Monday, January 16, 2006

In-Depth Details About the Shoulder Surgery, Part One: The Injury

(this is salvaged off the message board that is about to be decommissioned)

This is both a report to my friends about the results/progress of my shoulder surgery and an information guide to anyone who might be considering arthroscopic shoulder surgery.

There are inevitably a lot of shoulder injuries around here, so I figure this info is worth sharing. It's rather in-depth so if you don't care about my shoulder nor have any need of considering arthroscopic surgery, take a pass. Or just scroll down to the cool post-surgery scars.

My Injury:
Occurred on Still Rings in March this year. I did a dislocate when I wasn't warmed up. The dislocate went fine, got plenty of lift and clearance for my shoulders to come around. No jerk at the bottom as I was on a low set of practice rings. There wasn't anything dramatic - no popping sounds or horrible grinding - but it did hurt afterwards. But not so much that I thought I was injured. I tried to do more activity on it and it kept hurting. Probably made it worse.

It hurt when I would just hang and especially hurt when I would swing even gently on a high bar. Didn't hurt much at rest. I discovered later that I couldn't spike a volleyball. When I lay on my back it would hurt when I fully extended over my head (like a diver turned 90 degrees). In that position it hurt too much to lift the bad arm off the ground.

When standing I could hold my arm straight out from my body and hold weight without pain.

My Remedies:

1. Complete Rest
I gave it a good month or two of complete rest. Didn't try straining it, no stretching, no nothing really. It didn't improve at all.

2. Light Stretching, Range of Motion Work
I started stretching it every day, pinwheeling my arms, lying on my back and going through the whole range of motion (as far as I could with the pain). It started improving. Range of motion increased. Strength increased. Pain was still there but it was more specific to particular positions.

The physical therapist would later say that this was exactly what I shuld have been doing. Joints don't heal if you just let them sit still. They need motion to encourage proper healing.

3. Visiting the Doctor
My General Practitioner didn't know jack. He just handed me off to Physical Therapy.

4. Physical Therapy
The PT was excellent (Sarah at UCLA PT). She knew the shoulder joint very well and did a number of specific tests to identify where the pain was. She found that my lower traps muscles were much weaker than they should have been. That caused instability in the joint, leaving it more vulnerable to injury. She also found that both shoulder joints had more mobility than they were supposed to (too loose) and that my injured one was even looser than the good side.

She identified that the pain was in or near the AC joint.

2-3 months of therapy focused on strengthening the lower traps and adding stability. It worked. I was able to use my shoulder more and more without pain. I even could start to spike a volleyball if I was careful to keep the strike ahead of me rather than directly above or behind me.

However the injured area was still injured. The strengthening helped me do more with the shoulder, but didn't heal whatever was wrong in there.

She guessed that it was a labrum tear (the labrum is cartilage inside the ball-and-socket joint that adds stability while allowing broad range of movement). She told me to urge my GP to order an MRI.

5. MRI
Twenty minutes inside a freaky claustrophobic tube and nothing. The MRI showed some minor tendon damage (tendonosis) in the infraspinatus and supraspinatus but nothing that would be causing the specific, sharp pain I felt while fully extending and exerting my arm over my head.

6. Orthopedic Surgeon, Cortisone Injection
Along with the MRI my GP handed me off to an orthopedic surgeon (Dr. Motamedi at UCLA Santa Monica). He said the first thing to try was a cortisone injection to the area. Cortisone immediately reduces inflammation in tendons and can allow them to begin healing (inflammation prevents healing).

The cortisone shot was no big deal at all. He numbed the back of my shoulder with a spray and then did a quick, painless injection. I was told to gradually increase activity over the course of a month. The cortisone shot didn't do jack.

7. Orthopedic Surgeon, Final Options
My final options were to take an injection dye and do another MRI. But the surgeon felt that we may as well just go ahead with arthroscopic surgery.

Arthroscopy involves sticking a camera inside the joint and seeing for himself what's going on in there. As an added bonus he can also usually fix what he finds in there.

There are always risks, but they seemed minimal. He said that in most cases arthroscopic surgery is 85% successful at achieving a full recovery. In my case the odds were a little worse since my pain was so specific and only under "extreme" circumstances (swinging on a bar or spiking a v-ball is considered "extreme" relative to our sedentary population).

He said that one of two things will happen:

1. He'll debride the injured area - meaning he'll scrape away scar tissue and uncover the wound, forcing it to re-heal itself, but this time heal properly since it'll be guided by physical therapy. I would be able to use the arm immediately and being PT immediately.

2. He'll have to repair something. In the worst-case scenario I wouldn't be able to use the arm at all for 8 weeks! Then rehab will take six months. During that 8-week healing period he didn't think I'd be able to drive my stick shift car (since it's my right shoulder).

He suspected that it was either a tear in the labrum or in the rotator cuff.

Final Decision:
I decided to go for the surgery. I'd lived with this injury all summer and felt that I'd tried everything I could to help it heal and regain use of that shoulder. But it was still injured - and still hurt just as bad as when it first happened in March. It obviously wasn't going to heal itself.

Many of my friends here tried to talk me out of it - mostly the stuntmen whose careers depend on healthy appendages. I was grateful for their advice and especially their concern, but I was quite sure I'd explored and exhausted all my options.

I'll break this up since it's already getting very long.

Next post: The Surgery!


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