shoulder surgery

Bigcase:
Your intuition on your shoulder may be true. That is, the manipulation may not have gained your shoulder full range of motion.

As I mentioned earlier, do not let your surgeon led you to feel somehow responsible that your shoulder remains limited in ROM. A frozen shoulder is a difficult condition to remedy. It involves not only the actual ROM of the shoulder but also that scapular-humeral rhythm - that is, the ratio of scapular movement that must accompany shoulder movement.

Bottom Line: Do your best at maintaining and enhancing your shoulder's range of motion but do not overly stress the joint with ballistic or overly aggressive movement. Overly aggressive therapy will result in inflammation. Inflammation will lead to adhesion and scar tissue.

Do not let your surgeon lead you to believe that you are the "cause" of your shoulder's limitations. It is not that simple.

You deserve a hug,
- Karen -

BC, I have felt all along with the surgeon placing that 2 week time frame of how your shoulder should be was way off base. When surgeons talk like that I am very leery of them. Its the I did my perfect surgery now the rest is up to you. Maybe this happens in the perfect world but often it is not reality.

I echo what Karen said, this is not something you have caused & do not push yourself to the point of messing things up.

Take care.

I don't know I would have to think long & hard before I would consider more surgery with this guy. When it comes to surgery I sort of have this one shot at me rule & if they can't fix it in that one shot its time to look for a new surgeon. You may want to consider getting another opinion.

Sometimes a letter of medical necessity can help getting more treatment, it all depends on whatever the insurance decides to do.

You are really in a tough spot.

Remember, even in medical school, someone always graduates at the bottom of their class.

I had seen a surgeon that understood the 2 surgeries on my left shoulder when I injured my right. From my history, he agreed that I should skip the arthroscopy and go right for an open decompression. The insurance company 'sent me for a second opinion'. This arrogant jerk said he could fix me up with just an arthroscopy. So, of course, the insurance company only authorized for that.

Less than a year later, I was scheduled for an open decompression! Sadly, they wouldn't let me go back to the first surgeon. The one they sent me to for the procedure first called me a liar about my symptoms and then was overly aggressive when he did the surgery.

Trust your instincts. Mine was Worker's Comp and I didn't have any say in who operated on me. Get as many opinions as you can...interview for the position so to speak...I wish you the best possible outcome.

Hi. I revisited this thread because I went to the orthopedic surgeon referred by my chiropractor. The orthopedic surgeon says I needed surgery. He would file down bone spur and maybe repair muscle or ligament. I opted to do another nerve block first then maybe next year will do surgery. I'm having surgery this month to repair my hiatal hernia and didn't want multiple surgeries within a month.

Since your body has a propensity to produce scar tissue, perhaps discussion with your orthopedic surgeon options to mitigate scar tissue formation would be in order.

On thought would be to place you on low dose of corticosteroid in the weeks following your closed reduction. Ex. Prednisone or prednisolone or dexamethasone.

Be aware that there are risks with continued use of a corticosteroid, the most serious being pituitary suppression of the hormone ACTH that communicates with the adrenal glands to produce the life-essential hormone cortisol. You would want a physician (other than the orthopedic surgeon) to guide and monitor the titration process off of the corticosteroid (ex. a rheumatologist or an endocrinologist).

I doubt that your propensity to produce scar tissue/adhesions is all due to you.

A surgeon who is overly aggressive in the manipulation of the shoulder will set into motion an overly aggressive healing response - resulting in more scar tissue in the joint that was surgically mobilized. The surgeon must be sensitive to the fact that a closed manipulation is, in essence, an additional physical trauma to an already traumatized joint. Additional trauma with an overly egregious surgeon can and will set into motion excessive adhesion formation and possible reflex sympathetic dystrophy.

The take home message: Be critical of your surgeon and his technique.

At home, post-op, use gentle pendulum movement as your primary self-mobilization technique. Assume a gravity eliminated posture, with the affected arm/shoulder dangling at your side. Use your non-affected arm/hand, if necessary, to GENTLY guide the affected shoulder in a rotating rhythm. Start with a small circular circumference and increase gradually in circumference.

Knees have the benefit of continuous passive motion machines for the initial post-operative period. Continuous passive motion machines are a mainstay for post-op knees. Prior to the availability of the CPM, knees would adhere with generally less favorable outcomes. The key to using a CPM is to keep the rate of movement slow and gradual . . . the machine literally at a crawling speed.

There are CPMs available for the shoulder. I would inquire with your orthopedist about a rental CPM for the shoulder.

Also, there are rental cold therapy units for both knees and shoulders. These are water chilled thermal insulated units that are intended for hospital and in-home use. Easy to plug in. These cryotherapy units are popular with sports-medicine orthopedists and physical therapy clinics. They come with velcrow pads that contour to the knee or to the shoulder. Ice-cold water circulates through small capillaries that run through the pads, the water constantly recycling with the portable unit.
-Karen -

Bigcase: I do not think that the knee and shoulder CPMs are compatible. That is, the unit used for the knee is not the same design of unit used for the shoulder.

Nevertheless, CPMs are available for the shoulder and are available for post-operative use in the hospital as well as for in-home use.

As a PT, we would fit the shoulder units for total shoulder patients and shoulder manipulation patients for them while in the post-operative recovery unit and start the units within the first 1/2 hour after surgery. Patients were sent home with the same unit, charged through their insurance company or private pay. The rental expense was about $90 for a month for those who private payed. For those with insurance, the benefit was part of their durable medical benefit contract benefits.

The cryotherapy units were similarly fitted and provided with the patient at discharge. This is a level of cold therapy more effective than topical ice packs. The pads are designed to contour the knee and shoulder, respectively, with velcrow closure. The units connect with a plug-in adaptor through while ice-cold water circulates through capillaries embedded in the knee and shoulder pads. I highly recommend the cryotherapy units. Many sports-medicine clinics have their own that they rent/lease to outpatients post-op.

CPM for shoulders and in-home cryotherapy have added to the functional outcomes of shoulders and knees by reducing adhesion and scar formation. I would query your surgeon to lining up both for your use at home.
- Karen -

I have 2 of these from my last 2 knee scopes. I can tell you first hand they made a huge difference. It really kept the swelling down & helped with the pain. My life would have been easier if I would have had something like this on the first 3 scopes for sure.

I would talk to the surgeon about this.