Shoulder Surgery - Need advice

Just got the results of my MRI back and was shocked that my original diagnosis of a torn anterior deltoid was wrong. I actually have a torn labrum and a tear in my rotator cuff. The doctor told me that I need surgery. One surgery to fix the labrum followed by 4 weeks in a sling and 6-8 wks of rehab, then another surgery to fix the rotator cuff followed by 4 wks in a sling and rehab until back to normal.

My question is, is getting the surgeries the right thing to do? I don't hear much on hear about people having surgery but more about rehab to fix the problem. I have done almost 2 months of rehab and no progress so I was told this is the next step. I am just nervous that my shoulder is going to be permanently screwed! Can anyone (SLIZZ!) give me some words of encouragement or advice to whether or not I am making the right decision? I have great insurance so that is not a problem, I just would like to hear some other opinions on this. The doctor said I should be back to 100% if I do everything correctly and patiently. Thanks so much for anyone who can give advice. This is depressing.

Man, I am really sorry to hear that! That sucks. I can't tell you what to do, but I sincerely wish you a speedy recovery. Hope surgery isn't necessary.

With labral tears, if there is cartilage poking into the joint then yes it needs to be removed. Sometimes it's just a small rip and those can heal themselves if you let them, but if it's serious enough for the cartilage to be flapping around in the joint then that part will probably need to be fixed.

As for the rotator, depends on how severe the tear is but it's probably an ugly class 2 or a class 3 strain if they are recommending surgery and rotator cuff surgery works well. This usually has something to do with supraspinatus, but which rotator cuff muscle is messed up?

The biggest thing will be for you to be very, very religious about scar tissue removal. You will need to be working the tissue on a daily basis. Fortunately I'm going to be making a short series on self treatment for scar tissue. It should be a lot of fun and exactly what you're going to need. It also helps IMMENSELY to have a talented soft tissue therapist that specifically does medical massage on your occasional payroll!

Ask your doctor if he's going to refer you to a PT place that does passive range of motion work, because that will be crucial to minimizing scar tissue. That needs to be done like immediately, starting 1 week post op if they will approve it. This passive (and it is important for this movement to be passive. they make machines for stuff like this but people can do it too) movement will prevent most of the scar tissue from adhering together in a way that really restricts movement.

If you can't get that from him, do what the doc says or get a different doctor who works with athletes to supervise your post-op therapy. If it is his opinion, based on numerous personal patients that he operated on, that this full immobilization will get you back to a high level of athletic performance and he has professional athletes that have come through there and done what he said and got back to 100%, then listen to him. Most likely he WILL recommend some passive movement performed by a trained therapist starting fairly soon after surgery. At first the motions are very small, and as the days pass they slowly get bigger up to a certain extent.

Archbishop o balance said:

Man, I am really sorry to hear that! That sucks. I can't tell you what to do, but I sincerely wish you a speedy recovery. Hope surgery isn't necessary.

Thanks bud. It will be a long road, but I am kind of excited that this could potentially fix my shoulder completely. It will be nice to not have shoulders issues for once!

slizzardman said:

This usually has something to do with supraspinatus, but which rotator cuff muscle is messed up?

I believe you are correct. Also double checking on this. I didn't have much time this morning and only skimmed the post so I forgot some of the questions to ask. But, I heard them mention this muscle.

slizzardman said:

The biggest thing will be for you to be very, very religious about scar tissue removal. You will need to be working the tissue on a daily basis. Fortunately I'm going to be making a short series on self treatment for scar tissue. It should be a lot of fun and exactly what you're going to need. It also helps IMMENSELY to have a talented soft tissue therapist that specifically does medical massage on your occasional payroll!

Not sure if this is on the agenda. I will bring this up and let you know what he says, forgot to ask him today.

slizzardman said:

Ask your doctor if he's going to refer you to a PT place that does passive range of motion work, because that will be crucial to minimizing scar tissue. That needs to be done like immediately, starting 1 week post op if they will approve it. This passive (and it is important for this movement to be passive. they make machines for stuff like this but people can do it too) movement will prevent most of the scar tissue from adhering together in a way that really restricts movement.

Talked to the PT guy today about this. He said that I am coming to see him 5 days after surgery to begin passive range of motion work. He said for the first 2 weeks it will only be once a week, and then we will slowly ramp up into more ROM and more volume. He said that for the Labrum surgery we have to be very careful to not overwork it because we want it to heal tight to some degree. With the rotator cuff he said that it is much less severe and definitely want to get to work immediately on keeping it loose.

Thanks you so much for your response. Sorry you took the time to respond to my incorrect diagnosis in my PM. I appreciate both. You are a huge help. It cracks me up that after I visit the doctor I get straight on the GB forum and double check with you that they are doing the right stuff!!

Lol! Well, that's quite a compliment! It sounds like your doc is a very good one to me. He's right about the labrum, you don't want to stretch it out while it's healing. Not that the labrum really stretches, it's a lip of cartilage, but you would want to minimize your chance of damaging the repaired area before the healing has really become fairly permanent.

It sounds like you're going to have a great recovery man! Keep us updated!

Labrum tears often need surgery to be fixed and recovery is usually close to 100%. The rotator cuff is a different story though. First of all 2 months of rehab and you are already giving up? I did almost 10 months of rehab with partial tears before I could do anything serious again. Took another few years after that to get to a point where the supraspinatus wasn't bothering me at all anymore with any movement.

Most people with surgeries to the rotator cuff will tell that it's never quite the same after that. That doesn't mean that if you rehab right that it can't happen, just something that I wouldn't jump into unless it was at a point where I knew I completely exhausted all my other options. Such as letting it heal, tons of ART or other soft tissue work, tons of rehab, and other "alternative" physical therapy treatments.

When I tore my wrist all I tried was cortisone injections but I didn't know much about rehabbing back than and as a result got surgery. While I can use my wrist just fine for most sports there are certain things I have to avoid because it causes discomfort.

AlexX said:

Labrum tears often need surgery to be fixed and recovery is usually close to 100%.

Doctor said the labrum is pretty bad, and I previously had some labrum issues with the same shoulder a couple years back and still continued to have little flair ups. So I think that its been an ongoing problem for awhile and the injury pushed it over the edge if you know what I mean. He said the same thing. This surgery should yield some very good results.

AlexX said:

The rotator cuff is a different story though.

This one will be re-evaulated closer to the time surgery will be considered. Possibly another MRI to see if it's still necessary. The rotator cuff tear is in the supraspinatus, it is not as severe as the labrum tear and surgery is not set in stone at the moment, but he did reccomend it if it didn't get better from now to then. I will definitely consider your comment thank you very much for the input! This was why I asked, I am nervous about this very thing.

AlexX said:

First of all 2 months of rehab and you are already giving up? I did almost 10 months of rehab with partial tears before I could do anything serious again. Took another few years after that to get to a point where the supraspinatus wasn't bothering me at all anymore with any movement.

Wow. That's a looooong time. I didn't know it would take that long. The labrum needs to be fixed but, I will definitely discuss what you have said with the doctor when it comes time to discuss it. Thanks again for your comments.

Bilateral labrum repairs (jan + march of '09) on my poor shoulders... Labrum surgery is not the end of the world :-). Treat it as a new experience to explore your body and figure out what movement patterns got you to where you are. Life after successfully recovered labrums is awesome... I've learned a ton about anatomy, stretching, strength, massage and all sorts of valuable self-maintanance.

I didn't get back into gymnastics or gymnastics strength for ~9-10 months. I actually did P90X (don't laugh) for two months to do some basic strength. I had never lifted weights before so it was a fun switch from my traditional training. Once I started gymnastics again, it was excruciating for 3-4 months... Interesting side note: Kevin Tan told me his hurt the most on HB and any hanging exercises, while mine hurt the most on support skills. I tried to get back onto rings but I rushed it and ended up tearing my teres minor & major. Despite that I pushed through a season of gymnastics competition... needless to say my shoulder hurt pretty bad during and even for a few months after that season.

~2 years after my operations I started to do serious ring strength again! Mid June, I started to do the GB workouts and some of my own ring strength. After 2 or so months of *careful* and *consistent* work, I'm finally able to do ring strength on a daily basis without any pain. I actually held a cross for 5sec with no pain whatsoever (during or after) last week :-). I actually held it back in May at the Le Reve audition with Yuri but my shoulders hurt for 2-3 days afterwards haha. I hope to get my maltese back in a year or so!

My general advice:

-NEVER STOP DOING PRE/REHAB...EVER! As soon as you assume your shoulders are healed up and good to go... pow! something crappy happens that sets you back. When you think you don't need prehab, is the time you need it the most!

-You know how at some point in your workout you'll be able to say, "man I'm going to be really sore tomorrow!"... stop 2-3 sets before this happens. Thats probably the best advice (that I often forgot) my doctor gave me. It allows you to make a little progress everyday, instead of big jumps one day and then being sore for 3 days. It also translates nicely to working up training volume on the day to day basis, which is important for me if I'm going to be performing twice a night.

-Go back to the basics. It's easy to forget that your no longer as strong as you once were. Whenever you're using your shoulder, pretend your completely new to everything and approach it in a way that allows you to learn how to use your "new" shoulder. Be open to having to do less than you used to, enjoy (and please take) the *slow* process of getting back to your old levels... and beyond :-)

Keep you chin up and look to the future!

Please feel free to ask any specific questions

-Alex

Eddie said:

AlexX said:

Labrum tears often need surgery to be fixed and recovery is usually close to 100%.

Doctor said the labrum is pretty bad, and I previously had some labrum issues with the same shoulder a couple years back and still continued to have little flair ups. So I think that its been an ongoing problem for awhile and the injury pushed it over the edge if you know what I mean. He said the same thing. This surgery should yield some very good results.

AlexX said:

The rotator cuff is a different story though.

This one will be re-evaulated closer to the time surgery will be considered. Possibly another MRI to see if it's still necessary. The rotator cuff tear is in the supraspinatus, it is not as severe as the labrum tear and surgery is not set in stone at the moment, but he did reccomend it if it didn't get better from now to then. I will definitely consider your comment thank you very much for the input! This was why I asked, I am nervous about this very thing.

AlexX said:

First of all 2 months of rehab and you are already giving up? I did almost 10 months of rehab with partial tears before I could do anything serious again. Took another few years after that to get to a point where the supraspinatus wasn't bothering me at all anymore with any movement.

Wow. That's a looooong time. I didn't know it would take that long. The labrum needs to be fixed but, I will definitely discuss what you have said with the doctor when it comes time to discuss it. Thanks again for your comments.

I'm going on about a year of shoulder and elbow recovery now, and they are just now starting to feel proper. I plan on taking that through the end of the year at the least.

acegerter said:

My general advice:

-NEVER STOP DOING PRE/REHAB...EVER! As soon as you assume your shoulders are healed up and good to go... pow! something crappy happens that sets you back. When you think you don't need prehab, is the time you need it the most!

-You know how at some point in your workout you'll be able to say, "man I'm going to be really sore tomorrow!"... stop 2-3 sets before this happens. Thats probably the best advice (that I often forgot) my doctor gave me. It allows you to make a little progress everyday, instead of big jumps one day and then being sore for 3 days. It also translates nicely to working up training volume on the day to day basis, which is important for me if I'm going to be performing twice a night.

-Go back to the basics. It's easy to forget that your no longer as strong as you once were. Whenever you're using your shoulder, pretend your completely new to everything and approach it in a way that allows you to learn how to use your "new" shoulder. Be open to having to do less than you used to, enjoy (and please take) the *slow* process of getting back to your old levels... and beyond

Keep you chin up and look to the future!

Please feel free to ask any specific questions

I can't thank you enough for your encouraging advice and comments. I was pissed and really bumbed at first, but then I felt kind of relieved that its finally going to get fixed. Its been a constant nag for a couple of years, never as serious as now but has always been there. I am excited about starting over and re-building my upper body strength. I want to do everything perfect and have a great recovery so noone's advice is going un-recognized by me. I am glad to hear you have recoverd so well! It's very encouraging to hear!

slizzardman said:

I'm going on about a year of shoulder and elbow recovery now, and they are just now starting to feel proper. I plan on taking that through the end of the year at the least.

I guess I can join the club! I want to do the same thing and really do it right so its no longer an issue. Thanks for all your help!!

No problem, and take what Ace said to heart! Pre-hab is really the foundation of true strength.

Today marks 4 wks from the day of my labrum surgery. The surgery went very well, Dr. said he hadn't gotten one that tight in a long time, so I was very pleased. I am following my physical therapist's instructions exactly and am learning alot about this thing called patience! :wink: I am out of my sling pretty much all the time now and get nothing but good progress reports every week at therapy. I am going to continue rehab for a couple of months and then assess the supraspinatus, which turned out to be a pretty significant tear, but could be fixable with all this rest and rehab. Just wanted to drop in and say thanks for everyone's advice!

I plan on starting a training blog soon with before and after surgery pics to track my progress. I tried to get fat so I could have a nice little challenge of getting lean again. I gained over 10-12 pounds of fat on purpose thus far, so this is going to be neat to see! The pics are funny! But, enough said, just wanted to thank everyone for their time and give a little update. Later!