Reverse Shoulder Replacement or PT?

[janesm]

Hi All - brand new to this site. I fell and wrecked my shoulder 6+ weeks ago. Three of 4 rotator cuff tendons have complete tears:

Impression (MRI)​

1. Complete full-thickness tear of the supraspinatus and infraspinatus tendons with 12 mm of tendon fiber retraction and edematous atrophy and fatty infiltration of the muscles.2. Full-thickness irregular tear of the subscapularis tendon with tendon fibers retracted by 17 mm. There is muscle edema.3. Medial dislocation of the long head biceps tendon from the bicipital groove into the anterior glenohumeral joint4. Near circumferential labral tear as described with mild to moderate chondral fissuring of the anterior and central glenoid.5. Partial-thickness tear and sprain of the inferior glenohumeral joint capsule.

I am 68, retired, and hoping to gain enough ROM to style my hair, cook, and carry things using both hands. Both the Ortho Specialist and Surgeon thought that I might be able to gain enough function through PT only. If not, they recommend a reverse shoulder replacement. I started PT a week ago and have decided to try it for 6 weeks. Does anyone have any success stories about those who chose PT over surgery? I've been in a sling and in various degrees of pain for 6 weeks. The thought of going through a year of post-operative pain and PT is incredibly daunting. I need some inspiration and advice. Thanks!

 

[djklaugh]

@janesm Welcome to BoneSmart! Ouch I am so sorry to hear of your shoulder injury! Since 2 doctors think PT might help you, it would be an option to go ahead with that to see if it does help.

With shoulder replacements (I have had 2 standard ones), my experience is recuperation for many takes about 6 months. And for me anyway my shoulders continued to gain strength and range of motion even after I was done with formal PT. Of course everyone's situation is different and each person heals on their own time frame. So it is impossible to predict how long it would take YOU to recuperate from a shoulder replacement. Reverse replacements do have some different limitations concerning how much weight one can lift and possibly certain motions that might be restricted (ask the surgeon what those might be if you do opt in the future to get a replacement shoulder). The reverse procedure is usually done when the damage in the shoulder is to rotator cuff and/or other tendons or soft tissue. In my case the shoulder replacements were for degenerative arthritis plus a big bone spur on one shoulder and multiple calcium deposits on the other one.

For me the only things I can not do now is hook a bra behind my back and do a crawl stroke when swimming ..... everything else a shoulder needs to do, I can do easily And i traveled cross country for school reunions about 4-5 months after each replacement surgery with no problems at all.

Do keep us informed about what you decide and how you are getting along

 

[mature mama]

I can't imagine you will be able to really use your shoulder again without surgical repair but that is me. I had a similar issue 8 years ago at 58 and tried PT. After a few months I moved on to surgery and the surgeon said it was just in time to get back some of my use of my shoulder. After recovering, I would say I have an 80% shoulder. It was painful for a couple of months and PT was for 6 months but I think I have more use than if I had only done PT.

Just fell on the other 6 weeks ago and tore off one tendon entirely and am scheduled for repair surgery on 10/21.

Much luck in the recovery of your shoulder!

 

[janesm]

Thank you, ladies! After five PT sessions, the tech and I are in consensus that I need surgery - zero improvement in range of motion. Still in daily pain. Mature Mama you were right!I had originally thought it better to wait until January for surgery - a little concerned about having surgery during the holiday season when hospital staff may be limited. Do you think this is a valid concern? On the other hand, at two months post injury I am still in daily pain, ranging from 1 - 7. My PT person wants me to continue PT until surgery to "prevent me from losing function." I am thinking I will be in less pain if I stop PT until surgery. Any advice from those who have been through it? If this pain will continue through the end of the year (If I schedule surgery for January) it may be worth it to schedule it for an earlier date.

 

[djklaugh]

@janesm These days most people do not stay in the hospital very long following joint replacement surgery. Unless you had a serious medical complication, it is likely you could go home the same day as your surgery. So having this done over the holidays probably would not be of major concern re: hospital staffing. So IMO, schedule ASAP and at your convenience. For now since PT is not helping, yes it probably would be best to discontinue it.

There will be pain after the surgery ... of a different sort than what you have now. And that pain should gradually decrease over a couple of weeks. You will be in a padded bolster sling for about 4-6 weeks (or what ever your surgeon says). Those are awkward though not uncomfortable. You will be able to remove it to bathe, dress and do some gentle swing the arm exercises. You will need further PT though usually that does not start until after you are officially out of the sling (again up to your surgeon).

After surgery applying ice to the shoulder helps manage pain. Plus taking pain medication as prescribed will help too. Sleep may be an issue for a while, it is difficult to get comfortable though using pillows to prop and support the shoulder can help.

Do let us know what you decide! And best wishes to you!

 

[mendogal]

I agree that proceeding with surgery ASAP is your best path forward.
PT that is continuing to be painful now is more likely to create problems than to provide benefit.

 

[mature mama]

Both my prior and scheduled surgery were same day procedures. I would suggest sooner than later and you may be operated on and recovering before the holidays. I would highly recommend an ice machine. I had one prescribed, when they would pay for it for a total knee replacement and it is so good. I am again borrowing my friends machine they used for a shoulder surgery. The ice pack lays nicely around the shoulder and the cool running water is wonderful. Keeping up with ice can be a challenge, so I have frozen a few small water bottles and have started making ice for Monday.
I would discontinue PT as you know the movement and you can do them at home. I find pendulums and minor stretching helpful. Moving as much as possible without serious pain is important. I discontinued as I only have 15 sessions covered by insurance. So I am saving the remaining for after surgery. My doc advised I will be in sling for a month and can take of when I am sitting. They want to flex at your elbow so it doesn't freeze up. They recommend I start PT in week 3 but I will do the easy movement at home and start week 3 or 4.
Good luck moving forward!!

 

[janesm]

Well, I took some of your advice. Surgery is scheduled for November 5 - Election Day. I stopped PT and have finished most of the Pre-Op procedures. Starting to get nervous.

 

[benne68]

Hi @janesm. Thanks for the update. I've added a signature for you with your surgery date. Please confirm that you are having a reverse.

Anxiety is normal prior to any surgery. Try to focus on good it will be to get back your function!

We'll be here to support you on your recovery journey, so keep us posted.

 

[janesm]

Thank you. Yes, I am having a reverse.

 

[mendogal]

I'm glad the date is coming up soon - less time to worry!

Focusing on making your home ready will help distract you. Consider where you want to "nest" during the day, considering which arm and hand will be most useful. Add a snuggly throw and pillows?
Set up handy surfaces around it for holding beverage, books or magazines, electronics, snacks, etc.
How will you ice postop?

Before my knee replacements I precooked and froze my favorite entrees. Stocked up on favorite beverages. That was such a help!

Please do share any specific concerns you have.

 

[janesm]

Great ideas, Mendogal. I have my Polar Ice Machine that just arrived, and I’m mapping out landing places in my home for recovery.

 

[janesm]

I have a question: how many days per week of therapy are usually required for PT following a reverse shoulder replacement?

 

[djklaugh]

@janesm It may vary depending on your insurance or surgeon's recommendations. What I did with both my shoulders and my hips was to go in to see the PT folks about every 2 weeks and do the exercises they gave me diligently between visits. That stretched out my insurance benefits and got every thing into good working order very easily. Each visit they would check range of motion and strength, see how I was doing with the exercises, drop the ones that had become easy, and add more difficult ones.

 

[janesm]

Thanks for your reply. Is that typical or do people generally go once or twice per week?

 

[benne68]

Is that typical or do people generally go once or twice per week?

It depends upon the therapist, but also on you. Many people don't follow through with their exercise "homework", so their PTs want them to come in 2 or 3 times/week. But, if you are someone who is motivated enough to do the exercises on your own at home, you don't need to go that often.

 

[janesm]

Do I remember reading that many here run their ice therapy machine while they are sleeping? I can’t see any mention of that in the Polar Ice documentation.

 

[mendogal]

Yep, lots of us have done that post op. You need to protect your skin with a layer of fabric.

 

[ennasirk]

My surgeon recommended the ice machine one hour on, 30 minutes off for the first several days after surgery, but not to use it at night. If you have a dozen 500 ml plastic water bottles, pour off a little water from each (so they don't explode when they freeze) and freeze them. Then you can have a rotation of 4 in the machine, 4 freezing, and 4 frozen at all times. Helped me so much when I was icing all day and much easier than keeping up with ice cubes.