HardyWeinberg

7 years ago I got hit by a car and had a partial tear of my right supraspinatus. Just p/t'd it out and on I went.

This past Feb I toppled (pushed 'walk' button on signal with left hand, just flat flopped to the right) onto my right shoulder and dislocated it. It reassembled itself while I was on the sidewalk trying to figure out how to get up. Took a week off the bike. The following week I was riding super slow toward a bike rack when I hit a sidewalk crack/pothole when I was totally not expecting it and jarred my right arm straight back. That hurt a lot. The following month I had a lot of spontaneous near dislocations but I usually caught them in time. Went to p/t eventually, decided my external rotation was just not happening, yesterday got arthrogram/MRI, confirm 100% tear of supraspinatus and 50% of infraspinatus. The supraspinatus tear is not giant (10 x 8 mm). Also there is a torn labrum. Not sure if it is worse than when it was initially torn in that 2012 collision.

So I am going to see an orthopedist week after next. No real idea what to expect. P/T suggested that since I am right handed he would say that surgery could be indicated if there were a complete tear. I have since learned that some complete tears are worse (or at least bigger) than others (maybe they are not worse, complete is complete).

I bike-commuted today over my wife's objection. Just riding (as long as I don't hit things) doesn't seem to impact the shoulder (not as much as climbing a ladder and cutting down snow-laden branches after an ice storm in between the initial dislocation and followup injury, and I did a lot of that).

Anyway, that is that. If they are doing surgery on the supraspinatus, would they reconnect the infra while they are there? And fix the labrum too? Or just do each item in individual procedures as warranted? There are also 'numerous loose bodies' in the bursa. That sounds fun. I don't know how easy it is to collect and remove all of those.

CliffordK

It looks like I missed this post when it came up.

How did your doctor visits go? Surgery?

Mom has had both rotator cuffs worked on, both for range of motion as well as pain management.

The surgery helped alot with pain, and improved range of motion somewhat, although still not perfect. For her, as she got into her late 70's, one surgeon commented that it was really difficult to separate and reconnect the muscles.

Mom ended up with a complete shoulder replacement. Apparently there are two types:

Standard (ball on the humerus, socket in shoulder)
Reverse (ball in shoulder, socket on humerus).

For some things the "Reverse" shoulders are supposed to be more stable.

Good Luck

OldTryGuy

Which procedure depends on conditions of shoulder at the time ---

" ....A standard total shoulder replacement depends upon muscles and tendons around the shoulder joint to be intact. A normal shoulder replacement is designed to work only if those tendons are intact. In contrast, a reverse prosthesis is designed for situations where the rotator cuff is torn or malfunctioning..... "

YEARS AGO my first ortho tells me.... "Good news is tendons are fine and bad news is a total shoulder replacement is needed." Three years and 3 ortho surgeons later I had my right shoulder replaced by the doctor who told me I would be able to get back on my bike 2 days following the total replacement surgery. I waited until the 3rd day to go for a ride.

peterws

I was told by my doc that surgery isn't often done with the elderly, ie 70+. Me being 69 at that time didn't help either. I was sent to physio, although I've never usually benefit from their input; time and exercise with weights got the job done. This was my second time in the same place, but it's fine now. We are talking a couple of years . . . .

Just listen to your missus (guys can be so impatient) and all will be well. As long as you

HardyWeinberg

Hi folk
.
Well, I have surgery scheduled for 23 July. I agreed to it in late May, but by the time the insurance signed off and the surgeon got me in the 1st available date was 10 July and well the 23rd is more convenient.

I have done some reading and apparently there is no detectable benefit of surgery over non-surgery for 'non-traumatic' tears but there is for traumatic ones (which is what I have).

Surprisingly the ortho is more optimistic about 2 of the 3 tears the radiologist identified, but he is open to doing whatever once I'm on the table. So, the supraspinatus is 100% torn and needs repair. The infraspinatus the radiologist spotted as 50% torn which would not merit repair unless there was already a surgeon there working on other stuff. The surgeon is skeptical of the reading of that tear but will check it and fix it if needed. Finally, the 'slap tear' which was explained to me as cartilage damage 7 years ago now I am told it's a biceps tendon problem. They might relocate my biceps tendon from whatever shoulder bone it's supposed to be attached to, to the humerus. Will be a game time decision.

OldTryGuy

Just a

GOOD LUCK!! to you

HardyWeinberg

Thanks, and thanks for the responses

rojrdojr

Curious how recovery is coming. I had a rebuild back in '14. Met Hal Lindon from 'The Barney Miller Show' 3 days later at a fundraiser and he gave me the arm flopping over the head salute customary to a successful surgery as we can do that now. I had also torn the long tendon to which you refer but it had retracted to the elbow area for too long to recover. My left shoulder is next someday... always inflamed and sore. For shoulders, surgery is the bomb and well worth the recovery time. Cervical surgeries not so much...

I hope it is going well.

horatio 

An update would be great. I’m due for RC surgery next month. The ortho says I’ll have the arm immobilized in a sling for six weeks. Not sure how I’ll cope with that. I also hear PT is a beotch at first, but I’m determined to have a good outcome. Hope you’re progressing well.

OldTryGuy

Just a

GOOD LUCK!! to you

As I've mentioned, my total shoulder replacement was a "piece of cake" compared to RC. Getting very close to TKR for both knees.

HardyWeinberg

That's hilarious! The guy at the hardware store in the stripmall where my office is did that before I went in for mine.

So far for me it has been easier than it was for any of the people I heard from. I pretty much only heard awful stories about everything from start to finish from people I know. For me, my arm was immobilized for 4 weeks and still in a sling but no longer immobilized for 2 more weeks. I am starting week 2 right about now with no sling. I was wayyyyyyyyyyy proactive with the oxy and ice (set alarms to wake myself up every 2 hours the 1st night to take either oxy, the muscle relaxer, or 1000mg tylenol) and never really had much post surgical discomfort. I tried to get off the oxy a bit too soon, which my body let me know, so I loaded way up on it for 2 more days and then I was done with that. Still needed help going to sleep in the recliner for the whole time I was in it (I used the nausea medication they gave me for recovery from general anesthesia, which I was lucky enough not to need for that purpose), which was basically until I could lie on my back and not feel like my shoulder was going to unravel. I suppose it would be possible to sleep on your back earlier with a pillow supporting the shoulder. Note, this was even with the immobilized arm, the shoulder felt pretty unstable if I was horizontal.

Note, I was lucky enough to have sick time to take 5 weeks off work after the surgery, I doubt if I had gone back to work after a week or 2 I could have stayed off the oxy, I don't think tylenol would have been enough if I had gotten more active earlier. I am not positive it's enough now that I am more active this much later but sticking to it.

I used one of these things for ice, it was great. Now that I am not immobilized I just use an ice pack.

The 1st 6 weeks of PT (really just 4 weeks 'cause I started 2 weeks after surgery) was just passive mobility. I actually started at the 6 week mobility goal and they wound up cutting my appointments in half (1/wk instead of 2) so they didn't use up what my insurance had before we got to the stuff that they could help me more with.

This last week+ with no sling I've had pretty much the most discomfort of all, but I am just keeping up the tylenol (3000 mg/day) and ice and working through it. My PT has gotten to the level of active mobility, and doing it, I have twice hurt myself enough to disrupt the exercises (supposed to be doing them twice a day; 1st time was worse I think, I wound up taking oxy to be able to sleep that night; this second time I haven't been doing the exercises for a few days but still icing). Each time it was me overdoing the exercises, pushing too far or pushing through pain; my suggestion: if possible, don't get to pain in mobility never mind pushing through it. Going to get back to exercises as well as icing today. In another couple weeks I should get up to resistance exercises. Still no stickshift or use of my right biceps until 12 weeks after surgery, so 5 more weeks of that.

Good luck to you.

horatio 

Thanks for the update. I’m planning two weeks off work, but maybe I should rethink that. My ortho said a week should be sufficient. Glad you're making progress.

OldTryGuy

Agree that you might want to rethink. Very active doctor friend had knee replacement, yes not the same, 1 year ago and is not much better since before. Doctor was supposed to be The BEST. Keep us posted.

horatio 

I always expect the worst.

OldTryGuy

EXACTLY how I have lived my life for decades. Has served me well in reducing stress and worry. Had a prostate biopsy in 2015 and expected results to be cancer even though EVERYBODY said not to worry. Came back Gleason 10, the most aggressive. I was right so no big deal but if I was wrong it would have been a pleasant surprise.

BengalCat

If the torn labrum and supraspinatus muscle are in the same shoulder and you a middle age or younger surgery is your best bet IF, and BIG IF, you can get quality long-term physical therapy and are willing to endure the pain and time to rehab. Shoulders are about the hardest injuries to rehab. Generally speaking the needed quality PT usually isn't available to folks, even with insurance. The PT is too limited.

However, since you posted in the fifty-plus forum I take you are at least 50 years old. The older you are the more you should tilt toward just PT or a more conservative surgery if available.

I'm 73 and both labrums are torn as well as minor tears in both shoulders plus moderate to severe arthritis and some impingement. Surgery was offered as I'm always in pain, especially sleeping at night. I said heck no as at my age and relatively high level of conditioning from biking and other exercising I cannot to lose what I have to surgery and that I would never get back due to my age.

horatio 

I have considered just living with it as is, and have coped for the past three years following injury, but the pain is more frequent and the arm is getting weaker. I was told two of the ligaments have completely separated and if I do nothing I will eventually lose use of the arm. Surgery may be a gamble, but it’s one I’m willing to take. If it were my left (non-dominant) arm I would just make do.

BengalCat

The OP was talking about injuries to his labrum and muscles. You are talking about ligaments, (completely separated you say), so that means torn and surgery is mandatory.

horatio 

Didn't realize you were responding to the OP.

HardyWeinberg

There is literature that past a certain age PT is better than surgery, but I am not there yet. Also literature that, past a certain age, if surgery is the option, replacement is better than repair, but replacement carries function limits, so the hope is that at that age the function limits are still past other bodily limits... Finally, also literature that PT can be comparable to surgery for non-traumatic tears (this might be directly correlated with age, since past a certain age everyone has nontraumatic rc tears), but surgery is better for traumatic tears. Mine was traumatic, although it was 3 incidents not just one.