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June 27, 2017  
SHOULDER NEWS: Real Life Recoveries

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  • Finally, A Stable Shoulder


    January 15, 2001

    -A Real-Life Recovery Story
    by Tom Keppeler, Shoulder1 Staff

    A beautiful August day in 1992 found Charles Blakeley bodysurfing amid monstrous waves in Cape Hatteras, North Carolina. As an annual vacation spot, Hatteras offered Blakeley plenty of body surfing, fishing, time with the family, and a much-needed respite away from his day job as a New York City public defender. A nice, safe, peaceful respite.

    Or so he thought.

    Blakeley stood in the water to take a break from an afternoon of boogey-boarding. As he caught his breath, waist-deep in the ocean surf, he failed to notice the man-eating wave bearing down on him. The wave grew as it approached, gaining speed, strength and size that threatened to swallow him whole. Just before the wave struck, Blakeley turned around to see the Juggernaut before him. He panicked, holding his boogey board like a shield to protect him from the wave. "I lifted up the board with my right hand as though I was somehow going to stop the wave," Blakeley laughs. "This was not the product of any thought on my part."

    The ocean gripped his board and pulled him under with ferocious strength. When he returned to the surface, Blakeley believed he emerged unscathed. Once he caught his breath, however, he took an inventory of his body. "At that moment, I noticed that my right arm was way longer than it used to be," Blakeley says. As a burning sensation set into the right shoulder, he began to worry, because he knew the nearest hospital was at least a half-hour's drive away. He cradled the hanging arm with his left, hoping to stabilize it before seeking medical assistance. Suddenly, the arm popped back into the socket. "I could wiggle and move everything, I wasn't in any pain, and so I never went to the emergency room," Blakeley says. "I took some ibuprofen and iced it, learned to fish a little with my left hand, and basically paid no attention to it."

    Blakeley dismissed the dislocation as a freak accident. He continued to think so for three more years. Blakeley, still active at 54, enlisted in a five-day "intense beginner's" course in whitewater rafting on Massachusetts' Deerfield River. On the fourth day of the course, Blakeley felt his kayak begin to tip. With his arm fully extended, Blakeley tried to brace against a rock to prevent the vessel from tipping—a position perfect for another dislocation. The technique kept his vessel afloat, but managed to pop his arm out of the socket. He floated to the shore and explained to the course instructors what had happened. As he moved to exit the kayak, however, his arm again popped into the socket. Blakeley decided to visit an orthopedic surgeon.

    The surgeon explained Blakeley's options to him. Blakeley's second dislocation increased the chance of another dislocation by a huge percentage. The doctor said that surgery was an option, but not a necessity. A little rest, followed by a regimen of strengthening the rotator cuff tendons, the surgeon explained, could tighten up the shoulder joint and make it less vulnerable to injury. Blakeley decided to forego the surgery. He strengthened his shoulder muscles and regained enough confidence in the joint's stability to retake the kayaking clinic. He made it through the course unscathed.

    Trouble was still brewing in Blakeley's shoulder, however. Considering himself completely rehabilitated, Blakeley jumped into a pick-up game of soccer in a neighborhood park. He quickly tired of so much running and volunteered himself to play goalie. A player on the opposing team tried to kick the ball into Blakeley's goal. He dove for it, and landed on the ground with his right arm around the ball. A surgeon later told him that there is no better position to force a dislocation. Blakeley's right arm again popped out of socket upon contact with the ground.

    Blakeley knew that his shoulder was deteriorating. "It would not go back in on its own, and it was really painful," he says. Blakeley took some advice he had heard before—when the arm won't pop back on its own, the advice said, lay down and let the arm swing forward and up. He did that, and, after a few painful moments, his right arm fell back into place.

    Blakeley soon visited Dr. Joseph Zuckerman at the Hospital for Joint Diseases in Manhattan. Now that he had dislocated his arm three times, the doctor explained, he had stretched his ligaments beyond the point that they will heal on their own. Subsequent dislocations would happen with even less force, Zuckerman said. Surgery would be Blakeley's best bet if he wanted to remain active.

    The surgery took place a few weeks later. During the procedure, the doctor made a long incision in Blakeley's armpit to gain access to the arm (and later leave him with a mostly hidden scar). The surgeon cut through part of Blakeley's deltoid muscle to get to the inner parts of his shoulder. While inside the joint, the doctor debrided the tissue that had become frayed by the three dislocations, and repaired the compression fracture in the top of his humerus, known as a Hill-Sachs defect. The surgeon then tucked the loose tendons of his shoulder capsule, and stitched them together to make a tighter, more stable shoulder. Blakeley was awake during the procedure, numbed by both a nerve block and a local anesthetic. Because Blakeley's face would compromise the sterility of the incision, he was not allowed to look at what the doctors were doing; instead, he listened to the doctor and his assistants as they performed the procedure.

    Blakeley stayed overnight at the hospital after the procedure. His doctors issued him the painkiller Vicadin, which he says he barely used. "I did not experience a lot of pain after the procedure," he says. "I think I had the Vicadin in the hospital that night, and they gave me a prescription for some more that I never used." Two days later, he was back to work.

    For a few weeks, Blakeley had to wear a sling strapped around his waist, which, he says, troubled him the most after the surgery. "For a couple of weeks, you can't really bathe that area very well," he says. "Once the incision was healed, at last, I could bathe again, but I found that my shoulder didn't really want to move." However, a battery of physical therapy exercises gave him both his range of motion and his strength back in a few months.

    Blakeley speaks enthusiastically of his shoulder recovery and says he is pleased with the results. "I'm really glad I did it, and it was all successful," he says. "I didn't mind doing the physical therapy—it actually felt good, especially the stretching part. You could just feel the progress." Two years later, Blakeley says he has nearly full range of motion in his shoulder and far fewer concerns about dislocating it.

    Blakeley hasn't been kayaking since, and tries to avoid monster waves, but, otherwise, little wind has left his sails. "I'm still very active, and I'm really happy I did the surgery," he says.

    Last updated: 15-Jan-01

       
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