My Shoulder update – recent MRI

As some of you are aware, about ten months ago in October, 2013, I had surgery on my right shoulder to repair a tear in my rotator cuff. The surgery was done at the UNC Chapel Hill hospital. After the surgery, I went through a fairly extensive physical therapy program. Despite regular PT, and my own yoga practice, I was unable to develop mobility and strength in some movements of the shoulder. For example, I still cannot finish drinking a glass of water with my right hand without a little pain and some trembling of the hand. There is almost no external rotation. Essentially, the lack of mobility and strength have seemed similar to what they were before the surgery.

Because I was seeing no improvement in the situation, I had an MRI done a couple of weeks ago, followed by a visit to my surgeon to find out the result of the MRI. As I had anticipated, the result showed that rotator cuff was re-torn almost exactly to the same extent as it was before the surgery. The surgeon didn’t know how or why this might have happened. He was obviously very apologetic about what has happened.

For the sake of comparison, here are excertps from the MRI reports before and after surgery:

From MRI done recently (August, 2014), about nine months after surgery:

"Susceptibility artifact from anchor suture in the humeral head limits evaluation of the rotator cuff. However, a full-thickness tear of the supraspinatus tendon and anterior infraspinatus tendon is again noted measuring 3.4 cm AP x 2.8 cm transverse. There is mild subscapularis tendinosis without evidence of tear. There is mild supraspinatus and infraspinatus muscle atrophy."

Freom MRI done in June, 2013, before the surgery:

"Susceptibility artifact from tendon anchors limits evaluation of the rotator cuff, which are from prior rotator cuff repair. However, there is a full-thickness tear of the supraspinatus tendon and anterior infraspinatus tendon, nearly 3.5 cm AP and retracted approximately 2.9 cm. The subscapularis tendon appears moderately tendinopathic, but intact. There is mild fatty atrophy of the supraspinatus and infraspinatus muscles."

As you can see the numbers indicating the size of the tear and the level of retraction of the muscle away from the bone are almost identical.

As you may know, this was the second surgery on my right shoulder to repair the torn rotator cuff. The first one was about ten years ago.

Now the big question before me is "what next?". I asked this question from my surgeon who gave me these options:

• Lattissimus muscle transfer
• Reverse shoulder replacement
• Graft-jacket patch repair
• Do nothing – live with what I have

My surgeon also recommended that I get a second/third opinion to discuss all these options. In the meantime, one of my close friends connected me with his son who is an orthopedic surgeon specializing in sports injuries. I was able to discuss all these options with him in some detail. In his opinion, the best option would be to do nothing and see if I can continue with the level of functionality that I have at the moment. He ruled out the Reverse shoulder replacement as an option as it would potentially reduce my shoulder functionality instead of making it better. Lattissimus muscle transfer, he said, is fraught with uncertainty and can potentially increase the level of pain. So, the only option worth considering is graft-jacket patch repair. He himself has not used this technique for any of his patients so far. He is trying to help me get in touch with one of his friends who has done several of these procedures.

I asked him if by doing nothing the situation gets much worse, would I still have these options. According to him my shoulder is already in the "massive, irreparable tear of rotator cuff" category. Which tells me that it cannot get much worse over time.

Having gone through three shoulder surgeries in the past, I am quite aware of the intense pain that I had to endure after each surgery. For almost two weeks following the surgery, I could not get more than a couple of hours of sleep each night. As such, I am myself reluctant to go through another one of those painful experiences. As things stand today, I do have reasonable functionality of the shoulder as far as day-to-day work is concerned. The main issue is that there are a few yoga moves that my shoulder doesn’t allow me to practice or demonstrate in class.

In one sense I am extremely fortunate to have very understanding students. I have always been able to find one of the students to be the demonstrator for the class while I go around making adjustments and guiding students personally with their practice.

I will continue to seek professional opinion from experts in the field of rotator cuff repair. If you know of anyone in the triangle area in that category, I would love to know about them and consult with them. If I can get some assurance that a certain procedure will improve my functionality, both ROM and strength, then I will certainly consider that option. Until then, I keep enjoying whatever I can do in my own practice and continue to teach my classes enthusiastically.