Brian Schiff’s Blog

Lots of questions in your post, but here is my brief summary/synopsis based on the info you have provided. Keep in mind, I am giving feedback over the internet without examining you so this is all with a grain of salt so to speak. I cannot say with certainty that there is no nerve entrapment/pain. The dorsal scapular nerve could be irritated but does not seem overly likely. The tricky part is your fall as that could have affected the neck as well. Paralabral cysts are not uncommon and may be related to friction in the joint. MRI captures soft tissue injury, swelling, bone bruises, etc. Your symptoms seem to fall in line with some scapular dyskinesia and I would continue with scapular stabilizer strengthening for longer to see if that alone with rotator cuff strengthening helps. If you have gross motor weakness or loss of functional strength in the arm, then maybe an EMG but seems uneccessary right now.

I have no cartilage in right shoulder. How long should I postpone surgery before any damage is done to the joint. I have pretty bad pain and much limited mobility. I am 74 and can live with my problem but don’t want things to get worse.

Jerry,

If you have no cartilage, there is likely already some joint degeneration. Pain and function in daily activity should guide your decision making.

Im due have a shoulder replacement ina months time. Have seen a surgeon and gave
me resultsof my MRIand CAT scan. .. I do not have a lot of bone left in the shoulder and
feel concerned now of how my shoulder will be after the operation . As saying it would start loosening within 3 years.Not sure whether to have done. Could you give me advice. Thank you

Margaret,

I am not sure about the specific of your health history and prior treatment. I would not be concerned about the shoulder replacement coming loose in 3 months unless it is not done properly. The procedure is done to alleviate pain and allow for improved function. You may lose some range of motion after surgery (it is often limited lifting it up much past 120 degrees in many cases) unless you have already lost the ability to lift your arm overhead already.

Hi Vicki,

Yes your situation is complex indeed. It is hard for me to predict the success of the surgery, but it will hinge most on the skill of the surgeon followed closely by the skill of the post-op rehab. Assuming it is your dominant arm, the mobility would be important and if the strength is already greatly limited, you must ask yourself if the risk is worth the reward. It seems as of the MD feels preparing the cuff tear and removing the hardware will improve function. Provided there is not marked fatty infiltration in the muscles, it is reasonable to assume your strength can improve. The rehab will be arduous to be sure. The other tricky part is depending not the repair, there will be restriction on range of motion the first 6 weeks or so after surgery to protect the repair so the MUA and need to move the shoulder to keep the motion may be in conflict. That is a conversation worth having with the Doc as to timing of the MUA as well.

Thank you so much for your response Brian. You have mentionted something that wasn’t making sense to me: I am of the understanding that after MUA PT is supposed to be nearly immediate, and concentrated for a couple of weeks, which seems like a contraindication if I’m having a repair done, in which case i’ll Have to keep it immobile. Definitely something I will bring up to my surgeon now. Can’t tell you how much I appreciate your help. I have a big decision to make!

My MRI shows small tear in supraspinatus tendon, some bone spurs, 2 loose bodies in the joint space 1.5 and 1.7 cm., a small effusion, focal ulceration in an area of the glenohumeral cartilage and fraying of cartilage- I do not sleep well at night d/t pain, even though I am taking NSAIDs- I do not want cortisone injections, my ROM is not what it should be but I have learned to modify certain activities, and am able to get them accomplished with some, but minimal pain. I have pain in my joint most of the day- intermittent relief, but if I move “wrong” it comes back and stays. Does this sound like something that should be surgically addressed?

Becky,

I think that depends on whether you have failed physical therapy (for at least 6-8 weeks), whether it is your dominant arm, your age and how active you want to be moving forward. The bone spurs can continue to create more stress on the supraspinatus especially in certain positions, but the ultimate thing comes down to pain and function.

i am a 70 yr male was told i need reverse shoulder surgery. i hv started bk swimming doing around 30 min every other day. also doing shoulder ex in warm pool.still hv pain but hv got used to it.also do some lite weights on machines along with walking. it seems the swimming is keeping my shoulder loose and feels better. can i hurt my shoulder worse and is what im doing ok

Steve,

I would use pain as your guide and if the swimming feels good, stick with it. I would avoid overhead pressing at the gym and any full range pressing/flies.

If my ROM is good and I’m dealing with some pain in my non dominant arm would you consider surgery
or would I be better off trying to modify my ROM
when I’m pressing and stay away from surgery. For example if I were to do an Hammer Strength wide grip press it will cause pain in my shoulder whereas light weight Dumbbells with good scapular retraction works for me with pressing movements. I think in due time I’ll move up in weight. I fell on my left shoulder causing an partial tear of the supraspinatus and some bicep pain, the bicep pain is the worse. Physician is considering bicep tenodesis. Any comments would be appreciated.

Joe,

Pressing will always place more stress on the shoulder and ask more demand from the rotator cuff. If you are going to press, I would stay in the scapular plane and avoid extra heavy loads. As you near the top of the press, the rotator cuff and proximal bicep tendon can be impinged or rub if you will. Pain is always a good guide, but I would suggest not pressing often as there can be an attritional effect where the accumulative reps may aggravate the condition (consider risk versus reward so to speak).