Tear in Tendon

[Shanim]

hi

Has anybody with Psa had any problems with tears in their tendons ?

I have just had an ultrasound and found to have a torn tendon in the rotator cuff/bursa area of my shoulder, I have had a pain with trouble sleeping in that area for quite a while so my rheumy decided to send me for the ultrasound, I am not aware of any incident that could have caused this, so I have googled it and some sites say that it can be caused by Psa so I wondered if anybody else has had this

Regards

[Bakerannie]

I had tears in both rotator cuffs at the same time about a year after I was diagnosed with PSA, but before my symptoms were brought under control, both without any injury or event whatsoever. I struggled with the symptoms for a year and a half. Finally 3 months ago I was put on a JAK inhibitor (Upadacitinib), and had a steroid injection in each shoulder. By this time they were both "frozen" with a limited 20 degree range of motion in each. Within 6 weeks I had nearly full range of motion, not only in my shoulders, but in most of my other joints as well. My Rheumy said PSA was notorious for tendon tears, and being on Prednisone obviously didn't help much. Anecdotally she also said that her practice was having resounding success with symptom resolution with JAK inhibitors in Psa. Have they suggested a steroid injection in the shoulder?

[Shanim in reply to Bakerannie]

thanks for your reply, yes they gave me a steroid injection there and then because my rheumy unbeknown to me had booked me in for the scan with an injection if needed but they told me that the tear will not repair on its own and would need surgery to repair, can I ask if you are going to have surgery please ? They did tel me you can’t have surgery within 3 months of having the steroid injection.

Night was the most painful time with it and it has been better the last couple of nights as I only had it on Friday, I can lift my arm and bring it down now whereas before I had to hold it with my other hand and help it down.

Thanks

[Bakerannie in reply to Shanim]

The fact that you can now raise your arm without the assistance of the other leads me to believe that it is an incomplete tear - had it been a complete tear that would have been impossible to do. I had been told that my incomplete tear could not be surgically repaired, as it would just tear again and the repair would not hold with all the inflammation. Luckily, all the cards fell into place, and between a steroid injection into the shoulders, and commencement of the JAK inhibitor I now have full range of motion, so I suspect that I have healed on my own (yay!!) Wishing you the best, happy healing!

[Shanim in reply to Bakerannie]

that’s interesting that you say that because the technician that done the steroid injection and scan said it had torn through one part but not fully through the whole thing, my fear is that the arthritis has damaged the tendon and won’t be able to be repaired but that’s just me being fearful of the outcome, although I can lift it there is still constant pain in my shoulder but until I see a specialist I am not going to have these answers

Thanks for info

[Leics]

I don’t have psa but I got a rotator cuff tear in my left shoulder and even though I had several steroid injections I put up with it being completely frozen for almost two years. I was told I needed surgery but my notes and referral went missing. The final straw was when I picked up a coffee and my collarbone fractured. So for me I sat in fractured clinic and was taking no prisoners by that time. I refused to move until I was scheduled for an arthroscopic subachromian decompression (sorry about the spelling). Anyway I had the surgery physio was tough afterwards but I haven’t had too many problems since 🤞I was told that my surgeon was very surprised that I’d managed for so long as it was completely calcified and he had not ever seen one in a worse state. Don’t be fobbed off by steroid injections if you still can’t raise or use your arm but if the tear heals on it’s own then that’s great. My advice don’t put up with it for years as I had to because it was absolute hell.

[Shanim in reply to Leics]

thanks for reply, did they tell you that the tear would repair itself ? they told me that it wouldn’t and that you can’t have the op within 3 months of having the steroid injection, if that’s the case and it doesn’t repair itself then in my mind it’s just delaying the outcome for 3 months waiting for the injection to wear off, can I ask please, do you have any kind of diagnosed arthritis ?

Thanks

[Kags1068 in reply to Shanim]

Hi there

Like Leics I had a rotator cuff tear in my left shoulder. I have RA, not PSA. The joint is also very damaged so the surgeon wasn't sure how well the surgery would work. I had it repaired in 2012. It was open surgery - couldn't be done via keyhole. Afterwards the surgeon said it was a big tear, and he didn't know how long his repair would last, as the material he had to work with wasn't very good! Having said that though, it's still holding at the moment - 11 years later. I have very limited movement and didn't regain any, but think that's more to do with the joint damage. It did help a lot with the pain - especially the pain I had at night. I've had the same problem in my right shoulder for a few years now too, but so far the pain has been more bearable (mostly)!

As far as I know, I don't think I've had any torn tendons, but I have had, and still have, some ruptured tendons in my hands. I don't know about other areas of the body, but ruptured hand tendons generally require surgery (unless the prognosis is poor). I hope your tear heals well, and surgery won't end up being necessary. I know it seems a pain (literally), and the waiting is hard, but I personally would try and wait a bit and see if it heals. I've had lots of different surgeries for RA, and while I'm grateful to have had the operations, and some outcomes have been very good, results can't be guaranteed, and can sometimes be disappointing too. Obviously, we are all different and ultimately have to do what we feel is best, but for me, surgery is always a last resort when there's no hope of something repairing itself, or there are no less invasive options to try. If you exhaust other possibilities first, you can still opt for surgery later. If you go to surgery straightaway, then there's no going back. I wish you all the best with whatever you decide. 😊

[Shanim in reply to Kags1068]

thank you for the reply, I think at this point I need to see an orthopaedic surgeon to found out what my options are as the guy that done the steroid injection told me that the tears won’t repair themselves, my concern is that like in your situation the tear is caused by joint damage more than an actual tear but we will see. Thanks

[Kags1068 in reply to Shanim]

You're welcome. I think getting a surgical opinion is definitely your next step, as you say. Hopefully the surgeon will be able to tell you whether an op is necessary and be able to assess if any of the issues are due to joint damage. Then you would have a clearer idea what to expect from surgery. Good luck!😊🤞

[Leics]

Yeah I have rheumatoid arthritis. The tear in my tendon wasn’t too bad so didn’t need repairing but they said that I should be prepared for open surgery in the event that they couldn’t fix the problem laparoscopically but it didn’t come to that. I was much longer in theatre than they expected but there was lots to shave off and remove. Recovery went well and I’m glad I had it done even though I found it difficult to get full range of movement back but was very persistent and did all the physio I had to. I hope yours goes well but waiting lists are probably longer than 3 months so that’s perhaps why they gave you a steroid shot. I think they just tried to ‘fix mine with steroids but obviously that didn’t work. It had completely seized up hence the stress fracture of my collarbone.

[Shanim in reply to Leics]

well done for getting full movement back.

I wish mine wasn’t in my right shoulder as it’s hard to not use it too much and rest it, I do have private health insurance and need to have a carpel tunnel op so I think I will get the summer out of the way and get them done, then the 3 months will have lapsed, it’s the same surgeon that can do both ops i think.

Thanks for the info

[Leics in reply to Shanim]

I was lucky as I’m right handed that it was my left shoulder. Still made it difficult to work. Mine was injured I think by having private physio as I wasn’t able to straighten my arm out that’s why my tendon wasn’t torn completely just a ‘nick’. Good luck hopefully you’ll be out of pain soon.

[J1707-]

this happened with my Achilles. I had 9 tears in my tendon. It took 4 years for a diagnosis. A steroid injection made a difference plus physio but it’s still my weak point first to flare up

[smilelines]

I have a tear in my tendon at my elbow. I think I tore it from the repeated movement while skating. But why would it tear? Jeez it is still sore after 6 months and taking forever to heal. None of my doctors commit to giving me any reason for a tendon to tear without injury. I hope this isn’t from my PSA.