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Standard Shoulder Replacement Done 11/23. Getting scared, possible nerve damage?

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HandyWOMAN

HandyWOMAN

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OK, a weird up date. Today doing my PT at home, get to the lay down & push the wrist out with cane, elbow at side..... After few in & pushing outs, I try the hold lower arm upright, let go of cane....... it stays right up!!!? NO "WORK", acts like it has always done it? Slow let it down to stomach. Celebrate!!! Could NOT do it again for the life of me??? The nerve for sure, is the problem.
 

SaraK

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@handyman - sorry it's taken me a while to respond. I've been off the site the last week or so.

Yes, I think you are looking at the motion I was talking about perpendicular to the body. Has the PT suggested using a cane at home to be able to do some movement at home?

You might also ask the PT about a massage hook. I have a friend that is both a PT and a massage therapist. She had a couple of hooks that she allowed me to try and I saw something similar at PTs office - it allows you to do some deep massage in the upper back on your own. Dont try it, though without them showing you what to do and not do.

Chronic issues with movement can be so difficult to deal with - especially when you're so used to being physical and independent. For me, the patience muscle was the hardest one for me to learn to use!

Please do keep posting. As you say, the shoulder area is newer and has less information available. We need people to post on "perfect" recoveries and "not so perfect" recoveries to help out others coming thru!

Take care!
 
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HandyWOMAN

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I will add another up date. 1st is crazy!!!! I just discovered a SUPER easy way to get a coat on ALONE! (This is after you leave the sling) Just wish I had stumbled on it 4 weeks ago, with all the taking the dogs out! OK, you need a coat with a hood(go get one at Goodwill if you have to), & a hook at chin/neck level. Hang coat from the top of the hood, not the neck. Pull coat open to find & put you "bad" arm in it's sleeve 1st. Take a step out(pulls the coat wide open while still hanging on hook) spin your back into now open coat. Can get your good arm in it's sleeve easily! The hardest part is having to unhook the hood. It's like someone holding a coat for you!!! OK, it's the little things that make my day.
Shoulder up date: No more flash backs to my lower arm just doing what it should do? :-( Still only a little improvement on the movement of lower arm out from body(but, I can crack an egg open in frying pan, without risk burning my stomach now!), & yes, I do crank on it with the cane at home. I'd say 5 maybe 10% improvement on what "I" can physically do self directed movement wise, in the air. PT can get a lot more when he cranks on it(another reason for the now 3 times a week). I have set up a lot stuff at home, to do most the general PT he has me do there, arm pulley for general loosing/stretching, & cane work, pulling my lower arm out from body using my hand to grip door trim(he said to pull the elbow into body with my other hand), and elastic work now, etc. The 3 times a week now, he is mostly focusing on the the stuff I can't do at home. The deep hard ouch massage in the back of LF shoulder blade(I can't reach or even do it well anywhere, with the nerve damage to my RT(good hand, I'll add, he showed me the massage hook. 1) I don't have good control of my RT hand or LF really, 2)plus am so skinney(add muscle atrophy now, 3) They are too hard.) that's is breaking/looseing up stuff. About 3 different types/ways of electrical simulation. Some heavy duty cranking on getting the lower arm to rotate out. Last time, under electrical simulation, I could FINALLY push out(sliding lower arm/wrist out, while resting it on table a tiny bit. He was excited, so I guess I should be too, it is something I didn't have before. But this is 2 months out! He has brought up dry needling for bango tight spot in the back....... I HATE needles! But, I can't "see" back there...........? Anyone have dry needling done? So much for being a 4 month good to go person.
 
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tazzy13

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@HandyWOMAN , it can take up to a year for full recovery, 2 months is not so long since you had surgery , I know we wish it would move faster, and for some it does, but little by little you should see some improvement.keep up with the therapy and don't get discouraged it will get better,
 
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HandyWOMAN

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Up date: On the nerve problem(for anyone down the road). I had 3 PT visits with stimulated nerve & being able to move my lower arm out against "some pressure". Plus at home, I could hold my lower arm up right laying down. About one week time wise. Last visit, I could NOT move the lower arm under stimulation, nor hold lower arm up at home for 3 days. This morning could hold arm up?..... PT is tomorrow?
 

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Hmmm - hope PT can help out tomorrow!
 
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HandyWOMAN

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Very light muscle twitching now? Is it OK, to try to do a little more self PT using this area tonight? History: This is the Teres minor/ major area, that is where nerve damage is, that has been getting electrical simulations at PT for weeks now( I would be sitting up lower arm on table, could resist/hold against wrist pressure IN, could get nothing on me moving wrist out, with no pressure on it). Today, I was laying down doing PT......it "seemed" like today for the FIRST time I could lift the lower arm off my stomach to upright, to a little over to the side about 15%! I mean this is the FIRST time. I did it about 3 times, went on to other stuff. Now have a very light twitching off & on(it is a very small muscle). Can I try again, or let it be, as I've done enough for that area that may have just woken up, for one day?
 
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djklaugh

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@HandyWOMAN I'd suggest giving yourself a day between doing more just to see how the area feels. It does sound promising though. If I were you I'd try very gradually increasing the number of times you do that particular exercise. Like 3 today, wait a day then try 4, wait a day then try 5. Don't want to over work the area and risk further trauma. Also you might want to check with the PT who's doing the electrical stimulation and see what they recommend.
 

SaraK

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I'd definitely check with PT on frequency and number of times within each session. Definitely stop if there's pain but it sounds like the twitching is a good thing because it may mean that an affected nerve is starting up again. I'll keep my fingers crossed.
 
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HandyWOMAN

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Bad Nerve up date: PT was thrilled to hear about the twitching & said, YES, it finally woke up & did some real work. So I have been pushing the rotation out work since. Some days I more than others. I'm trying to catch that area up to the rest of my shoulder's abilities. PT is thrilled with my reaching up at this stage & strength in other areas. He is still working HARD on opening up the rotation OUT of lower arm, with cranking on it over the edge of table. I know I can't move the lower arm out self diracted, til it is loosen up in the first place. We are at about 65 degrees. He has said more than once, he wishes he could get answers from Surgeon on the state of my rotater cuff before surgery. I have told him, I was building my house & do heavy landscaping, transplanting trees, etc., I had NOT done anything to it, no injuries(more than a few done to my right shoulder over the years), & had NO problems with using my left shoulder, it just hurt to do so. I KNOW my body & I have "listened" to it, since I found out I have scoliosis at 20. I have had many smaller injuries I have "worked" through, as in take it slow & KEEP working even though injured. The Dr. has NEVER answered my questions about the nerve problem, Just stares back at me(2 visits). I'm now thinking HE DID tear it some or very over streched it during the surgery. There is NO way he tested the rotation out of my lower arm either, as it would NOT do it at home the 2nd day out, I couldn't get close to 0, maybe -15/20. I will NOT be going back to him for my right shoulder. A Dr. Kersten of Southeastern Sports.
 

SaraK

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I'm glad to hear that nerve is waking up and you're getting some movement! I'm guessing it will soon catch up with the rest of the shoulder. That movement was one of the last areas my PT worked on.

My own experience with my hips is that my surgeon didn't seem to want to hear about anything related to soft tissue - just wanted to cut, saw and hammer. Lots of things can happen during surgery, though, that won't have an impact on most patients. Then you have the one. He may not have done anything different with your shoulder - instead, you may just be the one! The lack of discussion and a search for solutions is more troubling. Which is why I switched surgeons/practices for my shoulder.
 
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HandyWOMAN

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The lack of discussion and a search for solutions is more troubling. Which is why I switched surgeons/practices for my shoulder.
RIGHT!! I tried twice. PT has tried about 3=4 times sending in reports, no answer to him either. Not even going to bother going back for last visit, no need to pay him anymore for no information. I know it's healed, all is in the right place, as it can be. Medicare won't pay for anymore PT from now on, (after 60 days), and I don't have the best coverage outside that. Need the money to pay for the extra PT work he caused. As I still need the hard cranking done, to keep opening that lower arm outward movement. Doesn't really hurt, he is doing it slowly, and gets a bit more each time. I know from the cut ulnar nerve on right arm. Nerve regenerates at about 1" to 3/4s"(us older folks). So I'm guessing damaged bad enough that I had to wait for nerve regeneration.

PT just started me working on arm behind my back, the last area to stress(the front cut area).
 

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@HandyWOMAN , slow an steady.you will get there.so long as you keep moving forward all is well. Don't push to hard, but just enough to see some improvement take care, stay safe.
 

SaraK

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Can you appeal the termination of PT? You clearly have an issue beyond the norm that requires continuation.
 
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HandyWOMAN

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Can you appeal the termination of PT? You clearly have an issue beyond the norm that requires continuation.
I did talk to PT today, about that, as I've dropped the 3rd day a week now. I didn't know you could appeal? I will up grade my insurance the next period, I guess. Things are coming,(he can't believe the straight up over my head I have. Says, I'm at 175+, & most TSR only get 150? ), except for that lower arm rotating out. He's still talking of testing that nerve. Thing is THAT is the most used movement! Reach out to, like open a door knob, pick ANYTHING thing up.
 

SaraK

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Yep - opening the door was one of the things that caused me the most pain after I tore the bicep and rotator cuff.

Whether or not you can appeal may depend on your insurance. 60 days is so arbitrary. Maybe it can be done under a different diagnostic code.
 

djklaugh

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@HandyWOMAN Gads it's a real shame you have to fight with insurance while you are recuperating from surgery! I have HMO insurance and while there is a limit on the # of PT visits there is no time frame. I went in every 2 weeks and did exercises diligently every day between visits. Each visit they would review the exercises, measure ROM, drop the easy exercises and add a few more difficult ones. Slow yes but highly effective for problem free return to what my surgeon said was full function. Well not as good as when I was 20 but darn good for nearly 74!
 
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HandyWOMAN

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The reason I was going so often, was PT was able to do things I could never do(or dare try) on my own with the problems. 1st was the lower arm rotation, could not even be done MANUALLY to 0, when I 1st tried day 2!!! (I didn't "know" how or how much to crank)! Totally locked up(so that was something the surgeon did) And something I should NEVER have had to deal with! 2nd, nerve problem showed up about a week later, when I could start to curl the bicep. Then there is all the electrical stuff he does. I do think I'm maybe 2 weeks out from from dropping to once. He getting a lot more each time, as I can do more at home, easier to maintain looseness & building strength up. & then see a couple times a month after just see where I'm at strength wise. If I didn't have to deal with surgeon's problems, I possibly could have been one of 4 months to normal people.
 
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HandyWOMAN

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Lower arm rotation out: Week 12+, 3 full months, I have it finally!!! History for other people with this problem, on possibly how/why now??? I have been doing strengthening, But guardedly. Like laying down & lifting the whole arm from floor to up & then over head & back down. I always do it, holding on to my cane held in other hand yet. As there is a point in the rotation down, that different muscles/tendons? kick in, take over, etc.? & there is a VERY unstable point there? I also could almost NOT do any pulling against tension from front to back, arm straight down at side. Other things that show an exstreame weakness lower outside shoulder blade area. Last day PT had me doing lifting whole arm rotation..........without "cupping it", laying down. I hit that weak point(maybe weak from too much other work before) but it started to dislocate out the back(I know the feeling from my shoulders doing it off & on since i was 35. I stopped, frozen & GRABBED my arm with other arm, knocking his away, I reacted so fast. So it just was beginning to. We quit, He worked on my neck & pushed what he called the "nerve bundle"? It ZINGED across & down the shoulder!!! Then massaged it some. Next day was in a lot pain in the back of shoulder(from it trying to dislocate). So I did light looseing PT & put on Heat packs all day. That evening when working PT with it, as it felt better. I had full(for me) lower arm rotation?! Still weak(A long ways to catch up), but can reach for a door knob, pick up something, etc. I ALWAYS felt a restriction back there, wonder if it trying to dislocate loosen something up? or the nerve zing woke something up? The arm pretty well "works right" now, just very weak in areas. Hopefully can get going now, as I can start to DO things that work correctly muscle wise.
 

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