cutterpose
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Joined: February 22, 2007
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I am looking for info regarding the optimal post-surgical PT following a distal clavicular resection that was performed open, rather than arthroscopically. My situation is complicated in that I am wheelchair-bound due to a spinal cord injury that occured years ago. The lesion was incomplete, and I've been able to stand and walk with a walker quite easily. Prior to the clavicular resection, I was able to live independently, work as a researcher, and maintain an at-home PT regimen as well as aquatherapy at least once a week.
Due to an auto accident several years ago, I suffered a type 1 shoulder separation that was excruciatingly painful and refractory to 8 months of conservative therapy. The orthopedic surgeon with whom I consulted said she was confident that surgery would restore my shoulder to 99% of it's capacity. Obviously, because I use a wheelchair, I must use both arms a great deal. In planning for the surgery and recovery, I made certain to emphasize and demonstrate to both the surgeon and her PA how much and in what ways I used my arms for transfers, standing, pushing the chair, etc.
The clavicular resection was performed and revealed an unstable distal clavicle and very small rotator cuff tear. No labral tears or any other problems were found. The surgeon had intended to perform the procedure arthroscopically, but had to do it via the deltoid because, she said, I'm a petite female and she simply didn't have enough room in the joint to work arthroscopically. After the surgery, she warned me to be very careful of straining the shoulder for 2 weeks, to prevent damage to the raphe. I used a transfer board for any necessary transfers (bathroom) and remained homebound. At two weeks she said I was healing nicely, and an occupational therapist started me on resistive exercises. I asked the surgeon several times what activities I should avoid, and her response was to use the shoulder as much as possible until it became too painful. I followed the PT regimen assidously, and was told I'd done a great job rehabbing the shoulder. It's mobility and strength were quite good; although the pain was still intolerable and I was put on a pain control regimen. About threee months after surgery the surgeon gave me the OK to resume driving and ADL's, and said we were done. I attempted to do so, only to find that the shoulder was still excruciatingly painful, and that this pain was hugely exacerbated by transferring,and ADL's such as trying to grocery shop, and return to work. About 6 months after the surgery, the pain was still intolerable, I was generally housebound, and profoundly depressed. I returned to the ortho group and explained the problems to the PA, who said that I must avoid any weight-bearing for another 6 months on the shoulder or it would not heal. His attitude was less than compassionate; he made a comment to the effect that 'well, you'll eventually develop a RCT on the right shoulder, so?"
I would add here that I adhered strictly to all the PT protocols I was instructed to do, and although I used the shoulder as advised I never tried anything ridiculous like lifting heavy objects, etc.
I eventually contacted the PT who had rehabbed me through the SCI. His advice was to rest the shoulder as completely as possible for several months, as he felt that the deltoid had never had a chance to heal properly and that with every painful strain on the shoulder I was simply reinjuring the deltoid. It is almost 2 years since the surgery, I'm homebound, the PT regimen that helped keep me healthy and active despite the SCI is not doable, and I'm being very careful not to strain the shoulder, which seems to help because finally it's less painful.
I would greatly appreciate any insight from those familiar with rehabbing shoulders post open acromioplasty. Were resistive exercises started too early?
In other posts on this board I have seen discussions regarding the quality of care received by athletes compared to the average patient. I have received the impression from some of my caregivers that because I have a pre-existing severe disability, being more disabled is not a particular concern. This situation has prevented me from resuming ADL's and getting back to work in my chosen profession of cancer immunology research. It took a great deal of hard work and determination on my part to earn my degrees, despite my SCI. I am totally perplexed why a relatively common surgery that I've read generally yields good to excellent results has so far basically ruined my life.
Any insight and or advice would be greatly appreciated.
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Therapy after Open Distal Clavicular Resection - 
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