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supraspinatus or rotator cuff....any ideas?(11 posts)

supraspinatus or rotator cuff....any ideas?bicycle268
Oct 10, 2003 7:40 AM
Hello all...

Crashed pretty hard Saturday and landed on my shoulder then head. Helmet crushed with ZERO head damage but I really messed my shoulder up. The doctor thinks it's a partial tear of the rotator cuff tendon.
FWIW- I have full mobility, there's no discoloration and minimal swelling.
however, I'm having some consistant pain along the top of my shoulder and pain with moving my arm above my head or letting it hang by my side.

My primary care md just says stay off the bike (yeah right!!!) and take motrin. I will of course be seeking the opinion of an orthopedist but....

Does this sound familiar to anyone? I'm curious as to how long before I'll be able to ride pain free again.

Thanks
One and the sameDrPete
Oct 10, 2003 7:50 AM
There are actually 4 muscles that make up the rotator cuff, and supraspinatus is one of them--sounds like that's the one, though. You may have also just bruised your deltoid, which is kinda separate from the rotator cuff. Hard to say without examining you. And I'm assuming that since you landed on your shoulder you got x-rayed and those were negative...

Most partial tears/low grade sprains and strains resolve totally in 4-6 weeks... Ice is good for 48-72 hours post-injury, then most people recommend going to a heat pack.

It may be good to stay off the bike for a little while at least, just to give the shoulder a little time to heal up. And motrin is good stuff...
My experience was different..spluti
Oct 10, 2003 10:33 AM
I iced and rehabed according to my MD's referal and PT's guide.
The problem was they both missed diagnosed me with a complete severed tendon. By the time I had surgery on this it was atrophied beyond repair. The good news is that I function very well without it.
My question...Should I have insisted on MRI at the time of the injury? What could I have done differnt?
Kinda tricky...DrPete
Oct 10, 2003 11:11 AM
Unforunately, that can be pretty tough to diagnose. Most of the time people with a tendon rupture will be pretty easy to spot initially, i.e. total loss of strength with the muscle that was affected or excruciating pain--if none of those were there, it may have been missed.

MRI is one of those tricky things in medicine, mainly because it's insanely expensive and, many times, unnecessary. That being said, the things that generally steer someone toward MRI would be worse-than-normal pain, lack of improvement with time, or obvious weakness on exam.

I can imagine a scenario with the right doc and insurance company where someone insisting on an MRI would get one, but I think it would put most doctors off (we hate to be used as mindless drug/test dispensers)--What would be good, though, is to express in great detail what about your injury is concerning and to discuss whether MRI might be warranted.

It's really hard to say whether it should've been done, or how obvious a complete rupture may have been, but yes, these things happen, and I'm sorry it happened to you. But the vast majority of folks just end up getting better...

The importance is to keep the dr-patient thing a two-way street. If something concerns you and you think a study or treatment may be warranted, ask why your doc thinks it's good/bad/necessary/not. That's the key...

DrPete
Thanks...spluti
Oct 10, 2003 11:47 AM
It was a good lesson for me. The good news is that my deficits are very minimal.
re: supraspinatus or rotator cuff....any ideas?Mel Erickson
Oct 10, 2003 9:11 AM
Yeah, been there, done that, still doing it. Did an endo on my mountain bike two years ago. A year and a half later, after much physical therapy and judicious use of drugs, I wasn't getting any better. Had surgery, still not better. In my case surgery was not the answer. The shoulder is a slow healer. The blood supply to the rotator cuff area is not as good as other parts of our bodies. We use it alot. Take your time. Get some physical therapy. Don't overdo it (although road cycling does not put a big strain on the rotator cuff), take anti-inflamatory drugs. Listen to your doctor and physical therapist and you'll probably be fine. Right now I'm trying glucosamine/chondoritin (for shoulder and arthritis in my back). The jury's still out because I haven't been on it long enough. Maybe if I think it will work strongly enough, it will work. You know, the placebo affect. Right now it shows promise. Good luck and swift healing.
re: supraspinatus or rotator cuff....any ideas?BigFatSal
Oct 10, 2003 9:12 AM
I'm not a doctor so I am certainly not going to give you any actual medical advice on this. However, I'll relate my own experience with this type of injury (hey, at least you'll know you're not alone). The best advice I can give is the obvious: Go see an orthopedist and if he recommends physical therapy then don't miss an appointment and don't be afraid to work that arm/shoulder. Aggressive physical therapy has been great for my situation. Shoulders are very complex. It's the joint that has the most range of motion/mobility in the body and there's a lot going on in there!

Last February I had a very bad snowboard accident, which tore a tendon off the bone in my shoulder joint, and also severely crushed the axillary nerve which runs thru the deltoid muscle, plus damaging a nerve that goes from the shoulder down to the shoulderblade area (suprascapular nerve).

After all the tests, my doctors said I'd probably get very little usage of my arm again since the nerve damage was so severe. I simply told them they were wrong and that I was going to recover and get my arm back again. So, they sent me to physical therapy 3 times a week, for a couple hours per session. This involved lots of exercises and stretching. What made matters worse was that I also had developed something called "adhesive capsulitis" (also known as Frozen Shoulder). I could barely move my arm, and I was in extreme pain, taking lots of strong pain killers.

Being an athlete my entire life, I was determined to recover (plus, I had just bought a brand new, gorgeous, Turner FS mountain bike which I wanted to ride!). After two surgeries to break up the scar tissue so the shoulder joint could have more movement, 6 months of aggressive physical therapy, lots of strength training and stretching, I'm now showing good signs of recovery. The electrical tests done on the nerves are actually starting to show life again.

My shoulder muscle has completely atrophied, but it's coming back again. I began riding on the road again in July and am convinced that somehow this has helped. Not sure if it's getting the blood really flowing thru my entire body during long, hard climbs or what - but something about riding has helped.

I'm sure you'll be fine. Keep taking the Motrin because it'll definitely help you to keep moving the joint. You don't want it to freeze up. But, in my experience, a positive, determined attitude to recover has been the key. I'm guessing in a month you'll be fine.

Good luck!
I had almost exact same injury.....dirthead
Oct 10, 2003 9:18 AM
earlier this summer. I was mountain biking, and while climbing out of a creek crossing on a very steep slope, fell over backwards and landed with my left arm extended. I immediately knew I had damaged my shoulder. I had full range of motion, but the next day I had almost zero range of motion. No swelling or discoloration, but serious pain. My MD did an X-ray, which was negative. After a few weeks, the pain almost entirely went away. I only felt pain when lifting my arm overhead or a couple other positions. Finally went to an orthopedic surgeon, who did a MRI. I was afraid of a tear, but the MRI was negative for tears. The final diagnosis was tendonitis, which had developed from the original injury. I had a cortisone (spelling??) injection in the shoulder 4 days ago, and the pain is almost completely gone. Should be 100% in a week or two.

I was certain I had torn something, and thought the orthopedic surgeon was nuts when he said he thought I had tendonitis. I guess that's why I crash mountain bikes and he is a surgeon!

Good luck with your shoulder, maybe you will be as lucky as I was and avoid the knife.
re: supraspinatus or rotator cuff....any ideas?Joe A
Oct 10, 2003 9:43 AM
A month ago I got hit by a pick-up and same thing - landed HARD on my shoulder and head. One concussion and a seperated shoulder later...

I was lucky though - nothing ripped or tore so "time" is all it will take to heal.
thanks to all for your stories and inspriation!! ouch to all ;-)bicycle268
Oct 10, 2003 10:01 AM
re: supraspinatus or rotator cuff....any ideas?Heavyhammer
Oct 13, 2003 8:03 PM
I'll add my 2 cents to general pool of common sense advice. I am not a doctor so take this as just another field report.
I was diagnosed last summer with badly inflamed(torn?) supraspinatus. Sports med doctor said "3 months rest" or risk a long painful life. I backed off everything but light biking and running. Took about 3 months with a few setbacks as a result of my idiocy.
Check the 'net for advice on rehabing this type of injury.
Lots of good info.

All the best with your recovery.

Hammer

H