Torn Rotator Cuff

[ryanman]

Hoping for some advice specifically relating to weight training.

About 8 weeks ago I noticed a pain in my right shoulder. I carried on training but noticed my strength on my right side dropped rapidly, week on week. For instance I was bench pressing 120kg but now it's a struggle to do 70kg. I know it's strength in my right side as my left arm is still strong in the other exercises and now far exceeds my right side (I'm right handed).

Anyway, I rested completely for 2 weeks and the pain went. So went back to the gym, and had only a small amount of pain, but my strength in my right side was still awful.
So I booked in privately with the physio at the gym and went today. She did a few tests and is completely sure I've torn my rotator cuff, specifically a subscapularis tear (with associated scapula winging). The test she did, the lift off test, should only show if the tear is 60% or greater (she didn't say that but that's what the papers i've read show).
But after diagnosing that she didn't make another appointment for treatment but she then gave me a few exercises with bands to do for a couple of weeks, then to start building up with weights again if it has started to feel better. She said she was confident it will be fixed and to go back to her if in a few weeks it hasn't started to get better. But that leaves me with a few questions...

1) All the reading I have done suggests that only surgery can fix a rotator cuff injury, so will these rubber bands and a couple of weeks really help? Is it possible to heal a torn rotator cuff without surgery?
2) The pain is really quite low, it's just a massive loss of strength, so how can I test that its better without pain as an indicator?Especially as I shouldn't really try to life heavy weight to test it?
3) If I'm going to be out of action for a considerable time, what do you guys think of training just one side of the body (and legs)? I know I don't want to create further imbalances but as its my naturally weaker side i'd be training maybe I could get away with it for a while at least before that becomes an issue?

I'm guessing this is a situation where internet help isn't really useful as you can't examine me, but any advice would be appreciated.

@AdamGB
@Scrap

Is this an area you have any expertise in?

Thanks

[Scrap]

I would have to see you.

[ryanman]

I would have to see you.

I knew you'd be responsible and say that!

[StrictlySP]

Hi ryanman,
I'm not going to be as responsible as Scrap...

Here are some thoughts and general recommendations (based on experience with rotator cuff injuries and treatments from orthopedic shoulder specialist):

1. Shoulder surgery should be considered a last resort/final option. According to the orthopedic doctors I've seen over the years, the shoulder is the most mercurial joint in the body. Surgery may or may not make it better and the rehabilitation/recovery period is amongst the longest and most painful. So, unless you're a professional athlete or absolutely need it to alleviate constant pain, I'd give all other treatments a shot first before going down the surgical road.

2. Continue doing all the exercises the physio directed you to do and do them exactly as directed. I'm sure the regimen includes external and internal rotator cuff exercises and stretches. If not, go to another physio...

3. If your physio didn't include them in your rehab regimen, you might want to add Codman exercises (Google it and you'll find all the info you need).

4. If you weren't prescribed/advised to take any medications, you might consider taking 800 mg of ibuprofin (i.e. Advil or Motrin) two times a day for two weeks (and two weeks only) for anti-inflammatory purposes to facilitate healing. Be sure to take it with food in your stomach. The last time I went for treatment with an orthopedic specialist, this is what he prescribed for me to do. I did it and it helped.

5. Ice your shoulder three to five times a day for 10-20 minutes each time for the same reason as #4.

6. The last orthopedic doctor I saw told me that one of the best things you can do for shoulder health (rehab and maintenance) is simply to hang from a bar (using both palms-facing-away and palms facing-each-other positions). Anyway, he said doing four sets of 30-second hangs per day is a good baseline program to strive for/maintain. With that said, he mentioned the longer you can hang, the better (which is also great for grip strength development too by the way). Personally, I do four sets of one-minute hangs.

Oh, in regards to training the healthy left side of your upper body (along with your core and legs), that's fine to do. It's good to keep active by working around your injury. Just be careful that you don't overdo it and injure that shoulder too. Be sensible...

Anyway, consider incorporating these suggestions for four to six weeks and see how they work for you. If you do, I hope they help...

Take Care,
Lito

[ryanman]

Hi ryanman,
I'm not going to be as responsible as Scrap...

Here are some thoughts and general recommendations (based on experience with rotator cuff injuries and treatments from orthopedic shoulder specialist):

1. Shoulder surgery should be considered a last resort/final option. According to the orthopedic doctors I've seen over the years, the shoulder is the most mercurial joint in the body. Surgery may or may not make it better and the rehabilitation/recovery period is amongst the longest and most painful. So, unless you're a professional athlete or absolutely need it to alleviate constant pain, I'd give all other treatments a shot first before going down the surgical road.

2. Continue doing all the exercises the physio directed you to do and do them exactly as directed. I'm sure the regimen includes external and internal rotator cuff exercises and stretches. If not, go to another physio...

3. If your physio didn't include them in your rehab regimen, you might want to add Codman exercises (Google it and you'll find all the info you need).

4. If you weren't prescribed/advised to take any medications, you might consider taking 800 mg of ibuprofin (i.e. Advil or Motrin) two times a day for two weeks (and two weeks only) for anti-inflammatory purposes to facilitate healing. Be sure to take it with food in your stomach. The last time I went for treatment with an orthopedic specialist, this is what he prescribed for me to do. I did it and it helped.

5. Ice your shoulder three to five times a day for 10-20 minutes each time for the same reason as #4.

6. The last orthopedic doctor I saw told me that one of the best things you can do for shoulder health (rehab and maintenance) is simply to hang from a bar (using both palms-facing-away and palms facing-each-other positions). Anyway, he said doing four sets of 30-second hangs per day is a good baseline program to strive for/maintain. With that said, he mentioned the longer you can hang, the better (which is also great for grip strength development too by the way). Personally, I do four sets of one-minute hangs.

Oh, in regards to training the healthy left side of your upper body (along with your core and legs), that's fine to do. It's good to keep active by working around your injury. Just be careful that you don't overdo it and injure that shoulder too. Be sensible...

Anyway, consider incorporating these suggestions for four to six weeks and see how they work for you. If you do, I hope they help...

Take Care,
Lito

Many thanks. I appreciate the time and effort you've gone to to give advice.

My physio has only given me internal and external cuff exercises to do. Just one of each with a band. And some chest stretches. Not a lot really.
I've just googled codman exercises and will incorporate these from tomorrow and will implement the icing too.
In your experience, is it possible to fully recover from a cuff tear without surgery? Are the non surgical treatments only able to alleviate the worst of it? The pain is not a great issue, it does hurt but it isn't affecting me hugely. It's the massive loss of strength that really is the main thing impacting on me.

[StrictlySP]

Hi Again ryanman,
You're welcome...

You asked:

In your experience, is it possible to fully recover from a cuff tear without surgery?

Yes, it is possible, I've done it. With that said though, my tear was a minor one. Anyway, when I rehabbed it, I did so diligently and thankfully, it paid off - no surgery needed whatsoever.

To better address your inquiries, here's something I found on the American Academy of Orthopedic Surgeons site. It will answer your questions more authoritatively than I can.

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Can a rotator cuff tear be healed or strengthened without surgery?

Many rotator cuff tears can be treated nonsurgically. Anti-inflammatory medication, steroid injections, and physical therapy may all be of benefit in treating symptoms of a cuff tear. The goals of treatment are to relieve pain and restore strength to the involved shoulder.


Even though most tears cannot heal on their own, satisfactory function can often be achieved without surgery.


If, however, you are active and use your arm for overhead work or sports, then surgery is most often recommended because many tears will not heal without surgery.


At what point does a rotator cuff tear require surgery to fix it?


Surgery is recommended if you have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment. Frequently, patients who require surgery will report pain at night and difficulty using the arm for lifting and reaching. Many will report ongoing symptoms despite several months of medication and limited use of the arm.


Surgery is also indicated in active individuals who use the arm for overhead work or sports. Pitchers, swimmers, and tennis players are common examples.

What options are available for surgical repair?


The type of repair performed is based on the findings at surgery. A partial tear may require only a trimming or smoothing procedure called a débridement. A full-thickness tear within the substance of the tendon can be repaired side to side. If the tendon is torn from its insertion on the humerus, it is repaired directly to bone.


Three techniques are used for rotator cuff repair: traditional open repair, mini-open repair, and arthroscopic repair.


Your orthopaedic surgeon can recommend which technique is best for you.


How important is rehabilitation in the treatment of a rotator cuff tear?


Rehabilitation plays a critical role in both the nonsurgical and surgical treatment of a rotator cuff tear.


When a tear occurs, there is frequently atrophy of the muscles around the arm and loss of motion of the shoulder. An exercise or physical therapy program is necessary to regain strength and improve function in the shoulder.


Even though surgery repairs the defect in the tendon, the muscles around the arm remain weak, and a strong effort at rehabilitation is necessary for the procedure to succeed.


Complete rehabilitation after surgery may take several months.


Your orthopaedic surgeon can prescribe an appropriate program based on your needs and the findings at surgery.


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I spoke with one of my best friends (who's a medical doctor - specifically, an anesthesiologist) about this and he told me that one of his best friends, who's an orthopedic surgeon, told him that when it comes to surgery on the joints (and their associated tendons & ligaments, etc), the shoulder is the most tenuous one of all and yields the most uncertain outcome as a result.

While the goal of surgery is to correct/improve/remove an ailing condition, when it comes to the shoulder, there's a "higher than normal" chance that the condition you were in prior remains relatively the same as it was before surgery OR worse yet, gets worse as a result of it. It's a roll of the dice...

So, for what it's worth, I'd give all non-surgical means of rehab and recovery an honest and patient effort before even considering surgery.

Well, I hope the non-surgical protocols work for you. You have my best wishes...

Take Care,
Lito