Reverse Shoulder Replacement My Shoulders?!!?

[Me2]

The January and left shoulder was new minor but many rotator cuff tears and debridement. Surgeon mentioned that the cuff was shredded. It's still very weak but making progress.

The right shoulder was in March with many "gaping" tears and bone spurs on AC joint. The surgery report mentions that top of humerus was"exposed" and degenerative changes. It also mentions that he repaired in two places only to have it tear through while still working. Total of eight anchors used to put me back together. Oh and bicep had torn and fallen down at least 18 months before surgery.

So I guess just patience and more hard work. I can do it, at least I think I can, so long as I feel like it's necessary and going to pay off. "Essential" I can do and will have to figure out how to pay for. If I got that right, your @Josephine advise and words of wisdom are as always very much appreciated and put my heart and mind st ease


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[Josephine]

I am so glad to hear that!

Surgeon mentioned that the cuff was shredded. He also mentions that he repaired in two places only to have it tear through while still working.

Yes, that will be my scenario I expect. I used to use flags in church and it pretty much wrecked both my shoulders! And I've seen the tissues shredding while being sutured so many times. It's awful. So I know what I am in for!

Perhaps you'd like to see an example of my flag worship, then you can see how I trashed my shoulders!

 

[Me2]

Your ceremony is beautiful..... Not quite the same beauty but similar wear and tear on my body I was a majorette from age 4 through teens when I switched to flags through high school. It takes quite a bit of strength to move the flags.


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[Me2]

I had a follow up visit yesterday - at 12 weeks after surgery on right, 20 weeks after surgery on left. Left is doing great. I can do that ! Full range of motion or at least 99% and strength getting there. I just wish I could do .

So, surgeon scheduled a stat MRI, and had it scheduled yesterday morning only to have the power to MRI turn off with last 6 minutes just announced. Go to second location and start over in an ancient MRI machine. I got a call that the report is ready if I want to pick up and that they will fax doctor a copy. Not sure what I'm hoping: Of course, it would be nice to hear "all is well, just keep working" but which of the two bad news is better: "retear of rotator cuff and we can fix just need another surgery" or "your screwed! Just face the fact that you'll never ever be better!"

 

[Me2]

So I picked up my report from my MRI

 

[Me2]

Appointment Monday morning to see what's next.


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[Me2]

@djklaugh I'm waiting in doctor's office quite stressed not sure what his treatment plan will be. I happened upon your comment in @Jamie thread that your replacement from 2013 is doing well? Need done reassurance that success is possible......?


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[djklaugh]

@Me2 My total shoulder replacement is doing great! I have almost full range of motion, zero pain (except occasional muscle aches if I really over do things), and I am thrilled with the outcome ..... so much so I'm back with the same surgeon to do something about the left shoulder that now is about as dysfunctional and painful as the right one was before surgery.

Hope all works out well for you - let us know what your doctor says!

 

[Me2]

So . . . . Saw my surgeon yesterday. He initially recommended a patch to hopefully get through a couple of years until I am "old enough" to do replacement. Discussed my physical specifics namely, full tear, retraction, atrophy and fatty deposits in the supraspinatis tendon. He said that reverse shoulder replacement is an option, and I asked, because he had practiced in Germany for about ten years as an Air Force military surgeon, what he would be recommending if in Germany or Europe. He said that if Germany he would most likely recommend replacement and if in France he would absolutely be recommending replacement. I really do not want to do patch on a muscle that seems to be so deteriorated only to have to do another surgery and year long recovery two or three years from now. I really do not want to have a disfunctional shoulder for another two or three years simply because I am not "old enough" in United States.

So, I have at this point scheduled replacement for July 1! But . . . really need some feedback?

 

[djklaugh]

@Me2 Sounds like the surgeon is stuck with replacement criteria set by non-surgeons - AKA insurance company! He told you quite clearly that in other countries you'd qualify for joint replacement no matter what your age is! But since he's opted for scheduling you for replacement surgery on 7/1 I guess he can over ride what ever was initially holding him back. So go forth with the replacement and hopefully this will turn out to be as good for you as mine has been for me! And I agree with you - doing just a patch and facing more surgery a year or several down the road - and having to deal with on going dysfunction plus 2 surgeries and 2 recoveries - does NOT sound like good medical practice! Nor much fun at all!

 

[Me2]

Thank you so much......I'm so afraid I'm jumping into it too fast. It's not really painful anymore just can't move it.


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[Me2]

Two weeks from today, surgery could be over and recovery beginning! Filled with normal fear, dread, anticipation, worry, indecisiveness, angst . . . .

So, since I'm still doing physical therapy for my shoulders, my physical therapist, Krissy, was of course anxiously awaiting my report from doctor's appointment last Monday. And, on Monday, she was fully in agreement that replacement was my best possible path with very positive information on recovery. As I've said, I absolutely think Krissy has to be the best physical therapist in the whole world and is usually easy going, friendly, supportive, etc. When I went back for my Wednesday session, she was in her no nonsense, I'm going to figure this out, focused mood. She manipulated, stretched and measured and quietly said "I want you to think about another option." She feels that just maybe we can re-train other body parts to do the job of raising and lowering my arm, regain most if not full range of motion and strength. So we set about doing a few different exercises and stretches that might make it happen or at least give her the information she needs on what my body can do.

She seemed very positive that I/we could do this at least until I questioned her theory about the surgeon pointing out the (in my words understanding of what he said) bony growths on the edges of the glenoid limiting my range of motion. Again in my words understanding of this, my body is reacting to the "superior subluxation of the humeral head" adding bone to the top of the glenoid? Also the finding of a "narrowing of the space between the humeral head and acromial process of the scapula"? So, would I just be postponing the inevitable with the expense of copays and time consumed in physical therapy?

I do seem to be able to do the exercises and stretches better in the four days, I still can't lift my arm on my own past my waist - but it gets waist high easier? It also doesn't feel as much like dead weight as I move through my daily living. And not nearly as painful as it was two weeks ago. Is my mind just fooling me? Is my body just learning to accommodate the changes?

I postponed having my hips done for so long, out of fear of all things medical but also out of hopes that my other physical therapists had inspired that I could fix with therapy and that my chiropractors said they could fix with what they do. Probably six, seven years of my life gone in increasingly reduced abilities in life that day by day I barely noticed until after surgery I could do again. I don't want to preemptively just throw out my shoulder but I don't want to waste more of my life away hoping to avoid the inevitable.

I don't ever want to have the pain I had back in November through March again. I can do surgery/early recovery pain.

I'm at a really good place work wise to do the surgery and immediate recovery. My child care business is mostly school age and preschoolers and on the more laid back lazy days of summer. I have my full time assistant of four years with me only til the end of summer then she's going back to college full time so I will have to be training someone new or going it alone. So that gives me 13 days to decide.

What to do? @Josephine or others in the community here. Do you have some input here for me? Can my body do this? And do which? I know there are no guarantees in medicine or life for that matter.

 

[Me2]

I can do it, at least I think I can, so long as I feel like it's necessary and going to pay off.

But which is necessary and going to pay off? Which is the better decision? Which has better chance of regaining permanent fullest recovery? Too much of my life has been wasted to this osteoarthritis. Pain and inability to do and long term recovery are changing who I am, who I want my children to remember, who I want to be.

And I'm still working on sorting out my back pain.

 

[djklaugh]

@Me2 I did PT for my shoulder prior to surgery also - and yes it did help a little bit for a little while ..... but like you I could not lift my right arm past my waist and that did not change with the PT (also had marvelous gals to work with!). Now I am glad I went ahead with the replacement surgery - I have pretty much full range of motion plus no pain. Still need front closure bras .... but hey that's a very very minor difficulty ( only real grouse I have is they rarely make really pretty front closure bras - ones I can find are very plain and utilitarian). When I saw my shoulder OS recently about the left shoulder he was very impressed with the out come on the right shoulder - and having a working shoulder really does make a massive difference in my life!!!!

 

[Josephine]

bony growths on the edges of the glenoid limiting my range of motion. Also the finding of a "narrowing of the space between the humeral head and acromial process"

What you are describing here is a purely mechanical obstruction which is not going to be improved with PT. Both these are ways of describing the same thing - rotator cuff impingement. It can only be resolved with n acromioplasty which means debridement of the osteophytes thus opening up the narrow space between the joint and the acromial process. There is a time when strengthening and re-educating other muscles to do the work would help and/or might even help distract the joint to open up the a/c space a bit. But that little window is short lived and my guess is that you are now beyond it.

I still can't lift my arm on my own past my waist - but it gets waist high easier?

That's because raising your arm engages three different sets of muscles. I can't remember which ones they are (will have to look that up some time) but the arc of movement goes in three stages, roughly 0-40 degrees, 40-100 and then 100-180. The middle portion is often the worst.

I've found that when I reach my hand behind my head for any reason, I cannot easily bring it down again but I can if I put my hand on my head and apply pressure, sliding my hand all the way down head, face and neck. Or I would use my other hand to lift it down! As a result, I have now asked my surgeon to do my shoulders in the next few months because it's getting to be irritating!

 

[Me2]

Both these are ways of describing the same thing - rotator cuff impingement. It can only be resolved with an acromioplasty which means debridement of the osteophytes thus opening up the narrow space between the joint and the acromial process.

But, that was supposed to have been done when this shoulder was repaired in March. Now, with "an extensive complete tear of the supraspinatus tendon" torn again, along with changes and "superior subluxation of the humeral head, the surgeon suggested that I could either

• do nothing and see what happens,
  
• do another probably arthroscopic but wanted to leave the option open to do open shoulder repair using a "patch" to repair
  
• and "if I was a few years older" in USA or in France or Germany (where he had practiced in military) do a shoulder replacement

At the time of appointment, I opted to schedule replacement as I was in serious discomfort and had been for quite a while, had such limited range of motion 13 weeks after surgery with nothing gained in 7-8 weeks, and little strength. Now, of course, as seems to happen EVERY TIME I schedule surgery, pain disappears, range of motion has increased SOME and even strength has seemed to increase.

So, can this be resolved with just an acromioplasty and patch with any degree of permanency or would I just be delaying the inevitable replacement? Or am I "throwing the baby out with the bath water?"

 

[Kssii]

Personally I think it is probably just a delaying tactic--unless you are OK with quite limited movement. I had a "clean out" and a bone spur removed two years ago and my surgeon was delighted with the results--said I "might" not need a shoulder replacement--ever and my recovery was quick and amazing. Then two months later things started going downhill dramatically. I did PT and acquired a marvelous PT guy that does great physical manipulation. With pain killers at night, my life was bearable. Then last January, I had an MRI before undergoing PRP; both my PT guy and my surgeon were amazed I had as much use of my arm that I did--arthritic remodeling along the glenoid, flatten humerus head, three partial tears--much worse than it was BEFORE the surgery one year earlier. (Not what my surgeon was hoping to see!!) I did the PRP and yes, my improvement since then has been amazing to say the least; however, it is still just a temporary fix and I am still going to need a replacement at some point. So the choice is "when" we give into it. Of course, by holding off as long as possible, we can hope they will come up with better choices than we have now.

 

[Jamie]

Just my two cents, but I'd go ahead and get the shoulder replaced. My surgeon and I had quite a discussion when I opted just to do the arthroscopic work instead. We made that decision because I needed to be functional to help my husband with the lengthy recovery he's going through. I know it was just a delaying procedure and now that things are healing, I can see where its limitations are. The pain is gone (my number one priority). I have some increased motion with the therapy like you're talking about. My therapist also talks about how she is working to strengthen muscles to pick up part of the load from various shoulder motions. But, because my joint is shot (no cartilage) and the head is worn to an oval, I feel pretty certain I will never get to the point where I can raise my arm straight up. For me this means rolling my hair and shampooing are a bit of a challenge. My arm will eventually go where it needs to, but there is popping and it just takes time to make the movement that should be one fluid motion. If I was in your place, having a summer to do healing....I'd go for it. My doc says these surgeries really do a great job of giving you your range of motion back.

But....please......think about it carefully. Talk to your doctor. Get a second opinion. Do whatever you need to do to make sure your decision is right for YOU.

 

[Me2]

Your advice is much more valuable than "two cents" , all of you. I do so appreciate your help reasoning through this decision. My gut is saying just do it.

I've been considering a second opinion, but I really do like my surgeon (and he's just fine with me doing surgery awake which you know, Jamie, is a huge thing for me). I do feel like he's giving me good options and thorough information from his perspective. But, his recommendation was initially doing another patch albeit when I pushed he absolutely conceded that, if in Germany/France, he would be recommending shoulder replacement. I waiver on "Has he done enough of these replacements?"

My research is telling me that a precise placement of the device is so important but we're still not sure what that is and several methods are done with varying opinions on what the precise placement is. I am having difficulty finding recent medical articles on what's good. Most recent is 2014 and most are from 2009 or earlier. Lots have changed then even in hip surgery.

Recovery articles seem to be so positive. I was surprised with my surgeon's time line of 4-6 weeks in a sling with therapy moving arm passively right away. Some articles say even sooner out of sling.

Do whatever you need to do to make sure your decision is right for YOU.

I feel like the wheel is in motion put there by me. That the pieces of my world can fit this in right now seems to be karma. Am I sure? Heck, I'm not even sure I should have done second hip replacement or SI joint surgery!

 

[Me2]

@Kssii Are you a horse person? I finally took a chance and putted myself back into the saddle last week and was able to do it with a little help . . . are you riding?

So the choice is "when" we give into it. Of course, by holding off as long as possible, we can hope they will come up with better choices than we have now.

This is a big concern for me . . . I did hold off on hip replacement . . . and big developments did come along. I was told by most of the opinions that after hip replacement I would absolutely NOT be advised to ride. I do think that it was when my surgeon finally said that I would absolutely be able to ride and I saw so many on BoneSmart who rode after hip surgery that I was finally able to see a benefit in my life.

As I said above, the articles I am finding are old, but are we on the brink of finding big new advances in shoulder surgery or at least a perfecting of the surgery.