Hey, it's called "off topic"...

~10 days ago, I had arthroscopic surgery on my shoulder to repair what we didn't know beforehand to be a torn rotator cuff. Now that I'm good enough to type at 80% of my usual speed again, I thought I'd do a dump on the experience and see if any of you have any useful advice or meaningful thoughts.

At least a year ago, my right shoulder started hurting. By mid-summer, it hurt bad enough that I was pounding naproxyn pills, with the pain sometimes wandering up from my shoulder to my neck and head, leading to some unpleasant migraine headaches. Last fall, I'd had enough. I asked around with friends and got the name of a local surgeon who specializes in shoulders, elbows, and knees and paid him a visit.

Step 1: x-rays and a cortisone shot. The cortisone shot was nigh magical, killing off the headaches and eliminating the need for the naproxyn. The x-rays showed a possibility of "calcific inclusions", i.e., rice-grain sized blobs of toothpaste-consistency yuck, buried in one of the tendons. The doc suggested that they could surgically go in with a tiny needle, suck them out, and I might then experience immediate relief. But we don't start off there. Nope, come back in a month and we'll see how the cortisone worked. Welcome to being over-40! For kids this stuff heals by itself.

Step 2 (one month later): another cortisone shot. The first shot got me from daily pain to my arm only hurting when I did various things above my shoulder. Like, no way could I swim, but squash was still mostly okay, since most of the action happens below the shoulder. Anyway, the second cortisone shot went in and, over the next month... did nothing. Also, they shipped me off for an MRI on my shoulder. The radiologist reported the possibility of a torn tendon, which the surgeon noted tends to have a very high false positive rate (i.e., 90% of the time, when the radiologist indicates this, there's nothing wrong whatsoever with the tendon).

Step 3 (another month later): Surgeon vacillates on giving me another cortisone shot or calling me in for surgery. If you do the shot, you have to wait a month to see what happens, so he doesn't want to have to wait around that long. At this point, we're in December, and I had a ski trip planned, so we decided to postpone surgery. Instead, I scheduled myself for a second opinion with another shoulder specialist in town. (There's a huge medical center next to where I work. Within walking distance, I've probably got 5-10 world-class specialists in arthroscopic surgery. Convenient, eh?)

Step 4 (the second opinion): Surgeon #1 could best be described as what happens when a serious tech nerd becomes a surgeon instead. Encyclopedic knowledge. Digresses easily to answer any and all questions on any and all topics. Surgeon #2 was a totally different character. Fashionable clothes. More reserved in his opinions. Nonetheless, for my usual $40 co-pay, he did all the same outward tests (push this way, push that way, does it hurt when I do this, ...) and he examined my MRI raw data, which I brought him on a CD that I got from doc #1. His conclusion: some possibility of fraying near the bone, but he'd be hesitant to do surgery. Instead, let's throw you at physical therapy for a while and see what happens.

Step 5 (physical therapy): I went to the PT twice a week, January - March. They quickly diagnosed the root cause of my shoulder problems as my bad hacker-boy posture. With my shoulders slouched forward, the end of the bone and its socket weren't properly aligned, leading to pinching of a tendon. Toss in my athletic pursuits, such as they were (swimming, squash) and I might well have been slowly damaging myself. The solution? Lots of exercises intended to strengthen my upper back muscles and get proper alignment of my shoulder. This process truly did help me a lot, but it didn't fix the problem. It just made it hurt less.

Step 6 (back to the surgeon): Now we're in early April and I decide to pay a visit back to surgeon #1. I detailed the history to him, he asked me many questions, and we reached the conclusion that it was indeed time for surgery. At this point, the diagnosis was still the possibility of those calcific inclusions with the additional possibility of a "labral tear" (i.e., a screwed up tendon). We settled on a surgery date and I had various pre-op things to get done knowing that my right arm would be in a sling for as long as two months. For example, I snaked all the crud out of our shower drain. Get that done while I can!

Step 7 (surgery): I walked to the hospital, reporting there at 6am on a Friday. (And I was the second procedure for my surgeon that day. Uggh.). I believe I was sedated and in the O.R. by 7:30am or thereabouts, although my memory is a bit fuzzy. I believe I came to around noon, and I'm told I was joking around with the nurses and whatnot, but I have zero memory of anything until 2pm. My wife was there, by then. I'm lying in the recovery ward, my arm's in a sling, and it hurts like nuts if I move in the wrong way. Also waves of nausea, for which the nurse would inject something into my saline drip/catheter/whatever it's called, which also has the side effect of being a sedative, so I'd probably go back to sleep. We didn't get out of there until 5pm. Even though it's less than a mile from home, they insisted that I ride home in a car, and I now understand why.

Post-surgery, I had an inkling that they'd done a rotator-cuff repair, but no actual information, no photographs, no nothing. That would come later.

Step 8 (immediate recovery): The two days following surgery, I was asleep probably half the time, fighting off nausea and other side-effects from the hydrocodone. They'd also installed an anesthesia drip into my neck, which every 30 seconds or so would inject half a milliliter of stuff directly onto my nerve. Moving my arm in any way was screaming pain, despite all this, but if I was just sitting there, it wasn't particularly bad. The anesthesiologist called me daily to make sure I was doing fine. ("Oh good, you're following my instructions. Otherwise you'd be in screaming agony.") Once the pump ran out, on Sunday night, I took two hydrocodone (just in case) and went to sleep. After that, I realized I wasn't doing all that badly, and dumped the hydrocodone and switched to just Tylenol. The pain aspects from undesired movements were exactly the same as beforehand, but now I developed feeling for all the weird places that the sling was pressing on my arm. The Tylenol only modestly compensated for this. Sleeping, since then, has been much more of a challenge.

Yeah, about the sleeping part. They suggested sleeping in a recliner rather than a bed, because you want your arm hanging properly in the sling. After a few days, when the pain went down, I was able to transition to propped-up pillows.

Oh and about showering: I was allowed to shower, and that was the only time I was meant to remove my sling. My arm was dead at my side while doing this, but it didn't hurt. I had to get my wife's help with some aspects, especially washing my underarm, which had begun itching like crazy.

Step 9 (post-op office visit): I had been planning to go to work on Monday and Tuesday, but my university and my daughter's school district were conveniently closed by virtue of the half a meter of rain that our city took on in less than 24 hours. I moped around the house. The surgeon's nurse called me on Tuesday and arranged for a post-op visit on Wednesday. Okay, no problem. At this point, I'm experiencing serious improvements in my condition. Like, I could walk the mile from home to the doc's office and the bouncing wasn't painful for my arm. He replaced the steristrips, gave me some super-basic PT to do (flexing my biceps, lifting my shoulders), and said "yeah, gonna be hard to sleep, most people turn into zombies, like some Ambien?". He cleared me to type, but with limited motion of my arm. This and my Kinesis ergonomic keyboard actually work together beautifully. The only change to my workspace is flipping my trackpad to the left hand.

The doc also walked me through a bunch of microphotographs of the inside of my arm, which they can take because the arthroscopic instruments have tiny cameras on them. He was modestly hard on himself for having completely missed the rotator cuff tear, which is now all knotted back to where it's meant to be. Oh and the only way to get tendon and bone to fuse properly is to have blood flow, which isn't a thing you normally have there, so they use a tiny little auger to chew up your bone to create blood flow. Lovely! Also of note, they found a small bone spur that didn't show up on either the x-ray or MRI. Fixed.

Now, 10 days post-surgery, everything is working as well as could be expected. I've sorted out how to mostly sleep through the night. I'm not even taking Tylenol any more, just icing my shoulder at the end of the every day. I can fully flex my elbow, meaning I can now button my shirts. (My outfits: aloha shirts and athletic shorts, the only things you can put on and take off one-handed.)

"Hey doc, any chance I'll be able to ride a bike by June?"

"Maybe. We'll see."

Ouch.

I've managed to injure my left shoulder with some inept over aggressive kayaking. It only hurts when I move my arm out to the side and behind (at which point it hurts a lot). I'm hoping at the moment it will sort itself out, it does seem to be getting slowly better.

I'm still kayaking of course, while trying not to make it any worse...

It's fascinating to me that the PTs, the surgeon, and the MRI/radiologist each had a partial understanding of my injury, but nobody was able to correctly predict the exact problem in advance of the actual surgery.

What's that mean for you, or for my advice to anybody else with the sort of pain that you can learn to live around but might prefer to fix? Go talk to many different sorts of people in the medical world. Doctors. Surgeons. Physical therapists. Get the MRI. Get the Xray. Get data of all sorts. And make sure the opinions of each specialist find their way to one another, hoping some sort of consensus emerges.

If we're swapping stories...

I've had similar issues with my right arm and shoulder over the last few years, though not as bad. I've not required surgery, and I'm glad that yours has gone well.

Initially it started when I jolted my right shoulder while snowboarding (repeatedly; I'm *very* right-handed when it comes to falling over). The consensus from my personal trainer was probably that I had some scar tissue hiding in there, and that -- short of surgery -- exercise to build up the supporting muscles was the only thing available.

Fast forward a while, and I'm starting to experience pain and stiffness in my neck, and occasionally numbness and tingling in my right hand, in particular my index finger. At that point, we decided that it was my crappy posture, coupled with the crappy state of my work chair, and the height of my desk. I quit that job (not specifically because of the chairs), and -- working from home -- I'm able to put my desk at the correct height, use a decent set of monitor arms, and get a decent chair (though I've still not splashed out on a Herman-Miller...).

I also started seeing the same personal trainer again, which helped with the lower back pain, and somewhat with the stiffness in the neck. I also went to a sports physio who concurred with the scar tissue thing and did some massage and manipulation which seemed to ease it a bit.

But the numbness and tingling wasn't gone, so I eventually got a referral to an orthopedic consultant (insert smugness about free healthcare here...). The consultant concluded that there was nothing actually wrong with my shoulder, but that there was still something wrong. The numbness was a complete unknown, so he referred me for an MRI scan, but I delayed it until this year.

We also decided that maybe the tingling and numbness was a direct result of the scroll wheel on my mouse, so I swapped that out for a vertical mouse, which has two effects: no forearm rotation, which reduces that source of stress; and I use a different finger for the scroll wheel (because it's positioned slightly differently).

I also started swimming regularly again, something which I've not done in about 20 years.

Result: no further problems with my shoulder, no neck stiffness, and mostly gone tingling and numbness in my index finger and forearm. We never got around to scheduling the MRI scan...

However: I fell and injured myself (torn abdominal muscle) while snowboarding earlier this year, which has meant no swimming (and no personal trainer) recently. It's also meant that I've regained all of the weight I lost after Christmas and New Year. I can also trace any new numbness in my hand or arm directly to the XBox One controller

Still, I think I'm healed, so I'll be getting the bike out of the shed and heading down to the swimming pool later this week, hopefully.

Dan, I could have just about written your whole post for you!

Three years ago my right shoulder started hurting. Just a little bit, and only when I back-paddled my kayak. I could live with it. But it ever-so-gradually began getting worse and worse, until in December I found that if I were lying on my back I couldn't raise that arm unless I picked it up with my left hand and lifted it past the pain point.

I went first to the chiropractor who was sure it was muscle-related (what else would a chiropractor think?), and he did deep massage. After half a dozen sessions with zero improvement, he decided it was beyond his pay grade and he sent me to the orthopedist. The orthopedist pushed and pulled and scheduled me for X-rays and an MRI. Those tests clearly showed a bone spur and a calcified tendon. (Sound familiar?)

The orthopedist scheduled me for surgery to de-calcify the tendon and remove the bone spur, and in the third week of January the work was done. I awoke in the recovery room and for the first time in years, without benefit of anaesthetic or pain medication, I was pain-free. I never needed nor took so much as an aspirin following the surgery.

Because the surgery was minor, and didn't involve reattaching tendons or repairs to the rotator cuff, the orthopedist (who was also the surgeon) relaxed his pre-surgery requirement of staying in a sling for weeks and possibly months, instead saying use the sling when doing exercise such as hiking in the mountains, and stay out of the kayak and off the bicycle for a month or so. Use a chair with an armrest when typing on the computer. A piece of cake!

Until... three months after the surgery, the pain began coming back, and over a period of a few weeks reached the pre-surgery level. An X-ray shows that the calcification is returning. Oddly enough, the pain only arises following a period of inactivity. I can hike (with poles), or kayak, or bike, or paint the ceiling -- you name it -- with little to no discomfort. But if I sit or lie down for an hour, then moving the arm is quite painful, say 7 on a scale of 10. It makes getting a good night's sleep difficult, as I have to get out of bed and swing the arm around until it stops hurting.

I went through the two cortisone injections, but as in your case the relief was only temporary. The orthopedist/surgeon says give it another month, and then we can talk about more surgery, in which he proposes to actually cut out the portion of the tendon with the recurring calcification and sew it back together. Sounds a bit scary to me.

I didn't fully understand the nature of the anaesthetic they gave me for the surgery, and had a bit of a fright. I was lying there on the operating table, fully conscious, awake, and aware, listening to the surgeon and the assistants discussing (en español, of course) what they were going to do, and having the horrible thought that they were going to start cutting me open while I was still awake. The anaesthetic had caused complete paralysis. I couldn't even flutter an eyelid or move a finger, no matter how hard I tried. How could I tell them, "Hey, guys, wait a minute! I'm still awake! Is this gonna hurt?" Then, before I could panic completely, the anaesthesiologist upped the dosage a tiny bit and I was out like a light until the recovery room. Whew!

Of course, the surgery left a huge, hideous scar on my arm. I don't dare go to the beach any more for fear of starting a panic as people see this horrible disfigurement and run away in abject fear. I've attached a photo to this post, but you probably don't want to look at it unless you are unusually horror-resistant.

OK, so I exaggerated a little bit. But that three-inch scar DID require four stitches! Hey, I was lucky to get out of there alive!

So that's my story, incomplete as of this writing. But I am confident things will get better.

FWIW, Mexico has (IMHO) really good medical care, at reasonable cost. The total cost of my surgery, including surgeon, anaesthesiologist, assistant, nurse, and who knows what others, plus a full one-day stay in the hospital, came to about $3,700 USD. The anaesthesiologist's bill was only $500 USD, it would have likely been ten times that amount in the U.S. My health insurance (through my retirement) covered 100% of the total cost.

tanstaafl.

Good to see someone got round to testing the file attachment part of the BBS on the new server

A couple related experiences, but not me (my only relevant experiences are a half dozen trips for stitches and once to pick gravel out of my back after an unfortunate incident with a rabbit).

My brother went under to get his knee scoped. He woke up with a 12" scar. The doc got in, and found so much more than the xray/mri showed he had to open him up. He's still running, biking, and skiing, albeit carefully. Finished a marathon, too.

My daughter was born with a "branchial cleft" - a birth defect resulting in a tube of skin going into her neck, which frequently oozed juice. They also often lead to cysts that cause really serious trouble. When she was 4 we (finally) decided to remove it. We visited experts at Childrens' in DC (a fabulous teaching hospital), did scans and even physical probes into the hole. Scheduled surgery.

On the day, she went in and under (5, 4, 3... zzz). We waited. And waited. And waited. And worried. And worried. Eventually - a couple hours after it was supposed to be done - the doc came out, gray, and his first words were "It was awful!" He went on to say the cleft was way deeper in her neck than expected, a "Y", branching on either side her carotid artery, with one end terminating in her esophagus.

Fortunately everything worked out - just a small scar on her neck. (And she got to freak out her preschool teacher when she brought in her anesthesiology mask for show and tell!)

-jk

Shoulder pain club! Woohoo!

I was helping a client move a piece of furniture about 5 years ago, and the next day I had a bad pain in my shoulder. Sort of like an extreme aching. I decided to try out a chiropractor - a business associate who was also a PT, so that was the more helpful part. He took some x-rays and saw some sort of awkward tear, but [unhelpfully] I can't remember exactly what it was at the moment. From what I remember, I could either have surgery or try to work on it. I chose the latter.

He gave me a few number of exercises to do in addition to my treatments and therapy sessions. After about four months and around 10-12 treatments...I felt marginally better. It was a little discouraging.

But then...it just sort of...went away? I'm not sure what happened, but I got better. Well after I stopped treatments, and well after I stopped my exercises at home, it just sort of went away. I can't even remember when that happened, which I guess is a good sign. Since that time I've gone through a move, done countless chores around the house including all the yard work, finished a big project to mount a new TV and install in-wall speakers (that sent me to the hospital for a different reason), and done all sorts of projects for various clients, including running ethernet through office ceilings. I guess that in the end I just needed to work the shoulder over a long period of time. But that was my case...

I too had a really bad case of chronic shoulder pain which went away on its own, untreated, but it took a couple of years for the pain to go away.

The initial bout of pain came from sleeping on my side on a particularly terrible bed which was hard as a rock, at a Circus Circus casino hotel. Two years of shoulder pain after that! Now? I'm fine as far as I can tell. I wonder what I did to it?

I had something like what Tony mentioned. Something in the shoulder was out of alignment. Low grade ache most of the time, pain when aggravated.

It fixed itself during a minor fender bender, where I was tossed forward against the seat belt. Said shoulder belt being over the good shoulder. I speculate that the jolt stretched everything out and let it snap back to its proper location. Instantly I could tell it was better.

I don't recommend the specific method, one was hurt but the car was a write off.

Another member, checking in!

Shoulder #1 separated in a mountain-bike accident in my 20s -- going down a hill, hit a patch of leaves at the bottom, that were covering a sand pit. Front wheel augered in, and I went over the bars. Fortunately it was after the cute woman I was riding with left, so my pride remained mostly intact. Unfortunately, it was after the cute woman I was riding with left, and I was stuck with just the burly man-beard dude to help me get back home, so I missed out on playing the sympathy card.

Shoulder #2 separated at a hockey tournament in Vegas in my early 30s. Caught an edge on the ice during the second game of the tourney, and went over on my shoulder. Played the rest of the tournament, and then went to a white water kayak camp the following weekend.

Never really did serious PT for either, and now both tend to ache in the mornings from sleeping on my side.

Pretty sure I tore a rotator cuff or something equally painful shoveling snow during the presidents day blizzard of 2003 in Maryland. Took months before I could lift anything with that hand and the pain was intense if I lifted anything in a certain way. After several months of babying it, it finally healed on its own. Not a bad story, but I definitely have some empathy for some of you guys.

Ugh, I hear you there. I was riding my bike at night around my college campus during the second week of my freshman year. I left the walking path to go around some pedestrians, but didn't see a pit that was covered with grass that had grown up to the same level as everything around it. The bike stopped still, I went over the handlebars, and the very first thing to touch the ground in front of me was my face, which took the full impact of the crash. My whole face was scratched and scraped for the first month of college. Fun stuff!

Prediction for this thread: First set of scar pics will be traded within ten days.

https://www.youtube.com/watch?v=dLjNzwEULG8

If I take a picture now, you won't be looking at my scars. You'll be looking at the amazing pattern of shaving that they did to my chest and arm. Let's just say that it's not the sort of manscaping that wins awards. Conversely, if I wait for things to grow back to normal, you won't see my scars at all.

Cortisone is either amazing or useless.

I've had problems with my knees since high school (apparently wrestling and hockey are rough on your body, who knew?). The first time my orthopedic surgeon gave me Cortisone shots in my knees, they hurt like hell for two days (like they were on fire) and then it felt like somebody lubed my knees. It was glorious.

Now, 12 years and two surgeries later, Cortisone does nothing for me. I just get to wait for my shots of pig fluids (Orthovisc/Synvisc) every 9 months while waiting to get old enough for the Doc to replace my knees.

Good times!

I have never understood that mentality!

Here you are, semi-crippled, in pain, and the doctor says, "Let's wait until you're old enough that you won't even need the knees, then we can put in new ones. No sense in putting them in while you're still young enough to enjoy them."

My wife went through similar battles with her doctor before finally convincing him that she wanted to do more than just sit around on the porch in her rocking chair watching the neighborhood kids at play. You know, things like hiking, kayaking, or (heaven forbid!) actually walking without pain.

Yes, I know -- they don't know for sure how long these replacements will last, but consensus seems to be at least 20 years. Since technical/medical progress over time has historically been asymptotic by nature, I am quite convinced that 20 years from now the problem of replacing worn-out prosthetic knees will have been solved quite handily, probably through stem-cell regeneration techniques.

tanstaafl.

Before I graduated, I toyed with the idea of making the jump into Biomedical Engineering for a graduate degree, specifically using advanced aerospace materials for joint replacements. My guess is the only limitations are financial.

The Doc's concern is that you can only replace the knees twice, then there isn't enough bone left and they have to fuse the leg together. That would suck.

Update: My followup with the surgeon went well, and now I'm free of the sling on my arm. For the next month, I've got a list of passive motions I'm meant to do with my arm (i.e., using my good arm to lift the other one). The point of all of this is getting back my range of motion. All of this while the surgical repair is still healing itself.

Still, this is a huge new thing. I have my two hands again. Huzzah. More importantly, the surgeon said I'm cool to ride a bike again, but I won't be swimming for a while yet.