Shoulder

I’ve had my pre-op physical and got my COVID test, which was negative. I spoke to the nurse about pre-op instructions and to the all-important finance department! So I’m ready to go for surgery! While I’m waiting for surgery this coming Monday, I’ve been doing some things to keep myself moving within the limits that the damage to my shoulder will allow. There’s almost always something you can do, even when you are limited!  Here are some of the things I’ve been working on:

1. Upper trapezius stretch- My neck gets tight from being in the sling and muscle guarding, which is when muscles near an injured area tighten protectively. This upper trap stretch helps.

2. Levator scapulae stretch- Same idea as the upper trap stretch but for the levator scapulae, which is more towards the back of the neck.

3. Backward shoulder rolls- Rolling the shoulders in backward circles helps with keeping the chest open, the scapulas (shoulder blades) mobile and the muscles around them working.

4. Shoulder isometrics- These can help prevent atrophy of the muscles from disuse. I’m also hoping this might help my axillary nerve, which was damaged by the dislocation, start to recover its communication with my deltoid muscle.

5. Shoulder passive range of motion- I’m using my left hand to support the right arm and gently raise it to about 90 degrees which is a relatively painfree, safe range of motion for me right now.

6. Supine alternating leg extension- I’m trying to keep my core strong using my legs for some dead bug exercises with the sling on to support my shoulder.

7. Pilates Arc stretch and roll up/roll down- This is my Pilates Arc, which I love. Sometimes I just lie back on it like this to stretch out my back, sometimes I do roll-ups from the position for some for core work.

8. Wrist and forearm range of motion- I’m moving my wrist and hand around in all directions so that it doesn’t get too stiff or atrophy from being in the sling.

9. Elbow range of motion/nerve glide- I’ve been doing this to try to keep my elbow from getting too stiff from being in the sling all the time.

10. Scapular retraction- I’m leaning forward letting my arm hang and pulling my scapula back and then relaxing it to let it go back to the starto try to keep my scapular stabilizing muscles from atrophying.

11. Pendulums- This is an exercise to gently move the shoulder joint in a painfree and passive way.

12. Stepper- I got this mini-stepper to try out before this injury happened and I’m so glad I did! It actually works really well for cardio and you can get a good burn going in your quads and glutes as well. I’ve been using this for short bouts a few times a day to try to keep up my cardio and leg strength.

I saw the orthopedic today and based on the MRI he and I agreed that without surgery this shoulder is all but guaranteed to dislocate again so we are going ahead with surgery. He said the joint capsule (the usually dense, fibrous connective tissue that forms a sleeve around the joint and encloses the joint space) is so stretched out “it looks like you could drive a truck through it.” He said he would normally schedule it for this Wednesday but due to the pandemic I have to have a negative COVID test five days prior to surgery. So I’ll have a COVID test tomorrow and surgery on Monday, Feb 1. I also have to have a history and physical from my primary care physician.

The surgery entails a Bankart repair – suturing or anchoring the labrum back to the glenoid (socket) where it belongs, capsulorrhaphy – tightening the joint capsule with sutures, and remplissage – anchoring the infraspinatus muscle and posterior joint capsule into the Hill-Sachs lesion (compression fracture dent in the head of my humerus) to fill it in. It’s a lot of work to do but it will all be done via arthroscopy or “scope.” He actually said he can see the joint better from all sides using this way than he could with an open procedure. I’m relieved by this because it means less muscle damage and less scarring.

After surgery I expect to be in quite a bit of pain for the first week or so. I will have to be in a sling for 4-6 weeks to protect all of these repairs and plan to take at least 2 weeks off seeing patients at all and then limit my schedule to those needing minimal or no manual therapy for at least 4 more weeks after that. It will be 3 months to get back to somewhat normal day-to-day function and then up to a year for full recovery. But my shoulder will be much more stable forever and very unlikely to ever dislocate again. So it will all be worth it.

Since the blog has mostly been academic so far with descriptions of the injury and anatomy, some folks have been asking how I’m feeling about all this. I’m mostly very sad about it. Sad about the damage and about being sidelined from seeing patients and all of the other things I love to do. And I’m anxious about the surgery because, while I’ve never had shoulder surgery before, I’ve treated many patients after shoulder surgery and I know how painful it is. But I’m also looking forward to having a much better shoulder that doesn’t feel unstable anymore. It’s just going to be a long road to get there.

I’m also having flashbacks about the actual incident–the trip, fall, and feeling of it dislocating. I can barely stand even to see other people running. And I’m never planning on running outside again! I didn’t like running to begin with!

And finally, I’m feeling frustrated and annoyed that this is all happening during the pandemic and the ways that complicates matters. It’s difficult to figure out how to accept badly needed help because we aren’t having anyone in our house outside of our little nuclear family. I should be getting my second dose of the Moderna vaccine on Feb 6, which will not be fun if I’m dealing with post-op pain AND get the side effects of muscle pain, fatigue, fever and chills that some people seem to have with their second dose. And I’m trying to figure out who I will see for PT after surgery. I want to find someone who is being as cautious about COVID as I am, which is a tall order.

Stay tuned for more!