What if I opt'ed out of surgery and went the PT route instead? Assuming he recommends surgery, of course. What does that mean, what are the implications, etc.
Rich: Not a doc but I know a bit about labrums. The way the ortho explained it to me is that the labrum is like a swim cap. The surgery essentially takes was labrum you have left (in my case about 30%) and then stretches the labrum and anchors it in place. A torn labrum will not heal itself and just grow back. I had to have surgery as I was at a very high risk to dislocate my shoulder again (and cause more damage). This made it impossible to swim, not due to pain, but the liklihood of dislocating again.
I'm a pediatrician not an orthopedist, so most of my shoulder knowledge comes from the fact that I have a similar injury I am currently dealing with. I go back to my shoulder specialist tomorrow. As far as surgery vs. PT goes, I don't think you can make the call until you get the MRI done. Shoulder stuff you've had all your life is likely rotator cuff tendinitis or other overuse injury - not a surgical problem. But if you've actually torn part of the cuff or a very large portion of the labrum, PT will not bring back the function that you want. Hopefully your MRI shows all is intact and you can take conservative measures.
So I had the MRI done last week, saw the doc on Monday. Results (a summary?) from the MRI (copying this from the paper I was given):
Nondisplaced fracture of the lesser tuberosity of the humerus (he explained this to me as basically a bone bruise)
High-grade partial-thickness (what does this mean?) articular surface tear of the subscapularis tendon.
Medial dislocation of the long head biceps tendon, which lies deep in the subscapularis tendon.
Supraspinatus tendinosis. Mild, focal muslcle strain with the anterior fibers of the supraspinatus muscle.
From the "findings" section:
No os acromial. A type II acomium is present. There is no significant AC joint arthosis. The coracoacromial ligament is intact.
A high crade partial-thickness tear of the subscapularis tendon is presne, with some of the tendon fibers appearing to remain intact. The long head biceps tendone is medially discloacted outside of the bicipetpal groove and lies deep to the subscapularis tendon. The intra-articular portion of the biceps tendon appear tendinotic, without definite tear. Soft tissue edema is present along the long head biceps tendon and adjacent to the subscapularis tendon, most likely post-traumatic. Supraspinatus and teres minor tendons are intact. Mild, focal muscle strain is present within the anterior muscle fibers of the supraspinatus. No other intramuscular signal adnormality is present. No rotator cuff muscle atrophy. No significant fluid with in the subacromial/subdeltoid bursa.
The biceps tendon anchor appears intact. No definite labral tear is visualized. The middle and inferior glenohumeral ligaments appear intact.
A nondisplaced facture of the lesser tuberoisity is present, with accompanying moderate marrow adema pattern. No other definite structure is visualized. Glenohumeral alignment is anatomic. The articular cartilage is intact. A small joint effusion is present. Synovitis and/or debris is identified within the axillary recess.
++++++++++++++++++++++++++++++++
Whew!!! I took 4yrs of Latin and 4yrs of Greek in high school but thems is some funky ass words up there . Doc's recommendation is for surgery to repair the bicep tendon and put it back where it's supposed to go. Would be in a sling for about 6wks and then PT to get range of motion and strength back. No running or cycling during this 6wks. Stationary bike/trainer and eliptical only.
The shoulder pain inproves daily but I can definitely feel this bicep thing above.
Any help or further explanation of the stuff above?
Thanks. Surgery scheduled for Jan 17. I'm pretty sure I can show up to IMWI next year the same or slightly better fitness than this year, but without the run I hoped to have. Oh well. Maybe I'll do IMCDA'13, rolling my WI fitness into that race? That worked well for me in '05 when I went 10:02 on the old course, won my AG at Wildflower, etc.
Of course, after WI I'll have a full schedule of dirtbiking and snowboarding so....
I was talking to my sister the other day about the situation, saying I could do this or that and she said "or you could quit riding motorcycles."
@ Rich. Sorry to hear about the shoulder. Hang in there and I hope you get back quickly from the rehab. I know you know this .. but definitely go to all of your PT and push for more aggressive work from them. Most HMO/PPO providers think that functional = OK, and of course for triathletes, that's not always enough in terms of reparied joint/tendon/etc. performance.
Sorry to hear coach but could have been the cuffs, etc. Remember yes you want the pain pump for at least 48 hours. This will be placed by the surgeon when closing. Hopefully and usually the procedure you are having is now lapa done. Meaning with scopes and nothing opened.
Yep, getting ready cause Wisc going to be HUGE!!!!
Just to be a little contrarian, I'm really glad that you have a diagnosis and prognosis that appears to be fixable. The process will suck, but this sounds like you won't be worse for the wear when you're 50. Without the MRI, you might be just vaguely trying to get better without success for a lot longer.
We all know you're smart enough to know you have to do the rehab. Now just show the discipline.... like you always tell us. :-)
One question...why such a long break before surgery? Just vacation/time of year stuff? Why not get it done ASAP?
Yeah, end of the year, vacation, stuff like that but that timing is also a function of insurance, etc. The earliest I could have it done is the 29th but pushing it into January saves us a lot of dough on the surgery, PT, etc.
Very very sorry to hear. Is the surgeon planning to do this with an arthroscopic approach or open?
There are alot of great post-op pain modalities these days that can really make the first few days after your operation more bearable. Some are surgeon driven (wound/joint infiltration systems), some anesthesiologist driven (continuous nerve block). It is worth asking about.
bright side: your fitness (musculature from swimming and using that Chuck Liddel portable fitness machine) likely kept your shoulder from dislocating posteriorly, which often happens with that type of fracture. a repair of the bone, without having to deal with confounding soft tissue or nerve injuries, should mean a pretty solid recovery.
Comments
Docs:
What if I opt'ed out of surgery and went the PT route instead? Assuming he recommends surgery, of course. What does that mean, what are the implications, etc.
So I had the MRI done last week, saw the doc on Monday. Results (a summary?) from the MRI (copying this from the paper I was given):
From the "findings" section:
No os acromial. A type II acomium is present. There is no significant AC joint arthosis. The coracoacromial ligament is intact.
A high crade partial-thickness tear of the subscapularis tendon is presne, with some of the tendon fibers appearing to remain intact. The long head biceps tendone is medially discloacted outside of the bicipetpal groove and lies deep to the subscapularis tendon. The intra-articular portion of the biceps tendon appear tendinotic, without definite tear. Soft tissue edema is present along the long head biceps tendon and adjacent to the subscapularis tendon, most likely post-traumatic. Supraspinatus and teres minor tendons are intact. Mild, focal muscle strain is present within the anterior muscle fibers of the supraspinatus. No other intramuscular signal adnormality is present. No rotator cuff muscle atrophy. No significant fluid with in the subacromial/subdeltoid bursa.
The biceps tendon anchor appears intact. No definite labral tear is visualized. The middle and inferior glenohumeral ligaments appear intact.
A nondisplaced facture of the lesser tuberoisity is present, with accompanying moderate marrow adema pattern. No other definite structure is visualized. Glenohumeral alignment is anatomic. The articular cartilage is intact. A small joint effusion is present. Synovitis and/or debris is identified within the axillary recess.
++++++++++++++++++++++++++++++++
Whew!!! I took 4yrs of Latin and 4yrs of Greek in high school but thems is some funky ass words up there
. Doc's recommendation is for surgery to repair the bicep tendon and put it back where it's supposed to go. Would be in a sling for about 6wks and then PT to get range of motion and strength back. No running or cycling during this 6wks. Stationary bike/trainer and eliptical only.
The shoulder pain inproves daily but I can definitely feel this bicep thing above.
Any help or further explanation of the stuff above?
Surgery???
Hate it for you but glad it wasn't worse.
As for the translation, that's why we have a radiologist on staff at EN! Paging Liebs....
Thanks. Surgery scheduled for Jan 17. I'm pretty sure I can show up to IMWI next year the same or slightly better fitness than this year, but without the run I hoped to have. Oh well. Maybe I'll do IMCDA'13, rolling my WI fitness into that race? That worked well for me in '05 when I went 10:02 on the old course, won my AG at Wildflower, etc.
Of course, after WI I'll have a full schedule of dirtbiking and snowboarding so....
I was talking to my sister the other day about the situation, saying I could do this or that and she said "or you could quit riding motorcycles."
Yep, getting ready cause Wisc going to be HUGE!!!!
healing vibes will be sent your way.
Hang tough.
We all know you're smart enough to know you have to do the rehab. Now just show the discipline.... like you always tell us. :-)
One question...why such a long break before surgery? Just vacation/time of year stuff? Why not get it done ASAP?
Wm
All,
Thanks for the good vibes.
Yeah, end of the year, vacation, stuff like that but that timing is also a function of insurance, etc. The earliest I could have it done is the 29th but pushing it into January saves us a lot of dough on the surgery, PT, etc.
Very very sorry to hear. Is the surgeon planning to do this with an arthroscopic approach or open?
There are alot of great post-op pain modalities these days that can really make the first few days after your operation more bearable. Some are surgeon driven (wound/joint infiltration systems), some anesthesiologist driven (continuous nerve block). It is worth asking about.
rich:
translation = it could've been worse!
bright side: your fitness (musculature from swimming and using that Chuck Liddel portable fitness machine) likely kept your shoulder from dislocating posteriorly, which often happens with that type of fracture. a repair of the bone, without having to deal with confounding soft tissue or nerve injuries, should mean a pretty solid recovery.
over and out.
gh