Serious shoulder questions for BC skiers, and my own labrum WTF thread

I bet it's torn too, the thing I don't understand is, how much, and how much would RC strengthening help or buy me time until the rest of the labrum and the rest of the joint gets tighter as I get a little older? And maybe it doesn't buy me any time, so I'll cut. I can't really see a downside to this plan other than a) prolonging impaired mobility by some number of months, and b) waiting so long that I move to a different job and lose my currently awesome insurance before I realize I have to cut.

I'm suspicious of those stats. My doc is telling me the same thing, but do older guys suffer fewer repeat dislocations because they tend to slow down and back off activities that might cause them, or is it because the joint is "tighter?"

Getting an MRI tomorrow. Got X-rays today and no apparent bone damage. Doc said rehab would be his first choice unless the MRI shows major damage to labrum and/or rotator cuff. Thing is, I've dislocated this damned thing 5 times in the last 6 months. How much is rehab really going to help?

Going to get an appointment with another sports medicine ortho surgeon at UW Sports Medicine clinic after I get the MRI done.

Should I start my own thread? Not sure piggy-backing on Schralph's thread is the right thing to be doing...

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Originally Posted by SchralphMacchio

Oh yeah, and here is the crux piece that I didn't understand at first. this is what the radiology report says:
"There is an increased signal within the anterior labrum suspicious for a tear ... abnormal signal within the anterior labrum suspicious for a labral tear (cartilaginous Bankart injury)." It's like the radiologist wasn't sure if it was frayed or separated. The first doc went straight to "oh yeah that's torn etc etc." The other two were a bit more cautious about extent, thinking that I had good odds to recover without surgery.

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When I had surgery on my shoulder they went in thinking it was fully torn, but when they cut me open, they found out it was just so loose that it looked torn. They had to change surgery plan right then and there.
So I think the truth is that they just don't know for sure till they cut you open. Imaging technology is getting better and better, but it's still a science and an art combined it seems. Looking at MRIs, I have no idea how the hell they can tell what's what and what's torn or not.

Chainsaw, I don't mind the piggybacking. Whatever works for you, and there is plenty of relevant discussion in here.

But 5 dislocations in 6 months sounds dubious for PT given what I've tried to learn this month. It's not like you're an inactive guy. Have you been doing mountaineering and climbing in the last year? It seems those activites would give you reasonable RC strength to begin with - so again, what more will rehab do? I'd ask those questions very strongly.

Oh yeah, powdork is no super young stud (I won't go so far as to say he is old) but he sends it bigger than I do and beaters just about as much as I do. He's had shoulder issues that he mentioned did tighten up with age, and he never did surgery. Maybe PM him.

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Originally Posted by SchralphMacchio

Oh yeah, powdork is no super young stud... He's had shoulder issues that he mentioned did tighten up with age, and he never did surgery. Maybe PM him.

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Building up strength is just a matter of putting in the time. For now you want to achieve flexibility in tendons/muscles...imho. Yes strengh, I think, is good, but need to do (at least!) as much time with flexibility exercises... Once muscles become stiff...seems as though most whom I know say = really tough & painful to strengthen..

Results are in from the MRI - it's my labrum. No rotator cuff tear, no bone damage. Made an appointment to discuss treatment with the doc on Friday.

Got a recco from one of my ski buddies who's a general practitioner for another shoulder specialist who he says is the best around so will get an appointment with him for 2nd opinion.

i had my surgery at age 31. since it was just progressively getting worse. i didn't have repeat dislocations, had several sublexes, but stability kept getting worse and worse. I think i initially dislocated when i was in college. eventually the pain and feeling like my arm was getting pulled constantly led me to surgery

Hey Willie, what's the word?

My PT is going well - looks like I have a fighting shot of rehabbing a stable shoulder. No "clicking" around my labrum that my PT was searching for ...

Schralph - good to hear the PT is going well for you! Hopefully we're in basically the same boat and we'll be back in shape soon.

Doc #1 really wants me to do rehab/PT rather than a full-on surgical repair. He does want to do a minor arthroscopy as the MRI showed a small piece of detached cartilage is floating in the joint plus he wants to clean up any rough/frayed cartilage and get a better look at the separated section of the labrum. For now I'm going with the PT/rehab route though doubt I can afford it as an ongoing option. I don't think I want him cutting on me unless it's absolutely necessary, and at that point might as well go all in and get the thing fixed.

Have an appointment with doc #2 at end of February. This doc is supposedly "THE Shoulder Guy" according to one of my ski buddies who's a general practitioner. Doc #1 is more of a knee and hip specialist and works in the same office as doc #2 and also highly recommended him for a 2nd opinion -said if he was going to have his shoulder worked on that doc #2 would be the guy he'd want doing it.

Went to first PT session today. The therapist immediately saw that my shoulder is all out of whack/alignment from me compensating for pain/weakness. She taped it back into a normal position and told me to leave the tape on for as long as I can stand it as it cues my body to hold the shoulder in a more natural position. Also gave me several exercises to do twice a day and I have a follow-up appointment on Thursday.

I've been thinking about this situation. I can use my arm as it is now. I have full ROM though there is definitely some pain/weakness. I need to get back to work, I've been unemployed since last May and my money is going to run out in a few months, not to mention that living on a shoestring like I have been is really getting to me and I really want to change my living situation. If I get surgery I'm not going to be able to work for several months, whereas if I can rehab/PT this thing I can go back to work as soon as something comes up.

I don't like the idea that it might dislocate again, but putting off the surgery and the long recovery seems like the prudent thing to do at this point. At least when it does dislocate I can get it back in pretty easily...

I went skiing on Sunday because I just had to know whether I could still do it. It was a freaking blizzard all day, just got deeper as the day went on. I didn't really push myself, didn't take any steep drops or small hucks like I might have on a day like that, but I didn't exactly hold back either. I still skied the steep lines I enjoy and skied them reasonably aggressively, enjoyed the hell out of myself and didn't hurt myself any further. I'm going to look into a brace that will hold the shoulder down to wear while skiing and go from here.

Chainsaw, I hope you get yourself a job with good insurance. I hope this situation works out for you - the dislocation in your sleep sounds like a red flag to me.

I'm still nowhere near being able to ski. Too much chance of quick/extreme external rotation that would cause sudden pain & inflammation and then result in a setback. My muscles are just re-learning how to fire correctly right now. The good news is that I snowboard better than I ski, and that the likelihood of falling with external rotation on my leading shoulder on a snowboard is way less than on skis, so I might be able to start doing that in March.

This brace is pricey but my doctor recommended it for me because it limits ROM. I have a Flexible Spending Account that I might use to purchase it, so that at least it's paid for with pre-tax money.
http://www.dme-direct.com/sawa-shoulder-brace

http://images.ridemonkey.com/index.p...cL._SS400_.jpg

hmm I bet I could strap a radio harness to that front buckle, then I'd be able to act like a real asshole to ropeducking snowboarders about to poach my line! ;)

I've seen a couple braces like that. Not sure how the strap that goes from chest to arm under the armpit would work under my ski jacket though.

My insurance is through my union. While the coverage isn't the best for some things (dental is really good and coverage for surgery is decent) the good thing about it is that when you're working it gets paid ahead. I got laid off last May and I'm covered through June '12, so basically your insurance is paid up a year in advance if you work steadily for a couple years.

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Originally Posted by Chainsaw_Willie

I've seen a couple braces like that. Not sure how the strap that goes from chest to arm under the armpit would work under my ski jacket though.

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It certainly depends on the cut of your jacket. My touring jackets are cut a lot more slim and might not allow the straps that limit abducting and rotational motion. I wonder if there is enough adjustment in the brace to work outside of a shell - which is why I was saying to double it up as a radio harness and look like a 'troller or SAR member :)

EVS sells a couple different shoulder braces with various levels of support. works really well. I use mine to boat with. really only had it in teh pool but it has kept my one shoulder in joint

Those EVS braces don't appear to have any hard limit to abduction or external rotation. However, they do fit under ski shells. I'm just wondering how much they are really going to help.

it actually has a bit built in to the design, granted its not a firm strap like the brace you linked but the cut of it prevents a lot. i i thought they offered one with a strap like that though, but could be wrong.

So just bumping this because I had an unhappy day today.

Last night I subluxed the shoulder while rock (gym) climbing on an overhanging bouldering problem and doing a strong move. I heard/felt a pop/crunch sound and felt the joint moving, instantly let go and as I was falling I could feel the joint move/pop/crunch back into place. It was all very bang-bang-bang so the humeral head was never quite out of the joint, but that movement felt to me very much like a subluxation. A little sore today but full ROM and popping IBU's.


To rewind a bit, since I haven't updated this thread since January:
-I elected to skip the surgery and try PT
-I did PT from February into May, at which point I had 99% ROM
-I got back into activities slowly, based on intensiveness - BC snowboarding (i.e., using a pole to skin) in March, skiing in May, mountaineering in June (i.e. using an ice axe as an ascending aid) and rock climbing (2-3x/wk) in June
-I had soreness issues when the shoulder was cold, weakness issues, felt funny sleeping on my side, going into the heart of summer it felt really good overall
-I felt good gym climbing and worked my way back up over the last 3 months from 5.8/V0 to 5.11a/V3 - no signs of instability during the last 4 months of climbing
-Since late June I tapered down rehab exercises (incorrectly) figuring that I was recovered and doing enough activities to stay strong
-I started having some minor impingement issues the last few weeks
-last night was the first sure sign of a compromised/unstable joint I've had since originally dislocating the shoulder


I guess at this point my plan is to go back into PT next week, take a few weeks off of climbing, and think about maybe looking into PRP/Stem Cell as a pre-emptive treatment. I am not considering surgery at this point unless it dislocates under a regular activity (excluding falls or strenuous pulls basically) ... then I am concerned about it being a safety issue in the BC for multipitch trad or multi-day ski touring.



Willie, how is your shoulder doing?

Sucks to hear :( I really think the real solution is surgery, mainly because I had a successful surgery and have been pushing my shoulder harder than I did before my injury with 0 issues (knock on wood). Obviously, everyones body is different, but I just hope either way, your shoulder gets to a point where you don't have to worry about it dislocating/sublux...

When you finish PT this time transition into a shoulder strength program.

Remember it typically takes one to two years to make a physiological change through exercise. PT gets your ROM back and does some basic strengthening. You need to do more than that.

Your best bet would be to find a facility that deals with strength and conditioning for athletes, with a specialty towards baseball and swimmers, ie athletes with shoulder problems. See if they offer group training to make it affordable. If you are doing it yourself Eric Cressey has a program you can order Optimal Shoulder Performance that is probably the next best thing.

I spent 1 year trying to recover w/o surgery. Had arthroscopic surgery. Did not work. Spent 5 years doing PT, subluxing, etc. Had proper surgery. Shoulder is WAY better now.

Some things need proper surgery. Even if you do all the right things, you still might end up looking like this...

http://i955.photobucket.com/albums/a...lderwound2.jpg

http://i955.photobucket.com/albums/a...ing-boy020.jpg

8 weeks in that fucking sling.

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Originally Posted by neufox47

When you finish PT this time transition into a shoulder strength program.

Remember it typically takes one to two years to make a physiological change through exercise. PT gets your ROM back and does some basic strengthening. You need to do more than that.

Your best bet would be to find a facility that deals with strength and conditioning for athletes, with a specialty towards baseball and swimmers, ie athletes with shoulder problems. See if they offer group training to make it affordable. If you are doing it yourself Eric Cressey has a program you can order Optimal Shoulder Performance that is probably the next best thing.

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Thanks for these comments. Thoughtful and useful.


I think for me the biggest challenges without surgery would be withholding my climbing and not allowing myself to get close to pushing 100% (a hard thing to do for people like us) and the mental roadblock of not having any trust in the joint and wondering if the arm is going to be dangling by my side the next time I pick up my mountain bike to put it on the roof rack, etc.

But shit man, ski season is coming up, and I'm planning on being too funemployed to afford a big surgery and PT recovery in June once the season winds down.

when yours blows out in bed like mine did, you'll be calling the surgeon

I was done fucking around wondering when it was going to happen again

Ha! This happened to me as well. Attempting to push myself out of bed and dislocation on the way up, was a nice way to start the day.

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Originally Posted by telemike

when yours blows out in bed like mine did, you'll be calling the surgeon

I was done fucking around wondering when it was going to happen again

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I know this is old but...

Circa 2006 I busted my ass on rail resulting in a posterior dislocation of my right shoulder and f**ked it all up. Many docs recommended PT until an MRI showed a labrum tear of like 80 percent.

That spring/summer it would sublux constantly or totally dislocate, even while sleeping. I had a technique down where I would step on my fingers and pull the shoulder back into place. It was awful. After 25 or 30 dislocations I finally had the surgery.

Doc performed real surgery and used 7 or 8 anchors to re-attach the labrum. I spent an entire semester of college throwing a tennis ball up against my apartment wall. PT was long and it was painful but SOOOOO worth it.

Range of motion is 100% 6 years later. The only time I feel pain (zero to hero, lots of pain) is if I am making movements like reaching back behind the seat of my vehicle. Tennis, climbing, bikes, skiing, all good to go. No persistent clicking or soreness and no signs of any chronic inflammation yet.

thanks for that - my PT's main concern with surgery is not being able to guarantee 100% ROM. In his opinion, it's climbing where I have a problem, and yet my climbing would be affected if I had limited ROM after surgery.

That said, I have yet to take a gnarly enough fall while skiing to blow it out.

I feel like I will probably need to have the surgery at some point, but not in the next 7 months ... ideally I do it right at the end of ski season, but I'm planning on being unemployed at that time and my health insurance will be very minimal at that point - not a great time to throw down on a surgery and months of PT - so it might have to wait until the end of the 2014 ski season, unless it gets dramatically worse between now and then.

ummm stop climbing?

best thing i ever did for my shoulders was stop climbing - nerve damage in my elbow was what really ended my climbing though.
had MRI - SLAP lesion, doc who really wanted to cut. mostly solved all of it by no longer climbing.
i was a 5.12 trad climber, so i know what it means to give it up - but skiing has filled the void.
YMMV

honeslty climbing was the best thing for my shoulders. just lay off those weird overhanging moves that stress the joint at weird angles. it will help strengthen the muscles around the joint which is what you want

^^I agree that the motions involved with climbing are healthy for recovery, and strength is key. I would be concerned though, having to rely on a shoulder that is in rehab. Shit can be sketchy.

To clarify my PT experience, its been 6 years since the surgery. It probably took a very solid two years to get to a confident 100% and then another year to where I don't even think about it.

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Originally Posted by crackboy

honeslty climbing will help strengthen the muscles around the joint which is what you want

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Originally Posted by regct

^^I agree that the motions involved with climbing are healthy for recovery, and strength is key. I would be concerned though, having to rely on a shoulder that is in rehab. Shit can be sketchy.

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Well neufox's comment that it takes a solid year plus of work to effect lasting changes is probably key here. Climbing does very little to strengthen supraspinatus or whatever ... my arms are strong for pulling moves, but my shoulder is less strong for external rotation, and actually very weak for that motion when you open up your arms from having them intially placed hands at your hips (I don't know what kind of motion that is).

You guys are right though, if it starts subluxing in my sleep, I'll be calling the cutter. I'm kind of glad I didn't do surgery to at least give myself a chance to evaluate the situation, but know I'm thinking, this past January would have been THE perfect time for me to have had surgery. Oh well, hindsight's a bitch.

Ha... I've only come here when I'm a gimp myself... but gotta comment as I just had my left shoulder done 2 weeks ago. I've had 3 operations on my right... 1st - ortho, 2nd - open bankart, 3rd - some name I forget... but I've got pins in there now and hasn't come out since. Did the right one climbing... can't say that climbing is the best thing for a unstable shoulder.

My left shoulder started popping out 2 years ago (kayaking)... both shoulders were anterior... then it got bad enough this summer that it was popping out pretty easily. When it popped out climbing at Lover's, I decided to go under the knife.

I know a lot of folks that have had one or two dislocations and no more... but if it pops out more than 2x a year, it's probably time to get it done. At that point there's probably enough damage to your labrum, some hill-sachs... and you can't repair that without surgery. PT isn't going to repair your labrum.

But as far as surgeries go, it's pretty mellow. In and out... on a bed for a day, then in a sling for 5-6 weeks. It's pretty boring but I can still get a workout on the bike trainer, and unicycle...

Thanks Yu.

I'm pretty sure I'm going to do the arthroscopic repair once the ski season is done. My capsule is just so loose that the muscles are misfiring and compensating in stupid ways, even with my ongoing PT. Plus I do have a Hill Sachs, so it's pretty much an open liability.

I did a week of climbing in J-tree over Thanksgiving and there was zero pain during the trip, but when I got back I noticed a completely messed up muscle directly opposite from where I think my labral tear is.

Good luck with your recovery dude!

Peronally people I know ,who had shoulder surgery ,did Not like the results in the long term.Maybee pushing re-hab to fast is the prob? I had a doc diagnose me as grade 2 shoulder separation.Healed better than new. I hear the rubber band exerciser works wonders(when your ready)

Carefull there Chainsaw......;my knee dislocated(doing reg work) a week before the mcl went 2 yrs ago.

Might be a little late but I had the exact same injury and complications. Spent 8 months rehabbing myself but I never got better. Finally went to the ortho and had an MRI, torn labrum in two spots plus a lot of other technical stuff I can't remember, rotator cuff was fine.

Ortho didn't want to do surgery due to my young age (24 years old) but said I could get better with extensive rehab. Went to a great sports PT who mentioned with labrum tears they won't heal themselves. After 8 weeks of 2x a week PT my shoulder is back to 95%. Just don't like heavy benching and military press anymore.

My advice go to a solid sports PT and do rehab

My shoulder has continued to dislocate - am seeing a doc about it next week. Last two dislocations have been posterior, previous ones were all anterior. MRI in Jan '12 confirmed anterior tear of Labrum, now I'm wondering if I don't have a posterior tear as well.

It seems to me if they can reattach the labrum that would be the thing to do along with PT/strengthening...?

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Originally Posted by Chainsaw_Willie

My shoulder has continued to dislocate - am seeing a doc about it next week. Last two dislocations have been posterior, previous ones were all anterior. MRI in Jan '12 confirmed anterior tear of Labrum, now I'm wondering if I don't have a posterior tear as well.

It seems to me if they can reattach the labrum that would be the thing to do along with PT/strengthening...?

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It's not that common to have BOTH anterior and posterior dislocations (and most are anterior to begin with). The aforementioned MRI from January didn't show anything in the posterior region of the shoulder (and was done with contrast injected into your joint)? Do you happen to be double jointed, etc, that would suggest lax ligaments? As a note, while the labrum is a cartilage rim that deepens the shoulder socket, it's certain ligaments tearing that underlie repeat dislocations. So when trying to prevent future shoulder dislocations, the surgeon will repair the labrum but also tighten the ligaments that attach to the labrum and are responsible for holding the shoulder in joint during certain positions of motion (for most dislocations, which are anterior, this is with your shoulder elevated 90 degrees and your hand back, as though you were throwing a baseball). If you have some damage to the back of the shoulder, it's a little more technically difficult but still very possible to repair those as well. Just not that common to have dislocations in both directions unless you're ligamentously lax (which can make successful treatment more difficult) or have had some real severe injury to the shoulder. Best of luck and keep us posted.

Orthoski - thanks for your input! According to the doc the previous MRI only indicated anterior tear. MRI was done with contrast injection.

Have no idea whether my ligaments are lax. I don't think I'm "double jointed" but don't really know what that means. I have dislocated my left thumb a couple of times, but given that I work in construction that's probably not all that unusual.

If ligaments are torn, how do you tighten them? I'd guess I probably have a torn ligament or two in my shoulder but the last doc never mentioned that. I'll be seeing two new docs next week so will be sure to question them about this stuff.

Thanks again for your input, much appreciated!

First appointment with a doc who gets what it means to be a middle-aged weekend athlete.

He showed me how to interpret the MRI of my knee. ACL blown but no evidence of meniscus damage. That's the good news.

When he looked at the MRI of my shoulder he got real quiet and kept scrolling back and forth between several "layers." Then he said that it appears my problem isn't so much that my labrum is torn as that it's simply gone. Said he wanted me to see his partner who specializes in shoulders and that I was going to need more than just a staple-the-labrum-back-together type of procedure. Yippee.

Bump!

Finally doing the arthro Bankart later today, about 7 years later after my first dislocation!

In 2012 and 2013 I basically just stopped climbing, save for random trips focusing on mellow climbing. No surgery, just rehab. Got way into MTB and felt mostly good. I did regular exercises and eventually the pain went away. I felt good but I popped it out fully in 2016, 5 years after the initial accident, doing a random fast twitch maneuver and I was able to reduce it immediately with a buddy’s help. Recovery from that was immediate and I still felt good enough to ski, board, MTB etc. But in November 2018 I slipped on ice and hit the concrete so hard it blew out my shoulder and gave me an awful concussion. Couldn’t self reduce and the circulation sensation and motion impacts were way worse that the previous ones. Had to get it reduced in the ER. Did numerous weeks of PT but could tell it was much worse than original dislocation in 2011. Hurts if I hold my 6 week old 12 lbs. daughter for too long.

Willie, did you ever go under the knife for yours?

Wish me luck! Actually, wish my wife luck because I won’t be doing diaper changes or picking up my girl to settle her for the next 6 weeks ... and she pees like 20x per day ...