Q. I am 52 and right handed. About six years ago in Boston, I had my right shoulder rotator cuff fixed. I did well till I fell in December and my right shoulder got injured again. It has remained sore and weak. It does not feel as bad as six years ago but it has not gotten better. I also do a lot of heavy lifting at work.
I saw an orthopedic physician who said the X-rays looked fine. The doctor said the MRI scan was not diagnostic due to the prior surgery. He thinks I retore my rotator cuff and need surgery. I would like to know how good these surgeries do a second time and do I really need it if the MRI is not obvious.
A. There are four muscles around the shoulder that come together to form a tendon that attaches to the ball part of the shoulder. These muscles rotate the shoulder, thus the tendon is called the rotator cuff tendon. If the MRI scan is not diagnostic, than an ultrasound or an ArthroCT scan may help define the extent of the new injury.
When this tendon is torn from the bone, it can not heal due to the limited blood supply of the tendon. However, the muscles still keep pulling on the tendon and over time the tear gets progressively larger. Generally, the larger the tear, the more difficult it is to fix and the poorer the prognosis. Retears tend to be larger than the first-time tears and may be harder to fix due to tissue and bone quality. In a right-handed young person such as yourself, if a retear is present, the best treatment is usually surgery to fix it as leaving it alone will ultimately likely lead to a massive tear with persistent pain, weakness and arthritis. Most retears will do well with surgery.
Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital. Send your questions to HarlanS@baptisthealth.net.