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  • Q&A with Australian Health Practitioners

    Is surgery my only option?

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    Musculoskeletal Health Orthopaedics
    These are the results of my MRI scan. 1. Nearly complete subscapularis tendon tear 2. Medial subluxation with partial tear of long head biceps tendon. 3. Complete tear of bicipital transverse ligament 4. Low grade partial tear of anterior fiber of supraspinatous tendon.
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    Brian Lee

    Physiotherapist

    I graduated from the University of Melbourne in 2004 and have worked in various healthcare settings, including primary care, private practice and community health services, … View Profile

    It seems like that you have acquired this from severe trauma. Partial tear depending on the degree would have potential to self repair. Complete torn of ligament as you mentioned is not a severe issue. The main problem is the subscapularis, which is the only muscle of the Rotator Cuff that acts at the opposite direction in contrast to the rest, internal vs external rotation. There are other factors to be taken into account, ie age and lifestyle, but say if you are relatively young, ie <65 yo, I think the option of surgey should be considered, as if torn tendon has been left too long unrepair via surgery, later it will be almost impossible to reattach, as severed tendon would contract and shorten at both ends. From your description, I would expect that you will end up having poor joint stability, impingement, and possible loss of full ROMs. From physio perspective, you should consider operation, esp when it's too advised by your surgeon.

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    Pete Ledger

    HealthShare Member

    I am 45. In fairly good shape. 3 years ago was competing in short course triathlon.

    Are you saying that with operation I will lose full ROM.

    I have pretty much decided for surgery and I do really appreciate your comments.

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    Brian Lee

    Physiotherapist

    I graduated from the University of Melbourne in 2004 and have worked in various healthcare settings, including primary care, private practice and community health services, … View Profile

    For your age and lifestyle, I do recommand you accept operation if it's also recommanded by surgeon. It's more likely for you to lose full ROMs if you DON'T have it repaired, as the head of humerus will be off centre if not stabilized by Rotator cuff, and as previously mentioned, the subscapularis is the only muscle out of whoe Rotatr Cuff that does internal rotation (the other 3 are for external rotation). So you can prob appreciate that if it's supraspinatus (one of Rotator cuff) got torn, instead of subscapularis, we can strengthen the other 2 external rotators (Rotator cuff) to compensate for the loss of supraspinatus. In the case of subscapularis, no other Rotator cuff muscle can replace its function, though pec major and others can provide stability to a degree, but it's just not the same. 

    I am not saying full ROMs will 'definitely' be restored following an operation, as you also got torn ligament that holds down the biceps within its groove, but in your case, ROMs should always be greater comparing to non-operative path. 

    We were long told that operation accounts for 50% of recovery while post-surgical rehab accounts for the other 50%. Surgery and rehab are equially important. You know this is the case when you've seen many cases of successful knee replacement but large proportion ended up having quite limited knee ROMs, coz many of them prob unaware how important physiotherapy is, hence either delay the commencement or totally ignore. 

    If you go through public, physio will be arranged for you as whole care package. If you go to private hospital for operation, they often provide limited physio post-op, ie only while you are in-patient, so may only be few days or even a couple of days. Just make sure if that's the case, you need to organize your own. You should always commence physio 2-3 days post-op if not earlier, but every operation procesure is different, ask your surgeon to put the post-surgical order down in writing, so you can show it to your physio, who can commence rehab with safety in mind. Generally if you have no complication, nothing particularly tricky happened during operation, healing of severed tendon should happen after 6-12 weeks post-op, but rehab should start way before this to ensure no shortening of ligaments/muscles/tendons, stiffness of joint, frozen shoulder, pain/discomfort from other structures that hinder your recovery temp or permanently.

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