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Probable tear of labrum - solution without surgery?

post #1 of 23
Thread Starter 
Friends, count me among the wounded. I dislocated my shoulder two weeks ago Sunday when I fell hard on it. It immediately reduced once I got to my feet - just from the weight of the arm dangling. Skied down and got ice and a sling. Off to the ER where I go a fancy brace that positions the arm, not across the chest, but at a 45 degree angle to it. Saw my own doc a couple days later and she made a referral to an ortho surgeon who has ordered an MRI (with contrast, at my request). He will see me after I get the results. But we chatted on the phone yesterday. I explained the mechanism of the injury and the fact that I have gained some range of motion with the light movement exercizes I have been doing. I can get the arm nearly parallel to the floor both in front and to the side - albeit with pain. No strength at all, however, in those positions. He told me flat out that I likely have a tear of the labrum which will be confirmed on MRI. As for treatment, he said surgery is an option, but not a necessity. So that is my question to you folks who have tread this path.
Assuming the MRI shows a tear, as expected, is this the kind of injury that can be "repaired" with aggressive rehabilitation? I think I understand the doc's comment. No one ever died from not having a shoulder procedure. But I would ot be content to have an outcome that would leave me unable to ski with confidence or get back to body building, my other passion and the activity that keeps me sane between ski days.
Anyone here have a similar injury and simply work through it? I realize that every injury is different, especially in shoulders. There can be full or partial thickness tears and other variables that determine an ultimate outcome. Just trying to get a sense of the path before me. Appreciate the help.
David
post #2 of 23
Hi David,

If you have not done so already, search this forum and read about the experiences of others with dislocated shoulders. There is not a best answer for all and the severity of the injury varies. All want to return to as near normal as possible, and, dealing with future uncertainty is a very normal concern following your injury. You will get more data, and, you will also continue to heal. Perhaps my point is that you will not be able to come to closure on treatment and/or your future at this time.

I was lucky as the "collateral" damage was minimal, it has not reoccurred and I function close to where I was. A year later, protection of my shoulder is something I give due consideration to in making risk decisions.

The most significant advice my ortho gave me was that I needed to tell him that I could not live with my injury as a precondition to surgery. Your doctor may provide you with much different advise, but, I would try to rehab without surgery. A few weeks or months is not going to make that much difference. Your experience with a physical conditioning program should be very beneficial in deciding. If  you want to get back as close as possible to where you were, that has to be considered.

Keep updating your status. The support group in Epic is a real plus.
post #3 of 23
Unfortunately, as a doc AND as a patient who has dislocated and undergone surgery on both shoulders (one 3 years ago, the other 3 weeks ago), I have "too much" insight into this problem.

The answers to your questions are very complicated and variable - and different docs will give different opinions.

With the exception of high level athletes, surgery is not generally performed for a first time dislocation. Age of dislocation is an important factor. In this case, advancing age is a good thing as dislocation at a younger age carries a higher risk of re-dislocation. Your risk of redislocating at this point is very high because the proprioceptive mechanism in the shoulder - which provide spatial feedback to our brains - are damaged and not working properly and the tissues are all inflamed. So the sling is used for comfort and as well as protection.

After the immediate aftermath, the long term decisions revolve around your level of pain, instability, "collateral damage" and redislocation risk (based on activity,etc).

I'm reluctant to give further advice beyond that, because it would be irresponsible of me. But I'll share my personal story and how things have gone down:

I dislocated the right shoulder backcountry skiing in VT in '05 at age 34. Pole plant went down, caught a hidden log, body came forward and shoulder came out. Was truly horrifying as we were hours from nowhere and took me 20 minutes to reduce it. I  took the conservative route and just did rest and home rehab. After a few months I was 100% with no pain or instability until I took a hard fall on ice several years later. From that point on I repeatedly dislocated, to the point that it was coming out in my sleep. So at age 38 I had it repaired and it's been rock solid. I've been skiing, biking and doing everything else without any problems.

Forward to 2 years ago....I glance a tree in Vail with my left and it subluxates (pops in and out - not a full dislocation). Labrum torn per MRI. I again take the conservative route and do fine until this December when I went down hard at around 40-50 mph when I failed to read a change in terrain in flat light. Shoulder out, and this time I need the ER to reduce it. Gruesome MRI - labrum torn 270 degrees, big Hill-Sachs fracture, etc. Told not to ski, but was skiing 6 days later. Skied another 10 days or so in January, then got it fixed 3 weeks ago. Unfortunately, I really dinged the articular cartilage which puts me at risk for arthritis when I'm older, but nothing I can do about that now. So at 40 years of age, I'm sitting here 3 weeks postop, back to work after 2, and still in an immobilizer - just waiting to start rehab and get back to biking by June. I'm glad I went the surgical route.

Good luck with everything.
post #4 of 23
Thread Starter 
Quote:
Originally Posted by The Squeaky Wheel View Post

Unfortunately, as a doc AND as a patient who has dislocated and undergone surgery on both shoulders (one 3 years ago, the other 3 weeks ago), I have "too much" insight into this problem.

The answers to your questions are very complicated and variable - and different docs will give different opinions.

With the exception of high level athletes, surgery is not generally performed for a first time dislocation. Age of dislocation is an important factor. In this case, advancing age is a good thing as dislocation at a younger age carries a higher risk of re-dislocation. Your risk of redislocating at this point is very high because the proprioceptive mechanism in the shoulder - which provide spatial feedback to our brains - are damaged and not working properly and the tissues are all inflamed. So the sling is used for comfort and as well as protection.

After the immediate aftermath, the long term decisions revolve around your level of pain, instability, "collateral damage" and redislocation risk (based on activity,etc).

I'm reluctant to give further advice beyond that, because it would be irresponsible of me. But I'll share my personal story and how things have gone down:

I dislocated the right shoulder backcountry skiing in VT in '05 at age 34. Pole plant went down, caught a hidden log, body came forward and shoulder came out. Was truly horrifying as we were hours from nowhere and took me 20 minutes to reduce it. I  took the conservative route and just did rest and home rehab. After a few months I was 100% with no pain or instability until I took a hard fall on ice several years later. From that point on I repeatedly dislocated, to the point that it was coming out in my sleep. So at age 38 I had it repaired and it's been rock solid. I've been skiing, biking and doing everything else without any problems.

Forward to 2 years ago....I glance a tree in Vail with my left and it subluxates (pops in and out - not a full dislocation). Labrum torn per MRI. I again take the conservative route and do fine until this December when I went down hard at around 40-50 mph when I failed to read a change in terrain in flat light. Shoulder out, and this time I need the ER to reduce it. Gruesome MRI - labrum torn 270 degrees, big Hill-Sachs fracture, etc. Told not to ski, but was skiing 6 days later. Skied another 10 days or so in January, then got it fixed 3 weeks ago. Unfortunately, I really dinged the articular cartilage which puts me at risk for arthritis when I'm older, but nothing I can do about that now. So at 40 years of age, I'm sitting here 3 weeks postop, back to work after 2, and still in an immobilizer - just waiting to start rehab and get back to biking by June. I'm glad I went the surgical route.

Good luck with everything.
 
TSW, really apprecite your response. Actually I found it quite reassuring.
For once, age is on my side. At 53, and with a first dislocation, the stats say I have around a 14% chance of redislocation (I presume spontaneous). If the first is before 20, it goes up to 90% - but you already know that.
Do you mind sharing the type of procedure you had for the labral tear - open, arthroscopic, Bankart, etc?
If skiing were my only vice, I suspect I could get away with the conservative approach. The fact is that I am getting more range of motion every day - now at 90 degrees with little if any instability, though with onging pain. But I am a weight lifter as well - not competitive.  I am at the gym after work 4-5 days per week. I do it for mental health reasons as much as anything. And to preserve bone density (and my vanity). While this injury has given me the "opportunity" to really get my legs in shape, my goal is not just to get back to the slopes, but back to the bench.
We learn from ever experience. As a doc, I have no doubt that your injuries give you personal insight in to the medical trials and tribulations of your patients. And that makes you a better doc. I am an attorney who represents all manners of people in disability cases. Having faced a few medical issues of my own, including this most recent one, helps me to "hear" my clients better and that makes me a better lawyer.
I wish you well with your recovery.
David
post #5 of 23
David,
Your stats are correct.

Had I only had the one dislocation on each side, I would not have had surgery. Each time I went several years without symptoms or significant restriction before redislocating.

But keep in mind that with every subsequent dislocation, the ultimate success rate for surgical repair decreases.

I'm like you in that skiing is only my winter vice. I'm an avid mountain & road biker as well. In regards to your weight training, I'd generally advise you to avoid any behind the neck exercises like shoulder presses (OK to  keep them in front on the chest) & reverse pull ups and don't do deep dips - these put you in a mechanically disadvantaged position and no point in taking that risk.

Both of my surgeries where done arthroscopically. I have a very talented shoulder surgeon who also happens to be my next door neighbor and bike buddy. He's the team doc for our local Div 1 college team and several of our local sports teams. I have roughly 5 anchors in each shoulder. No Bankart or Letterjet procedure for me....yet. Not all sugeons can do it through the scope and some prefer the open approach - which leads to longer healing time, pain, etc......

The bummer for me is my risk of redislocation because of my continued high risk activities (skiing, aggressive MTB, waterski, etc) superimposed upon two joints with large Hill-Sachs defects (wiki it ! ), sizeable articular damage in the left and mild congenital glenoid dysplasia (which genetically put me at risk for this injury).
post #6 of 23
ps: Food for thought....

there are studies showing that complete immobilization of the arm in a neutral position for several weeks following an initial dislocation cuts down on recurrence rate. You may want to hold off on regaining range of motion so quickly - talk with your ortho about it.
post #7 of 23
Thread Starter 
TSW, I did Wiki the Hill-Sachs defect. It leads me to conclude that the shoulder is a miracle concept, but suffers from significant design flaws. Knees too. But I am no engineer.
I did have plain Xrays done on doi presumably to rule out fx. I am hoping the negative reading means no Hill-Sachs lesion, because it was an anterior dislocation.
Just got scheduled for an MRI next week. I asked for a study with contrast. In my work, I read a lot of medical records and have come to know that an MRI without contrast is considerably less effect in detecting soft tissue injuries in the shoulder.
That study about long-term immobilization is interesting. In the ER I was given a fancy sling that immobilizes the arm 90 degrees away from the body (perfect ski pole position). I used it constantly for a week and then weaned off it and started doing light ROM. Then I spoke with the orthop doc who felt this was all good. Wearing that brace for weeks woud require heavy sedation for me. I also wonder about muscle atrophy and adhesive capsulitis with such immobilization. But that is just a lawyer playing doctor.
I understand that not all dislocations cause labral tears. But are labral tears always operated on? It goes back to my initial question wheter such tears (away from the humerus?) can spontaneous resolve (heal) or does one just come to some "accomodation" with this kind of injury.
David
post #8 of 23
Best answers I can give (opinions vary, as you know):

1. Xrays don't usually detect Hill-Sachs. The MRI will tell. I have them on both sides, but neither showed up on xray.
2. My ortho doesn't require a contrast study - some prefer it - it's a doc to doc preference. Contrast is the safer route but requires an injection
3. I'm wearing the "ski pole" sling right now. 3.5 weeks in, hoping to be out on Monday. The immobilization is the hardest part for me. And the atrophy is quick, and unavoidable. The repair is delicate, so standard of care is full immobilization postop for 4-6 weeks. Seeing 20 patients daily in clinic, and having to explain to each and every one what happened, is also draining.
4. The advice given to you by your ortho regarding ROM is not wrong - just pointing out that there are a number of studies showing that immobilization for several weeks cuts down on recurrence. Again, opinions differ.
5. The shoulder is the most commonly dislocated joint in the body. Mobility = Instability
6. Not all labral tears require surgery for the reasons spelled out in my prior post. Deciding factors have to do with pain, instability, recurrence, etc....They can heal themselves. Again, I had MRIs on both shoulders following my initial dislocations and had extensive tearing, but I was asymptomatic and stable until the reinjuries. It all went downhill from there for me (this is the common story)

edit: I think this is a good link:
http://www.conquestchronicles.com/pages/labral-tear-shoulder
Edited by The Squeaky Wheel - 3/3/10 at 9:14am
post #9 of 23
Thread Starter 
TSW, I appreciate your insights and the link which is a great primer. Send me the bill, doc.
Warm regards and happy trails,
David
post #10 of 23
Quote:
Originally Posted by deliberate1 View Post

TSW, I appreciate your insights and the link which is a great primer. Send me the bill, doc.
Warm regards and happy trails,
David

This one is gratis. Consider it my personal contribution to health care reform.
post #11 of 23
Thread Starter 

Well, MRI with contrast confirmed what I suspected from my crash three and a half weeks ago. A tear of the labrum - of the Bankart variety. Also evidence of partial thickness tear of the supraspinatus tendon. Good news - no fracture or bicep tendon or rotator cuff tendon tear. And the joint shows only minimal degenerative changes - not bad for a 54 year old joint that has been used, though not abused, in the gym for 30 years.
To see the doc in two weeks to consider options. Right now I have more pain with ROM than a feeling of instability. No feeling that the shouler is going to give out - though I have not tested it. I guess rehab will be my first choice if the doc says that I will be able to get back to lifting, in time. Skiing is less of an issue because it is not so much a weight bearing activity. But if the doc suggests that I will only get so far on rehab, or that the procedure can be done arthroscopically and will better stablize the shoulder with greater dependability, I would be tempted. I have read that surgery can be a better option for older patients becasue the blood flow to the shoulder, which promotes healing, diminshes with age.
Would appreciate from those who have faced this decision.
Thanks,
David

post #12 of 23
Hi Deliberate1! 

I had a circumfrential tear (pretty much all the way around) to my labrum and a very prominent Hill-Sachs lesion and bicep tear from a bad fall on on outstretched arm on Jan. 5th.  I skied the rest of the season with my arm strapped to my torso at the elbow.  This was the only way I could stop the arm from dislocating.  Between the time that I fell and surgery the arm had dislocated 10 more times.

I had my surgery 2 days ago.  The doc, thought for sure that he was going to have to perform the Laterjet procedure on me but started with the scope and found that the bone loss wasn't as bad as he thought it would be and there was enough good tissue around the labrum to get all of the necessary anchors in.  He cleaned up the bone and tightened up the capsule while he was in there too.  I was kinda dissapointed that I didn't get the Laterjet because I've heard that it's the last shoulder surgery that I would ever need, (this is my 2nd surgery on the same shoulder in 16 years) but I swim competitively and am happy not to loose any ROM.

Living with a very unstable shoulder stinks!  I was starting to get back and neck pain from overcompensating with my good arm and shoulder and I was even walking sideways whenever I was in a crowd to protect myself.  I'm on my 3rd day post op and with the pain pump and some pain meds along with lots of ice, it hasn't been that bad.  I'd make the exact same decision to have the surgery again if I were faced with this same problem down the road.  Of course I'm writing this Before my first session of physical therapy!

Hope this helps!
~Anne~
post #13 of 23
Quote:
Originally Posted by Snowmiser View Post

Hi Deliberate1! 

I had a circumfrential tear (pretty much all the way around) to my labrum and a very prominent Hill-Sachs lesion and bicep tear from a bad fall on on outstretched arm on Jan. 5th.  I skied the rest of the season with my arm strapped to my torso at the elbow.  This was the only way I could stop the arm from dislocating.  Between the time that I fell and surgery the arm had dislocated 10 more times.

I had my surgery 2 days ago.  The doc, thought for sure that he was going to have to perform the Laterjet procedure on me but started with the scope and found that the bone loss wasn't as bad as he thought it would be and there was enough good tissue around the labrum to get all of the necessary anchors in.  He cleaned up the bone and tightened up the capsule while he was in there too.  I was kinda dissapointed that I didn't get the Laterjet because I've heard that it's the last shoulder surgery that I would ever need, (this is my 2nd surgery on the same shoulder in 16 years) but I swim competitively and am happy not to loose any ROM.

Living with a very unstable shoulder stinks!  I was starting to get back and neck pain from overcompensating with my good arm and shoulder and I was even walking sideways whenever I was in a crowd to protect myself.  I'm on my 3rd day post op and with the pain pump and some pain meds along with lots of ice, it hasn't been that bad.  I'd make the exact same decision to have the surgery again if I were faced with this same problem down the road.  Of course I'm writing this Before my first session of physical therapy!

Hope this helps!
~Anne~

 

Healing vibes go out to you....your injury and surgery sound identical to mine.

If you tell me how many anchors you have, I'll do the same
post #14 of 23
I see the doctor on Wed,  so I will ask him how many I have then.  I forgot to ask after the surgery, but I probably wouldn't have remembered anyway!
post #15 of 23
Here's my story:

Exactly one year ago at Taos, on Bambi, of all things,(age 66) through my own stupidity (was looking over my shoulder for my companion) I hit a "slow" sign propped in the snow with wands. It hooked my left arm and wrenched it up and out and as I slid along face down, I think my arm caught the snow. Long toboggan ride to the base, where the M.D. at the clinic xrayed and diagnosed a huge dislocation and a fracture of the greater tubercle of the humerus, the lump the rotator cuff muscles attach to. The shoulder socket sliced it right off. He gave me a general anesthetic and reduced it right  there. The broken bone went right back where it belonged, and about three weeks later I started intensive therapy for about three months. Both my orthopod at home and the one at the fancy clinic in Taos said the doc at TSV did s great job - couldn't believe it was a closed reduction.

Finally at the end of the summer I had an MRI, which revealed no remaining rotator cuff injury, but a labrum tear, maybe a quarter of the way around.  My only limitation is some deficit with outward, upward rotation but since it was my left arm and I'm not in the Phillies' starting rotation and I was back riding metric centuries on the road bike by August I'm not doing anything. Doesn't affect my skiing. I don't see how therapy can improve a labrum tear, and everyone seems to think surgery unnecessary. 
post #16 of 23
Thread Starter 
Quote:
Originally Posted by Snowmiser View Post

Hi Deliberate1! 

I had a circumfrential tear (pretty much all the way around) to my labrum and a very prominent Hill-Sachs lesion and bicep tear from a bad fall on on outstretched arm on Jan. 5th.  I skied the rest of the season with my arm strapped to my torso at the elbow.  This was the only way I could stop the arm from dislocating.  Between the time that I fell and surgery the arm had dislocated 10 more times.

I had my surgery 2 days ago.  The doc, thought for sure that he was going to have to perform the Laterjet procedure on me but started with the scope and found that the bone loss wasn't as bad as he thought it would be and there was enough good tissue around the labrum to get all of the necessary anchors in.  He cleaned up the bone and tightened up the capsule while he was in there too.  I was kinda dissapointed that I didn't get the Laterjet because I've heard that it's the last shoulder surgery that I would ever need, (this is my 2nd surgery on the same shoulder in 16 years) but I swim competitively and am happy not to loose any ROM.

Living with a very unstable shoulder stinks!  I was starting to get back and neck pain from overcompensating with my good arm and shoulder and I was even walking sideways whenever I was in a crowd to protect myself.  I'm on my 3rd day post op and with the pain pump and some pain meds along with lots of ice, it hasn't been that bad.  I'd make the exact same decision to have the surgery again if I were faced with this same problem down the road.  Of course I'm writing this Before my first session of physical therapy!

Hope this helps!
~Anne~


 
Anne, I saw that picture of you on the slopes all smiley with your arm strapped to your side. I thought, Anne Oakley.
I wish you all the best in your recovery. If you are inclined, post on your rehab. I'd be real interested to hear what they have you do in the gym.
Warm regards.
David
post #17 of 23
Thread Starter 
Quote:
Originally Posted by evansilver View Post

Here's my story:

Exactly one year ago at Taos, on Bambi, of all things,(age 66) through my own stupidity (was looking over my shoulder for my companion) I hit a "slow" sign propped in the snow with wands. It hooked my left arm and wrenched it up and out and as I slid along face down, I think my arm caught the snow. Long toboggan ride to the base, where the M.D. at the clinic xrayed and diagnosed a huge dislocation and a fracture of the greater tubercle of the humerus, the lump the rotator cuff muscles attach to. The shoulder socket sliced it right off. He gave me a general anesthetic and reduced it right  there. The broken bone went right back where it belonged, and about three weeks later I started intensive therapy for about three months. Both my orthopod at home and the one at the fancy clinic in Taos said the doc at TSV did s great job - couldn't believe it was a closed reduction.

Finally at the end of the summer I had an MRI, which revealed no remaining rotator cuff injury, but a labrum tear, maybe a quarter of the way around.  My only limitation is some deficit with outward, upward rotation but since it was my left arm and I'm not in the Phillies' starting rotation and I was back riding metric centuries on the road bike by August I'm not doing anything. Doesn't affect my skiing. I don't see how therapy can improve a labrum tear, and everyone seems to think surgery unnecessary. 
 

Evan, that sounds like a very nasty injury and a remarkable recovery. I hope I have the same outcome.
I have done a bit of reading since my crash. And I learned that, for once, age seems to be on our side with these kinds of injuries. Subsequent dislocations become considerably less likely with age. As I understand it, the surgery for a labral tear (ie: Bankart procedure) is designed to stablize the shoulder cuff, thereby preserving the integrity and function of the joint. It can also be done to clean up the damaged tissue that causes the arm to "catch" with certain movements. Whether surgery is "unnecessary" would surely depend on the amount of damage done and ultimate instability caused by the trauma. Your one quarter tear is different than the full tear Anne describes above.
And there is a no doubt a quality of life componant as well. No one ever died from not having a should repair procedure. But if not having it means you have to give up an important part of your life (like skiing or weight lifting in my case) the choice may seem more palatable. And I damaged my dominant arm which is a factor as well. Finally, the stats I have read suggest that this kind of procedure is extremely successful in retruning most patients to their previous level of functioning. If I can rehab my way out of this I will. But if not, I would not hesitate to do the surgery.
Appreciate your imput.
David
post #18 of 23
I started pt last week David!  So far, so good.  Something that is working really well is a pulley that hooks over a door.  Could probably build one out of a hook and some nylon rope.  (I'm frugal :D).  I pull the injured arm up with the good arm until I can't stand it anymore, then I slowly lower it.  I'm also walking my hand up the wall as high as possible, then walk it back down again.  Another one is to stand close to the wall with my arm at a 90 degree angle and slowly push away from the wall with my fingers.  Then, stand with your back to the wall, and with the arm again at 90 degrees, push away from the wall with your upper arm and elbow. 

Hope these help.  I'll add more when I get them.
post #19 of 23
Thread Starter 
Friends, I am just nine weeks since my crash with resulting torn labrum (Bankart tear) with partial supraspinatus tear and probable brachial plexus nerve involvement. I figured surgery was inevitable, but not so. Two surgeons told me that with old tendons like mine, and where there is little risk of recurrent dislocation, surgery is not necessary. Pain would be the only reason to touch the supraspinatus. I have been doing lots of stretching, particularly with this cable rig that gets your shoulder to go where it does not want to.
The arm feels more "natural" all the time - not so heavy or fragile. I can wash my hair with both arms, reach into my hip pocket and even tend to other "business"." But it is still quite weak, possibly because of the nerve damage from the stretch injury. Lots of atrophy in the rear delt. But I got back to the gym last week for the first time and id some light bicep and tricep work. All close to the body.
No doubt that this kind of injury is a difficult and recovery is slow and uncomfortable. And I have had it much easier than some. My only advice is not to assume the worst which is so easy to do during the first month or so. Get into some PT before agreeing to the knife, and do some serious stretching. I notice immediate improvements as soon as I started moving the arm beyond my comfort limits.
And my best to Snowmiser and The Squeeky Wheel who have been great comrades as we all dig ourselves out of this hole - with the good arm.
David
post #20 of 23
Thanks for checking in.

I'm exactly 10 weeks postop today.

ROM is almost full. Strength is coming along.

I was released to road riding (biking is my other passion) and celebrated Sunday with a nice 45 mile spin. Shoulder feels great....zero pain. I've been riding the spin bike in the basement for the past 6 weeks and 3 weeks ago restarted lower extremity & core strengthening. No upper lifting for me for another 6 weeks.

I still have 6 more weeks of rehab until full release. Then I can start MTBing again and I'll be strong for next ski season.
post #21 of 23
Thread Starter 
Quote:
Originally Posted by The Squeaky Wheel View Post

Thanks for checking in.

I'm exactly 10 weeks postop today.

ROM is almost full. Strength is coming along.

I was released to road riding (biking is my other passion) and celebrated Sunday with a nice 45 mile spin. Shoulder feels great....zero pain. I've been riding the spin bike in the basement for the past 6 weeks and 3 weeks ago restarted lower extremity & core strengthening. No upper lifting for me for another 6 weeks.

I still have 6 more weeks of rehab until full release. Then I can start MTBing again and I'll be strong for next ski season.
 

TSW, good for you. Sounds like you are on your way to a great recovery. But be careful on the bike. A fall is a fall is a fall....
David
post #22 of 23
Thread Starter 

Friends, this is a follow-up on my progress since dislocating my shoulder on Valentines Day this year. I hope my experience gives others in this situation a bit of insight and no small amount of hope.

I had a bad fall in February and suffered a pretty good sized labral tear and partial tear of the supraspinatus - one of the structures in the rotator cuff. Saw two of the best shoulder docs in Maine and they both told me no immediate surgery. One said just to do range of motion and the other some stretching exercises. I met with a physical therapist a few times. She gave me a pulley rig that allows one arm to stretch out the other. And so I set off on this conservative approach. And it went well. Throughout March and April I made some progress. I increased my range of motion and flexibility. But I still had a very considerable amount of pain from the extreme tightness in the shoulder.  And it remained very weak with considerable atrophy from disuse and a possible brachial plexus injury.

I was getting discouraged from the lack of real gains, sleepless nights on the couch and absence from the gym where I would normally go at the end of nearly every work day - my drug of choice.

I saw the therapist about a month ago and she congratulated me on my "progress," and felt that I had gotten as much as I was likely to from the cable rig and stretching routine. Bummer. I knew I was going to see the surgeon in mid May and I was at the point that surgery seemed like a reasonable option. The therapist said I had maxed out but I still had significant limitations and was no where near where I wanted to be. The pain was unrelenting and I felt like chewing off my arm. And my other shoulder was starting to hurt from over use.

 But before going the surgical route, I decided to take a more aggressive approach. It was how I have dealt with less serious injuries before. I figured that the tears were likely stabilized and even healed. Around May 1 I went back in the gym. I started doing light, close to the body exercises like bicep curls and tricep work. Then I added in a bit of back work, like seated rows and pull downs done on an angle. It hurt like a bastard the first time - but a good hurt. And the next day, my pain level was down and my range of motion was up.

Over the past month I have been increasing my gym work with every session - adding exercises that more directly challenge the shoulder, like adducter and abductor cables and even some light chest work - all designed to hit the shoulder from every angle. I am slowly increasing the weights as well. My comfortable range of motion is increasing. I can now reach in to my back pocket and almost tuck in my shirt. And my muscle tone is returning and I can now sleep in a bed.

My progress is not just from the weight lifting. I developed  a set of (sometimes) torturous stretching exercises once I had maxed out on the cables. I developed a series of sets for  my 75 minute commute along the quiet roads of Maine. With one, I reach up and walk my arm back (palm up) and to the side along the ceiling. When the joint relaxes, I push the hand to increase the angle to stress the joint. With another I grab the suicide handle and push the elbow in towards the door (do this only at stop signs/lights). One of the hardest is reaching behind my seat, keeping the arm at as close to a 45 as possible. And I also lean back, put my outstretched arm behind the passenger seat and then lean forward. 

At home and in the office, the most advanced I developed involves putting my arm behind my back, bent at a 45 degree angle. Here is the fun part. I then lay down on top of the arm in that position. The pressure of my body weight against the arm which is sandwiched in between is a great stretch but one that must be done slowly and carefully. I also lay on my belly and then raise my arm so it lays, at a 45, on a low table or chair seat. I then relax the shoulder and let the weight of my body slowly stretch out the joint. All of this is designed to stretch out the ligaments and bust up scar tissue that binds the joint. That is where the pain now comes from  - not the actual tears.

I am now 3.5 months into the most difficult injury I have ever had, physically and emotionally. I am making more progress every week and have regained about 70% of my strength and ROM, though the stamina is not there yet.

I have learned a lot about my body from this experience. I got good advice from two docs who declined to run to do surgery. But in the end, what worked for me was taking a more aggressive albeit conservative approach. And that is what has made all the difference. But it has been a lot of work, and there has been no small amount of pain. But I learned how to push through the good pain and stop at the bad pain. That, too, is a very valuable lesson.

I fully expect to be back on the slopes when the snow flies - have already bought my Sugarloaf pass. The mountain gave me a credit for 50% for my pass and that of my wife towards  tickets for the upcoming season. Very righteous of them.

I hope my experience gives some hope to anyone who, at this moment, may feel that a real recovery without surgery is not possible. It is. But it will take some serious and smart work. I stress that this worked for me, in my circumstances and with my injury. I do not encourage anyone to try what I have done without checking with their doc or therapist. My only advise is that you take charge of your recovery, no matter where that takes you.

Happy trails,

David

post #23 of 23

Very nice thread, i injured my shoulder (collar bone) too, i've started another thread as i never saw anyone's collar bone pop up. You know that saying "Healthy person does not understand the sick one." It is good to see that you are not the only one to hurt yourself, especially as you see people not training as hard as you do and there is never anything wrong with them.

 

There is a lot of good information here. Myself i don't know should i rest or train, I was busy with a course that i a doing and wanted to finish it on time (???), I am afraid that i may have done extra damage. It feels a lot better now, but by reading other people's experience i expected to recover sooner.

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