Opinions on instability outcomes

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Topic Title: Opinions on instability outcomes
Created On: 08/12/2008 09:28 PM

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 09/25/2008 05:39 PM

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tgrtrnr

Posts: 21

Leanne, I hope they don't have to do too much, and hopefully they can fix your shoulder with out making it open. They released my bicep tendon last time, the good news is it really doesn't hurt any when they're done which is nice. I had my MRI, it turned out good for the most part, thank goodness. The only notable thing is one of my rotator cuff tendons is "very slim" as he put it. Which means it may or may not tear, which is not really of any help. The pain is worse and I had another shot done in my AC joint this time, it helped a tiny bit ( 1 hour of relief, lol) but the shoulder is still pretty heavy feeling. When I go to work this week and do the usual overuse and repetitiveness we'll see how good it is. I'm on a 6 day kick of steroid pills too, if this eliminates all pain then I would guess I would be put on a medication to treat inflammation other than usual Motrin. If it fails then he's going back in. Diagnostic arthroscopy again- haven't had that in awhile. He said my shoulder misbehaves and is tricky. He's pretty sure I have mass scar tissue that needs to come out which is probably 80% of the pain. I'm sure he'll go fishing and take a looksy make sure everything else is remained intact and may fix on site. I will have to make that decision in 4 weeks. Oh and here's something new, I may get Botox!! I have costochondritis secondary to my shoulder being crappy. The inflammation in my pecks near sternum spasms 24-7. Apparently they can use botox to block muscle spasms for up to 3-6 months and it doesn't weaken cartilage like cortisone can. I need to do some more research on this, but am considering it- that is if my other doc can convince the insurance company its not for cosmetic purposes. Hope you had a nice time in Europe.....gosh I could use a vacation. Tgrtrnr
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 09/23/2008 10:59 PM

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leanne13304

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hi tgrtnr,I saw my OS today and had an injection around my biceps done. I have had some relief but I'm feeling pretty stiff right now. I am hoping that is just the immediate after effects of the shot. I will go back and see him in 6 weeks again but I had relief right after the shot so my OS is pretty convinced that my biceps tendon has scarred in the groove, causing it to tether when there is tension in my biceps. He said this ultimately means he's gonna have to go in again. I am not sure if this will be done arthroscopically or open, because he mentioned making an incision over the tendon and releasing it. i guess I will find out more in a few weeks. How have you been doing? Did you end up going for an MRI?CheersLeanne


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Leanne
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 08/27/2008 01:44 PM

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tgrtrnr

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Leanne, Best of luck with ultrasound and injection. I hope you do get some relief- and can avoid another surgery. I did not get any relief from my shot. Yeah on the outermost layer of muscle that gets inflamed, it helps, but those shots have always really aggravated my joint pain. I tried to be optimistic with it and went with my OS's advice to do this first, but I knew it wasn't going to help. So for now I just go about my days lifting heavy stuff as usual, and try to ignore the snap crackle pop and return of what reminds me of the partial dislocations. I use lots of ice, we have a TENS unit at the house, and eat the Motrin 800 to catch whatever relief I can get. Since I had no relief from this shot I have to get another MRI set up in the next few weeks so my OS can see what the heck is still going on in my joint, we will see how that goes and what I have to do next. Have fun in Europe, take care.Tgrtrnr
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 08/26/2008 11:00 PM

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leanne13304

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I saw the OS today, and I must say that i hate dealing with residents, they are horrible listeners. They came to the conclusion that I am definetly having some issues with my biceps tendon. We opted to try an ultrasound guided injection around the tendon to see if that relieves the biceps pain and if not, then we will discuss surgical treatment. I will be in europe for 3 weeks as of tomorrow and will do the injection when i get back and then go back to see the OS at the end of sept again. We'll see what happens with that. tgrtrnr, how have you been managing? has the cortisone helped at all? Hope all is well.Leanne


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Leanne
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 08/21/2008 05:02 PM

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tgrtrnr

Posts: 21

Leanne, The coracoid impingement I had read too is done open frequently, but I also have good OS he is all about arthroscope, my last surgery was nuts with all the tears and what not, and he did with out it being open. If you have a great OS I bet he does it with an arthroscope too-when or if that time comes just ask. The largest scar I mentioned is because they may have to move/release your bicep tendon out of the way to get to the repair...I would not consider that being open, but maybe some literature does.An MRI may be a good idea. I was a skeptic to them because my first two were crappy, and the old OS couldn't see squat. My new OS had me get a new one, with a doctor who's good at doing shoulder MRI and it turned out so clear. He was able to see possible rotator cuff tear, evidence of early Hill Sach's, the bicep tendon tear he discovered in the OR, and was looking for it because I told him how bad my bicep hurt for the past 4 months. And the mystery hole in the MRI he couldn't explain turned out to be the rotator cuff tear, which is the Interval.Yes I had clicking/popping before this. That was my first big sign/symptom of instability and my out of place shoulder blade. After the surgery its still there but improved. Loud snapping turned more into crepitus noises. Sometimes it relapses and is bad, other days my shoulder won't make a peep.As far as dissapointment goes, just be prepared for it, its hard to stay positive. Instablility as I understand is very difficult to manage. After getting the coracoid fixed I was pumped, excited, my muscular pain gone, no more nerve issues, I could now move my arm in new direction with out pain. I'm now at 8 months and have returned to job I love, but its manual, repetitive labor. I refuse to give up my career so I take a lot of pain.Unfortunately I still can not do anything with my shoulder/arm above my chest with out awful pain, but I have good strength. I have that range of motion to have my arm up that high, just hurts like crazy to use it that way. I have something new to tackle. And my OS is a little concerned, at 8 months post-op I should be somewhat pain free, but unfortunately working and using the arm is recurring the pops, snaps, and increasing the pain. Further more its an issue of controlling inflammation. I had a cortisone shot today if I don't have any significant improvement in 2 weeks then I will get a new MRI done to see how everything is looking (hopefully I wont need number 5 soon, but we'll see). I would say this if you come all this way, and had that many surgeries, whats one more. That was my attitude. Unfortunately that could be my motto again. I think if I say no after having 4, the shoulder would just crumble with out maintenece, or I'd be really aggravated 24-7 b/c of it, and of course I take into consideration the OS opinions too. Nice to compare notes and know your not the only person with something so annoying to deal with. Keep me posted on your appt and how things go.
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 08/21/2008 04:11 PM

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leanne13304

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tgrtnr,Thanks for the response. I am not worried about the scar, even though I already have 6 on my left shoulder from all the arthroscopies. I was just reading up on coracoid impingement and it said they are pretty much only done open, and i would like to avoid open surgery as much as possible considering it's a lot more trauma to the joint. I do know that right now, this is very debilitating, but I am just worried I will go through another surgery and end up disappointed again like I have with the past 3. But, I think it's inevitable that I have to try something to get rid of this pain. I also have not had any MRI/CT scans of the shoulder and have no idea if I have any tears in the rotator cuff from all of this impingement. When you had your rotator cuff repaired, which tendon was it? was it a supraspinatus tear? Also, did you ever have clicking in the joint before you had the coracoid decompressed? I figure even if I don't get all the range back, I can live with it somehow, but as long as the pain is associated with it, I want it fixed, because I've got a lot of years ahead of me with this shoulder.I do have a good surgeon though who specializes with the shoulder. He is one of the top orthos in the country and he has been great to try and keep me positive through this all and actually takes the time to listen to everything i have to say regardless of how long he has to spend in the office with me. which definetly helps through this whole process. I hope all went well with the OS today and let me know how it went. I appreciate all the help from you thus far, you are the first person i have talked to who had such a similar situation.Leanne


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Leanne
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 08/20/2008 10:45 PM

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tgrtrnr

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Leanne,My coracoid impingement surgery was done arthroscopically. If you are worried about a scar, I have one about the size of a nickel at the top of my bicep. It was a lot less painful than the plication by the way, considering I had 4 things repaired in one sitting. I had to have the surgery because my motion and pain was so debilitated in certain ways. If I would not have said no to it I would be in terrible shape right now, and I had questionable ROM at the time. After having it I am happy to say that I can move my across my chest, one motion I have been given back and it really rid my muscular pain by 90%. The only downfall is its just more trauma to add near your joint, and thats what I am stuck with, and semi decent working joint. After completing PT I can lift like 50-70 pounds easily, but as I mentioned before I can not lift squat above my chest and its difficult for me to apply force with the arm as opposed to strength to lift. You may win some, or loose some, risk you take with any surgery. If I learn something new tomorrow at the OS I'll let you know-they seem to have some interesting fact every time I go.I would think long and hard about what you really want to gain, and what you could possibly be giving up. If your lucky everything will be great and you won't have any complications. Also I scouted out a certified shoulder specialist to do this, as opposed to a general orthopedic surgeon. I was told it can be a touchy operation so I wanted somebody who had done it successfully with people doing it to me. Good luck.
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 08/20/2008 06:43 PM

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leanne13304

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Michael, I think I have been doing a stretch similar to that. My PT gave me a stretch after my last surgery that involved lying on the unaffected side, with my affected arm behind my back with the palm facing out and a 5 lbs weight strapped around my wrist. I would hold it there for 5 mins, take a break and do it again for a total of 20 mins of stretching at a time. I have done this twice daily since then. I have been doing this stretch since last november. It causes excruciating pain going down my arm and my internal range has not improved. My physio did manage to get a little give back in my posterior capsule several months ago, but no more has come back since then.tgrtnr-when you had the surgery for coracoid impingement, was it arthroscopic or open surgery? Do you find that it was worth having the surgery done? I go back to my surgeon next tues and have to decide what I want to do then. I do know that I am unbelievably frustrated with being in pain all the time. I'm only 23 and am worried that if I just leave it the way it is, I'll really be paying for it down the road. The pain is worse with overhead motion, but I have kept away from that to try not to make it worse. It is still bad with just below shoulder level movements. I also noticed it has been getting weaker over the past 2 months, even though I am still doing strengthening exercises daily. I started to notice it while driving, when I make right hand turns, I have to really put in a lot of effort to turn the wheel and I get pain in my shoulder, sometimes it clicks while doing this and then aches even more. It just seems things keep going downhill and I am getting new symptoms. I really hope I haven't torn my rotator cuff or labrum.


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Leanne
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 08/20/2008 02:47 PM

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Michael14668

Posts: 457

Tgrtrnr - you are headed down the path of a replacement when you get older. When you have these type of complications from instability, you will most likely develop GH Arthritis, I'm tracking about 10-15 years ahead of you, but I do not have a labor intensive job.
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 08/20/2008 02:00 PM

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tgrtrnr

Posts: 21

To answer the first sort of questions, my rotator cuff was torn, not bad but repaired. The bicep tendon did have a tear as well and was also repaired. The exact dates of surgery are personal to me, even though this a forum, but the manipulation followed the cap plication 4 months later. 6 months later I had the SAD done. Then 6 months later I had the biggie fixing the impingement and tears. I will say this- my muscle tone heals very well and I get strong quick with PT. But the joint pain is terrible. Leanne, That is odd we have the same sort of thing. It appears I'm one surgery ahead of you. I will tell you this about coracoid impingement- if you decide to do the surgery repair there may be a plus and minus for you. The good thing is you will be able to easily put your arm across the chest and it may rid muscular pain if you have that going on. The recovery is quick, which is good too. But after having this done, my joint pain is of different sorts. It went from dull and achy, how it always has been, to sharp and stabby, and I feel more unstable with overhead activities (if you have to do that sort of work). Remember they are shaving away bone that you can't have back. I don't think its as expendable as doctors perceive it to be.Oh and the pain that runs down your arm should go away as well. I had that, and they tried to diagnose me as having RSD. I found out this was not the case, the impingement can aggravate the muscles so much they constantly spasm and can even irritate the nerves. I still have a click and pop when my arm is certain positions, it has not yet gone away nor do I think it will. Your internal rotation may not be normal again either. I left PT and they stated my internal rotation sucked- it does, so does my external rotation. It is something I have to live with for now- and I do my exercises and stretches religiously but theres a point I just can't pass to improve.Good Luck.
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 08/20/2008 06:27 AM

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Michael14668

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I want you to try this stretch over a long period of time to tell me if it helps you...Lay down flat on your back. Put your stiff arm in the middle (almost as high up as you can) of your back (with your palm down on the floor). Then rotate your hips and body weight towards your shoulder that is stiff. Hold it for 10 seconds, repeat 3 times. (You will feel a little pain after this, because I can almost guarantee you are not stretching this muscle like this).This will stretch your subscapularis and posterior capsule, which should help over time with the internal rotation problems and stiffness. No one ever showed me this, after my many surgeries and similar problems that you've had I've found this to be what has eleviated my pain, but it took about 1 year following my last surgery.Good luck.
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 08/19/2008 10:47 PM

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leanne13304

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WOW! Does your situation ever sound so close to mine!!! I am 23 years old and first had my right (dominant) shoulder fixed for instability with a capsular plication. The surgery was a success and just over a year later (jan 05) had a capsular plication done on my left shoulder. My left was very loose, actually had a few dislocations and a hill sachs lesion that didn't need to be fixed.I had troubles from the start regaining range of motion and developed severe pain with overhead activities, internal rotation and abduction. Especially bringing my arm across my chest. A year after the first surgery (jan 06) I had surgery to remove scar tissue between my rotator cuff and deltoid and also had a manipulation done at the same time. We thought that would fix everything, but the pain remained and the range still never came back. In Sept '07 I went in for surgery again for impingement syndrome. They did a SAD and bursectomy. During the surgery they tested for instability again but was negative. However, although I was getting impingement pain down my arm into my biceps, subacromial impingement was not noted during the diagnostic arthroscopy. They did the SAD/bursectomy anyways to make more room. Since the last surgery, I still get the same impingement pain down the arm and especially during movements across my body and internal rotation are the worst. I have had an ultrasound which was negative for impingement. My physio is pretty convinced I have coracoid impingement and possibly posterior superior impingement between the glenoid/labrum/cuff. I have a stiff posterior capsule and severely lacking internal rotation, which she says is the giveaway. I go back to see the OS next tuesday aug 26 to make a decision as to how to further treat this. Is it possible I will be headed for surgery to fix coracoid or posterior impingement? I have also developed a consistent click in my shoulder (mostly coming out of internal rotation which is felt deep in the joint, which was noticed first on my own followed by my physio while she was mobilizing). I am amazed at how similar our situation sounds, especially since we are both in our 20s.Leanne


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Leanne
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 08/18/2008 06:41 PM

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Michael14668

Posts: 457

Without having an idea of when your surgeries were (each one) and how detailed that last one was, I can only guess at some things. Did they fix your cuff tears or debride them? When you say fix your bicep tendon, did you have a superior labral tear or a tenodesis done?All of these things change your time to heal and how long it will take. But with true MDI, if you are throwing a ball, playing tennis, or lifting weights (bench press, military press, behind the head lat pull downs), you'll eventually ruin you repair.
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 08/13/2008 11:11 AM

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tgrtrnr

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All of my surgeries have taken place in just under 2 years. Simply put one thing is crumby so they fix it, then find something else. I have had 3 MRI's. I think I go to OS and the table almost as frequent as the dentist. First and I was told the only surgery I would need is, capsular plication. That went ok, but I developed frozen shoulder, so I had to be manipulated. After this I still had bad pain putting my arm across my chest. So I had a SAD and bone spurs removed. This helped too except I still had the pain of the arm across my chest. My old OS discussed a coracoid impingement but refused to do it because of my age( in my 20's). I got my self a true shoulder OS specialist and found out I had to have the coracoid impingement fixed. So that was done, but they also found rotator cuff tears, along with my bicep tendon that had to be fixed, and shaped up my AC joint from the previous surgery. I think that's all, so much has been fixed it's hard to keep track of it all.
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 08/13/2008 06:37 AM

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Michael14668

Posts: 457

Please list all surgeries you have had on your shoulder and approx month and date of each.
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 08/12/2008 09:28 PM

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tgrtrnr

Posts: 21

To make a long story short......I was originally diagnosed with MDI. Whether I acquired this from untreated sport activities or if it came from wear and tear of physical job who knows. I have had multiple surgeries and have had everything done to my shoulder just about except a replacement. Unfortunately I still have a lot of pain in the joint on the job with overhead activity and and sleep. I can not even throw a tennis ball for example, its quite pathetic, I have no extension or force with the throw what so ever. I also have lost some range of motion from all this. I know it can take up to 8-12 months, I almost there, for total healing, but I'm curious if there is some unfortunate "snowball effect" of bad things that will only get worse with this problem. Has anyone had one simple surgery as they tell you the first time, but then found yourself stuck in a whirl of problems elsewhere in the shoulder because of instability?
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