I Failed Rotator Cuff...

Thurs. Jan. 12, 2012

Crud. And I usually do so well in exams.

It seems not only do I have a torn rotator cuff, but part of the shoulder blade (acromium) pinching it against--the clavicle, I think. It hurts whatever it is. Plus the bursa is inflamed.

So what that means is surgery. Oh boy. The last time I had surgery was about 35 years ago, and while it slowed me down a little bit, it didn’t incapacitate me. Back then, they also kept me mostly unconscious for three days, so I missed a lot of the pain.

Let me back up a minute. When the orthopedic surgeon walked in to the room on Monday, and started talking, I asked him to show me on the MRI films. I could be wrong, but I think it slightly irritated him—like rarely does anyone want to see their films. Partly, as has been suggested to me, most surgeons are not McDreamy’s and have minimal patient skills, aka a bedside manner.

Anyway, we walked down the short hall so he could shove films on the viewing board, pointing, talking a mile-a-minute in doctor talk. I stopped him and asked him to speak English. He said he couldn’t describe it except in Doctor. “Try.”

By the way—some of this is going to be interesting only to me, but don’t skip—you might miss the good parts!

I pointed at this and that, asked some questions, made sure I understood mostly what he was talking about—except he kept saying—I thought—“a cromium” when he was talking about the end of the clavicle. (It’s actually the acromium; I found that out on google.) Not knowing that, I asked if it was the curved bone that looked like it was floating in air in the fluoroscope. Yes.

OK, so we walk back to the room, I picked up my little recorder that I’d set on the exam table, and asked to start over from the beginning. (I don’t know if it’s significant or not, but I “accidentally” got a copy of his notes from the check-out gal before I left, and someone (doc or ?) noted that the “patient recorded conversation.” hmmm….

First, I did not really know what a rotator cuff was. You hear that all the time, and I had pictured like the cuff of a sleeve, and a little ruffle-y sleeve around the shoulder joint—which is really shallow, which is why it’s so easy to dislocate a shoulder. Well, the cuff is actually four tendons that attach to…ummm, which ever bone(s) they attach to. They are also why the shoulder joint has more mobility than any other joint in the body.
Well, one of my tendons is partially torn; I think it’s the one under the acromium and above whatever the other bone is. It also appears to be rather thin. Doc said it should be between 4mm and 8 mm thick. He’s betting mine is less than four…so, instead of just repairing the tear, he will probably cut the tendon where it’s thin, and pull until a thicker portion of the tendon is in place, then sew it together. Ow.

There are, I think, something like 7 bursa in and around the shoulder joint. He apparently is going to take out one that’s inflamed, although why I can’t take something to un-inflame it and keep the bursa, I don’t know. I didn’t think to ask then, but I will. The bursa is cushion. I want cushion.

Also, because the shoulder end of the acromium is impinging on things it shouldn’t (did it shift when I dislodged my clavicle?), he is going to shave off the end of the bone. OW! And all this supposedly done arthroscopically…and of course, as an out-patient. (I need to check out bone images again; I’m probably getting things confused. This is one of my transcriptions of what doc said: Take off the end of clavicle so it doesn’t rub against the acromium.)

At the end of the surgery doc will do an inter-scalene block which will leave my arm dead for around 12? hours. Sling/swath around arm/shoulder/body to keep my shoulder immobile for a week. It’s my right shoulder. I’m right-handed. Talk about inconvenient. Not to mention OW OW OW after the block wears off.

Stitches out a week later; more sling and mostly immobile for another week, and sling for another two weeks after that. Not sure when the physical therapy starts.

Now, remember way back when I said the bursa is inflamed? Well, because the internal med doc prescribed two dose packs of Medrol in November because he thought the pain down my arm was just inflammation, although if there’s enough trauma to dislodge a clavicle, a doctor really should figure that maybe there’s other damage connected to it. The only reason the Medrol helped for a short time is because there was inflammation—but he never even considered anything else.

Because corticosteroids can inhibit healing, Ortho doc suggested I wait till around the end of Feb. before I have the surgery. Meanwhile I have to get a pre-op exam to make sure I’m healthy enough to have surgery.

Well, it turns out the pre-op has a lot of what I’m due for in the well-woman exam in April. Then I got to thinking I probably wouldn’t be able to have my mammo then because I wouldn’t be able to get my shoulder into the right position…and in fact, the way it’s feeling right now, I still may not be able to have it positioned without screaming. Be that as it may, I called our insurance to find out if I could have my well-woman a little early.

Turns out the insurance pays for it once a calendar year. It doesn’t have to be a year in-between—like April to April, like I thought-- just one in 2011, one in 2012, etc. Yay!

So I have all of that set up first day available with my primary, which isn’t until the end of this month. After which, whatever results are the pre-op results will get sent to the surgeon, which means I can then schedule the surgery.

I am not looking forward to it; at the same time, I want to get it over with. It’s the inconvenience and incapacitation of it all that really bugs me. Still, I’m already practicing doing things with my left hand. And even with the right arm strapped down, I’m seeing myself walking Baxter; I’m seeing myself using the elliptical; I’m seeing my self at the computer. I don’t see myself as “helpless”—just ticked off!

Aside from doing the minor pre-surgery PT, I’m being a little more cautious about stressing my shoulder—partly because I’d hate for the cuff to completely tear, and partly because it aches all the time now.

Heh, I asked the doc what I should Not be doing right now. Bench presses. (I was doing those a couple of weeks ago, before we returned the new weight bench.) And overhead exercises…you mean like what I was doing that very morning with the elastic tubes? Crud. I don’t want to turn into a blob of flab!

The doc had pushed down on the shoulder, asking if I could resist the pressure—and I couldn’t keep my shoulder in place. This kind of thing can cause weakness there, and tonight I noticed my right shoulder slumps. It won’t stay at the same level as my left shoulder without me consciously holding it in place. That’s one of the “signs” I read about.