Thread: Tendon Transfer
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Old 06-15-2010, 10:02 AM
PeakPT PeakPT is offline
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DBeach
Just wanted to chime in on your post.

I love Dr. Tomaino's reply re the possibility of the suprascapular nerve potentially contributing to your symptoms. I think a key here is you have to remember that determining why YOU have pain means everything in terms of WHAT treatments are chosen. Getting a thorough exam or 2nd opinon is at the heart of things. Based on the content of your original post I just want to confirm that you are, in fact, referring to an "irrepairable" rotator cuff (RC) tear and not possibly something else.

I've certainly had patients in the past who were told something they had was "irrepairable" and the Dr wasn't referring necessarily to a "torn" tissue not being able to be repaired or fixed but just simply that they didnt' feel surgery would help their problem. Maybe a small semantics thing but potentially the source of misunderstanding too. Just wanted to clarify.

I've seen patients with RC tears that could not be fixed who compensated fairly well. There is no doubt that if you do have a RC tear that you're going to be relying on a required amount of substitution or compensation from the remaining healthy muscles to produce function in the absence of those RC tendons. There are some limitations that people may have that inhibit the body's ability to do that "legal cheating" that will be required though. If, for example, your thoracic (mid back or trunk area) spine is restricted or your scapula (shoulder blade) is not mobile enough then the muscles that attach there might not adequately be able to do the extra work required to move your shoulder.

You mentioned that your motion and strength are good...but I'd still wonder where you're getting that "good" from. A good evaluation would help ascertain if you've got the motion at adjacent areas to optimize your function in the presence of a RC tear and if there are muscles that might be able to be trained to better help your function so that undue stresses are not placed on your shoulder or other tissues that might be contributing to your pain.

If there is a tear in there then no doubt you have altered mechanics of the joint and it is absolutely a source of stress and potentially the primary cause of your pain. But I have had patients who also had shoulder diagnoses and some even procedures done when ultimately it was later determined to be a cervical (neck) problem that was at cause of their shoulder pain. Thus, a thorough evaluation still must be done to attempt to decide where/what is causing your symptoms and then decide if there are any other things that might be tried before further surgery is required or if surgery is, in fact, the right thing to do first.

Thanks for posting your question. You've obviously done some research yourself in trying to figure out a solution. I'm sure that your diligence in seeking out answers and being actively involved in the process will help you reach the best solution possible.

Best wishes for success

Mike Napierala, PT, SCS, CSCS, FAFS
Peak Performance PT
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