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Shoulder Pain 7 wks post op
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Shoulder Pain 7 wks post op - June 11, 2008 2:20:43 PM
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Edagnan
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Joined: June 11, 2008
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I am an OT and hadd a bike accident. I landed on my shoulder and elbow. I had 2 RC tears, bone bruise, and SLAP tear. I had surgery 7 weeks ago - the surgeon ended up doing a debridement of the SLAP and 1 RC repair (the other tear was debrided). I am having a sharp pain with end range ER AROM and PROM. The location of the pain is posterior in the region of the infraspinatas. My motion is limited. After joint mobs/stretching and ultrasound, I have a painful end range of 75 deg for ER. AROM scaption with scapula stabilized in adduction and depression - 120 deg - sitting.
Any thoughts???
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RE: Shoulder Pain 7 wks post op - June 11, 2008 11:06:45 PM
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SJBird55
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The size and location of the tears are relevant. Bone bruises take a while to settle down. You still have one tear continuing to heal. If overall things are better, at this point in time, I wouldn't worry about the sharp pain at the end of motion - it would be expected. Don't push through it... just take your motion to the edge of the pain, things will generally continue to improve with time. You also don't mention your position during the PROM or AROM. Sometimes it also helps to remember the scapular biomechanics and think of not allowing the humeral head to basically move cranially during the motions so that you aren't impinging the tissues.
I'd probably save some cash and skip the ultrasound...
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RE: Shoulder Pain 7 wks post op - June 11, 2008 11:18:34 PM
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TexasOrtho
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I'd echo SJ's post. Seven weeks out isn't time to be worried and 75 degrees of ER is not bad (not GREAT) but not bad at all. Work on ST/GH control and not jamming on the joint with aggresive PROM as this can stir up inflammation and reinforce poor movement between the GH/ST.
Sounds like you are overall on the right track but remember the more work the doc does = longer recovery time for you. I bet in 1-2 months your shoulder will be doing well. Not that I'm into asking women this question, but you didn't mention your age?
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Shoulder Pain 7 wks post op - June 12, 2008 6:21:00 AM
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Sebastian Asselbergs
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Rod, buddy. You have detection systems much better than mine: where did you see that Edagnan is a woman? :-)
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Mundi vult decipi
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RE: Shoulder Pain 7 wks post op - June 12, 2008 10:08:23 AM
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TexasOrtho
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Bas you are hilarious...didn't even notice that. Must have subconsciously been playing the odds. All I said was "I'm not into asking women this...". Like how I crawdad out of this one? (nb "crawdad" is a gulf coast term for walking backwards back into your hole)
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Shoulder Pain 7 wks post op - June 12, 2008 10:39:27 AM
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jesspt
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From: Illinois
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I don't think I'd be overly worried about any of the symptoms you describe, unless AROM and PROM seemed to be decreasing and pain seemed to be increasing. From personal experience, some of my patients with rotator cuff tear repairs just seems to come around a little more slowly than others.
_____________________________
Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy
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RE: Shoulder Pain 7 wks post op - June 12, 2008 11:02:10 AM
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Tom Reeves DPT ATC
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When they do those surgeries, they remove the bursa so they can see what they are doing. You need that to reduce/manage friction. It is my understanding that it takes 6-8 weeks to reconstitute itself. Plus what SJ said.
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RE: Shoulder Pain 7 wks post op - June 12, 2008 12:20:40 PM
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Edagnan
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I am a woman - 30 years old. I posted this in a hurry and forgot to mention some things -> my hand has been going numb (ulnar distribution) and I have deltoid and scapular weakness. When I had the accident, I landed on my shoulder and head. I tested my grip strength and it is 30# on the bad side - 70# on the good. My hand goes numb approx 4 times a day. Do you think some of the shoulder weakness/pain could be neck related?
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RE: Shoulder Pain 7 wks post op - June 12, 2008 12:21:59 PM
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Edagnan
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he made a good guess!!
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RE: Shoulder Pain 7 wks post op - June 12, 2008 1:52:29 PM
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TexasOrtho
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The ulnar paresthesias would need investigating. As you well know, there are multiple possible sites for entrapment of this nerve from neck on down. The weakness you mention is significant BUT is this inhibited by pain or straight weakness? If by pain I might chalk it up to the fact your shoulder rehab isn't complete. However if this is weakness in the absense of pain I might be more curious as to what's causing it. It'd be tough to say...are you rehabing yourself or do you have someone working on you?
Even if you are pretty sharp (and I'm sure you are!) I might suggest an independent eye on your case. Preferably a CHT or OCS. Either way good luck!
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Shoulder Pain 7 wks post op - June 12, 2008 3:48:20 PM
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Edagnan
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I am having a PTA treat me. A PRN PT came in yesterday and looked at my shoulder. She said that something wasn't right. We decided to post on this website because it has helped us in the past with questions. The shoulder surgeon initially told me I would be back to normal in 6 weeks at the most. He was not happy with the slow progress after 4 weeks. I got a steroid injection which initially helped, but the pain came back after 5-6 days. He was also not concerned about the numbness - he said if it continues to get a nerve conduction test.
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RE: Shoulder Pain 7 wks post op - June 12, 2008 8:42:44 PM
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SJBird55
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When it comes to weakness and neurological symptoms, I look to the c-spine and the t-spine. Maybe you ought to have a PT assess those areas also. I, personally, wouldn't be confident in the skill level of a PTA (but that is just me and my opinion). You might have what I refer to patients as a double whammy. Your main initial problem after the incident was shoulder symptoms. It seems as though with definite injuries with definite mechanisms of injury that the body doesn't concurrently process every injury simultaneously. I can't cite any literature with that, but seems to be common after say automobile accidents (with people that aren't playing games to increase financial return for their "pain and suffering"). The surgeon addressed the obvious shoulder injury, but at the same time you may have also had some type of cervical or brachial plexus injury due to the mechanism of injury. Again, nothing yet to really fear because you have no baseline data at this point to know that your current situation is truly getting worse. With regard to the weakness, you need to look at normative data for your age group, gender and for dominant versus non-dominant extremity. There would be a component of disuse atrophy because of potential post operative protocol. As you move forward and the PT assesses and collects data and assesses your condition over time, then you'll know more. You can't worry at this point because nothing has been done to target or address your neurological complaints. The neurological complaints could indirectly also be contributing to your pain complaints. And of course a surgeon would expect quick recovery - surgeons view patients with a very narrow focus and really don't piece together the various variables that impact outcomes. That is okay - that's why there are physical therapists to consider the bigger, broader picture.
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RE: Shoulder Pain 7 wks post op - June 13, 2008 2:10:06 AM
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bonez
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There certainly could be a cervical compoenent(C5-6) to your problem but consider an injury to the suprascapular nerve too. The upward force on your humerus could creat the right forces to traction the nerve in the notch.
Is there significant supraspinatus/infraspinatus atrophy? this nerve is common to the c5-6 branches of brachial plexus that serve the shoulder complicating the Dx.
Have you assessed your initial complaint of end range limitation of ex rotation with gentle external stability (from the front)to keep the humerus seated on the glenoid and not allow it to creep forward thereby impinging posteriorly? Relief of pain/improved ROM for me would suggest as others have posted that your rehab is incomplete. No change would suggest that other issues may overlay.
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RE: Shoulder Pain 7 wks post op - June 14, 2008 12:33:51 PM
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Edagnan
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I had the PT assess my end range limitation of ex rotation with gentle external stability to keep the humerus seated on the glenoid. I got approx 5 more degrees and had the same sharp pain. The PT also addressed the C-spine and my symptoms were consistent with a disc bulge. I started the appropriate neck exercises. He also did some impingement tests and those were also positive. I am starting to note some supraspinatus atrophy as well. Should I see about getting a neck MRI and nerve conduction test?? Thanks for all the feedback!
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RE: Shoulder Pain 7 wks post op - June 14, 2008 3:10:29 PM
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SJBird55
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What is your function like? What is your pain like on average (you know like when you are not doing your exercise program)? What's your lowest pain level and your highest pain level? 4 times a day of numbness in my opinion is quite minimal... the folks I worry about are the ones that can't find a comfortable position, have continual non-relenting pain that doesn't respond to anything, have increasing weakness, aren't sleeping... you don't sound like you'd fall into a category where I would be worried. You're inconvenienced and you aren't at your pre-injury level of being. When you become injured, you're going to be inconvenienced.
What do you want to achieve with an MRI? You haven't even given conservative care for any type of cervical problem time to provide any indication as to whether conservative care will be helpful for you! You are falling into the same trap of most patients... first if you are having supraspinatous atrophy, I'm very sure that if it were due to a brachial plexus injury you're not going to find literature to substantiate that any surgical intervention will be highly beneficial for you. The atrophy could also be due to a) surgery and b) the non-repaired tear. IF you had a cyst sitting in that area, sure, surgery would help. Did you happen to have a potential disc problem in your neck prior to the incident and now it is just stirred up? You have no idea - the MRI isn't going to tell you when the problem began.
Your best option, when no red flags are present, is to 1) focus on the positive, you are young and it should resolve 2) attempt conservative care that is based on evidence 3) graded exposure back to activity. If I were you I'd demand only PT treatment - you potentially have a double whammy - PTA's are not trained in assessing.
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RE: Shoulder Pain 7 wks post op - June 14, 2008 5:01:59 PM
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jlharris
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From: Nebraska
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I agree with SJ. An MRI, at this point, is very unlikely going to provide you with much info for your time and money (although many an MD will allow it to singularily Dx your problem). I've had many pt's with supraspinatus atrophy s/p RCR. This is from dissuse and the surgery.
Throw in that 6 weeks is just enough time for you tissue healing s/p and NOT enough time to regain normal function, you are likely jumping the gun wanting an MRI. It's all about progress. If you are consistently making it (and expect to slip back once or twice), you shouldn't worry.
And see a PT. You've moved past simple post op care and into a more complicated care that needs FREQUENT assessment and re-assesment which PTA's are not trained to do.
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Jason L. Harris, PT, DPT
My PT Blog
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RE: Shoulder Pain 7 wks post op - June 15, 2008 12:28:47 AM
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Edagnan
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I definately want conservative treatment. I am just frustrated with the pain and the whole situation. I had to watch the Ironman 70.3 I was training for from the sideline. I am just anxious to get back to normal. I have only slept through a handful of nights since the accident due to pain.
We have 1 PT and 3 PTA's in our outpatient. I am the OT in outpatient seeing lymphedema and nuero. I feel like I am getting the shaft on the treatment because I work with all these guys. They have to sqeeze me in at lunch and I end up getting treatment time cut off. I guess they thought I would be an easy one to rehab given my age and athleticism.
My function: Working one handed (all lymphedema pt's on hold) - by the time I get home my shoulder pain is a 7/8; resting pain is 4/10. If I try to use my arm to do simple things such as fold clothes, my shoulder hurts the entire next day. I don't think I have a low pain tolerance given I trained 4-5 hours a day for the last 2 years.
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RE: Shoulder Pain 7 wks post op - June 15, 2008 2:57:29 AM
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SJBird55
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If the therapist in your department are just "working" you in... screw them. That's not appropriate care - you are a customer. You need to go to a therapist where you matter! If you want to get back to the athletic activities, your best bet is to get the care you require. Doesn't sound to me as though that is happening. Maybe you need to back off in certain activities you are doing at work? I don't know. I do know, with your last post, the therapist working with you is just going through the motions. Get out of the system and get an unbiased physical therapist that will focus on you and what you need and your goals. AND, I wouldn't feel one bit guilty about it either - it's your shoulder and it's your life that is being affected. If you think you're getting the shaft, you're getting the shaft.
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RE: Shoulder Pain 7 wks post op - June 19, 2008 5:19:18 PM
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Edagnan
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I went the doctor today. He said that I have adhesive capsulitis. He was not concerned with the numbness. He looked at the scope pictures and said - nothing is wrong with you shoulder. He also asked if I had a lawsuit pending - which pissed me off a little - the answer is NO. He did not address any other symptoms. He said that did have scapular winging. I am going to a new PT clinic Monday morning. He also thinks I am getting the shaft at my clinic. I guess I will wait and see if the PT looks at the bigger picture next week. I told the MD that my shoulder felt better before surgery. I got prescribed a dose pack for the inflammation.
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