shoulder surgery questions - is this normal?

[imaguest]

hi, i just had shoulder surgery to stop my right shoulder from slipping out of the socket which was causing my shoulder to sublux and twist painfully with simply moving into the wrong position. it only happened once a year or so because i guarded it a lot. it always would resituate itself after 20 minutes or so and i never ended up in the e.r.

the first time it happened was from a bucking horse. it's happened swimming, falling, reaching, serving a vollyball and even sleeping over the years. at least 20 times. and i was always careful or it would have been more.

i've been lurking and read all the old shoulder surgery posts so i thought i knew what to expect.

the doctor didn't request an mri, just an xray, which showed nothing.

i went in for an arthro capsular plication. i came out with a bankart repair for a torn labrum which the doctor did not expect. the tear looked like a ' v ', the gap was larger than the instrument the doc had next to it. plus he said i have a dent that he did not expect or repair. 2 absorbable anchors and 4 sutures.

since the sugery almost two weeks ago, i have not had my shoulder out of the sling at all.

when i first got home i sat down and tried to pull some pillows under the sling. i lifted my shoulder upwards a bit and while doing that i heard a small 'noise' under the front shoulder dressing. it was right where the front stitches are.

1. is that normal? i am worried that something broke.

i slept on my side and my arm was completely across my front when i woke up, instead of towards the side like it should have been. then when the nerve block wore off, my shoulder muscle suddenly started pulling and trying to resituate itself, the way it does when it's out of the socket. it felt different than in the past, but still the same sensation. painful.

2. is that normal when the nerve block wears off? muscles to 'pull' like that? i thought if it was in the correct position it shouldn't have to pull itself anywhere.

two days ago, sitting up, i leaned over towards the right to pull a blanket and i felt my shoulder 'slip' a bit. again, not in the way it used to, but the sensation of slipping was the same. i was using my left hand to pull.

3. is it normal to feel a slipping sensation? i thought i would never feel that slipping feeling again. it was very disheartening to feel that.


yesterday i thought maybe i need to change the direction i am sleeping in. so instead of laying with my right shoulder propped into the sofa for support, where i could just roll off the edge to get up, i reversed it. that made getting up a strain. when i finally got upright my bad shoulder 'clunked' into place.


4. is it normal for a shoulder to make a clunking sound after surgery?


i haven't done any exercises other than squeezing a ball. i've been careful but i have caught myself leaning on my sling more than a few times while at my desk and in the john, and i've opened a stubborn lid this week. and i pulled my own dressing tape off my back, that took some contorting but it was itching and needed to go. also someone grabbed my hand and pulled it outwards causing pain.
i feel like i can move my shoulder upwards with no pain now.

i had gone through 6 months of pt to strenghthen and stop the subluxing before the surgery. it was catching and clicking a lot during pt, especially when lifting any weight. it felt better but still partially subluxed once at the end of the 6 months and constantly felt like it was going to again so i decided it was time for the surgery.


i see the doc later this week. the instructions for post op were very minimal.

does it sound like i have a good or bad outcome?

anyone have any info? had any of these things happen?

[William Murderface]

Doesn't sound right.
Sleep in sling, get used to sleeping on your back.
baby that shit.

Weird that your doc didn't request an MRI for you...
::

[drmark]

All operated shoulders make some noise.

If you feel that is it slipping or going out of place again, while you are just laying around, then the operation did not do what it was supposed to do and you need to look into it.

[surrender_monkey]

1) he will socialize medicine(and all else) telling you what is approved
2) he will support the trial lawyers to sue your ass
3)he will confiscate your hard earned income and give it to me....for my season pass/crazy check

[imaguest]

drmark-
what do you recommend as far as looking into that?

i was shocked to feel the slipping, even though it was only a little, it never happened that way before.
i suspect the doc will say pt for a while and wait
should i request something?

[ectreeskier11]

I dislocated my shoulder twice, had surgery, and then did it again. I've also felt it pop a bit a couple times after that. Just be careful and don't do anything the doctor tells you not to do. Take rehab seriously, but don't stop strength training after rehab. Keep doing the exercises they give you and add others like db rows and such once you feel your back to full strength. The worst thing you can do is just let it sit there after rehab in my experience.

[drmark]

One thing for sure, I would keep it wrapped up. A new MRI will light up like a Christmas tree so that won't be of any help.

The best idea is to talk with your doctor and have him examine you. And then get another opinion if necessary.

[imaguest]

Doc took out the stitches and said I had a full labral tear.

I am to let it hang and swing a bit for 20 minutes at a time this week several times a day.

Doing that feels REALLY strange. At first my elbow would not even bend down all the way. My shoulder feels like it is running over a sideways speed bump and moving inward on it's own while swinging it.
Is this normal?

And as careful as I am trying to be, a family member careened into my shoulder already.

PT instructions are laying down
to have someone lift my elbow and hand about 5 inches upward,
lift my hand and swing it gently inwards and back to up position,
and for me to lift my hand straight upward from the elbow.
No shoulder movements still. Although swinging my hand does seem to move my shoulder a bit, I guess he means outward?

I am finally feeling able to care for myself a bit. Learning how to use my left hand. No driving.

[imaguest]

Also, I noticed most posters say they have the immobilizer on for at least a month. Do they mean the pillow attachment?

My doc took the immobilzer pillow off at the 2 week appt. Just use the sling portion. Is that normal?

Starting passive PT at 2 1/2 weeks seems very early. Too early?

And the sling seems to allow some movement of the shoulder, just by me moving and standing. Normal? I feel like getting out the duck tape and taping my shoulder to my body.

Doc said the slipping feeling was because my muscles are weak. Even though I just finished 6 months PT?

And am I the only one here that didn't get an MRI? I thought I had a good doctor...

[zeke511]

I have a similar situation, I had an awesome 2 1/s weeks after my surgery, no pain or discomfort than tweaked it I think and little pain in upper bicep and top of shoulder?

I found it good to sleep on my back or on my opposite shoulder side though toss and turn during the night. Do use your sling even when you don't think you need it.

[TahoeCP]

Ima-

There are a lot of different protocols for a Bankart Repair. Most Docs have specific guidelines and you will drive yourself crazy if you try to compare yourself to other patients, especially online. Your rehab so far seems similar to what we do. No matter how much strength training you did prior to surgery the "weak muscle" feeling is in response to the trauma caused by the surgery and the immobilization for the last 2 weeks. Remember "your body doesn't know the difference between surgery and an axe attack" A friend of mine in San Fran loves to tell his patients that. Do what your therapist and doc tell you to do unless you pick up some weird vibes and at this phase of your recovery stiffer is always better than looser and noises in the shoulder are perfectly normal.CP

[drmark]

the state of the art for shoulder recover is changing.

when I first started in practice, everyone was immobilized for a long period.

In the late 80s through the past year or so, everyone was put on early motion.

Now the pendulum is swinging back, because unlike the knee, the shoulder tendons seem to heal better kept still for the first six weeks. Most rotator cuffs and Bankarts seem to do better with immobilzation for the first month to six weeks.

So, what may seem like an archaic protocol, may, in fact, be the state of the art.

[imaguest]

zeke -here too. I'm in more pain now than one week after surgery because I accidently 'rolled' on my elbow, full weight, getting up from the wrong direction. Like a slow motion movie clip, I saw it happening but was in motion and couldn't stop the roll. Bad, bad, bad. Before that I was mostly feeling painfree.




CP-Thanks. Axe attack, good comparison. I had an arthro and it wasn't nearly that painful, but I understand what you are saying. I can drive myself crazy pretty easy since I can't do anything else!





Dr. Mark - I don't feel like the sling immobilizes enough. How about a shoulder/upper-body cast for the first few weeks?





I'm still feeling lots of slipping. Unnerving to say the least. Especially since it is happening when I bend only a little and I am still in the sling.

PT movement was less, and painful after the rolling incident. I stopped after the PT did one set of reps because it felt 'caught'.


Anyone have info about grafts? That looks like my only option if this doesn't work...
My photos show three views with 'dent' marked on them. And my labrum was not only completely torn, it was also partially pulled away from whatever it attaches to.

Right now I am feeling worse off than before the surgery and my family is getting tired of waiting on me.

[drmark]

A body cast won't hold it any better than the immobilzer

If your arm is slipping out again, its a good bet the surgery failed.

THe fix is a Latajet procedure wihich takes a bone graft locally.

It leads to excellent results in these difficult cases. We have had a 0% recurrence rate with it.

This situation probably could have been predicted, so you may want to see another doctor.

[imaguest]

Dr. Mark - Thanks for your answers.

How can I be sure if the slipping feeling is just from weak muscles? It has the same sensation as the 'start' of subluxing/coming out of socket. But it is just a small movement at this point, not actually coming out. Just enough to unnerve me. But in new directions in addition to the old direction. (I'm in the sling so it can't actually come out which only happened when my arm was outstretched somewhat.)

The best way to describe the sensation to someone who hasn't actually experienced it - like stepping on a 3 inch patch of ice and slipping half an inch, enough to make you say 'whoa' for a sec but that's it. You know you slipped a bit, nothing happened, nobody noticed, but you're more careful. Subluxing is an actual fall.

Do patients normally have this sensation a little after surgery? Until the muscles are stronger?

Or is this absolutely not normal?

Any posters here who had successful surgery ever had this sensation?

Is Latajet done arthro? How does recovery compare? Should I try to continue PT for a while to see if it is the muscles?




One of my biggest fears of this surgery was that at least I knew what to expect before, that it would go back in. Now I worry that if it goes out I'll end up in the ER or trapped helpless somewhere.

[drmark]

If it feels like its slipping out, then it is. You should ask your surgeon if there was a bone defect on the humerus or at the socket. If there was, then there is your answer, and further immobilzation or PT will just be a waste of time-but again almost all people need to learn the hard way.

The most common reason that arthroscopic surgery for shoulder stabilization fails is poor quality work. The second most common reason, is a bone defect that was not appreciated at the initial surgery. I guess that also counts as poor quality work too.

If a bone defect present it needs to be grafted, as in the Latjet procedure. This is not an arthroscopic procedure, but the end results are always better, with a return to sports by four to six months, and a recurrence rate of just above zero.

The question is why do you ask about arthroscopy? Other than in marketing blurbs, there is no published evidence that arthroscopic repairs of the dislocation shoulder work any better. In fact, most published results indicate that the arthroscopic repairs lead to a higher rate of redislocations and resubluxation, as you are demonstrating on this post. The internet reading lay public is not informed of this because arthroscopic surgery (which is something I do every day) is a "cooler" thing to do, nowadays.

I, however, am aware of its limitations.

[imaguest]

Brief googling showed this on Latajet

http://www.shoulderdoc.co.uk/article.asp?article=912

This surgery looks massively invasive.

[drmark]

Please tell us if you can think of anything more "invasive" that a failed
"minimally invasive" operation?

Any operation that fails in my not so humble opinion is massively invasive.
Now if you neither value your life or your time, then that question is up for discussion.

[imaguest]

All good points.

I went in thinking this would work and this 'second opinion' doc assured me that it should. If he had doubts he didn't say them. He's the shoulder doc for the college football team in town. The only shoulder specialist. Guess he's not used to seeing old shoulders.



I ask about arthoscopy for two reasons. 1. The faster,easier recovery, less scaring, less pain.
2. Two friends had an open procedure and had a large loss of ROM and both had a frightful recovery. Which is why I put off my surgery for so long. And a relative lost use of his arm from an open not too long ago..




Thanks for the slap down. I guess I've wasted my time.

The 3 photos marked 'dent' from the surgery are bone loss from repeated subluxing but the location was not marked. That would be the bone defect on the humerus or socket you mentioned that was "not appreciated at the initial surgery"?.

( BTW The 'first opinion' doc told me that at my age I shouldn't get surgery at all, that some people should not play sports or exercise, that the subs. would stop as I age and surgery isn't all it's cracked up to be and sent me for PT. No MRI. When I subluxed in my sleep he said since it came right back instead of being out for 20 minutes that I was better, just keep PT'ing. My PT person told me not to get surgery either, just keep 'rowing'.)

Thanks for your advice.

[drmark]

Shoulder dislocations or subluxation when a guy is asleep indicates that the bone defects are severe enough that arthroscopic type of surgery is contraindicated. It means that the bone defect is the signifigant probem. If a guy tells me this, I don't even consider doiing an arthroscopic repair.

Your University Shoulder Specialist should have known that. Perhaps he needs a bit more CME. My guess is that he is a young guy that has little experience performing open surgery.

Serious loss of motion after open surgery usually occur in the hand of guys that dont quite know what they are doing. You have all ready met such a man or woman.

Find a competent man or woman to do the Latajet, and you will be done with this misery. We have had nothing but sucess with this procedure.

You may need to take a car or plane ride.

Are you from the USA?

[imaguest]

Yes. East coast. Not close to any major city.

Will a doctor see you one day and operate the next? Especially on a second surgery? Recovery in a hotel room? How can you travel home after an open surgery?How do you handle follow-up visits?

[drmark]

I am from NYC. My wife's famly in in Houston, so that's how I got here.

For the out of town patients, we see them the day before or the morning of surgery, get the X-rays, CT scans, or whatever we need, and do the surgery that afternoon.

Guys go home from the hospital that evening, or stay overnight if you come by yourself. Many times, but not all the time, our hospital will cover the travel expenses.

In your case you will be in a shoulder sling for six weeks. You will be fine to travel home by plane 48 hours later. You will find the post op pain to be certainly no worse than the arthroscopic procedure, except the shoulder will feel snug.

You will have to find a friendly doctor or nurse to take out the sutures in two weeks. I am sure your previous surgeon will be happy to assist, considering the egg is all over his face.

At six weeks, you take off the sling and start the exercises. It is highly doubtful that you will need to come back, except if you want the other side done.

Ed (my rehab guy) and I direct the exercises via the phone and email.

Expect to be back at sports in four months at max.

[xrup2x@aol.com]

Hi, i underwent arthroscopic surgery on my shoulder back in 2006. I had a torn labrum, 5 disposable anchors put in, had muscles in the posterior and anterior tightened up. Surgery went well and i havent had any problems till now. I got back to lifting weights and everything but just i while ago i noticed my shoulder started making popping noises. For instance, if i swing my shoulders in wide circles to get them warmed up the shoulder pops and cracks. Or, when if i put my hand on my shoulder to feel it and throw a jab, i can feel some tendons or something moving around and making small popping sounds. Im going to see my surgeon next week to see what he thinks. This all started when i began working my shoulders harder to strengthen them. I hoping that if i just rest it for a couple of weeks and just do theraband exercises i can fix this. please let me know what you think this is really bugging me.

[drmark]

Noise in the operated shoulder is common. If it isn't associated with pain, I would forget about it and get ear plugs.

[xrup2x@aol.com]

Thanks for getting back to me so quick, its reassuring to hear you say that. One last thing though. I dont have any "clunking" sensations, but i can feel some grinding. It feels like tendons rolling around or like they are out of place. But i dont have any pain so even that is okay? Sorry if im being redundant, im just a hypochondriac haha