional losses will determine the ultimate course of action though.   Remain positive, prepare for the worst, hope for the best and except anything in between.  Discuss all of this with your orthopedist, especially your concerns, and lean toward the treatment that will alleviate the problem while leaving you with the best functional outcome.

If you have any other comments or questions feel free to write back.

Respectfully,
Dr. J. Shawn Leatherman
Director of Clinical Rehabilitation
WWW.SUNCOASTHEALTHCARE.NET