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Seeking advice - Rotator Cuff Surgery
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I'm seeking advice from others on the pros / cons of moving forward with rotator cuff surgery. I'm struggling with whether or not to go through with surgery this fall. I'm a bit of a naturalist and skeptic of surgeons. But this injury has me in a tough spot. I fell skiing in January 2014 and took a hard blow to my right shoulder! I'm a 39yo female who is a total jock - I work out 5x per week and love all types of activity / sports. I compete in triathlons and formerly played college and semi-pro basketball. My goal is to be very active into my 60s-70s in triathlon, skiing, basketball (realistically only for the next 5-10 years), and strength training.

The MRI report from April 2014 says I have a 2.5 cm TV x 2.2 cm AP near full-thickness tear of the mid and posterior fibers of the supraspinatus. There is also undersurface fraying of the anterior fibers of the supraspinatus.

The surgeon recommended surgery considering I'm a very competitive athlete with a 90% chance of a full recovery and for an improved quality of life. He also said that rotator cuff tears (full tears) do not heal. I can only make it worse with another accident or overuse. At the time I visited the Dr in April / May 2014, I was having very bad pain at night. I gave up swimming altogether as the Dr said it could further damage the tear and I feared it worsened the night pain. I decided to hold off on surgery and see how I felt at the end of the 2014 summer.

I decided to see another DR for a second opinion in July 2014. He did not tell me definitively what I should do but recommended I do PT for 4-5 weeks and if there is improvement then reconsider surgery. If I do not improve then the PT will benefit me going into the surgery. He did say that rotator cuff tears DO HEAL with scar tissue..and this is as good as healing. I'm getting mixed messages from both docs on whether or not time and PT will actually heal the tear. Help! ;-)

Here I am with summer over and my partner & family asking me daily = "Are you going through with surgery this fall or not?!!" My night pain has subsided and I swam once for 15-20 minutes on August 20th and the shoulder felt 80%...ie. pretty good. I've done some basic PT typically prescribed for rotator cuff surgery. After 4 weeks of PT, there is still slight pain and limitation. I'm not crazy about the idea of surgery, but I know the shoulder is still a liability and I get occasional pain and limitation when I do day-to-day things like hitting a volleyball with my arm stretched out, lift heavier objects or children, or partake in athletic activities involving an outstretched arm or pushing overhead.

Has anyone out there with a full thickness tear decided to opt out of surgery? If so, how is your shoulder feeling today?

If I go through with the surgery and all goes as planned, will I still have functional limitations with swimming, overhead lifting or pushups, etc? With surgery, will I simply trade off one set of limitations and pains for a new set? Will the shoulder ever get back to 100%?

What can you all recommend?

Best,
Kathleen
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Re: Seeking advice - Rotator Cuff Surgery [katedundee] [ In reply to ]
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I'm not sure I am exactly who you're looking for a reply from but since I've been through this, I figured I would share my experience...

I don't know exactly when my injury occurred but I believe it was lifting weights. One day I woke up and my shoulder was sore. I skipped the gym that day and the next day it was sore as well. This continued and eventually I just tried dealing with it but that didn't go well either. Finally I went to my doctor and he told me to take 2 weeks off from any physical activity. It started to feel better so I went back to the gym and the next day it was sore again. UGH! Back to the doctor he told me to take 6 weeks off but it was more of the same. Finally he ordered an MRI and they found that I had a torn rotator cuff. I put off the surgery for a while. I was never in terrible pain but it was constantly sore. Eventually that got old, although I wasn't a triathlete (or much of an athlete at all) at the point, I was still annoying. I finally grew frustrated and scheduled the surgery.

I'm not exactly in your shoes because while they were in there, they noticed an issue with my shoulder so they also did a thermal capsular shrinkage procedure. I was in a sling for a while (4-8 weeks i think?) before I started physical therapy. It was pretty tough work to get back to normal. This was 10 years ago so it's hard to remember the specifics but I went to PT for a few months. I got a lot better but eventually insurance ran out and I stopped going. They gave me exercises to do on my own but I was too lazy to do them. This was a huge mistake. While I regained most of my range of motion, I would eventually learn that I didn't gain all the strength back. I was back to normal for the most part, except throwing a baseball and was quite happy.

Morale of the story, the surgery was a success and I'm glad I did it. No more pain after that but looking back I wish I had followed through with all the PT. I still find myself weak with certain motions.
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Re: Seeking advice - Rotator Cuff Surgery [katedundee] [ In reply to ]
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I've been in your shoes before, once for a knee surgery and once for a torn labrum in my shoulder. If you are unable to do what you love now without limitations, surgery may be your best option. If the injury is severely lessening your quality of life you need to take the necessary steps to heal and move on. Hopefully you've found yourself a trusted and reputable surgeon who will steer you in the right direction.
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Re: Seeking advice - Rotator Cuff Surgery [katedundee] [ In reply to ]
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In 2001 I fell running and broke my arm at the elbow. No one checked my shoulder at the hospital and my arm was in a cast and sling for 6 weeks so I never thought too much about it until a year and a half later when I could hardly lift my arm quick motions were very painful. The mri showed a torn rotator cuff, torn labrum and a detached bicep tendon. I asked the doc how all this happened and he said that once you damage one part you just keep causing more damage unless you get it fixed. He repaired the shoulder and it has been 100% ever since.

In 2011 I fell from a scaffold at the World Trade Center and tore the labrum in the other shoulder. Again I couldn't swim and any quick motion was painful. I had it fixed right away and it too is 100%

The key is to find the best shoulder specialist that you can find. You want some one who works on this one problem all day long and knows it inside and out. A good example is the girl who told me about Hospital for Special Surgery in NYC. She had a torn hip labrum. Her orthopedic surgeon in Princeton told her that her was very familiar that and he saw one or two every month. Her surgeon at HSS sees two or three every day before he has his coffee break.

Another very important thing is PT. Your shoulder will need PT after the surgery and you have to complete it. There are a lot of people who have shoulder surgery by non specialized orthopedic surgeons and don't complete their PT and have trouble for the rest of their life. You don't want to be one of them. Get the best doc, do your PT and just like the people in the nursery rhyme you will live happily ever after.

Good luck with it all.

---------------------------
''Sweeney - you can both crush your AG *and* cruise in dead last!! 😂 '' Murphy's Law
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Re: Seeking advice - Rotator Cuff Surgery [Sweeney] [ In reply to ]
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I had my knee done at Hospital for Special Surgery, can't recommend it enough.
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Re: Seeking advice - Rotator Cuff Surgery [Sweeney] [ In reply to ]
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Sweeney wrote:
The key is to find the best shoulder specialist that you can find. You want some one who works on this one problem all day long and knows it inside and out. A good example is the girl who told me about Hospital for Special Surgery in NYC. She had a torn hip labrum. Her orthopedic surgeon in Princeton told her that her was very familiar that and he saw one or two every month. Her surgeon at HSS sees two or three every day before he has his coffee break.

This.

Two wheels good. Four wheels bad.
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Re: Seeking advice - Rotator Cuff Surgery [katedundee] [ In reply to ]
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Get the surgery. I had the same deal, tried the pt route for a few months and finally had it done and only regretted not doing it sooner.

Get a doc that has done this op thousand(s) of times before, prepare yourself for a good month of immobilized arm but once done, if like me, you will make quick recovery, build up wasted muscles and back in action.

Best of luck regardless.
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Re: Seeking advice - Rotator Cuff Surgery [katedundee] [ In reply to ]
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Do it.
I had an 80% tear in the supraspinatus most likely from going too heavy lifting weights. I put off surgery for a couple of months due to work conflicts. I had a shoulder injection and several rounds of PT. Th shot helped with the constant pain, but the PT didn't do a lot to strengthen my shoulder. I had the surgery on July 17th 2013.

The tear was repaired, my bicep tendon was cut and relocated and I had bone shaving to the acromium. The bicep tendon relocation probably doubled my recovery time over just a repair to the tear. I completed the Lavaman Olympic in November of the same year on very little swim or bike training. I was told to not run or swim for 3 months and stuck to it and did PT every day and once or twice a week with the therapist.

Pain 100% gone, strength mostly back, but my throwing ability (speed and distance) is pretty lame.I attribute that to a changed range of motion. After surgery my swim is improved ( my recovery with my right arm used to be what I would call a wide arc instead of a high elbow) Staying in the aero bars is more comfortable. Biggest plus, PAIN FREE. BTW I am a 56 year old male firefighter, very active and do a lot of work related heavy lifting at odd angles, frequently overhead and at arms length that I couldn't do before the surgery. (Chainsaw and chopping stuff, lifting EMS patients etc.) I have my first post-surgery 70.3 in two weeks.
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Re: Seeking advice - Rotator Cuff Surgery [katedundee] [ In reply to ]
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My wife had this procedure done 10 days ago and the recovery is going very well. She was out of the hospital in about 3 hours, only took the heavy duty pain meds for one day after the nerve block wore off, and will be in the sling for about 6 weeks. I'm not a fan of many types of elective surgery, but this one is a no-brainer - you should have it done.
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Re: Seeking advice - Rotator Cuff Surgery [hen263] [ In reply to ]
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hen263 wrote:
Get the surgery. I had the same deal, tried the pt route for a few months and finally had it done and only regretted not doing it sooner.

Get a doc that has done this op thousand(s) of times before, prepare yourself for a good month of immobilized arm but once done, if like me, you will make quick recovery, build up wasted muscles and back in action.

Best of luck regardless.

+1 I was in this situation and like you I've been an athlete all of my life and tore my rotator. I went the "resting" route for a while, had a few cortisone injections (don't do this!) and finally decided on the surgery. Wish I would have done it sooner! You'll be in a sling 6-8wks but since you're active you should have a pretty "easy/quick" recovery if you follow through with ALL of the PT. Don't skip it and don't push too soon even though you'll want to initially.
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Re: Seeking advice - Rotator Cuff Surgery [ONDave] [ In reply to ]
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OnDave - Great to hear your wife is doing well. How is the sleeping going? I just lined up a recliner to spend my nights and avoid sleeping on my shoulder. I appreciate your encouragement. Maybe we should be "pen pals". ;-)
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Re: Seeking advice - Rotator Cuff Surgery [katedundee] [ In reply to ]
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Kate, sleeping has been a problem and we probably should have picked up a recliner. Part of the sling is a firm pillow about 4 inches in diameter that straps around her waist, and Velcro on the forearm of the sling attaches to the pillow. This immobilizes the shoulder and also keeps you from rolling over onto the shoulder while sleeping. My wife is not used to sleeping on her back so she is not sleeping soundly.

I think the two best bits of advice in this thread were to find a surgeon who does the procedure routinely, and take your PT seriously. My wife was in physio for 2-3 months prior to the procedure such that she had very little pain or inflammation going in, and I think this simplifies the surgery and speeds the recovery. Her first post-op appointment with the surgeon is this Wednesday and she is eager to get physio started again.

Over the weekend we removed the strips that were securing the incisions and there are 4 very small incisions with no visible sutures on the back of the shoulder that should heal quickly leaving very small scars.

Feel free to send me a message if you would like to chat more about this.
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Re: Seeking advice - Rotator Cuff Surgery [katedundee] [ In reply to ]
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I'm 7 months out from multiple tears. While my shoulder specialist was at it (highly recommend a doc that specializes in shoulders) he fixed my separated shoulder and cleaned up a bone spur he found. Be prepared for 4 months of doing nothing at all athletic. At six months, he ok'd me to start riding and I expect it will take another 4-5 months to get really strong again. I'm up to about 1000 yards swimming - doing 100's at a time.

Was not prepared for how long I would be in pain. We're not talking a few days or a couple weeks, but months of serious discomfort.

This will be the center of your life for a year.

It's really a matter of which sucks less: The way you are now, or a lot of pain and a year away from solid training.

Geoff from Indy
http://www.tlcendurance.com
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Re: Seeking advice - Rotator Cuff Surgery [geoffreydean] [ In reply to ]
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Thanks for the dose of reality! It's a tough decision but I'm looking at the long haul of my athletic endeavors and regaining my strength. When you say "no athletic activity" for 4 months - could you go for brisk walks or do body squats?? Anything to keep my mind right and not go crazy from inactivity?

How did you hurt your shoulder? if you don't mind me asking.
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Re: Seeking advice - Rotator Cuff Surgery [katedundee] [ In reply to ]
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katedundee wrote:
Thanks for the dose of reality! It's a tough decision but I'm looking at the long haul of my athletic endeavors and regaining my strength. When you say "no athletic activity" for 4 months - could you go for brisk walks or do body squats?? Anything to keep my mind right and not go crazy from inactivity?

How did you hurt your shoulder? if you don't mind me asking.

It sounds like the prognosis can vary patient to patient. My doc spent an extra hour in my shoulder cleaning bone spurs, biceps tendodesis and fixing my labrum. It's not the same as rotator cuff surgery but the recovery processes are somewhat comparable.

I'm middle-aged and they were eager to get me going on PT rather than let things get too stagnant. I started PT at 2 weeks, it's still on-going. I was riding a recumbent bike at the gym at about 3 weeks, and moved up to a stationary bike with permission over the next couple weeks, ensuring everyone that I wouldn't put too much weight on the arm [it's possible, but is definitely not aerodynamic]. No running, no dog-walking, no swimming, but I walked a lot and did the PT stuff whole-heartedly and didn't do the things they said not to. No driving while in the brace is a big rule. If it doesn't hurt, walk.

Last Wednesday was my 10 week anniversary, and on Thursday they cleared me to run (gently and with good sense), but not to bike outside for four more weeks.

I've been working on my diet and stretching this whole time. Throughout this process, sleep has sucked.

Saturday I did my first run, a slow 2.5 miler and promptly gave myself shinsplints. Gotta love it.
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Re: Seeking advice - Rotator Cuff Surgery [katedundee] [ In reply to ]
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One of my athletes got surgery for both his shoulder and knee (football accidents years before) and was actually back training again soon after.
After his shoulder, he was back on the trainer a week later. It took 6 weeks to get back to running (flat roads only) and a bit longer for cycling.
He was back swimming less than 3 months post operation.

There is some evidence that PT works well depending on ROM, but it's mostly in atraumatic RC injuries. In your case it doesn't apply so most
likely surgery is the quicker route. But with a good shoulder specialist.
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Re: Seeking advice - Rotator Cuff Surgery [katedundee] [ In reply to ]
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I had a small tear in rc from overuse/growing old, took six months of dedicated exercises from the (excellent, swimmer) PT to stabilize it. Since then it's been fine, with occasional twinges. Other changes:
- swim more stroke not just freestyle
- add in the PT exercises, mostly scapular stabilization work, to the winter weights program
- different arm recovery in the pool

As Francois says, traumatic injuries are typically the ones for which surgery is a reasonable option. I dislike being cut, so did not pursue that for my injury. PT is just another training discipline really ;-)

switch to x-c skiing instead of downhill, better workout and the risks of traumatic injury are far lower.. ha.
Last edited by: doug in co: Sep 8, 14 15:42
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Re: Seeking advice - Rotator Cuff Surgery [katedundee] [ In reply to ]
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Being a naturaliat would historically mean you would get dropped for being a burden to the group and you would die miserably. ;) thankfully you dont have to do that!

Go with what the medical experts tell you. My daughter had a torn labrum and got it surgically repaired in December. Shes a swimmer and was seen by an orthopedist that is a former swimmer and us swim team dr. She was operated on by a sports shoulder specialist and is doing auite well now.

The shoulder is painful and you'll be in a sling for 8 weeks but after you heal it will be fine. Youre probably only prolonging your discomfort by waiting if surgery is indicated.

who's smarter than you're? i'm!
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Re: Seeking advice - Rotator Cuff Surgery [katedundee] [ In reply to ]
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katedundee wrote:
Thanks for the dose of reality! It's a tough decision but I'm looking at the long haul of my athletic endeavors and regaining my strength. When you say "no athletic activity" for 4 months - could you go for brisk walks or do body squats?? Anything to keep my mind right and not go crazy from inactivity?


How did you hurt your shoulder? if you don't mind me asking.


Before my surgery, I fixed up an upright bike on a trainer so I could ride indoors with one arm. After the surgery I rode it a few times, but it seemed futile to try and stay in good shape. I decided to embrace my first time off from hard training in many years and I have a feeling I'll end up living longer as a result of my decision. Here's a post I made three weeks out from surgery.

Without going into a long autobiography, a quick thumbnail into my athletic background: Basically 56 year old with 33 years of year-around training for multisport competition – running races, triathlons long and short, duathlons, etc. The past couple years with the addition of cyclocross and an even more intense “off-season”, my cycling in particular has spiraled upwards to new levels; a formidable accomplishment for an "old guy."


I've always taken pride in my Peter Pan energy, physique and looks but the past couple years I noticed some changes that clued me into the fact my body won’t stay young forever. These include without getting overly specific: mild sexual decline, and having to pee more often and more urgently.


Three weeks ago, I had surgery to repair a pretty screwed-up shoulder, so I've been about as inactive as I ever have been in my whole life as of late. I assumed I would be fighting major depression during this recovery time, but this hasn't been the case. In fact, it’s been kind of nice not having two to four hours workouts hanging over my head every day. I've had time to think and read about a couple other loves of mine (photography and film making). But the most telling thing that has happened during this recovery period is the obvious increase in testosterone which is making me feel more like 36 instead of 56. Another thing I noticed is I do not have to get up to pee at 2 am every night; it’s like my bladder has increased its capacity, and in addition I've had no episodes of the very urgent need to pee. Again without getting too graphic, my digestive system has “normalized” to a consistent once a day bowel movement instead of multiple visits to the toilet.


Now I've always been aware that hard endurance training – chronic stress - reduces testosterone and increases cortisol and other stress hormones and can cause hormone imbalances and lots of other problems. But this personal experience has really made it real to me.


I guess the take-away for me is that as a coach, I would encourage my athletes to take an off-season break; if not every year, at least every once in a while. Not taking time off in my mind has always been a secret weapon to take my fitness to the next level but it’s not without side effects.


Being competitive was nearly the most important thing in my life up until a month ago, and the reason for the surgery was to be able to swim stronger, so this break has been given me an interesting perspective. I’m not sure how I’ll come out on the other side. I very well may step right back into the same pattern as before – or maybe not.



Geoff from Indy
http://www.tlcendurance.com
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