Shoulder Surgery

[BCGroup]

I am scheduled for shoulder surgery Friday--after a tumble down some stairs, I apparently dislocated my shoulder and tore a ligament. The doc is saying six weeks in a sling, along with lots of therapy/rehab. Just wondering if anyone has had similar experiences, and wants to share some tips! I've managed to clear my schedule for the most part and wont' be traveling again until mid-June. Thanks in advance.

[whereinthehellami]

Have you had any major surgeries before? I've had multiple knee surgeries and I think the biggest thing is to go into them with the right frame of mind. Know that the rehab will be tough and long. Pump yourself up for the challenge. Expect to hit the proverbial wall at some point after the surgery regarding rehab and keep it all in perspective.

[bluebear]

I have dislocated both my shoulders, torn 2 labrums, and at least one ligament. I had surgery on one of the shoulders and did straight rehab on the other. The older you get, the less likely they are to recommend surgery unless you are a serious athlete. Now, there may be additional specific reasons why surgery is recommended for you. My surgically repaired shoulder is slightly more bothersome than the non repaired shoulder but I really abuse them kayaking...
My biggest recommendations on the surgery are:
1) Keep the sling on for the 6 weeks or until told otherwise. It's very easy to forget and try to move it in the wrong direction. The last thing you want to do is undo the repairs.
2) If you don't have a recliner look to get or borrow one. Sleeping is tough for the first few weeks and it is very hard to lay down because of the way gravity pulls down on your shoulder. You can probably prop yourself with pillows in a bed but a recliner with arm rests is much easier..
3) Ice is very helpful for the first few days after surgery. I had a special ice /compresssion sleeve which was extremely useful.
4) Be very aggressive (appropriately so) and consistent with the rehab. Your shoulder will be very stiff after the 6 weeks and regaining range of motion is a bear. I probably was only able to get 85% of my range of motion back despite being very active.
5) Rehab is painful with the hardest part being trying to stretch the joint back out..the strength portion comes back quickly..
Let me know if you have any other questions

[bluebear]

After rereading my post, I should also mention that with diligent rehab, you should be back to normal doing all activities. While I had some loss of range of motion, it is not noticeable at all in either daily or more athletic activities. My surgery was also on my non-dominant arm which probably contributed to the range of motion deficit, as I use it less..

[BlueDevilBaby]

What bluebear said. I have had two surgeries on my right shoulder in 12 months for two different problems. My lesson, take it slowly on the rehab. Baby steps should be the mantra. I did not after the first operation and probably put too much stress on my shoulder, causing the second injury. I have good range of motion but not the strength yet. The ice/compression sleeve with the cooler pump is an awesome machine. I have kept mine just in case. Best of luck.

[Johnboy]

I had rotator cuff surgery on March 27. My right arm is in a brace as I type this (I have to mouse with my left hand).

The second and third days after surgery were the worst for pain. Use your pain meds.

Follow instructions on what you are allowed to do and not do, and do your exercises carefully and religiously after surgery.

A cold therapy unit is awesome. I first got one from knee surgery a few years ago. They sent me home with one from the hospital. I think everyone should have one of these to use whenever ice is recommended. I have used mine for back pain, a sprained ankle, all kinds of stuff.

Sleeping is the toughest, especially at first, but it gets better. We do not own a recliner, so I was propped up in bed or in an overstuffed chair to (try to) sleep.

Physical therapy will be challenging and painful, but it is satisfying when you see dramatic improvement, which happened for me after a couple of weeks. My recovery has been, in my mind, much slower and more difficult than my ACL surgery a few years ago, but I know several people who have had excellent results, and my surgeon assures me that if I follow the physical therapy and other post-op instructions, that I can expect a complete recovery of motion and strength.

Good luck, and I'd be happy to commiserate with you on your recovery.

[kmspeaks]

Get a journal to record your rehab milestones. When you do hit that wall and get discouraged it may be helpful to look back and say 3 weeks ago I was excited about getting my arm to __________ (fill in the blank) and now I'm way past that.

[greybeard]

Depending on where you live, you might be able to get significant help in your recovery from a Feldenkrais practitioner. There are many physical therapists who have been trained in the method, which operates on premises diametrically opposed to the concept of "no pain/no gain." To the contrary, one of the elemental strategies of the work is to take what the student can do easily and take over that action for him or her. Then the process of influencing the nervous system/brain to do other things with the same ease, exploring the extent of how that might be possible and what inhibits it and addressing those things, moves along.

Moshe Feldenkrais, the first Westerner to earn a black belt in Judo and a world class physicist/engineer/mathmatician, developed a method of exploring how to help improve movement over a 40 year period. Sometimes a picture is worth a thousand words.

Feldenkrais was invited to address a group of physicists and discuss his work. He was introduced to the group in terms that were extremely synical to say the least, and after lecturing, agreed to work on a woman in the group who had severe whiplash and had been treated for several weeks by a physical therapist with no discernible improvement.

Google “Moshe Feldenkrais + whiplash + video” and you should find the video. You will note that M begins by testing the woman's ability while sitting to lift each hip off the table. He discovers something that he will use much latter--that her right hip, which is on the same side on which her neck and shoulder are severely restricted in their ability to move and terribly painful to the woman, in fact moves up quite easily. He also discovers something about how she is preventing her spine and ribs from cooperating in the movement of her upper body, and making the movement of her head and shoulder impossible for her. You will also note how he gets the woman to move her neck dramatically by tying her right extremity, her arm, to the movement of her head, holding the arm close to her head and fully supporting both. The results to her ability to move her head (neck) and to differentiate and move her arm independent from her neck, are dramatic, at least to me.

Not every Feldenkrais practitioner is good at doing this type of individual work. Some are terrific. If you are impressed by what you see in this video, it might be worth your time to seek out a practitioner who is good at this individual work known as a Functional Integration lesson.

I believe that the exact link to the video is http://www.veoh.com/browse/videos/ca...11338hqwqGxg9# For some reason, when I copied it from a link a colleague sent me, the link doesn't serve as a link. Computers, feh!

By the way, M was pretty ticked at his audience by the time he did this demonstration. You might detect that in his demeanor. If you saw the beginning of his lecture and the questions he was asked, you might understand why.

At any rate, the best of luck with your recovery. Be aware that all parts of your body will participate in the immobilization of the shoulder that the initial stage of your recovery will require. Getting them reoriented to support your shoulder in movement is not to be overlooked, after they have been trained to help maintain it in lockdown mode for so long.

[BCGroup]

Thanks for all the advice. I am trying to get my head around everything--it's been sort of crazy--I resigned from my university to take a job with a university in NC, so I'm also trying to get this done before the insurance changes. I have a great support system, and am already lined up for therapy starting Tuesday. I'll look into all the ideas you gave me--I'll be staying with my boyfriend who lives in the Asheville area. Thanks again!

[AluminumDuke]

If your anesthesiologist offers you an interscalene block, I suggest you take him/her up on it. It's an injection of local anesthetic in your neck which will make your entire arm, including your shoulder, numb for several hours after the surgery. Having watched patients wake up after rotator cuff repairs both with and without having had a block, I would not allow anybody that I cared about to undergo a significant shoulder surgery without one. Even after the subjective numbness has worn off, patients require far less pain medicine when they've had the block done. There are some other options, including a pump which slowly injects local anesthetic into the shoulder after the surgery, but none which have been shown to work as well as an interscalene block. They'll sedate you before the injection, so don't let a fear of needles scare you away.


Good luck!

[bluebear]

If your anesthesiologist offers you an interscalene block, I suggest you take him/her up on it. It's an injection of local anesthetic in your neck which will make your entire arm, including your shoulder, numb for several hours after the surgery. Having watched patients wake up after rotator cuff repairs both with and without having had a block, I would not allow anybody that I cared about to undergo a significant shoulder surgery without one. Even after the subjective numbness has worn off, patients require far less pain medicine when they've had the block done. There are some other options, including a pump which slowly injects local anesthetic into the shoulder after the surgery, but none which have been shown to work as well as an interscalene block. They'll sedate you before the injection, so don't let a fear of needles scare you away.


Good luck!

I had one of the these and it was great...the only downside is when you come to and touch your arm, it feels like you are touching someone else's arm..weird sensation..there is also a period of "pins and needles" as the nerve block wears off..

[BlueDevilBaby]

Very good point about getting the block. I totally forgot about it. It definitely helps to get off the pain killers quicker. I was off them within 2 days after each surgery, except perhaps for one at night to help me sleep after the rotator cuff surgery. Keep us posted.

[DukePA's Mom]

Make sure your pt person is tops for shoulder rehab. I have one at Duke Sports Medicine for my torn rotater cuff. He is great. My doc, Allison Toth wanted only him to take care of me. She is the Duke WBB doc and the shoulder person my ortho doc sent me too. Good luck. Be sure you do as your doc & pt person say.

[OZZIE4DUKE]

Best wished for a successful surgery and a quick and complete recovery. Can't offer any suggestions as I've never had surgery. Well, except for ... never mind. It wouldn't be polite to talk about that, here or anywhere else.

[Johnboy]

While I would characterize much of the PT I've had as inducing discomfort (including occasional yelps and frequent grimaces), I would not charaterize my physical therapists as subscribing to the concept of "no pain, no gain" - in fact, my surgeon and physical therapists have all advised me not to do anything that is painful.

In the early stages of PT, the patient's job is to relax and give the arm over to the therapist, who then stretches out the repaired area so as to avoid frozen shoulder.
From the linked article: "Frozen shoulder can develop after a shoulder is immobilized for a period of time. Attempts to prevent frozen shoulder include early motion of the shoulder after it has been injured." Your shoulder will be immobilized after surgery, and the surgery is an injury of sorts. Accordingly, you gotta do the PT or you risk this very painful condition. Or so I have been advised.

Best of luck with your surgery.

[BlueDevilBaby]

My PT screams at me to stop if she can tell an exercise hurts in the slightest. I, of course, try to press on through the pain and finish anyway. IMO, they don't want you to have any pain except when stretching. I think I still have a frozen shoulder blade. She's been trying get her thumb under there for 12 months now and cannot do it.

[Ima Facultiwyfe]

is a regular bionic man. He's had new knees, hips, and rotator cuff surgery and is now looking forward to spinal surgery. He's seen it all. The shoulder was by far the worst at first for pain. Be sure to stay on top of it with your meds. Don't try to be brave. Next advice is to go to Sports Med for your therapy and do EXACTLY what they tell you...no more, no less. You'll be really glad you did.

Good luck and keep us posted! Bless your heart.
Love, Ima

[greybeard]

You might try asking your therapist when you get that far to move the torso in order to rotate the upper arm bone in the shoulder joint rather than the other way around. Will hurt a lot less. Why? I could tell you but what for. It just will. Trust me.

The question you will face after surgery is how do you get the muscles that are protecting the joint from moving to stop. Those muscles include groups quite distal from the shoulder joint. Muscles work by constricting. Your relevant muscles will have a tremendous amount of residual constriction even when they are at rest.

Now, you can try to work against the constriction (what we call stretching) and exhaust the muscle with the hope that it releases, which is going to hurt tremendously. Of course, you better remind your PT that it is not just the muscles proximal to your shoulder joint that impede or enhance ease of movement but muscles that are distal. We're talking stretching out a lot of muscles here sports fans, and anyone who has done Yoga and was not particularly "flexible" to begin with can tell you how much time doing that effectively might take. All I can say is, please do write.

Or you can use other strategies that will work much more effectively and will not hurt--that secure the cooperation of your nervous system and your brain, which after all control how you chose to move what and when (neither will be happy or learn a darn thing if you move into pain). At least, there can be choice, but only if you learn to do something other than what is habitual and know HOW you do it. Without such knowledge, you have no choice

Muscles for the most part do not stretch. They work by constricting. That's the list. When they don't relax completely, hold residual tension, they prevent antagonist muscles from working efficiently.

So, what prevents your head from turning easily to the right so you can look over your right shoulder. Is it the muscles on the right side of the neck, or perhaps the muscles on the left side of the back, which hook up to the muscles in your left butt, all of which are influence by the degree of "flexibility" or not of the ribs, and let's not forget, the tilt of the pelvis?

If you have difficulty turning behind the ball in your golf swing, is it your left latt or right butt that is the issue, and what about the ribs and pelvis, and whether your clavical moves or not as it should, and if not, why not.

Interesting stuff.

[BCGroup]

Wow--this board has never let me down! I talked to my anesthesiologist today and he is doing the interscalene block. Also, I called and ordered the ice pump, which will be here by the time we return from surgery. All the other advice is very helpful and I will do my best to follow it. My boyfriend is planning to keep me on top of the pain meds and therapy, so I think I'm good to go. Now, if I could just go to sleep....Thanks for all the well wishes. Barbara

[OZZIE4DUKE]

My boyfriend is planning to keep me on top of the pain meds

He's just trying to get you drunk!