Shoulder Arthroscopy Cannot regain external ROM post latarjet AND debridement surgery.

johnnyhustle41

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Hey so I got latarjet surgery in october of 2020, 3 months later I fell off of a hammock right on to my shoulder and fractured it.. causing it to be in a sling for 2-3 weeks. After that I tried for basically a year to regain ROM externally (specifically when my arm is to my side) & it was simply stuck. The surgeon recommended I get a debridement surgery (basically when they go in and cut out all the scar tissue and get me to full range of motion while I am under) I did this January 17th of 2022. 4 months later and I am still stuck :( This is ruining my life so much, I am constantly in pain due to this. I meticulously have been doing PT 3 days a week and do all the stretches im told but nothing is opening it up. People can stretch me to close to functional range but the second they stop it clams back up. A deep tissue massage therapist told me it doesn't feel like the problem is from soft tissue but more so thicker tissue causing it to act this way. If anyone has ever gone through this please let me know what helped you get it opened up. I'm considering dynasplint as it seems that can train my muscles to lengthen again.
 
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Jaycey

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@johnnyhustle41 Welcome to BoneSmart!

What does your surgeon say about this lack of ROM? This recovery can take one year or longer. And you basically started all over again after your surgeon and manipulation. Four months is still early days.

I'm going to tag a couple of my colleagues who have had shoulder surgery and see if they have any suggestions. @djklaugh @SaraK
 

djklaugh

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@johnnyhustle41 I am sorry you are having such problems with your shoulder! I'm no medical expert and have had two regular shoulder replacements so I am not familiar with the procedure you went through. From the little I read the latar jet surgery is to repair muscle and/or tendon damage rather than repair the bones of the shoulder.

I agree with Jaycey ... get back with your surgeon and ask if it is possible that you have some nerve damage - or further soft tissue damage - to the shoulder. You mentioned that others can raise your arm and get reasonable ROM but you can not do that your self which suggests to me that this might indeed be a nerve problem.
 

SaraK

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@johnnyhustle41 - I've had a rotator cuff surgery so I'm not familiar with the procedure you had. I agree that it would be best to talk to the surgeon and see whether the surgeon thinks that this is normal or whether additional intervention is necessary. I will say that it took some time after my rotator cuff surgery to be able to get certain muscles to move on command. It was a progression from one movement to the next.

Djklaugh mentioned the possibility of a nerve issue. That could be a possibility as it could prevent your muscles from getting the signal to move. I'd also ask about the possibility of a tendon rupture - that could prevent the muscle from moving as well. Something is impeding active range of motion.

Good luck!
 
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johnnyhustle41

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@johnnyhustle41 - I've had a rotator cuff surgery so I'm not familiar with the procedure you had. I agree that it would be best to talk to the surgeon and see whether the surgeon thinks that this is normal or whether additional intervention is necessary. I will say that it took some time after my rotator cuff surgery to be able to get certain muscles to move on command. It was a progression from one movement to the next.

Djklaugh mentioned the possibility of a nerve issue. That could be a possibility as it could prevent your muscles from getting the signal to move. I'd also ask about the possibility of a tendon rupture - that could prevent the muscle from moving as well. Something is impeding active range of motion.

Good luck!
Hey so my surgeon is upset that its not opening up... he thinks I may have arthrofibrosis... I am getting an MRI regardless next monday to see whats going on.. How can I look into it being a nerve problem?
 

Jaycey

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@Pumpkin might be able to recommend some information on arthrofibrosis. Please let us know how the MRI goes.
 

Pumpkin

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@johnnyhustle41
Sorry to hear you may have Arthrofibrosis, if you do, most likely they will recommend lysis of adhesions. It is done with arthroscopy, or open lysis.
Here is a list of surgeons with experience with Arthrofibrosis: Names of US surgeons with experience in arthrofibrosis
Keep us posted on the results of your MRI.

To check out your nerves, ask for a nerve conduction study.

Good Luck,
Chris
 

Pumpkin

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Here is a brief article about arthrofibrosis, it is written for knees, but much of it will apply to shoulders.
Arthrofibrosis Article

Arthrofibrosis is excessive scarring that limits a joints normal movement. It occurs during the healing process after an injury or surgery. For reasons not yet understood some individuals bodies respond with an excessive amount of scar tissue. There are two types of Arthrofibrosis, Type 1 effects individuals due to an underlying predisposition to form excessive scar tissue in response to any injury or surgery. Type 2 follows an injury or surgery in a localized area, and is not a part of a healing disorder. The primary focus of this article is Type 2 Arthrofibrosis.

The frequency of Arthrofibrosis after knee replacement is approximately 1% to 10%, following autologous chondrocyte implantation (ACI) 1% to 20%, and less than 10% following ACL reconstruction.

Early identification of Arthrofibrosis is important to achieve a satisfactory outcome and return patients to an active lifestyle.

Symptoms that may develop are a flexed knee gait, worsening pain, weak or wasted quadricep muscle, a warm joint, and continued swelling past the expected recovery time, and loss of previously gained ROM.

Arthrofibosis may form within the joint or outside the joint, resulting in a loss of flexion (how much you can bend your knee) or extension ( how much you can straighten your knee) or a combination of both. Your surgeon will need to do a thorough examination to determine where Arthrfibrosis in located in order to develop an effective treatment program for return to an active lifestyle.

Diagnosis of Arthrofibrosis includes the patient history, physical examination, and ruling out other diagnosis.

The following diagnostic tests may help with determining the location and extent of Arthrofibrosis.

X-rays - will show if the patella is in the too high or too low, and heterotrophic ossification.

UltraSound - Can show joint capsule thickening and increased blood vessel formation

CT scan - is helpful for identifying heterotrophic ossification.

MRI - for locating scar tissue and new bone formation.

Diagnostic Arthroplasty - arthroscopic exploration of the knee.

Biopsy - To determine if the histology of the cells are consistent with Arthrofibrosis.

Treatment will depend on the extent, location, and time since surgery.
The first line of treatment in early stages usually is a gentle manipulation under anesthesia (MUA).
Surgical options are arthroscopic lysis of adhesions and removal of scar tissue, or an open surgical procedure for removal of adhesions and removal of scar tissue.

Surgical and non surgical procedures are usually followed by a well planned individualized physical therapy program with a therapist skilled in Arthrofibrosis treatment. Medications may also be prescribed, such as prednisone and anti-inflammatories.

References:
Noyes F, Barber-Westin S. Knee Arthrofibrosis: Everything You Need to Know to Recognize, Treat, and Prevent Loss of Knee Motion after Injury or Surgery, 2013
 
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johnnyhustle41

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Has anyone ever heard of failed latarjet surgery? Maybe the surgeon tightened the screws to tight?
 

dapplega

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@johnnyhustle41 - I had a ream and run shoulder replacement so different procedure but I am familiar with the tightening and inability to gain ROM no matter how much stretching PT is done... For my right shoulder this was resolved with a Manipulation Under Anesthesia (MUA) that was done when I went in for surgery on my left shoulder. The MUA really made a difference to my right shoulder. I'm pretty certain my left shoulder will benefit from this too and will be speaking to my surgeon about this soon as I'm not six months out for the left shoulder.
 

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