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-   -   Shoulder Surgery and Recovery (http://www.socnet.com/showthread.php?t=128921)

labman2 9 January 2017 13:47

Shoulder Surgery and Recovery
 
There are quite a few threads on here about shoulder issues-labrum, rotator cuff, surgery etc. I received a ton of invaluable information from this site prior to my surgery. I'll post my experiences from pre-surgery through the rehab in the hope it may benefit someone in a similar spot.

Background-lots of shooting, rifle, pistol, carbine both job related and competitive. The last couple of years, shot skeet with my oldest as he competed. I suck at it, but it's fun. General archery and bow hunt alot. Fishing, love to fly fish and pole a skiff. Weights-searched for the 400+ bench, squat, dead lift, lots of heavy weights, nothing that benefitted a 54 yoa.

Fall of 2015, I had constant pain in my right shoulder, generally caused from teaching and coaching high school age kids how to block and tackle. Nothing like holding a blocking pad for a 17 year old who weighs 300 pounds. Pain levels came and went, but it was always present.

Fall of 2016, when I cannot raise my arm more than shoulder high, I finally see an orthopedic shoulder specialist who does shoulder surgery only, Two weeks later I have the MRI results back and he’s asking me to evaluate the pro’s and cons of surgery. My only question was when we could schedule.

Pre surgery opinion based on the MRI was bone spur/arthritis removal, bicep tenodesis, and cuff repair. Four small incisions and I’d be off to rehab.

12/5/16 is surgery. I wake up with two small holes and two 4 inch incisions. Doc says the labrum was frayed (apparently the labrum location sometimes prevents a clean MRI view), bicep tendon was frayed to the point of tearing completely off in 3-6 months, so a portion is removed and then the end is wrapped a surgical moly bolt which is drilled in to the shoulder bone, bone spur and arthritis removed, and rotator cuff is repaired. The incisions are due to the amount of work necessary to repair all the shoulder issues, as the doc couldn’t complete the repair utilizing only the small arthroscopic holes.

I’m given Percocet for short term pain relief and hydrocodone for long term relief. Doc administered a 72 hour nerve block, and everyone strongly recommended not getting behind on the pain meds.

12/9/16 is my first PT appointment.

labman2 9 January 2017 14:09

First PT appointment is 72 hours post surgery for an overall assessment and evaluation. I did some some small (2-3 inch small) movements and scheduled for 3x weekly. Little to no pain post PT session and I quit the hydro and stuck with OTC pain relief.

Over the next 10 days, got used to the sling, sleeping in a recliner and trying not to grab anything with my right arm, fall over or generally f**k up the surgically repaired shoulder.

PT progressed quickly. This week 1/9/17, five weeks removed from surgery, I have approximately 90% range of motion with external rotation and can raise my arm vertically within 90% of vertical. I have slight discomfort on the initial 4-6 inches of the vertical arm raise, but it improves daily.

I do the PT exercises 3-4 times daily. Due to the excellent recommendations I received here, I ice after every session, and use a cryo cuff for 3 hours daily (hour on/off). The first post op visit with the doc went well, and his PA recommended Aleve twice daily.

I haven't had any recurring pain since the surgery and hope that the range of motion will continue to improve. My strength has declined dramatically, but this week in PT will start small steps in band work for strengthening the shoulder.

Bottom line, after speaking to several docs, PT's and people who have had shoulder issues and surgeries, here's my .02.

Cuff tears and labrum tears can heal on their own, but normally do not, especially if the same repetitive motion and activities are maintained. The tears may completely heal, but typically that area is at risk for damage at some point later.

Find the best surgeon you can. A friend of mine had emergency open heart surgery several years ago to fix a heart valve issue, he said the post surgical pain from that operation paled in comparison to his pain from a similar to mine shoulder surgery.

I'm a layman, but am convinced that the greater the skill of the surgeon is tied into the level of post surgical pain or lack thereof.

ramzmedic 9 January 2017 14:21

You are going to be in some serious pain and the narcos are fine short term. What got my attention from your post is the hydro for long term pain relief. From my experience, I would only do the short term, then transition to a non-narco pain med or even some OTC stuff. Naproxen is a miracle drug IMO. The combination if a non-narco and Naproxen is a good possibility to keep you out of trouble. There are some good long term options out there like the Neurocet/Neurofen combo. If you have good self control you can also now get Oxycontin with Naloxone. This has shown to be effective for keeping the abuse down, but only if you do not have the urge to crush it up and snort it you would be fine.

I had rotator cuff surgery a few years ago and I got through it with only a 2 weeks supply of hydro, then went to Celebrex. Came off everything in a few months with no problems.

Good luck!

labman2 9 January 2017 19:37

I quit all narcotics on day 4 post op and transitioned to OTC pain relief only. I still take Aleve 2x daily only due to the doc recommendation for anti-inflammatory to assist with the rehab.

I didn't articulate the intended use of the narcotics very well. The hydro was prescribed for 12 hour relief, and the perc was as needed. I took the hydro 2x daily for four days post surgery, and had one perc before the first PT session.

I've never been a big fan of narcotics-itching, constipation, general unease, and some really crazy dreams make the narc usage a no go for me. Five weeks out from surgery and I've been very happy with the almost complete lack of shoulder pain post op. The Aleve takes care of any minor aches and pain that crop up.

Just Another Guy 10 January 2017 11:35

Be aware of infections. Mine was P-ACNE (common in shoulders) and wasn't found until a new ortho made them run the blood draw for twice the time after 8 surgeries. On the ninth surgery, there wasn't enough bone left for a regular prosthesis (total joint) so he had to put a ball with everything attached. No range of motion of upper arm remains and a lot of pain continues and won't improve.

AustinPT 10 January 2017 19:36

It sounds like you are off to a really good start. Actually, I would say you're 2-3 weeks (minimum) ahead of where most people would be at the 5 week mark (most RC/labral repairs I see don't even start PT until the 5-6 week mark). 2 bits of advice - One: you're doing great, so don't fuck it up; ie, don't think you're doing so well that you decide this weekend would be a great time to go pull-start the lawn mower, carry groceries, throw ball, hit the dojo etc. That's at least 2-3 more months down the line, typically more like 5-6. Two - it's great to start PT early, but it also means you burn thru your visits quicker. Make sure you know your insurance benefits, and if there's a limit on your visits. I've had patients that the doc wanted started early, 3-5x/week, only to find out they have a "hard stop" (absolutely no exceptions per the insurance carrier) of 15 or 20 visits. Good luck and keep us posted.

labman2 11 January 2017 01:29

AustinPT, thanks for those reminders! My PT and I had a long chat today about overdoing anything. She asks detailed questions about my activity level to ensure I'm not being a dumbaass.

Luckily, I scheduled the surgery with several weeks left in December and BCBS allows for 75 PT visits annually on the calendar year. I look at it as having a few extra visits in 2016.

I go back to the doc on 1/18 and hope to start the strengthening portion after that visit. It sounds like my doc has a very step by step process that he generates for PT to follow. Mine advised it's a bit more regimented than some docs, not much room for deviation.

Although the current PT program is boring, it's somewhat amazing to recognize the almost daily progress. I'm keeping daily notes on changes in ROM, pain, strength etc. I started it out of boredom, and realized after the first week it was a great resource to keep motivated and grounded. First day- move your arm in the sling 2-3 inches in a circle. Today 36 days post op, I raised my arm up unassisted with decreased pain. Small progress in some ways, but the mental relief was huge. Good stuff.

AustinPT 11 January 2017 06:16

Excellent. PM inbound.

labman2 12 March 2017 16:36

Week 14. Mobility and range of motion is almost 100%. The only area lacking is placing my arm behind my back from the waist up and head down. That'll come within a couple of weeks. The PT was cautious in beginning those stretches due to the ensuing pressure on the surgery area. Strengthening is fine, although feel like I could and should go much heavier.

PT and Doc both cautioned me with a word of warning that the 12-18ish week period is where a lot of patients put themselves at risk for re-tears two and three years out. They ramp up PT and physical activity at this juncture as they feel great and become impatient with the progress. However, the repaired areas aren't fully healed and may never become fully healed if too much activity, weight etc stress the area. The patient may never realize the damage done (area never fully recovers and heals) until stressed 2-3 years later.

I'm following the prescribed regimen as I don't want to undergo another surgery for stupidity. Got the ok for fly casting, it's somewhat tiring, but great for mobility and range of motion. Other than that, doing lots of band work, a few cable machine exercises and stretching 2-3 daily.

Jimbo 12 March 2017 21:01

Do not add weight for strengthing. Concentrate on form and go for max reps (30+). If your surgeon or PT has not mentioned it yet, your shoulder will continue to loosen up to 18 months post surgery. Do not get ahead of your recovery. Sounds like you have lots of sleeper stretch and towel stretch ahead of you. Good luck!

Stretch 12 March 2017 21:34

ladman2,

Great news!!!

My father taught himself to fly cast left handed when knew the surgery was coming.

Do your PT and be sure to post fish pics when you start catching again... :D

S

labman2 11 June 2017 22:44

June 5, I was cleared for all activities by the Dr., mobility in the repaired shoulder is better than the other one, strength is improving.

Three weeks ago, I started shooting pistol and a .22 carbine. My pistol presentations, transitions and draw all suck. I haven't found the groove for any pistol movement, everything seems a bit off still. Trigger is still fine with .18-.22 shot sequences for 2-6 round shots, but getting the pistol on target from a draw or ready gun index is really slow. I've been reviewing some old class notes from various courses and will take my time. The other issue is my grip strength has really atrophied, something else to work on.

I'll probably shoot some .223 next month, shoulder was a bit sore after the first.22 carbine round. I was disappointed with that, but the next two sessions went fine with no soreness afterward.

Fly fishing is good, some soreness, just need to build more muscle. Poling a boat kicked my ass after about 20 minutes, need lots more functional strength for that activity. Fighting a big red definitely was not an easy task.

Working out consists of lots of stretching, 3x weekly no contact boxing work out on heavy bag (some soreness, but less and less). 1-2 spin classes weekly and walking. Lifting is now a routine of shoulder complexes with 5-15 lb weights, and some occasional core work. Lots of isometric work, and the mace/club stuff posted a couple of days ago looks great.

If the indoor community pool renovation is ever completed, I hope to add some water work as time permits.

The doc and staff were excellent to work with and asked me to check back in mid September. The shooting and boxing activity were out of the ordinary for them and they want to monitor the progression. Good luck to all with shoulder issues, it's been a journey to reach this point, but not near as bad as I had prepared for.

wetblade 11 August 2017 21:34

Rotator cuff both shoulders. Average time after surgery to heal is what?

litepath 11 August 2017 22:41

Check this link wetblade: http://bfy.tw/DKvq


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