A NEW INJURY AT PHYSICAL THERAPY

I went to PT today for my shoulder, and my therapist said she was going to hurt me.

I did not expect it to leave a mark:

 

The red mark is a burn from the heat therapy.  I found it a couple of hours after PT and it's starting to blister.  Now that I know that it's there, it really hurts!

SHOULDER INJURY PHOTO

I took some photos this morning, and after I looked at them, I could see the misplacement of my shoulder. So I thought I would post a photo of it.  Also, you can't see it in the photo, but I noticed this morning that my bad arm is hanging in front of my body and out to the side, where my good arm hangs straight down and touches my body.  Like an arm should.

If you look at the top photos, the shoulders are symmetrical.   In the bottom photo, you can see that it is no longer so.  Also, in the bottom photo, it looks like my sports bra is on crooked, but it is not.  It looks that way because my right side is twisted to the front and it is pulling my spine to the right.  And it looks like my right shoulder is shrugging.

You know how you do the Hokey Pokey and you put your right shoulder in and put your right shoulder out?  The out position is the way the right shoulder is all the time.

STARTING PHYSICAL THERAPY - TAKE THREE

I just saw my new PT. She disagrees with what the other PTs have told me. Big surprise. Here are some of the salient points:

1) Adhesive Capsulitis (Frozen Shoulder) is the most painful PT that there is. It is less painful to have a total knee reconstruction.

2) The PT is so painful that I will have to be doped up on narcotics for each session (three times per week) in order to be able to tolerate the pain. The less conscious I am, the better, so that means I have to be driven to and from each session. I do not tolerate these narcotics well, which means that I will spend the rest of the day in bed after each therapy session.

3) I get to have a machine at my house that I get strapped into a few times per day that will stretch my shoulder.

4) I have to do 15-20 minutes of PT on myself every two waking hours.

5) My husband needs to learn how to PT me at home for the things that I cannot do to myself.

6) My left (good) shoulder is giving out because of overuse, and is becoming very painful.

7) The therapy will take a few to several months, and every step will be very painful.

8) Although the other PTs have told me that my muscle spasms are involuntary, the new PT says that I am doing it consciously and I need to learn to control my muscle spasms with my will power. I need to learn to concentrate and will my muscles not to go into a spasm.

9) After the shoulder is released, then it will be time to make a decision on whether or not the rotator cuff needs to be surgically repaired.

10) Basically, my life, for the foreseeable future, revolves around my shoulder. Unfreezing my shoulder will be the focus of each day. It's a good thing that I am not working outside the home, because if I was, the PT said I would have to go on disability or quit my job. You cannot work and go through this rehabilitation at the same time.

Yes, there is a light at the end of the tunnel. No, I am not happy. I am feeling overwhelmed.

SHOULDER THIRD OPINION - I THINK WE HAVE A WINNER!

Round and round and round she goes, and where she stops, nobody knows!

Opinion #1: I have a little rotator cuff tear, no frozen shoulder and only need PT.

Opinion #2: I have a serious rotator cuff tear, a frozen shoulder and a bone spur that is damaging my tendon, and I need surgery right now or I will never get any better. The surgery would be to sew up the tear and cut the adhesions of the frozen shoulder to release it.

Opinion #3: I have a moderate rotator cuff tear, a frozen shoulder and a tiny bone spur that is not doing any damage, and surgery should only be considered after the frozen shoulder has been completely healed through PT, anti-inflammatory drugs and possible cortisone shots. If that does not heal the frozen shoulder, manipulation under anesthesia would be an option, and surgery would only be a last resort. The torn rotator cuff may never need surgery, but if it does, it could be six months to a year in the future.

Dr. #3 does not understand opinions #1 and #2. He says that surgery like Dr. #2 suggested is risky and I could end up with a frozen shoulder that is even worse than the one I have now.

He said that the post-op treatment for a frozen shoulder is mobilization, and the post-op treatment for a rotator cuff tear is immoblization, so it is not smart to do both of those surgeries at the same time.

I left my new doctor's office and went straight to schedule PT and drop off my prescription at the drug store.   I guess time will tell if this has been the right decision.

By the way, one thing I liked about this doctor is that he has my identical injury on his own right shoulder, and he chose not to have surgery, and healed his frozen shoulder with physical therapy.  If it was good enough for him, maybe it will be good enough for me.

THE ROLLERCOASTER GOES ON - SURGERY AFTER ALL

I saw my new doctor today, and here is what he told me:

arthroscopic rotator cuff repair

subacromial decompression

distal clavicle excision

bicep tenotomy

These are the surgical procedures that need to be done to my right shoulder as soon as possible. Evidently, the jerkk doctor from Monday was also stupid, because he did not even look at the MRI pictures, and barely glanced at the MRI report.

I have an 80% thickness tear of my supraspinatus tendon (part of the rotator cuff), which means the rotator cuff is holding on by a thread and could tear the rest of the way at any time.

I have a bone spur that is sticking into the muscle and causing inflammation and damage to the muscle.

My shoulder is frozen. Scar tissue has fused the top of my arm bone to my shoulder socket.

Because of everything else, my bicep has been damaged and needs repair.

So.... I am scheduling surgery on Monday.

They are going to punch three holes in my arm for a camera and instruments. They are going to shave off the bone spur and carve the bone out underneath it to make more room for the supraspinatus, so it will not be compressed.

They are going to cut off all the torn edges of my rotator cuff, drill into my shoulder bone and put titanium anchors in to stabilize the stitches that will sew my rotator cuff back together.

They will remove my bicep from the spot that it is compressed in and resew it where it will be free to move.

They will cut through all the adhesions in my shoulder socket, releasing the frozen shoulder.

Due to my past history of post-op complications, they are not going to do the surgery in the surgical center, but are going to do it at the hospital, where I might be able to stay overnight if I am having problems.

All in all... gruesome and frightening.

For six weeks after surgery, I have to wear a pillow sling:

For that six weeks, I also have to sleep sitting up in a chair.

For the six weeks after that, I have to wear a regular sling.

Physical therapy starts two weeks after surgery and continues for six months, at which time I hope to regain 85-90% of the use of my shoulder.

NEW PHYSICAL THERAPY INTAKE AND NEW DOCTOR

Well, in your face, Dr. Cold-Cutter, because I just got back from my physical therapy intake, and it turns out that my shoulder is displaced and frozen and that is why I cannot lift my arm.

I can tell by looking in the mirror that it is in the wrong position (it looks like I am shrugging and pushing my shoulder forward), but Dr. Cold-Cutter did not bother to actually look at my shoulder, preferring to ponificate on the absoluteness of the MRI.

Yes, the MRI does not show that I cannot lift my shoulder. It took pictures of my shoulder in the down position. Duh.

Here is another problem: My PT says that when I fell, it traumatized my rotator cuff tendons and they clamped down. That is why, within a few days of falling, I could no longer put my hand behind my back and other positions.  So my shoulder joint is frozen.

One last thing: I now have adhesions between my muscles and skin from my shoulder all the way to my elbow. Just trying to "pinch an inch" of skin on my upper arm is very painful. So I got to have 15-20 minutes of massage that breaks adhesions that felt like a hot poker being rubbed over my skin.

Here is the plan - First, all the adhesions in my arm have to be broken down by message and ultrasound. Then the "posterior capsular tightness" (frozen shoulder) has to be loosened. Then the "scapular dyskinesis" (displaced shoulder) has to be PT-ed back to where it belongs.

This will no doubt be a process that takes a few months.

My PT gave me the name of a ortho doc that she trusts, and I have an appointment with him on Friday.

So, not great news, but anything that is not surgery is good.

SHOULDER DIAGNOSIS - NO SURGERY BUT THE DOCTOR IS A JERK

Good news bad news. Good new first:

NO SURGERY! The tendon tear of the supraspinatus that was there before is still there. There is no obstruction in my shoulder that is keeping it from moving.

Bad news:

The surgeon obviously thinks that I am lying about my pain and immobility. He would not listen to my questions. He was brusque and in a hurry.

I told him that it was my physical therapist that told me there was an obstruction. He talked over me, saying the MRI does not lie.

I asked him why I could not lift my arm, and he took hold of it and tried to force it to go up, which of course caused me pain and I could not do it.

I told him I was confused why it would not go up, and he looked me right in the eye and said, "There is no reason why it can't go up."

I said, "Well, if the rotator cuff is not torn, and there is no obstruction, then is it just frozen?" He said, "There is nothing wrong with your shoulder."

I feel like I'm taking crazy pills!

I asked him what the solution is, and he said I have to hit the PT hard for 6 weeks at the least, and if the therapy does not hurt real bad, it is not going to help.

I found myself trying to convince him that I don't want the surgery and that I am relieved but confused. Did he take that to mean that I am some kind of weirdo that seeks out surgery?

After he left the room, I got a copy of the MRI report. I caught up with him and asked him if the tear had improved since the first MRI in December. He looked at me like he was irritated, and said there was no way to tell. And then he said, "It hasn't gotten any worse, if that's what you are trying to find out."

Like he thought I was trying to make more out of it than there was, when the opposite was what I was hoping for. I wanted to at least be encouraged that the tear is healing.

I walked out of that place so angry. What is his problem?

Any way, I just looked up frozen shoulder and it looks like they were writing about me:

What causes frozen shoulder?
There are patients who develop a frozen shoulder after a traumatic injury to the shoulder, but this is not the usual cause. Patients who sustain a shoulder injury, or undergo surgery on the shoulder can develop a frozen shoulder joint.

What are the typical symptoms of a frozen shoulder? Shoulder pain; usually a dull, aching pain, limited movement of the shoulder, difficulty with activities such as brushing hair, putting on shirts/bras and pain when trying to sleep on the affected shoulder.

I have the symptoms of a frozen shoulder, but the doctor looked right at me and said it was not frozen. And I can't imagine why. He is either an idiot or he thinks I am faking.

I wish there had been a secret video camera in my house showing me unable to get dressed, unable to hook my bra, unable to fix my hair and unable to put my own hand on my own stomach when I lie down in bed.

Sorry for the rant. I'm just so mad I could spit.

On a happier note, I have an appointment with a new physical therapist tomorrow morning.

Also, my niece is a PT, and I just got off the phone with her, and she gave me some good advice. She said that if I have pain and immobility, I need to go to a pain clinic and get either shots or pills so that I can do the PT without having pain. She said she does not believe in pushing through the pain with PT, that it will only make the inflammation worse.

She said that since the second injury was three months ago, that it is obvious that I have chronic inflammation in the shoulder joint and am heading for a frozen shoulder.

I guess she knows more than the surgeon.

Okay. Now I blew off steam and I feel better.

NO SURGERY! DOUBLE YAY!

MORE SHOULDER WOES

I went to the doctor yesterday to talk to him about my right shoulder.  He has given me a referral to a shoulder specialist to get surgery.  My appointment is in four weeks.  During that time, my physical therapist wants me to hit the PT hard to see if we can solve the problem and make the surgery unnecessary.  I guess he thinks that there is a 50-50 chance that surgery will not be needed.  Fingers crossed...

My physical therapist is concerned that I have torn a tendon in my shoulder, which is causing it not to operate properly.  I am on my way to a frozen shoulder - I cannot put my arm behind my back at all, I cannot put my hand on my hip and I cannot lift my arm above my head.  Plus, I am having increasing pain - getting dressed and undressed by myself has become more and more of a challenge, and it's not even easy if I have help.

NO SHOULDER SURGERY NEEDED - PT AND DRUGS ONLY

I just saw the orthopedic surgeon and he said that if they can get me 50% better in four weeks, I will get all better in time.

YAY!

He also said that, even though there is a small tendon tear on the top of my shoulder, he thinks the main source of the pain is the pinched nerve in my neck.

I am going back there for my PT evaluation in about an hour.

I asked the doc if I could start lifting again, and he said to ask the PT person. He said they love people who lift weights, and they will be able to tell me exactly what I can and cannot do.

The doctor said that I could go ahead and do cardio, and I told him I don't do traditional cardio - that I only lift weights. He looked at me like my head had just spun around. A woman that does not use the elliptical machine??? Unheard of!

Anyway, I am very relieved and hoping they will let me do some (all?) of my PT at home.

I also was put on an anti-inflammatory for three weeks. He said if it makes me swell up, to stop taking it and do without. I do have a history of swelling up with those drugs. He said this one is better for that. We'll see.

MRI RESULTS

I just got my report. It says:

Impression:

1. Small interstitial supraspinatus tendon tear and mild supraspinatus peritendinous bursitis. No full thickness retracted tear seen.

2. No labral tear seen. (This is what my doctor was 99.9% sure I had.)

3. Intact biceps pulley tendon mechanism. (He also thought this was messed up.)

So, YAY, basically! According to my PT niece, I am headed for physical therapy and NOT surgery. Of course, the doctor will have to confirm this, but even the medical sites I looked at just now said that you should do PT for 3-6 months before considering surgery.

My appointment is not for another week, so I guess I will just lay low until then and relax and stop thinking about surgery.

By the way, I looked up to see what the PT would be for this, and it was all of the arm exercises and weight lifting that I have been doing as part of my regular workouts - push ups, rows, etc.

ARTHROGRAM MRI - ANOTHER HORRIBLE MEDICAL PROCEDURE TO CHECK OFF MY LIST

Yes, I am evidently on track to have every horrible medical procedure known to man before I die.  I just got back from having my most recent - an Arthrogram MRI of my right shoulder.

I spent about 45 minutes in the open MRI, which is not a problem for me.  I got to listen to Christmas music and I fell asleep a couple of times.  Afterward, I went to another room to get the contrast injection.  I was lying on the table, and saw an x-ray of my shoulder, which was pretty cool.  The technician asked me if I wanted to watch the screen while they inserted the needle into my shoulder joint.  He obviously does not know me.  Here is what they did to me, and just in case you are wondering, the patient in the video is not me:



I know it may look like fun in the video, but it was not.  The first needle going in wasn't bad at all, but when he started injecting the lidocaine, I felt sharp pain not only in my shoulder joint, but shooting up into my chin and down to my fingertips.  It was pretty rough and I yelled a bit.  He said he was done, and that I was numb, and then he started injecting the wonderflonium and guess what!  I was not numb, I yelled a little bit more, and he had to numb me again.  When he did that, I had to yell some more.

By this time, I was pouring sweat, shaking and headed into a mild panic.  He asked if I was prone to panic attacks, and I told him yes, but only when I am having painful medical procedures.  He got me to open my eyes and reassured me that the painful part was over.  He finished the procedure, and there was no more pain.  After the contrast material was in the joint, I went back into the MRI for another 15 minutes.  I just could not relax, due to the stress of having the pain, and I felt myself scowling all the way through it.

I am home now and feeling nervous and I want to binge on carbs.  They gave me a little gift at the MRI place - four Fannie May chocolates in a pretty little box.  I ate three of them and gave one to Bill.  I also ate the box.

They also gave me a disk with 221 photos.  Here are two of them:

Ah!  I see... that I have an arm bone. Aside from the bone, which I definitely have, I have no idea what I am looking at.  In 24 to 48 hours, they are going to fax me the report that will say whether or not I have a torn muscle.

Just in case you are new around here, you can read about my shoulder injury.

SHOULDER INJURY

I went to an orthopedic surgeon today. Two days ago, I evidently tore a muscle in my shoulder. Technically, I did it weight lifting, but not during my regular routine. I picked up a 14 lb. weight (not that heavy) to move it, and I was not careful, and was immediately in big trouble and pain. I put it down quickly, and I have been in hot pain ever since with limited movement and strength.

Based on the 34 painful positions he put my arm in, the doctor suspects a SLAP lesion.

I am scheduled for an x-ray guided contrast injection MRI on Monday evening, the 20th. If it is what the doctor thinks it is, he says I have to have surgery to repair the muscle. He says PT and drugs will not help without surgery first.



I looked it up on the internet, and all of the sites said that most SLAP lesions don't need surgery, and that physical therapy and drugs should always be tried first.

When I looked up the surgery, it said that you cannot use your arm for 6 weeks after the surgery (yes, it is my right arm and, yes, I am right handed) and the time to total recovery is 3-4 months.

I guess I will be getting a second opinion after the MRI results come in. I have my next appointment with the original doctor to discuss the MRI results on December 27th. They said I just have to live with the pain until then, and don't do anything with my arm that causes pain.

Sometimes it seems like two steps forward and ten steps back. I do not want to stop weight lifting. I don't want to lose the muscle I have gained and gain back the fat I have lost. I am just basically a big baby when it comes to surgery, and I don't want to be scarred in a place that shows in a sundress.

I did this to myself. I was careless. I don't want anyone to think that it was sensible weight lifting that did this to me, and avoid lifting, because it is so important to health, especially to women "of a certain age".

Anyway, not happy. Not happy at all.