Reverse Shoulder Replacement My Shoulders?!!?

[Pinky]

Well, Me2, having read all this in one late night/early morning sitting what a rollercoaster. I feel like I was with you all thru it

I enjoyed your happiness in grooming your horses. Glad you’re happy with the outcome

 

[Me2]

Actually came on to give a fourth anniversary update for hip surgery and realized I'd not updated here in quite a while either - even missed my second anniversary of shoulder replacement --- but nothing much to update other than that both shoulders still doing great. Right replacement shoulder still feels mildly different, still reminds me NO when I move wrong or lift something too heavy but those are healthy reminders. Still quite difficult to write with my right hand (not sure why?) but certainly just fine. My left shoulder is doing well also with just a few reminders that I needn't be lifting 35-40 pound kids or 50 pound bags of horse feed. Again, good reminders. Sheryl's shoulders still doing just wonderful.

 

[Pumpkin]

Thanks for the update, glad your shoulders are doing well!

 

[djklaugh]

@Me2 What a great way to start the day .... seeing a happy update from you with 2 shoulders doing well! Oh, yeah I know those healthy reminders myself You might not want to lift those 35-49 lb kids but isn't it wonderful to be able to hug them and play with them without pain or worries about straining shoulders ( or hips for that matter )

 

[Me2]

Happy New Year one and all!

With the holiday season (and another tooth ache), I've managed to keep stuffing newest happenings with my shoulder out of my mind. But, time to start dealing with it.

Back in early October, I scheduled an appointment with my shoulder OS to see why I was seeming to lose strength and range of motion in my right shoulder which had reverse replacement back in July 2016 with an amazing recovery: nearly 100% range of motion and no noticeable difference in strength. Again, I was hoping for "all is fine, you are just hypochondriac." However, I got a bone scan and than let's see what happens with physical therapy and some massage. Krissy (my miracle working PT) will let you know when and if we need to see you. About six therapy appointments that were surprisingly painful and a considerable lessening of strength and less range of motion with replacement shoulder, Krissy suggested I call back to schedule a follow up with the shoulder specialist of the same practice.

I saw Dr. Florez on Monday, 16 December, and I guess the news is not so good, actually almost the worst. He said that I'm in for at least one surgery, but he'd be going in blind. MRI, of course, is not available because of implant. When he does do sugery, he would be checking the bicep, of course, but also the subscapularus (I think) as my pain and inabilities seem to indicate that as likely or also a problem. The simplest problem would be the bicep only but because Dr. Walker reattached it a little lower than it normally would be Dr. Florez couldn't be sure bicep or subscapularus (again, I think that is what he said). Those would both most likely be "simple" repairs.

HOWEVER, a bigger problem lies in that, on the bone scan, one of the screws in the same area appears to have loosened. If that is the case, a slight chance of fixing that. However, if its loosening and visably causing problems, then he'd take out the whole implant, leave it out for a couple of months (with shoulder being detached) and then try, try again. Yikes. Even with worse case scenario, he only estimates six months recovery time. Ha! I had a legit nine months last time, and almost a year from start of real pain in shoulder on November 9, 2015 til mostly healed in August 2016. And I didn't ask whether open or arthroscopic but assuming since last bicep repair had to be open that even "simple" bicep/subscapularus repair would be open.

I had a guided shoulder aspiration last to check to see if any infection to throw into the mix. I go back to see shoulder specialist January 13 to find out what next.

Good part of very bad situation. My chief concern is that I cannot do any sedation or even think of general (panic attack/PTSD). When I asked whether he would accommodate, his face lit up with recognition! "Oh, that's you! You're the one!" Apparently, I'm quite famous for my wide awake surgery style. He's very willing and even pleased to do without sedation. Looking back thru this post I came across a poster about him doing a workshop on orthopedic surgery without sedation. Yea! At least I have that.

Hoping for feedback from the experts and those with experience on possible and lived thru reverse replacement replacement.

 

[Jaycey]

@Me2 Welcome back to BoneSmart! So sorry you are facing yet more surgery! Sure hope the simple repairs are all that is needed.

Since you have been away @Jamie has become our shoulder expert. She had a standard replacement February of last year. I've tagged her for you to see if she has any input.

Did your surgeon give you a reason why all this has failed?

 

[Me2]

Thank you, Jaycey, for the welcome back. No, no reason given by surgeon as to why. I didn't ask as I think I know .... probably my somewhat abuse. When I was thinking about the replacement, both the OS and PT told me I would most likely not have 100% range of motion as in lifting above head nor reaching behind my back. I was very cocky when I did have almost 100% range of motion raising straight up over head. And they were very excited about that. However, I assumed that since I could do that when I was told I wouldn't be able to, and everyone was all so excited and praised me as "super" patient that I would also be okay since I COULD reach almost behind me and had full strength reaching with bent elbow to my right. I even spent that first winter opening and closing the barn door.

Well, at one year follow up, I excitedly showed off how wonderful I could move my arm, When I showed the OS how I COULD move my arm to the right, I thought he was going to kill me. He's usually very positive, great patient rapport. He emphatically told me, tho I could do it, I SHOULD NOT move my arm that direction as it would cause damage. My engineer son has since explained the mechanical principles of why I should move that direction. So, I'm guessing my own doing. I have to admit that there have been quite a few times even since that I have mistakenly made that move. Even when my body began reminding me that I should not. STUPID.

 

[Jamie]

@Me2 .... I'm so sorry to hear of your current problems. Sometimes life just isn't fair. Please don't beat yourself up too badly about something you may or may not have done to cause your problem. It is my understanding that with reverse shoulder replacements, one needs to be a bit more careful about some movements as the potential for dislocation is greater than with a standard replacement. I think this may be what your engineer son was trying to explain. It has to do with the way the "reverse" components are placed in your joint. As you probably know, the ball is attached to your shoulder itself and the cup is at the top of your humerus on your arm.

But the mechanics of your implant may not be why you have attachment issues with your muscles. It's possible you did do more activity early on than you should have, but normally you would feel pain if you were doing damage (pulling away the muscle where it was re-attached) and you say you didn't have any of that. I think at this point it's just not possible to say for sure what is causing the issues you have now with your muscles and the weakness, but it's great that your surgeon thinks it's fixable. It's possible any repairs can be done with arthroscopic surgery. I hope that will be the case for you.

The potential loosening of one of the screws is a different matter. It will be important to determine why the screw has loosened, if that is in fact happening so that can be addressed. I've not known any of our shoulder BoneSmarties to have this problem, so unfortunately I'm not going to be much help with that. You'll be blazing new territory for us and I'll look forward to any information you can provide after talking with your surgeon again. Don't hesitate to ask him lots of questions about the "hows" and "whys" of whatever he finds. Copies of any x-rays you get would be good for us too, if you can do that.

The possible loosening screw can seem daunting, but what your surgeon is proposing is pretty much the same procedure followed for hips or knees when a revision is done. When the new implant is placed, the surgeon can use bone grafts if needed to repair damaged or missing bone and it works quite well. Of course, we'll hope this is not needed in your case. Try not to speculate too much and just take things one step at a time.

The first order of business will be for the surgeon to get in there and see what's really going on. The main thing I would encourage you to do is to not delay this first surgery. Even if the problem is "just" a torn muscle, it is possible to worsen the tear if it's not fixed promptly.

I'm sorry you're having to go through this. But you've found a good surgeon and you're getting it checked out quickly. That's important. Hang in there and let us know how things go.

 

[Hoppy Nanny]

Sorry to hear of your ongoing problems with your new shoulder @Me2
I remember your problems with you being awake for your hip & the problems that ensued so glad this surgeon is on board with that...
Chrissie xx

 

[Me2]

Thank you @Jamie for your response. I have been peeking at it since you first sent but, honestly, I'm really just "taking one step at a time" and just avoiding thinking about what I really can't find much information on and can't fix on my own. I'm babying it a little since the doctor said he wouldn't worry too much about lifting a cup of coffee but not much heavier. Other than that, I'm waiting to talk to him on Monday. I've not really even been able to think of many questions to ask as I feel he indicated that he's going in "blind" and won't know til he looks. Scary. I feel like a have to have "blind" trust.

You mention not to delay this first surgery. That is difficult so difficult for me, as I feel always happens to me, I'm not feeling a ton of pain anymore. Since I stopped therapy and have been "babying" it, its not been crazy painful. Range of motion really depends on day's activities. Never the 100% that I had up to four or five months ago or even 75%. Still hugging it a bit to my body as I move it. And my neck and back muscles on that side are really more achy. Do I remember that correctly as what happened with original tears and especially after replacement surgery as different muscles took over the work of moving my arm?

No, if the surgery is necessary and possible to fix the arm, I want to get done quickly so I can do the majority of recovery thru the winter months and maybe be back in the saddle before summer is over.

I'll keep you all posted as to what happens on Monday. On to blazing new territories for the shoulders.

 

[Jamie]

Since I stopped therapy and have been "babying" it, its not been crazy painful.

Babying a shoulder with a torn muscle is definitely good. The fact that your surgeon told you not to lift anything heavier than a coffee cup tells me you surgeon is also concerned about the possibility of more damage. It would follow then, that your pain levels would decrease because you are babying the shoulder. So, just know nothing is really improving, you're just not getting any worse....a good thing.

And my neck and back muscles on that side are really more achy.

Do I remember that correctly as what happened with original tears and especially after replacement surgery as different muscles took over the work of moving my arm?

You are exactly right! You have injured critical muscles and your body is trying to compensate by having other muscles pick up the slack. They are not made for those movements and they're letting you know they're not happy about it.

An interesting thing with my shoulder....I thankfully didn't have any torn muscles, but my should obviously had been going bad for a very long time. As far back as 2003 when I started with my personal trainer, she was always telling me to relax my left shoulder down when working on the shoulder press machine. Nothing ever hurt, but when I'd move that left shoulder, once I got my arm about shoulder height, my whole shoulder would kind of hike up unless Angie held it down. Now that I've had the attention of a good physical therapist, she explained that even back then my body was compensating for the worsening shoulder. By the time I had my surgery, my body wasn't able to use all the rotator cuff muscles properly and my subscapularis muscle was terribly atrophied. The other muscles had completely taken over! So in therapy, I had to completely relearn how to use the proper muscles with my new joint. It wasn't painful, but it was very difficult. I'm pleased to say my therapist and I were able to get that done with exercise and her wonderful muscle massages. So, I know it's possible. But I would caution anyone not to let their shoulder get to that point.

 

[Me2]

Really have not been able to update as that Monday appointment was a disaster. The new shoulder specialist surgeon started off the appointment almost two hours late so I was a mess going in since I have great difficulty leaving my work for normal hour or so for appointments but now I was gone over three.........then he proceeds to relate that he'd been thinking about my shoulder issue over most of his holiday. He started in with confirming that he would be most likely "going in blind" as to what he was fixing and that he would most likely be taking impant out. Therefore, he had decided that he wouldn't attempt to start with me awake since he can't be sure to be able to complete if I am awake. So, anyone familiar with my extreme phobia, psychiatrist diagnosed PTSD, knows my mind went into absolute panic mode and really was unable to focus on much of the rest of the discussion. He decided that he wanted to order a ultrasound guided lidacaine injection of bicep and subscapularis to see if pain was affected. My original surgeon happened to be in office at the time and stopped in to see me. I was still in panic mode so somewhat difficult to remember. I do remember that he assured me that all would be fine, that he was fairly certain that I could do awake, that he had done surgery on me before and that we could do this. He thought it was a good plan to get injection done, and we would revisit issues after that.

However, the script was written for a doctor who was out til the end of April. I called back to see who to go to then and next referral didn't do that sort of injection. So, I called pain specialist who I had had several ultrasound guided injections with who referred me to his partner who could do. But, he met with me and referred me to some new specialist in Pittsburgh that has some super-duper ultrasound machine AND was a specialist in soft tissue and movement around replacement joints (supposedly one of three in United States) and would be able to diagnose exactly what was going on with my troublesome shoulder. So, he was able to make appointment the following week. Dr. Onishi (the ultrasound specialist) saw me. And talked extensively about what he saw. What I understood him to say: My bicep muscle looks pretty good. Attached in a different place (which I knew - it had fallen and my shoulder guy had had to fish from way down almost to my elbow and reattach) but looking pretty good. Unfortunately the subscapularous was hanging on by a thread and, according to him, couldn't be causing me "so much pain" as it was barely functioning. I reiterated that I was not in so much pain but was more concerned that I had lost and was losing so much range of motion when I had had nearly 100% after replacement. Dr. Ultrasound Specialist seemed more concern that he could see a lot of fluid in the area which ?? indicates either infection or joint rejection or loosening. He was leaning toward joint rejection. But, my shoulder joint was put in almost four years ago???

So, back to Dr. Shoulder Specialist who I was terrified to go back to but even more terrified to have to wait for an appointment with my shoulder guy who might just say I needed to see Dr. Shoulder Specialist anyway. And they had made appointment with Dr. Shoulder Specialist. So this past Monday, I went to see him. AND he proceeded to tell me that it was okay I could do surgery asleep as, of course, he said I could. That, he would most definitely be going in to remove joint. AND, yes, he would be moving the subscapularus to fully see the joint, get some fluid, have it tested which would take about fifteen twenty minutes (but way back my shoulder guy said that would take at least two weeks to fully test). ALSO that no, no the subscapularus would not be repaired as I really didn't need the subscapularus. Well, wait, I'm here because of diminishing range of motion especially things I can't do that I could do. That's okay, I'm the shoulder god, and I don't usually repair that as you don't need it with a reverse replacement. ALSO, since all the other reasons indicated we needed to remove the implant. So, if I didn't want to sleep for the surgery, the surgery couldn't be done, and I could just wait to see what happens. Well, what do I do if rejection or infection or loosening. What happens if I just let it go? It'll get worse, you'll start seeing signs of infection: fever, redness of skin, rash above/around the joint. Hmm. I thought these joint infections could eventually kill me? That not a good idea to just see what happens with either infection or rejection or loosening?

So now I have to wait til March 26 to see my old shoulder surgeon and find out if we couldn't go back to his plan or if his thoughts have changed. This is essentially what he said we'd be doing back in November except he saw no problem with me doing awake. I've yet to gather the nerve to call to see if there wasn't someway to get an appointment any sooner. My heart hurts from the stress of thinking about all of this.

So, finally, that's my update. Any words of wisdom? reassurance? advise?

 

[Pumpkin]

@Me2 ,
Frustrating you have to wait until the end of March to see the surgeon and find some answers to your questions.
I would want to know what was going on and rule out an infection, rejection, or loosening before deciding to just wait. Can they draw a fluid sample from your shoulder and test it for an infection?
Wish I could be more helpful,

 

[Jamie]

Boy, I wish I had some words of wisdom for you, but it would seem you're going to need to wait and see what happens in your March appointment. I'm like Pumpkln and wouldn't think it would be wise to not know more about the possibility of an infection. Please let us know how you're doing and what the results of that next appointment are. In the meantime, be sure an move your shoulder as long as it's reasonably comfortable to do so, but don't do any heavy lifting with it.

 

[Me2]

With all the craziness going on in this world, I am continuing on my journey of learning patience.

Fortunately, I did get in to see my shoulder surgeon late in February. First, he did assure me that he was pretty certain I would be able to do surgery without sedation. No guarantees, of course, but he'd talk to Dr. Shoulder Expert and the Dr. Head of Anesthesia at the hospital. I knew I had talked extensively to Dr. Anesthesia about my issues and, after the first shoulder surgery, he was excited about doing so that I could be awake. However, he said Dr. Shoulder Expert probably would need more information about the whys my shoulder was loosening before committing. I scheduled more physical therapy to just see if I could get more range of motion and avoid surgery. They did a second aspiration of the shoulder to check for infection, did a full allergy test on all things replacement joint, another bone scan to further check for any indication of infection. Test results all good .... absolutely no sign of infection, absolutely no allergies. But, yes, loosening has definitely occurred . And we scheduled another appointment to review.

THEN, the pandemic happened, and the world STOPPED.

Fortunately, I had a couple of visits with my amazing physical therapist before, and we continued virtual visits through pandemic. She got a good baseline for where I was and just really worked with me on what I was having trouble with. Over all the pandemic and reopening, we got a good bit range of motion back (from about 40 to 110 with one pound weight) and got rid of most of pain in just moving my arm. Only pain when I use it for things like buckling seat belt, opening jars, opening doors, lifting more than half gallon milk to pour, waving good bye.....really painful when crazy lady that I am decided going kayaking with sons was necessary.

So, I had one virtual visit with my shoulder surgeon, who relayed that Dr. Anesthesia was quite certain he'd have no problem having me awake and allow whatever surgery on my shoulder go just fine even if they do have to take the whole thing out. His block could last 18-24 hours if need be. Both did talk to Dr. Shoulder Expert who my surgeon said seemed ok with the anesthesiologist resassurances. BUT, all elective surgeries were postponed to see how Pittsburgh did the pandemic. (Oh my, how did all of you with so very painful hip and knee, and first surgeries deal with postponing? I kept reminding so many in worse shape than me.)

After the pandemic, we scheduled another in person visit to update. The xray seemed to show more increase in loosening, and Sheryl got sent off for a CT scan to see what was going on with the old shoulder. CT scan gave him whatever he needed to say yes, front screw is very very loose. So, surgery is scheduled for July 30 with the new plan to take off the plate and replace with new plate by same manufacturer that goes deeper into shoulder and is attached with four screws. The bone where the loose screw is will have to be filled in with some bone tissue. If I were doing general, they would take from hip, but feels best to use something else mixed with my cells. (I didn't quite catch all of that part as I heard the word "sedated" and stopped listening.

Now, its scheduling all the pre surgery testing, and a visit to infectious disease doctor. I guess they don't want to believe me that I really think I just was so excited my shoulder was bionic and really abused it. I really do think a mechanical failure, and I'm okay with that.

Sheryl is on to Surgery number 7 or is it 8? I had the Mohs surgery for cancer spot on my nose but that wasn't replacement parts ..... but that toothache that happened at the same time before Christmas and getting fixed was interrupted by same pandemic? Just had three teeth pulled for four dental implants to be done .......yea me? More bionic parts.

 

[Jamie]

Oh my......you have been through so much on top of the pandemic! I'm so sorry....but glad that things are finally going to move forward. You aren't the only one who "lost" a "perfectly good" shoulder. With my replacement, things were going fine until an overzealous mammogram tech gave my arm an unexpected shove to put it in proper position (couldn't she SEE I had a shoulder scar and just ask me to move my arm???). I ended up with a torn biceps tendon that the surgeon hasn't been keen on repairing. Since we've been involved with the pandemic, I haven't seen him in person to talk about it, but the word by phone from his assistant was that I'd be okay just to leave it. I'm not so sure about that....

Best of luck to you with your shoulder and teeth.

 

[Me2]

@Jamie Ouch, I know personally how bad a torn bicep hurts. And how frustrating to hear that you'll be just fine without it! I am so grateful that I kept looking for surgeon who dug my bicep out and reattached it. Where the specialist shoulder surgeon felt the subscapularis isn't something he'd worry about fixing, my shoulder surgeon said he'd definitely fix it as he felt necessary for the range of motion I want and need to have for my life.

The pandemic, while scary and horrible, has not really made my personal life all that much different. I guess I am a "socially distant" person anyway so that part was nice having the rest of the world okay and being socially distant also. I have my small child care business and was supported by the State in being open and providing safe care. Parents were all working from home so my day went from 7 a.m. to 6 p.m. to a very short for me 8:45-4:15....almost heaven!

Hopefully you'll be making headway on your shoulder repair also.

 

[Me2]

So, just two more days, two more sleeps before another surgery. And long weeks of recovery. I feel I'm much more anxious about the surgery than some of the others. Not sure why but ....

Yesterday, I did meet with Drs. Walker and Florez (the specialist). Appointment went well. I feel much more comfortable than before meeting with them. Sounds to me as though they are still "going in blind" as they've been saying since December despite all the tests. The huge decrease in range of motion could need just subscapularis repair, could be subscap and bicep (probably not), but they are not sure what shape the subscap/bicep is in regardless. My PT person tells me the bicep is definitely still attached and firing. Surgeons said yesterday the subscapularis could be anything from minimal tearing to totally destroyed and/or adhered to bone. Adhered to bone would be "messy." Then, they'll check for "quiet" infection. If infection (probably not), then they take everything out. And then months wait to put back in. If not infection then they'll check the shoulder implant. Dr. Walker seemed to say he's fairly certain it's loose enough to take out and replace. Dr. Florez said probably loose but always chance it's not that loose. If not loose, then they'll leave it in. If it is loose they take that part out and replacing the Zimmer shoulder part with a stronger Biomet shoulder part that has bigger longer nail into shoulder and four screws rather than two. Zimmer and Biomet are the same company but different. 1 - 3 days in hospital.

Reading through the above, I guess I am anxious in that I really don't know as they don't know what I'm in for surgery or recovery wise. I remember the rotator cuff surgeries being extremely painful with tons of PT work after whereas the replacement surgery was relatively easy with tons of PT but not nearly as hard of a recovery.

I seem to remember being so anxious with other surgeries for it to be over. This time I really just want it to stay ahead of me. So many uncertainties.

 

[Jaycey]

It's tough to go into any surgery let alone with it all "up in the air". Sounds like you trust your doctors - that is key.

All the best @Me2 ! See you on the other side soon!

 

[SaraK]

I know it's daunting going into another shoulder surgery - especially not knowing exactly what they'll need to do. On the other hand, the healing can't start until you get the surgery. After everyone told me how much worse rotator cuff surgery was than my hip replacements, I felt so much better within a couple of weeks than before surgery (weak but pain free). Let's get this party started and I'll meet you on the healing side!