I read all your submissons (thanks!), looked on the internet and then did what I do .. looked in the medical journals for the real "state of the art". Here is what I found
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Appropriate methods of treatment of rotator cuff tears have not been finalised. The current clinical approach does not mandate surgery for tears through less than 50% of the muscle. The dividing line of 50% between surgery and none is a "rule of thumb" and not based on any clinical research.
Where surgery is necessary the muscle is cut and cleaned up (i.e. shortened!) and then stretched and attached to the bone.
Even if a surgeon succeeds in reattaching the tendon to the insertion site (i.e. the bone), delay between injury and repair have a dramatic effect on success of the union.
The torn muscle retracts (shrinks) after injury The longer the delay between injury and surgery, the more tension that has to be put on the tendon to reattach it to the bone.
The more tension the less likely the success.
If you get to surgery within say a day or two, then the tension is minimal. If you wait 2 weeks then you need about 3x to 6x the tension force.
If you wait 9 weeks you need about 6x to 10xthe tension force.
Tension force increases only gradually after 9 weeks.
In my case I went undiagnosed for 3 months, so the chance of a successful operation was low.
The private consultant neglected to mention this in his consultation.
After I did the research I decided to let time do its work and not have a high risk surgery.
I had never stopped yoga but now I intensified the regime (under expert supervision) to keep fit and to get blood flow to the region.
I went to an osteopath and that seemed to help. Actually the remedial massage (pure pain!) was the most necessary thing to free up the muscles.
I started very light weights a few months later and continue them along with light exercise like half pushups.
I got in the water about 5 months after the incident.
I've surfed a few times now and fitness is coming back.
If things tear again then I'll get directly to surgery.
More stuff:
- Some believe that severe acute tears are more likely to enlarge and extend over time than chronic tears, while others maintain that acute tears occur in an already diseased tendon and thus early repair may unnecessarily subject the patient to an invasive procedure.
Radiography is used as a first attempt to diagnose. X-Ray images can show spurs on the bone, but their success in showing tendon tears is limited and depends heavily on the expertise of the operator.
Arthography is a well established technique for diagnosing full thickness tears with great accuracy (but it is an invasive procedure).
Ultrasound is a less costly diagnosis method but identifies only 70% of full-thickness tears - it should be used together with arthoscopy.
MRI is more costly but able to be used to diagnose complete tears around 90% of the time. MRI is less successful in diagnosing partial tears.
NOTE: when you combine the lack of difinitive diagnosis with the "rule of thumb" 50% tear, you end up with a very hit and miss decision from the experts. I suspect it's mostly "cut and see". "Since we're here let's do it anyway" (how else do you get paid for the surgery?).
*From a Chapter "Mechanics and healing of Rotator Cuff Injury" by MH Zgonis, NA Andarawis and LJ Soslowsky in a book "Arthroscopic Rotator Cuff Surgery" published by Springer in 2008