Torn Rotator Cuff - Going Under The Blade

[snowman]

I tore BOTH rotator cuffs, in ONE night. Brutal workout in Judo with a 320 pound Gorilla. He managed to tie me up in such a way to tear BOTH rotator cuffs in one fell swoop.

I had the surgery, a miracle. Both rotator cuffs were badly torn, easily viewed on an X ray. Total pain, unable to sleep, unable to function. Surgery offered almost immediate relief form the constant outrageous pain. It took about 15 weeks for the pain to go away at night, but whatever the pain was, it was LESS than before the surgery. Almost a year later I was back to normal range of movement, not quite back to before, but close enough.

Don't put off surgery. This is a purely mechanical thing, it won't heal by itself. Your muscle is TORN and must be reattached, It won't do it by itself, no matter how much cortisone you inject.

[rcecale]

Okay, this is gonna be two, two, two posts in one...!

First of all, snowman...how the heck did you deal with having both shoulders repaired at the same time. Didn't they have to imobilize them for a few weeks after surgery??? My right shoulder is the one needing surgery, but lately, my left is seeimg to get the same way. I wonder if it might be from overcompensating for the right side.

Now, for the second part of this post. Whew. what a doozie!!!!

Showed up this morning as scheduled, for my procedure. Everything was going fine until it came time fo the anesthesiologist. Super guy, very knowledgable, terrific rapport, no problemo.

He explained to me about something he called an anesthetic block which was supposed to numb the nerves, temporarily, to my shoulder for several hours after the procedure was complete.

Well, he hooked up the electrical device which was used to licate the shoulder nerves, causing my arm to jump. Once identified, he applied the injection....things went downhill from there.

Rather than heading south into my shoulder, the juice went north, into my neck, and up through the side and back of my head. It was as if I was having some sort of allergic reaction or something...and as far as I know, I'm alleergic to nothing.

Broke into a serious cold sweat...soaking my gown, the sheets, the second set of sheets they brought, a couple of towels...I was a leaking sponge.

I also got a serious bout of restless leg syndrome...I couldn't keep them still. They tried hooking up an EKG, but I just couldn't hold still long enough.

I don't remember this part, but apparently I started to pull all the other things connected to me off, and while I was reaching for the IV plugged into my hand, said something like, "I can't do this. I'm outta here!"

Fortunately, they got me under control...once they took me by ambulance over to the Emergency Room....I'm telling you guys, I was a mess!!!

So, long story short of it, Surgery has to be rescheduled because I missed my window of opportunity. Doc had to move onto the next patient.

Have any of you medical folks seen anything like this before? Scared the *****e outta me, after the fact!

Randy

[pavulon]

Bummer!!!

Fully suspect the local anesthetic meds made their way into your epidural space...which runs from your tail to the very top of the inside of your head. This is a known (but unusual) complication when placing an interscalene block. The good news was that the medication sounds to have been on the outside of the dura mater...had it been somehow placed on the inside of that membrane (in the CSF)...you'd have been in deeper.

I'm sure you had everyone's undivided attention and it sounds like they did a respectable job of dealing w/ an unusual and difficult situation.

If you agree to having that block next time you're in, I bet they inject reeeaaaallllyyyy slow.

Good luck!!

[Hugh R]

Wow randy, a little static in the attic? Seriously, I hope your OK. As a marine with your arms and legs flayling around like that, its a wonder that you didn't kill a couple of them. Hang in there.

[Moses]

Originally Posted by pavulon

1. Find a surgeon who does the vast majority of their repairs via the scope.
2. Fail that, get an interscalene catheter placed for post-op pain control.

Absolutely!
If your surgeon doesn't do the VAST majority of his cases through the scope, run like hell. Seriously.

The interscalene block is a great addition. I had no catheter, just an interscalene Marcaine block. Worked fantastically.

In terms of recovery time and full restoration of function and a lower risk of bleeding and infection, DO IT THROUGH THE SCOPE!!!!!

[Tobra]

ice is your friend, so is your physical therapist, you will only think they are trying to kill you.

DO YOUR POST OP THERAPY

oops, missed the reschedule thing, do as much therapy as you can stand preop, stronger it is before, less you have to do to recover

[snowman]

Sorry to hear about your bad experience. Not normal for sure. Check out your orthopedic man with your GP and any other medical types you can find. If they do not recommend him or say some non committal kind of response, find someone else. Same for the anesthesiologist.

No they did not repair both of mine at the same time, I would have been a complete invalid. Its been several years now, both arms are fine, no pain at all.

[rcecale]

Originally Posted by Moses

Absolutely!
If your surgeon doesn't do the VAST majority of his cases through the scope, run like hell. Seriously.

The interscalene block is a great addition. I had no catheter, just an interscalene Marcaine block. Worked fantastically.

In terms of recovery time and full restoration of function and a lower risk of bleeding and infection, DO IT THROUGH THE SCOPE!!!!!

Great advice from both of you. Dr. Wertheim (The Orthopaedist) comes highly recommended. Here's a link to a wite-up page Even before the episode, all the hospital staff commented that he was the best guy around.

The man has been in the business for 26 years. I feel confident in his skills and experience.


The same goes for Dr. Schinelli, the Anesthesiologist. When things went sour, he was right on top of everything. When the "entire staff" was looking after me, he was leading the charge. Dr, Schinelli is another one with several years of experience behind him Total confidence in his abilities.

Randy

[Dixie]

I have to agree on getting someone to do it arthroscopically. The recovery will be muchfaster. (As I understand it, not all rotator cuff repairs can be done with a scope, but most can.)

Personal testimony:
I had my right shoulder done last week. Frayed labral tear, large tendon tear, and acromional spur removed (end of collar bone). All done via scope. My arm is not immobilized. I'm already in physical therapy, and will be allowed to raise my arm next week.

I had my left shoulder done two years ago. Fully detached supraspinatus. (Not visible in the MRIs. Misdiagnosed as tendonitis for three years. Another story for another time.) Tendon reattached to arm, and acromion shaved to reduce impingement. Done via scope. Again, no immobilization required. Physical therapy started two days post-op and completed in six weeks.

Hope this helps.

[snowman]

arthroscopic surgery is the way to go. BUT sometimes it just can't be done, it just depends on how much damage you have to your shoulder, so you can't ever say no. If anyone tells you it cannot be done arthroscopically, get a second opinion for sure.

Back on subject, the injury is purely mechanical in nature. It cannot and will not ever fix itself. It will never get better, it will always be painful or at least very limiting on your activity.

The surgery is almost 100% corrective (you may have a slight movement limitation), there is every reason to get it and almost none to not have it. It is one of the very few things that medicine offers that is black and white beneficial. But it sounds like your going for it so you just have to follow thru.

You are now very apprehensive, you appear to have been somewhat to begin with, thats normal. I don't remember having the same kind of anesthesia that you experienced. I had general anesthesia and as far as I know no EMGs and nerve blocks. This kind of surgery is so significant in terms of manipulation of your body, I would suggest general in any case. I had local for a carpel tunnel operation in my wrist. You can feel them tugging and pulling on things. With a shoulder it is more so.

[rcecale]

Oh, I'm definitely going through with it, block be damned. No doubt about that. I'm too tired of the constant pain and ROM limitations of the current situation.

I'll be calling the doc's office today to see about the reschedule. The sooner the better. In fact, I believe the other shoulder may be somewhat damaged as well so I'll be letting him know about that too.

The block that was administered was an "optional" addition to the general they intended to use. May pass on that, but I'm definitely going to have the procedure, expecially if he can do it arthroscopically.

I appreciate all the input!

Randy

[Dixie]

Randy,

GET THE NERVE BLOCK! And make sure to start taking the pain medication before it wears off.

[rcecale]

So, Rob...are you saying I SHOULD have the nerve block?

I guess I wasn't clear in my last post. Yes indeed, I'll do the block. What I meant previously is that I won't let what happened stop me from trying again. Even before he administered it, the Anesthesiologist warned of a small percentage of times where things could happen.

The staff was on top of it...literally! From what I was told, at one point, while they were trying to get an EKG started, there were 3 or 4 people laying on my legs, trying to hold me still. I wasn't having any of that! They couldn't keep this ol' devildog down. (I remember none of this!)

As Hugh alluded to earlier, I'm glad nobody got hurt! LOL

Randy

[Tobra]

Originally Posted by Capt. Carrera

Randy,

GET THE NERVE BLOCK! And make sure to start taking the pain medication before it wears off.

and have some bland food in your belly prior to taking that pain medication. Eat a bacon cheesburger and you are likely to get a second look at it.

Speak to the surgeon about alternating ibuprofen and narcotics(NSAID at 0800, 1200, 1600, 2000; narcotic at 0600, 1000, 1400 1800, 2200 for example) Will manage your pain better

[snowman]

My shoulder hurt so bad that the post op pain was a great relief!

[rcecale]

Well, did the nasty and got her done! Went under the blade yesterday and had the repair performed. Anesthesiologist said we weren't gonna use the block, and so far so good.

Doc was able to do the repairs arthroscopically, so I only have the 2 or 3 smalll incissions as opposed to the one huge one.

Percasets seem to be doing the job so far, no pain whatsoever. Only a little stiffness, but that should pass in time, I'm sure.

Randy

[WI wide body]

Originally Posted by Moses

Absolutely!
If your surgeon doesn't do the VAST majority of his cases through the scope, run like hell. Seriously.

The interscalene block is a great addition. I had no catheter, just an interscalene Marcaine block. Worked fantastically.

In terms of recovery time and full restoration of function and a lower risk of bleeding and infection, DO IT THROUGH THE SCOPE!!!!!

It's always risky to say the least when giving medical advice. Every situation and person is different.

Rotator cuff surgery is no different. Yes, doing per "scope" is less invasive but any surgeon who tells you that he can do just as good a job as opening up the area which allows immensely better access is simply full of *****. A little common sense ought to tell you that.

You may have had good results and that's wonderful. But in another case it could be an invitation to a questionable job and poor long term results.

IMHO as one who had serious rotator cuff surgery with good results...so far.

[bigchillcar]

Originally Posted by Red Baron

I had RC surgery back in March and they had to repair a torn tendon also. At 42, my power lifting days are now behind me.

It's a tough recovery, at least it was for me and my doctor says to expect it to be a year before full recovery. The doctor that performed the procedure is a well known NFL, MLB doctor and did a really nice job. I've finished PT and have about 90% of my range of motion and about 60% of my strength back. THE PAIN IS GONE! And that's what is important because it was effecting my sleep in a big way.

Best of luck!

dang, this is my nightmare. strength-coaching certification, 28 years of lifting, 20 of it powerlifting or push-pull contests..and i'm 42. i have to take 800 mg of ibuprofen an hour before any kind of pressing movements. i do rotator cuff warm-up exercises with cables to help some, but my 'heavy days' are numbered. i'm still in the 400-lb club on bench, but just barely. even with periodized training regimens, only strength training for 6 weeks at a time every 3 months, by weeks 5 and 6 i'm hurting. no telling how much gunk's in my rc's. and...i have NO medical insurance. sleep without rolling from one side to the other all night? what's that??

[azasadny]

Randy,
I'm glad you got your shoulder taken care of. I'll keep you in my prayers!

[JavaBrewer]

Originally Posted by bigchillcar

sleep without rolling from one side to the other all night? what's that??

LOL...I know what you mean. A couple months now of going to the gym and stretching and no real change in my pain levels. Sleep comes in 90 minute intervals and has been that way for more than a few years now. I'm growing weary of this and as I get older it can only get worse.

I have good medical insurance but having a difficult time finding a doc that I can trust with this. Anyone with a San Diego referral?