However, I would also want to be honest with the surgeon in letting them know that an orthopedic surgeon had previously been consulted and that a second opinion was being sought. You may find it interesting to note that a prior subacriomial decompression is not necessarily an indication that future surgery to address other injuries or further biomechanical problems will not be successful. If, however, you are active or use your arm for overhead work or sports, surgery is most often recommended because many tears will not heal without surgery. there is a small full thickness insertional tear identified relating to the posterior supraspinatus. X-rays are often not very useful in diagnosing shoulder injuries. Always been natural. The researchers used a custom-built shoulder testing system to measure the effects of varying loads placed on the muscles of the rotator cuff and parascapular muscles. There is synovial fluid at the glenohumeral articulation. damage to the tendon without swelling). I have been seeing an orthopedic doctor for the past 18 months. Players involved in sports requiring fast throwing actions (baseball) or overhead hitting (volleyball, tennis) may also sustain a traumatic injury to their rotator cuff and the supraspinatus tendon in particular. working a full time job nd being a mother of three I could never fit it in my schedule but was also told by a family member that PT would not help. In full-thickness tears, surgery is indicated in many patients. Unfortunately, I think 1cm retractions of torn tendon fibres do not favor natural healing of those portions of the tendon (without surgery). A recent study from Kim et al 19 used en masse suture bridge techniques for full-thickness supraspinatus tears. I have been diagnosed with a tear of the supraspinatus tendon by exam and u/s. make sure you do it some place where anesthesiawill do an interscalene block for post op pain relief. This can occur normally over time, or with repetitive use or a re-injury. @anonymous: Hi Donna, I am sorry to hear about this trouble you are having with your shoulder. If not then, your surgeon will be able to give the likely benefits, risks and recovery time following surgery. HubPages is a registered trademark of The Arena Platform, Inc. Other product and company names shown may be trademarks of their respective owners. I had periodic pain and tingling running all the way down my forearm. It is not very common that two orthopedic specialists would have very different opinions on what is wrong with your shoulder (although does happen from time to time). If the pain has been present for only a couple of months (or less) and there were minimal risk of worsening the condition with delay, then often a trial of conservative management (e.g. But not result in a normal shoulder. I would expect the radiologist and orthopedic surgeon at a VA hospital would both be skilled in this regard. if applied to the common anterior supraspinatus tendon tear, the term full thickness means that if the tear is viewed . I had subacromial decompression February 2010 a year after a motor vehicle injury (I am currently a 34 year old female). I am in aching pain consistently. However, it sounds as though you must be under the care of a medical team in order to have received MRI results, which is a good thing. The rotator cuff is a group of four muscles that come together as tendons to form a "cuff," or cover, over the head of the humerus (upper arm bone). The rotator cuff is a group of tightly connected muscles that stabilize the shoulder joint. While I can't give you specific advice over the internet, it sounds like you are doing a great job following the recommednations of your doctors. To recap I have had debridement and subacromial decompression, am 34 years old and now have arthritis, bursitis, tendinitis and impingement. However, I can just mention some general information that may be of interest. I'm sorry I can't provide you with specific advice, rather I only provide some general information. Also, don't be afraid to ask doctors / surgeons lots of questions. This is just general information of course. i'm a long distance runner and in good fitness and the shoulder problem does not bother me during running. A-C joint is moderately to severely degenerative. After an initial diagnosis from an Orthopedic specialist, the initial course of action was a steroid injection treatment into the "affected area" and a course of physical therapy. In some cases, surgery to repair the tendon is also required. while that helped in the short term and improved my left arm motion range, after i stopped the therapy the pain came back and reduced the range. Methods: Between 1995 and 1999, 139 full arthroscopic rotator cuff repairs were performed; 37 were repairs of full-thickness supraspinatus tears. Because of the risk of infection and and nerve damage. I will congratulate you on actually doing your exercises! At the . However, not all tears need surgery. Unfortunately I can't give you specific advice over the internet. for an examination, an x-ray or MRI, but other times soft tissue injuries can lead people to report similar symptoms even though no dislocation occurred. The retracted margin of the tendon is at the level of the lateral and anterior margin of the anterior acromion. @brando87: Thanks brando87, that's what I aim for! I have been saving up a couple months to cover my deductible expecting to schedule surgery. This surgery is no joke!! There is a small band of hyperintensity on the footprint attachment of the anterior aspect of supraspintus in keeping with tendinopathy -small unretracted intra-substance tear. Just found out I have a partial tickness undersurface tear of the supraspinatus tendon. The plastic surgeon gave me 3 options, leave it be and it would only get worse as i age, cortisone shots which is just temp obviously or fix it.. should i get another mri to see if its healed some, i have got partial thickness insertional tear in supraspinatus 9mm*5mm. @anonymous: Hi Kazikp, I am sorry I cannot give you advice over the internet but here is some general information you may find useful. What ever recommendation you received, you are looking up more information on line. A good doc should be able to assess your shoulder and give you some specific advice regarding the best next plan of attack. If you have only seen your family physician or general practitioner so far it would be a good idea to ask them about a referral to an orthopedic specialist who primarily treats patients with shoulder conditions. If surgery is not indicated, your doctor should be able to refer you to a physical therapist who will likely assess your shoulder movement and be able to provide you with a tailored program to help strengthen your rotator cuff. I tried to figure out what the onset was, but could never figure it out, it just seemed completely random. Generally speaking, do small tears need surgical repair? There's a hole or rip in the tendon. The rotator cuff is a group of four muscles and their associated tendons that originate from locations on the scapula and insert onto the humeral head. An orthopedic surgeon will be able to provide you with all the information you need regarding surgery, however, regarding exercises to return to badminton it might be wise to see a physical therapist (also known as physiotherapist) who specialises in sports injuries and rehabilitation. Dr. Mike great info here thanks. On the other hand, if surgery is inevitable or at least the most likely outcome, then the treating doctor / surgeon(s) may recommend early surgery. The blue arrows indicate a full-thickness tear in the supraspinatus tendon, the most common location for rotator cuff tears. These injections usually include an anti-inflammatory that can last for a couple months delivered directly to the problem area(s) and a local anesthetic that will work for the first few days until the anti-inflammatory starts to give relief. List of pain and limited mobility for about a week. Good luck! So don't give up on your ambition to participate in exercise. Frequently, patients who require surgery will report pain at night and difficulty using the arm for lifting and reaching. The tear in his supraspinatus tendon may be torn across its full thickness (but probably not completely ruptured which would require it be torn across it's full thickness and the entire width of tendon). Good luck! I am sorry I can't give you any specific advice over the internet, but here are some thoughts that may be useful to you. Superior subluxation of the humeral head. Nonetheless, it worth noting that as a general principle, synovial fluid is very important and helps lubricate the joint. (See Fig. So I think it would be wise to discuss the timing of surgery with your surgeon in the context of wanting to fall pregnant. They will be able to give you information about the likelihood of a conservative approach being helpful in your specific case. Full thickness tears: usually categorized by size in centimeters. That is one of the reasons why surgeons will take a detailed history and conduct a physical examination to gather clinically relevant information. I don't lay on the side of the hurt arm as I don't think it will be good for it. If you have any uncertainty around the need for your sling use, please call your surgeon's office today. Your physical therapist should be able to help you improve the strength and functioning of your rotator cuff muscles. Some things to consider when you are discussing your options with a surgeon is the length of recovery time following surgery (likely to be months), consider time to return to work (also consider whether it it possible for you to return to light duties at work). A moderate size full thickness tear . The lack of a normal amount of synovial fluid in the joint space could potentially be a sign of adhesive capsulitis (also known as frozen shoulder) among some people. It is difficult to know whether your husband will need surgery based on this information alone. This article discusses shoulder impingement, rotator cuff rehabilitation exercises, and surgical considerations relating to rotator cuff tears and the supraspinatus tendon in particular. INTRODUCTION. If you have injured your shoulder or have chronic shoulder and arm pain, it is best to see an orthopaedic surgeon. Good luck! Thanks. A few months ago it seemed to hurt more and I had problems lifting my arm out or above my head. I experienced a fall on August 31, 2012. Each of the rotator cuff muscles can be affected; the supraspinatus muscle is most commonly affected, followed by the infraspinatus, the subscapularis and the teres minor muscles. It did manage to decrease my overall pain but I still feel like I'm suffering unnecessarily. Following the post-surgery protocol will help minimize the chance of a poor outcome and further problems. If they repair the tendon surgically, this will probably involve wearing a sling and not using that shoulder actively for at least 4-6 weeks and then quite slow gradual progression for the weeks / months after that. In these cases often a multidisciplinary treatment team skilled in treating whiplash can be very useful (this may include health professionals like physiotherapists, psychologists, occupational therapists and doctors). Again, because your case is not straightforward, seeking advice from your surgeon(s) in this regard is certainly wise. (2) In the presence of a full-thickness tear, there is less ability to generate joint torque, hence a positive lag sign. At age 74, not sure whether to endure surgery with hard rehab and recovery or continue with PT . Let us know how you go! Methods: Sixty-five consecutive shoulders with a chronic full-thickness supraspinatus tear were repaired arthroscopically in sixty-five patients with use of a tension-band suture technique. I am sorry I can't give you specific advice but here is some general information that may be useful to you. If the ball is popping out of the joint (dislocating), then that is a major concern (but this usually doesn't occur without trauma)! It is not possible for me to give you any specific advice over the internet etc., but here are some general thoughts. Her MRI shows a full thickness tear of supraspinatus tendon and a tear of the majority of the infraspinatus tendon (with a few lower infraspinatus fibers still attached). Am I destined for surgery in order to regain even 50% of what I've loss or should I try another round of prolotherapy? There is a moderate amount of fluid distending the subdeltoid bursa maximal over the anterior aspect of supraspinatus and the rotator interval. I get asked about this a lot, perhaps I should write a page on rehabilitation following surgical repair of supraspinatus tendon tears! P.S. Small area of subacromial bursitis present. Many professions require repetitive or heavy overhead work (roof plasterer etc.). If a condition stays the same or become worse, then its usually a good idea to get it checked out again, or even a second opinion if you are not happy. Your orthopedic specialist will be able to give you advice about the best option for your circumstances. From the description of your MRI report it sounds like your shoulder must have been quite painful and inflamed at the time (perhaps it still is)! Thanks for stopping by and leaving a comment. Any advice would be greatly appreciated. I could write another article regarding shoulder surgery for rotator cuff tears (perhaps another day!). Good luck with it and I hope you are feeling pain free sooner rather than later. Modify Sport Techniques . I have pain all the time, it hurts to put a shirt on, can't lay on it, reaching out to my side it hurts to turn my pillow. So my tear went from a near full thickness tear to a full thickness tear. I guarantee you will not be the last person to read this page wondering about a difference in doctor opinion or trying to figure out whether they have a supraspinatus tendon tear or adhesive capsulitis (or surgery versus no surgery). What does all that mean in simple layman terms? There are many sub-types of SLAP tears and varying severity. If you want any further clarification just post any follow up question. Also now taking Tylenol 500 with5 hydrocodone. The radiomics model of no tears or tears achieved a high overall accuracy of 93.6%, sensitivity of 91.6%, and specificity of 95.2% for supraspinatus tendon tears. Overall, it will often take 6 months or more before the shoulder is completely back to normal. Rehabilitation plays a critical role in both the nonsurgical and surgical treatment of a rotator cuff tear. Some can be altered with conservative rehabilitation exercises in order to prevent further tearing and ongoing pain, while others cannot be altered without surgery. Equally as important is a discussion about the likelihood of certain outcomes without further surgery. I'm sure it is no surprise to you, but when someone is experiencing worsening pain with conventional conservative management like physical therapy this is also not a good sign for a speedy recovery without surgery. Thank you for the info posted on this page. My arm is very weak. He prescribed Vicodin and arthrotec for painbut I would like to get pregnant within a year but would like to be fixed first for obvious reasons. I have continued to have problems with my arm and initially was told that I had a partial tear of my rotator cuff. Re-attaching the tendon to the bone as you have described is a substantial surgery, the first months of recovery after this type of surgery are very important to ensure that the tendon does not detach / rupture and optimal recovery can occur. If it has been a while since the MRI, this may involve getting another one (as tendinosis can weaken the tendon, which may in turn lead to larger tears or even a complete rupture), it may also involve a trial of PT or a referral directly to an orthopedic surgeon. It is certainly worth discussing a more conservative approach, such as seeing a physical therapist that specializes in shoulders, with your orthopedic surgeon; particularly if you feel you have noticed improvements previously. Debridement involves trimming the frayed edges of the tear back to healthy tissue in order to allow it to heal itself. Particularly about what many people are likely to experience during the often long road to recovery. I have a second opinion on Monday. but can get back fairly good motion about the shoulder . How do you treat a supraspinatus tear? The results showed a "partial tear of the supraspinatus tendon, with large swelling and irritation". The pain is mostly in neck and shoulder blade and collar. However, in some cases it is clear that surgery is likely to be the best option. The orthopedic said that after 6 weeks of PT if there is pain then we looka possible surgery, is there something else that I should do or look at? Osteophytes and inferior capsular swelling indents the superior margin of the mytendinous junction of supraspinatus. At the final follow-up, the VAS, Constant, ASES, and UCLA scores were 1.1 0.9, 84.3 16.4, 88.3 17.4, and 31.1 6.0, respectively. Any thoughts? In September '12 I had surgery to reattach both the right rotator supra and infraspinatus with excellent results. I was an elite athlete most of my life and have accepted that I will no longer be able to return to my sport 100%. So my tear went from a near full thickness tear to a full thickness tear. I maybe take a few Advil a week with no loss of function at all. However, worse yet would be delaying in such a way that you miss out on falling pregnant or delivering a healthy baby. Many people have seen sporting heroes dislocate a shoulder during a heavy contact, have a medic "pop" it back in, then continue on 15 minutes later. 6 months ago a different ortho diagnosed the problem as frozen shoulder and gave me a cortizone shot followed by physio therapy for few weeks. There are other things your physical therapist may be able to help you with to give you some relief in the short term. MRI does demonstrate a complete massive tear of my rotator cuff with retraction and severe atrophy. Good luck! Partial tears can be just 1 millimeter deep (only about 10 percent of a tendon), or can be 50 percent or deeper. Thanks for sharing. I did PT around December for a month, twice a week. Sounds like no guarantee of 100% return to normal, and I'm about 95% now, not to mention a lengthy recovery. Your question regarding using a graft of some sort to help repair a rotator cuff tendon is an interesting one. This is a good example of why MRI's can be very valuable in cases like this. When the most effective non-surgical interventions (such as physical therapy) have not been able to provide sufficient relief of symptoms, then arthroscopic shoulder surgery is often considered. the defect measures approximately 1cm anterior to posterior and medial to lateral. It is interesting that you are not experiencing a lot of discomfort with a very large tear, but this sometimes happens and can lead to difficulty in diagnosing the exact structural damage that is causing the condition. My question to you is why can they not try and repair the rotator cuff using a graft of somesort. Shoulder muscles are very good for stabilizing the ball and socket joint and making large movements (to help lift things, throw objects etc. As another rule of thumb, if you are getting mixed opinions from non-specialist doctors, it is often a good idea to refer you to a specialist (who will have most likely have seen your condition ever other day and have plenty of experience treating it). Thanks for stopping by and sharing your story. In the interim, physio, chiro, massage, taping were part of my pain management and ROM for all pain sites relating to MVA. @anonymous: Hi Bobby, Thanks for stopping by and leaving a comment. 1 Supraspinatus Rupture causes microscopic tear, major tear and dislocation from its attachment to humerus and scapula. It is also worth mentioning that when surgeons send patients for PT and don't hear from them for a while, they may well have just assumed everything went well and there is no more problem (or they have so many patients that they haven't given it much thought). It is also worth mentioning that not all PTs are created equal. I appreciate your thoughts on this matter. I am worried I will not improve my ROM this time. I now am having surgery but is it safe to have with whiplash symptoms. By June '13 I was better in many ways than before the injury. D.C. Stitch positioning influences the suture hold in supraspinatus tendon repair. Supraspinatus tear can be caused by lifting something too heavy, falling on your arm, or dislocating your shoulder. 19 The thickness of the tendon at its insertion was . Even pain from a full-thickness tear can be relieved without surgery through exercises that make other muscles strong enough to pick up the slack. If you are seeing the orthopedic surgeon it is a good idea to tell them about therapies you have received and about your persistent pain. Hopefully your physio can set you up with an exercise program to strengthen your rotator cuff and improve the biomechanics at your shoulder joint. Some general information that may be useful to know is that some people who have similar pathology to that which you have described end up having surgery while other do not. Make sure you ask the orthopedic surgeon about what to expect after the surgery and the likely recovery time. If you know you have a rotator cuff tear, worsening pain and decreasing strength may mean the tear is getting larger. My question to you is why can they not try to repair the rotator cuff using a graft of somesort. Thanks to my hubby for finding this site. @DrMikeM: Dr Mike - as you rightly say I must wait to learn the actual facts of my case - and I have an appointment soon so I will learn then I hope. 2. mild labral degeneration. People doing repetitive work above shoulder height may find themselves at higher risk of a supraspinatus tear. I don't think there is a clear answer to this one. Not too sure if this article is still active but I'll ask anyways. If you have any follow up questions just post them here and I'll get back to them as soon as I'm able. I think this is a common dilemma that people face. For most of my life I trained with bodybuilding-style workouts 4 or 5 days per week. Thanks for stopping by and leaving a comment. Full-thickness rotator cuff tears are diagnosed with the help of a thorough history and physical examination, as well as the use of imaging studies, most commonly, MRI. My best wishes go to all of them. In many cases, surgery is required. This was caused by contact with another person and (I'm self diagnosing) some prior existing minor tendon tears. I am angry, confused and cannot get any pain relief. Dr Mike, Please help me understand what options I might have or questions to ask the surgeon about my full Reallmadhatter Mar 14, 2013 @ 3:44 pm. Unfortunately I can't give you specific advice over the internet, without conducting a physical examination etc. It's very good of you to reply so promptly and clearly though. I know that since it has been years since seeing a dr about it that I should make an appointment, but what is your opinion of my situation? Moderate subacromial/sub deltoid bursitis. I was told that there were a few other muscles around the supraspinatus that were torn and I also had some bone spurs that could also be causing some irritation. In terms of general information that may be useful to you, I am not sure I have seen any sound clinical research evidence indicating that prolotherapy is likely to provide long lasting benefits for people with MRI diagnosed supraspinatus tendon tears. The postoperative recovery period following a surgical rotator cuff repair will take months and involve a specific program of range of motion and strengthening exercises that your surgeon will prescribe, often in conjunction with a physical therapist who will teach you exercises and monitor your progression. You have a full thickness rotator cuff tear. Anyone want to shed a little light for a vet? This has caused thickening and abnormal signal in the supraspinatus tendon consistent with tendinopathy and/or a partial tear. . Also can I try a more Conservative approach and see a phy therapist that specializes in shoulders before any surgery. Hopefully your doctor can give you specific advice in this regard. I take anti-inflammatory meds for a long time for other problems, but it sure has not helped my arm. As such, a therapist can provide a safe and progressive therapy program. Especially since my injury has gotten worse instead of better. I've only got a couple of minutes, so I'll keep this short. Most people who do have surgery experience acute pain during the first few days (although the acute pain medications usually help with this). Humeral head is riding high abutting the underside of the acromin process. I was referred to a surgeon who stated that they could not repair the rotator cuff due to the size of the tear from a surgical standpoint. This kind of tear does not heal on its own. A full-thickness tear is when the wear in the tendon goes all the way through the tendon. Don't be afraid to ask lots of questions about what is likely to happen if you do or don't have surgery. Acute Tear If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. What I think is more common, is two doctors not taking the time to explain something in normal everyday language and ensuring their patients have understood whatever it is they are trying to say (so lots of people feel like they are being told different things)! For anyone contemplating surgery, buy a recliner to sleep in after surgery. It seems as though you have now had two MRI reports. I was released from the P.T. This likely represents extension of an existing tear. @anonymous: mike but not dr. mike. These four muscles (supraspinatus, infraspinatus, subscapularis, and teres minor) stabilize the glenohumeral joint, enable rotation around the joint, and provide a counterforce to . Generally speaking, MRIs definitely help the surgeon to make a diagnosis and give them an idea of whether surgery will help. Acromioclavicular joint degenerative changes, which means nothing to me. I'm 43 and have been suffering from shoulder issues for over a year. Care is taken to preserve as much of the CA as possible. I have a referral to a specialist and hopefully I will have some answers soon. Some minor tears may be treated without surgery. The average duration of follow-up was twenty-nine months. I understand most of it but I was wondering is there supposed to be fluid in the acromioclavicular joint. If a medical doctor (assuming they have nothing to personally gain by referring you to another health professional) suggests something may work based on their years of training, in depth understanding of anatomy, physiology, common pathology, research evidence and clinical experience with many patients, it is usually worth considering what a family or friend (albeit that they are usually well meaning) is basing their opinion on. Either way, don't be afraid to ask your surgeon lots of questions (likelihood of success in your case, what will happen after surgery, recovery time-frames etc.). The fact that you still have full shoulder ROM is a good thing, now just need to get the muscles /tendons (or potentially other structures) working as they should. Thanks! Being referrfed to a shoulder specialist Tuesday. or should you just ask for their opinion with no outside information> Thanks Judy. Similarly, some benefit from conservative approaches (physical therapy / injections etc. I'll go check out some of your lenses now. This can be one of the most frustrating things for people who have whiplash associated disorders. there is no focal atrophy or fatty infiltration.that is my M.R. Advertisement. The incident happened on Sept 25 and it is now Nov 10. Your doctor should be able to explain your options and potential expected outcomes. I don't know what exactly to do, or what my REALISTIC problem could be. @anonymous: Hi LB, Sorry for the delay, I have been away for visiting family for a week or so. He says that my tendon is failing. So first off, I should say that I have certainly seen situations where a small supraspinatus tear has been surgically repaired, only for a worsening of symptoms to occur after further pathology (such as other rotator cuff tendon tears) either develop or become easier to detect on imaging (e.g. What do you think of the other therapies? Poorly defined large full-thickness tear of the supraspinatus and infraspinatus tendon measuring at least 2 cm in anteroposterior dimension. The supraspinatus is the tendon that tends to suffer from partial tears most commonly. Thanks for stopping by and sharing your story. About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How YouTube works Test new features Press Copyright Contact us Creators . That is some interesting advice you have received. In addition to arm elevation, the supraspinatus muscle is critical in pulling the head of the humerus (the ball part of the ball and socket joint) into the glenoid (socket). ( roof plasterer etc. ): Hi Bobby, Thanks for by... Hole or rip in the short term arrows indicate a full-thickness tear my! The thickness of the supraspinatus tendon, with large swelling and irritation '' why can they not try repair... What the onset was, but it sure has not helped my arm or. As such, a therapist can provide a safe and progressive therapy program tears and severity! Heal itself it 's very good of you to reply so promptly clearly! Interesting one humerus and scapula care is taken to preserve as much of the reasons surgeons. All the way down my forearm know whether your husband will need surgery based on this alone! High abutting the underside of the risk of a rotator cuff repairs were performed 37. 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Posted on this information alone, worsening pain and decreasing strength may mean the tear back to as... More information on line need for your sling use, please call your will! Back to normal amount of fluid distending the subdeltoid bursa maximal over the anterior.! Worse instead of better you for the info posted on this information.! Require surgery will help minimize the chance of a supraspinatus tear can be one of the risk infection! If not then, your surgeon will be able to explain your options and potential expected.. Swelling and irritation '' to give you some relief in the tendon is at the level of the ca possible. Important and helps lubricate the joint from a near full thickness means if... Questions about what many people are likely to be the best option for your circumstances: Between 1995 1999! The most frustrating things for people who have whiplash associated disorders its attachment to humerus and.. 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A specialist and hopefully I will not improve my ROM this time hold in supraspinatus tear. Tendon is also worth mentioning that not all PTs are created equal and orthopedic about. My M.R chronic full-thickness supraspinatus tears other things your physical therapist should able! Ago it seemed to hurt more and I 'll keep this short have surgery it... Office full thickness tear of the supraspinatus tendon surgery tear were repaired arthroscopically in Sixty-five patients with use of a tension-band suture technique layman terms frayed..., which means nothing to me surgery through exercises that make other muscles enough! To know whether your husband will need surgery based on this information alone full-thickness tear in the supraspinatus is tendon. Regarding the best next plan of attack take anti-inflammatory meds for a vet anterior to posterior and medial to.! Fall on August 31, 2012 humerus and scapula was wondering is supposed. 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Had two MRI reports not very useful in diagnosing shoulder injuries SLAP tears and varying.... Contact with another person and ( I am currently a 34 year old female ): Thanks,! Up with an exercise program to strengthen your rotator cuff using a graft of somesort, Inc. other product company!
full thickness tear of the supraspinatus tendon surgery