Reverse Shoulder Replacement Voltaren Gel, PRP, PT, cost of waiting, COVID-19 risks

rcol

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I am currently 4 weeks away from a reverse TSR. I am convinced I need to do it, sooner or later, but I am really dreading both the procedure and the LONG and PAINFUL recovery. I have already delayed it once. Several questions come to mind, and I would greatly appreciate constructive comments:

1. Voltaren gel - discovered this about a month ago, and apply it about 4 times a day. I know it is "not studied for shoulders" but it has dramatically reduced my pain to manageable level. I dropped other pain meds. I still have sever movcement limitations, etc. but I have learned to be careful. It also says, "do not use more than 21 days." Why not, I have.

2. PRP - should I try it prior to shoulder surgery. Two ideas have kept me away: a) pain from PRP is reported and I have been so "pain soaked" over the last two year, that the idea of inducing more pain as an experiment is not attrtactive, and 2) I am being quoted $1500 per treatment and I might need 3 treatments. I am not rich.

3. PT - should I engage physical therapy prior to surgery. One surgeon says "no" another says "yes."

4. COST OF WAITING: ONE VENERABLE SURGEON EARLY ON said: "the only reason to have shoulder surgery is unmanageable pain. If you can wait, then wait ... the technology continues to improve. I am mostly managing thed pain, but an MRI reveals lots of joint damage by OA and rotator cuff tears. What is the cost of waiting. I will be 75 and have other morbidities.

5. COVID-19: the fifth surge is underway. They will delay surgery if infected. If hospitalization climbs, hospital staffing will take a hit, and increase probability of a mistake or accident. My surgeon says "I will not do the surgery if I fear it is unsafe." Well, he has boots on the ground, but I dont like the paternalistic attitude. It is elective surgery and my decision, not his.

This is a long post covering many topics. please comment if you can
 

Jaycey

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@rcol The decision to proceed is yours. However you are right, delaying will only result in further damage to the joint and surrounding area.

Voltaren gel is normally not very effective. However it seems you are one of the lucky ones who is seeing good results.

Please note that Votaren is a NSAID (Non-steroidal anti-inflammatory). Long term use of NSAIDs is not recommended due to multiple side effects. You can read about NSAIDs here (scroll down the page).

Sounds like your shoulder is too far down the damage road for any PRP treatment to have any impact. I really would not waste your money on this.
My surgeon says "I will not do the surgery if I fear it is unsafe." Well, he has boots on the ground, but I dont like the paternalistic attitude. It is elective surgery and my decision, not his.
On the contrary - if your surgeon feels it is not safe to do the surgery due to staff shortage or fatigue - then they will make the call. However you should note that most orthopaedic areas are some of the safest these days. They are staffed with specialist teams and in most cases areas are kept remote from any covid patients. If the surgeon does not feel the team is in a position to operate certainly you would want them to make that judgement.
 

djklaugh

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@rcol Welcome to BoneSmart. Having had 2 shoulder replacements myself ( standard not reverse) I'd like to reassure you that the recuperation from this will probably not be as painful as you anticipate. Pain medication works much better after surgery! Plus using ice or frozen gel packs on the shoulder helps with pain and reduces swelling. Also the recuperation may well be shorter than you anticipate. The key to that will be going slow! For my surgeries physical therapy did not start until about 6 weeks post op (other than some gentle swing the arm exercises) and lasted about 4-5 months .... I went in every other week and did exercises at home that were given by the PT folks. I did do those diligently and now have pretty much full range of motion in both shoulders. There are only a few things I can not do - crawl stroke when swimming (just can't get a smooth over the head around and down motion) and hook a bra behind my back ( does not apply to you -- for me I think the surgery made my arms a bit shorter than they were).

I wish you all the best with your up coming surgery1 Do check out the shoulder threads both here in pre op and over in the post op section to see how others have managed.
 

koala78

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I am currently 4 weeks away from a reverse TSR. I am convinced I need to do it, sooner or later, but I am really dreading both the procedure and the LONG and PAINFUL recovery. I have already delayed it once. Several questions come to mind, and I would greatly appreciate constructive comments:

1. Voltaren gel - discovered this about a month ago, and apply it about 4 times a day. I know it is "not studied for shoulders" but it has dramatically reduced my pain to manageable level. I dropped other pain meds. I still have sever movcement limitations, etc. but I have learned to be careful. It also says, "do not use more than 21 days." Why not, I have.

2. PRP - should I try it prior to shoulder surgery. Two ideas have kept me away: a) pain from PRP is reported and I have been so "pain soaked" over the last two year, that the idea of inducing more pain as an experiment is not attrtactive, and 2) I am being quoted $1500 per treatment and I might need 3 treatments. I am not rich.

3. PT - should I engage physical therapy prior to surgery. One surgeon says "no" another says "yes."

4. COST OF WAITING: ONE VENERABLE SURGEON EARLY ON said: "the only reason to have shoulder surgery is unmanageable pain. If you can wait, then wait ... the technology continues to improve. I am mostly managing thed pain, but an MRI reveals lots of joint damage by OA and rotator cuff tears. What is the cost of waiting. I will be 75 and have other morbidities.

5. COVID-19: the fifth surge is underway. They will delay surgery if infected. If hospitalization climbs, hospital staffing will take a hit, and increase probability of a mistake or accident. My surgeon says "I will not do the surgery if I fear it is unsafe." Well, he has boots on the ground, but I dont like the paternalistic attitude. It is elective surgery and my decision, not his.

This is a long post covering many topics. please comment if you can
Did you have your surgery - how are you doing? I've had multiple hip replacements, dislocations and infections and have no left hip replacement or joint now permanently. Two of four rotator cuff tendons completely torn and inoperable. Needing reverse total shoulder replacement but wondering if I should do it - I'm 58.
 

koala78

new member
Joined
Apr 18, 2011
Messages
16
Age
59
Gender
Female
Country
Canada Canada
I am currently 4 weeks away from a reverse TSR. I am convinced I need to do it, sooner or later, but I am really dreading both the procedure and the LONG and PAINFUL recovery. I have already delayed it once. Several questions come to mind, and I would greatly appreciate constructive comments:

1. Voltaren gel - discovered this about a month ago, and apply it about 4 times a day. I know it is "not studied for shoulders" but it has dramatically reduced my pain to manageable level. I dropped other pain meds. I still have sever movcement limitations, etc. but I have learned to be careful. It also says, "do not use more than 21 days." Why not, I have.

2. PRP - should I try it prior to shoulder surgery. Two ideas have kept me away: a) pain from PRP is reported and I have been so "pain soaked" over the last two year, that the idea of inducing more pain as an experiment is not attrtactive, and 2) I am being quoted $1500 per treatment and I might need 3 treatments. I am not rich.

3. PT - should I engage physical therapy prior to surgery. One surgeon says "no" another says "yes."

4. COST OF WAITING: ONE VENERABLE SURGEON EARLY ON said: "the only reason to have shoulder surgery is unmanageable pain. If you can wait, then wait ... the technology continues to improve. I am mostly managing thed pain, but an MRI reveals lots of joint damage by OA and rotator cuff tears. What is the cost of waiting. I will be 75 and have other morbidities.

5. COVID-19: the fifth surge is underway. They will delay surgery if infected. If hospitalization climbs, hospital staffing will take a hit, and increase probability of a mistake or accident. My surgeon says "I will not do the surgery if I fear it is unsafe." Well, he has boots on the ground, but I dont like the paternalistic attitude. It is elective surgery and my decision, not his.

This is a long post covering many topics. please comment if you can
Did you have your surgery - how are you doing? I've had multiple hip replacements, dislocations and infections and have no left hip replacement or joint now permanently. Two of four rotator cuff tendons completely torn and inoperable. Needing reverse total shoulder replacement but wondering if I should do it - I'm 58.
Oh also I have a prescription compound topical cream with amytripiline and ketamine which helps with pain/itch
 

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