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Acupuncture

March 3, 2021 By Mindy Nagel, PT, DPT, OCS

Experiencing a Catastrophic Shoulder Injury from a Physical Therapist’s Perspective, Part 12 — The long, slow work of recovery

I haven’t updated the blog in a while for the simple reason that I just didn’t feel like I had anything very interesting to share. It’s been almost 7 weeks since I dislocated my shoulder and a little over 4 weeks since the surgery to repair my shoulder labrum and fill in the Hill-Sachs lesion (aka the dent left in my humerus from it being smashed into my scapula). I’ve been going to PT once a week and doing my PT exercises religiously (maybe manicly?) 3 times a day. The exercises are still mostly focused on restoring range of motion with a couple thrown in for preventing my shoulder muscles from completely atrophying. I’ll post my exercise program for you further down. I’ve met my range of motion goals for week 4. I have 2 more weeks until I’m free of the sling. All is on track. Nothing exciting to report.

I started back to work seeing a few patients and Pilates clients this week to try to ease back into normalcy. As I told a patient about not posting for a while because there’s nothing interesting to say he reminded me that the long, slow, unexciting pace of recovery is something that could actually be really important to post about. He was absolutely right! The chunks of time that seem to go on forever in between the big achievements and exciting realizations of recovery are where it gets hard. These lulls are where people tend to give up and stop doing their home exercises or drop out of physical therapy. But these are the times where perseverance is everything. You have to keep pushing on that long, slow uphill climb to get to the mountain tops where you can celebrate the bigger victories.

On the mental health front, unsurprisingly, I’ve also been pretty depressed the past couple weeks slogging through this process. Not being able to see patients/clients really brings me down. I’m thankful to be ramping my practice back up now. It’s not wasted on me how blessed I am that I have the type of job where I still get to see people face-to-face even in the midst of the pandemic.

On top of that I’m still not sleeping very well. I have to sleep in the sling and still can’t sleep lying in bed so I’m using a recliner.  My shoulder gets really achey and stiff and wakes me up at about 3 or 4 am. When you don’t sleep well everything seems worse. Studies show that your pain tolerance is actually lower when you aren’t getting enough sleep. What a cruel joke! You can’t sleep because you have pain, but you can’t tolerate the pain well because you can’t sleep.

Also, if we’re going to be real here, as I’ve been walking to and from my office like I usually did daily before this injury, I’ve realized that I have a fear of walking on the sidewalk. I have to keep my eyes down on it in case one of those evil sidewalk cracks tries to grab my foot again. I keep remembering the sidewalk flying up at me and the feeling of my shoulder coming out as my hand hit the ground. Sometimes I walk in the street just to avoid being on the sidewalk (only on the empty side streets of course). I’m hoping walking regularly to and from the office, just doing it anyway, will eventually help me get over that.

And now for your excited viewing pleasure I have some photos of my current home exercise program, which I do 3 times a day without fail.

Shoulder shrugs
Various versions of shoulder shrugs, shoulder rolls, and shoulder blade squeezes. The shrugs have actually been really hard for me even though they’re usually an exercise I would give someone to start on because they’re relatively easy and innocuous. To be honest, I don’t really know why they’re so hard. I’m thinking it has to do with reduced mobility at my acromioclavicular joint.

 

https://www.collegehillpilatespt.com/wp-content/uploads/2021/03/20210302_1032354721.mp4

Cervical retraction to help with alignment and to counteract the effects of wearing a sling all the time.

 

https://www.collegehillpilatespt.com/wp-content/uploads/2021/03/InShot_20210303_002024271.mp4

Wand shoulder internal and external rotation – I’m using the dowel to let my unaffected hand and arm push my surgical shoulder into internal and external rotation. The motion you see here is all I have right now, it doesn’t go any farther in or out even though I’m pushing on it. I might not ever get full range of motion back in these directions. Studies show most people in my position don’t. But that’s okay. Since I’m not trying to be a baseball pitcher or anything I will get enough motion to be functional.

 

Shoulder pulleys
Shoulder pulleys allow you to pull down with your unaffected arm to stretch the surgical arm up. I’m not really allowed to go any farther up than this at the moment. My motion has to be limited and progress slowly to preserve the stiffness of the joint that the surgeon created when he tightened up my joint capsule. That way I won’t end up back where I started with a hypermobile joint.

 

https://www.collegehillpilatespt.com/wp-content/uploads/2021/03/InShot_20210303_003343615.mp4

Bicep curls help keep my bicep from atrophying as much while I’m not using it as much as I would normally use it because my arm is in the sling. I’m using a 3 lb weight in this video. I’m thankful that there was no damage from the dislocation  to my bicep tendon as it comes up over my humerus. If there had been damage there I would have to avoid activation of my biceps so I wouldn’t be able to do this yet.

 

Rotator cuff isometrics
Rotator cuff isometrics are also to help avoid muscle atrophy. This time it’s atrophy of the rotator cuff muscles that perform shoulder external and internal rotation. My shoulder gets mad about the external rotation. I assume that’s because of the anchor through my infraspinatus muscle, which performs external rotation, into the Hill-Sachs lesion to fill it in.

In addition to all of this I’m also still using ice a few times a day and at night. I’m massaging the incisions with Mederma and using my microcurrent point stimulators, which are great at preventing and treating scar tissue, on them. I’m seeing my acupuncturist weekly, which helps a lot with pain control, anxiety, and I get my best night of sleep all week the day I see her. My rhomboids (muscles between my shoulder blade and spine) have been painful and tight so she did some cupping on them, which helped a lot. This brings me to my last point for today…

I’ve realized how lucky I am to personally know so many great health care providers. I knew a great orthopedic surgeon when I needed one, a great PT, a great acupuncturist… And I have great massage therapists and chiropractors and others that I know I can call on if (when) I’m ready and I need them. I can’t imagine going through all of this and not knowing who to see or not having that level of trust with my people. What a privilege it is for me to be the person that my patients and clients trust when they are in the midst of the long, slow climb to recovery.

 

Filed Under: Acupuncture, Hypermobility, Physical therapy, Shoulder, Shoulder injury, Shoulder rehab, Shoulder surgery

February 11, 2021 By Mindy Nagel, PT, DPT, OCS

Experiencing a Catastrophic Shoulder Injury from a Physical Therapist’s Perspective, Part 10 — Tips for daily life with one functional arm

First a status report! Things are progressing very, very frustratingly slowly. I’m still struggling with pain management. I’ve used up the Percocet that I was prescribed right after surgery. I could request a refill from the doctor but given that it was only marginally effective to begin with I’m switching to acetaminophen (Tylenol). I still have gabapentin and Flexeril, but again, I’m not sure how much those are doing for me other than making me sleepy so I’m only taking them at night.  I’m pretty much using the cold therapy machine, which circulates icy cold water through a pad I strap onto my shoulder, constantly except for when I’m doing my PT homework.

Speaking of PT homework, that’s also frustrating as my motion is extremely limited. To be clear, that’s what we want because the surgeon tightened up my shoulder joint capsule so that it will be stable when all is said and done. But at the moment I can only move it maybe 2 degrees into external rotation and even that tiny motion is very painful. I also can barely shrug my shoulders up toward my ears and even that simple motion is also very painful. So very frustrating! On the other hand I finally got back to acupuncture for the first time since surgery yesterday and actually got a full night of sleep last night for the first time in 2 weeks, so I’ll take that win!

Since I dislocated my shoulder on January 14th and continuing after surgery on February 1st I have had to keep my right arm supported in a sling. Even though it’s my shoulder that’s actually hurt using my right hand is challenging too. That’s because most of the things we use our hand for require stabilization and rotation from the shoulder to get the hand in the optimal position and at the best muscular advantage to complete the task. As my patients like to point out to me, I always say everything is connected. We joke that I should get that painted on my wall so I can just point to it all day. If your shoulder can’t work correctly neither can your hand. (This is also a great illustration of how if you have a hand, wrist, or elbow problem the underlying problem might be a lack of stability and strength at the shoulder!)

Some of the things that are difficult to do with one hand are things that, before this experience, I wouldn’t have even thought about how they’d be affected. In researching how to do things with one hand many of the resources I’ve found are for people who have had amputations or were born with congenital limb differences. These modifications generally use the residual limb to assist with the activity. In the case of an injury like mine you can’t really use the injured side to help at all. So for an injury like mine the modifications are necessarily different and temporary.

I’ve found some good tips and tricks that might come in handy for anyone who, like me, is temporarily unable to use one arm for daily activities due to an injury. Of course for me it’s my dominant hand, which just complicates matters even more!

Handwashing is always essential, but especially important during a global pandemic! It’s challenging with one hand because you can’t use the friction of rubbing your hands together to soap up all surfaces of your hands. What I’ve used to solve this problem is actually meant to be used on the floor of your shower to help you wash your feet. I have it suction cupped to the side of my sink. I get some soap from a pump dispenser in my left hand and then use this to lather up my functional hand.

Foot brush used for single-hand handwashing
I’m using this foot brush scrubber for single-hand handwashing.

Dental flossing with one hand is pretty much impossible as far as I can tell with traditional floss. I’ve been using these flossers to keep up what any dentist will tell you is an essential dental hygiene habit even though I can only use my left hand. I also recommend an electric toothbrush, especially if your functional arm is your non-dominant side. That way you can make sure you are still doing a good job of brushing even though you’re using your less coordinated hand.

Flossers for single-arm dental hygiene
These are the flossers I use to keep up with flossing with one hand.

Washing dishes is difficult with one hand mostly because you normally use one hand to hold the dish in place while you scrub with the other hand. In my case, my husband has been doing most of the dishwashing. We also have a dishwasher so things that can go in there I can just rinse and put in. But sometimes I just want to wash a dish myself or I want a pan or something that can’t go in the dishwasher and I don’t want to bug my husband to do it. After all, he needs to work since one of us needs to be earning money right now! So I got this nonslip mat for the bottom of the sink to hold the dish relatively still while I scrub it with my left hand. I’ve also seen suggestions to use a hammock-like netting across the sink so that the weight of the item being washed holds it still in the fabric hammock. I figure this nonslip mat will be more useful for us in the long run as we can keep using it even after my shoulder recovers. We also have a sprayer on our sink which I’ve found essential for directing higher pressure water where I want it for rinsing.

Non-stop sink mat for washing dishes.
This is the non-slip sink mat that I got for washing dishes.

Staying warm in the middle of winter while wearing a sling is a challenge. This one is admittedly more about wearing a sling than about having one arm to use. Because of the sling I can’t just slide my right arm into a coat. I also can’t really zip up a coat by myself since that’s another thing that you have to stabilize with one hand pulling down while you pull up with the other hand. Luckily ponchos are in style right now. I even saw a hooded, faux fur-lined poncho for sale. I didn’t get that one though as it was a little beyond the price I’m willing to invest.

Hooded poncho for staying warm
This is the hooded poncho I ordered to wear when I have to go out in the cold.

Also, someone gave me this awesome thing as a gift. The Comfy is basically a giant hoody made out of a fleece-lined velour blanket. I can put The Comfy on over my head and put my left arm through the sleeve and just let the right sleeve dangle empty while my right arm stays in the sling inside it. This thing is super warm, cozy, and big enough that it’s not hard to get it over the sling.

Me in The Comfy
This is me taking a selfie in The Comfy, which is basically a giant hoody made out of a fleece-lined velour blanket. So warm and cozy!

Typing on a computer has been difficult for me. This is something I wouldn’t have thought about before this injury. You would think if it’s just my shoulder affected that typing should be one of the few things that I can still do without any modification. But it’s actually difficult for me to get my right hand turned forward in the right direction to face the keyboard correctly. They do make keyboards that are separated into two pieces, one for each hand, so that you can have your hands in different orientations to the keys. But that’s not an investment I want to make since, as slow and frustrating as this recovery is going to be, it’s not a permanent situation. Also, even if I had the fancy separated keyboard it’s still difficult for me to pronate my right hand (turn it palm down) to type because again, any rotation at the forearm, wrist, and hand doesn’t exist in isolation from a corresponding rotation at the shoulder joint. Therefore, as tedious as it is, I’ve been using my phone to type and also using the voice-to-text feature whenever possible. The phone keyboard is small enough to be used with one hand or with two hands without any pronation of the right arm required.

Typing on my phone is easiest
Using my phone to type things like this or using the voice-to-text feature is much easier than trying to use a computer keyboard.

There are a lot of assistive devices out there to help with doing all kinds of activities of daily  living with one hand. Most of them are things I would only get if this was a more long-term or permanent situation or possibly if I lived alone and didn’t have a good support network of folks to help me. For example, just like with washing dishes, cooking is difficult because you would normally have one hand to stabilize the pot while you stir with the other hand. There are pot stabilizers you can get to help with that. There are also food prep boards you can get that have spikes to stabilize something while you chop it with one hand. Click here for a great resource from the UK’s NHS for all kinds of modifications to make activities of daily living easier to do with only one hand.

If you have questions or other ideas that are helpful for doing daily activities with one hand, send me a message or comment on the post on social media. You’ll find me on Facebook @chppt and on Instagram @collegehillppt.

 

Filed Under: Acupuncture, ADL Modifications, Hypermobility, Physical therapy, Shoulder, Shoulder injury, Shoulder surgery

January 28, 2021 By Mindy Nagel, PT, DPT, OCS

Experiencing a Catastrophic Shoulder Injury from a Physical Therapist’s Perspective, Part 6 — Acupuncture

Yesterday I shared my pre-op exercise routine. Today I want to share something else I’m doing for self-care and to hopefully put myself in the best possible position for recovery and healing. I’m lucky enough to share office space with an acupuncturist!

Pre-operative acupuncture can relieve pain, anxiety and stress as you prepare for surgery.¹,²,³ Not only that, pre-op acupuncture has actually been shown to decrease post-op pain, significantly decreasing the need for opioid pain medications after surgery, as well as decreasing post-op nausea and anxiety.⁴ Postoperative acupuncture has been shown to enhance recovery and alleviate postoperative pain and nausea.¹

So, of course, I’m taking advantage of the expertise of Amanda Wellman of Wellman Acupuncture. Yesterday’s treatment was the second I’ve had since my injury and after each treatment I was able to sleep through the night without being awakened by pain, which has not otherwise been the case.

I’m no acupuncture expert myself, but Amanda is great with educating her patients. She told me that these points are used to treat general pain, shoulder pain, tendon & ligament issues, stress, and to calm the brain.

 

Acupuncture

Acupuncture

Auricular Acupuncture
Auricular (ear) acupuncture

I’ll be following up with Amanda as soon as I can post-op to keep these recovery benefits going!

 


1. Yuan W, Wang Q. Perioperative acupuncture medicine: a novel concept instead of acupuncture anesthesia. Chin Med J 2019;00:00–00. doi: 10.1097/CM9.0000000000000123

2. Hyojeong Bae, Hyunsu Bae, Byung-Il Min, Seunghun Cho. Efficacy of Acupuncture in Reducing Preoperative Anxiety: A Meta-Analysis
September 2014Evidence-based Complementary and Alternative Medicine 2014(2):850367
DOI: 10.1155/2014/850367.

3. Wang, Shu-Ming MD, Peloquin, Carol MD,  Kain, Zeev N. MD. The Use of Auricular Acupuncture to Reduce Preoperative Anxiety.
Anesthesia & Analgesia: Nov 2001; Volume 93 – Issue 5 – p 1178-1180.
doi: 10.1097/00000539-200111000-00024

4. https://www.asahq.org/about-asa/newsroom/news-releases/2020/10/acupuncture-before-surgery-means-less-pain-significantly-fewer-opioids-for-veterans

Filed Under: Acupuncture, Hypermobility, Shoulder, Shoulder injury

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