More About My Shoulder
As I mentioned in yesterday’s post, my shoulder is pretty messed up right now. What I didn’t really get into is the fact that my shoulder has been messed up, more or less, for about ten years. It has been injured in the middle of races. It has been injured as I have come down the teeter (anyone want a teeter? Free?). It has been injured dozens of times in Moab and at Gooseberry Mesa. It has been injured when I lifted a very heavy book.
I’ve been thinking about getting it (my shoulder, not the book) fixed.
In fact, about seven months ago, I went in and had a doctor take a look at my shoulder. He pulled on it, pushed on it, and then turned it a certain way that made me collapse and beg him to stop, please, for the love of all that’s good in the world, please just stop, I’ll tell you where the submarine is hiding, just please stop twisting my arm that way.
And then he sent me to get an MRI.
After the MRI came back, the doctor told me that my shoulder’s all messed up, and that I should have it fixed, surgically.
“Well, that sounds super!” I said, my voice full of enthusiasm, for I knew that, after the surgery, I’d have to take extra double specially good care of my shoulder for a few months.
I told him that I’d wait ’til after the end of this riding / racing season, then do the surgery so I could recover during the Winter.
New Reality
Back when I got this checkup, I had this fantasy going of me getting the surgery, coming home, and then lounging through Thanksgiving and Christmas, my wife taking care of me because I wasn’t supposed to lift anything heavier than an Xbox controller.
Of course, since then, things have changed. Susan’s gone and upstaged me, injury-wise, having the nerve to go and get fractured hips and ribs as a result of the tumors in her bones. Which has not only seriously disrupted her career as a power lifter, but has made it kind of difficult for her to get around, or to lift something as heavy as a jug of milk.
Imagine, if you can, the grand comedy of neither of us being able to lift anything heavy for a month or two. After a while, I suspect that even our really great neighbors and family might find that a little tiresome.
So I had planned to pass on the shoulder surgery for now.
But then I had this wreck last Friday, and now my shoulder hurts all the time. It grinds and pops. It aches. It restricts my range of motion to pretty much nothing.
So, I figure I’d put the question to my genius readers, among which I seem to have an expert on practically everything: Take a look at my MRI report, below. Then tell me:
- What does this mean? My doctor told me, but I’m pretty sure he was speaking Estonian.
- Is it serious, Doc?
- What should I do?
- Is there any particular urgency?
- How long will it take for me to recover?
- Suppose I do whatever you say, then go mountain biking again and take another fall. Will I bung the whole works up again, undoing all the fancy stitches, duct tape, rubber bands and whatnot?
- Do you really have any expertise, or are you just channeling Dr. Noah Drake? Not that I mind self-proclaimed expertise, but I like to know whether you know how much you (really) know.
My MRI Report
EXAMINATION: MR Arthrogram right shoulder
HISTORY: Recurrent shoulder subluxations. History of a remote injury and chronic shoulder pain
TECHNIQUE: Multiplanar T1 and T2-weighted MR imaging following a gadolinium arthrogram procedure of the right glenohumeral joint.
COMPARISON: None.
FINDINGS: There is a dominant superior-inferior tear of the anterior glenoid labrum. There appears to be inolvement of the anterior articular cartilage of the glenoid labrum (a defect which appears to be either grade 4 or severe grade 3 chondromalacia involving the anterior 6 mm of the articular surface of the glenoid). There is a heterogeneous appearance of the mid-anterior portion of the glenoid labrum with some periosteal stripping anteriorly.
The posterior glenoid labrum is unremarkable. The superior extent of the tear appears to be at the 12 o’clock level. The inferior extent is approximately 4-5 o’clock anterior-inferior. The middle glenohumeral ligament is intact. The biceps tendon is intact. There is a very small full-thickness perforation of the mid-lateral supraspinatus tendon with a tiny amount of fluid extending into the subacromial-subdeltoid bursa. Otherwise, rotator cuff tendons are intact. Normal lateral downslope of the acromion. Very small subacomial enthesophyte. Mild-moderate AC joint osteoarthritis, but no inferiorly projecting osteophytes. Not mentioned above, there appears to be a second articular-sided erosion of the mid-lateral supraspinatus tendon measuring approximately 7 mm medial-lateral x approximately 8 mm anterior-posterior. This lesion involves approximately 30-40% of the tendon thickness.
IMPRESSION:
1. Type 5 SLAP tear with tear from the superior to inferior labrum, anteriorly. There is involvement of the anterior glenoid articular cartilage, and periosteal stripping anteriorly.
2. A small articular-sided supraspinatus tendon tear and a small far anterolateral supraspinatus full-thickness tendon perforation.
PS: Help a Friend of Fatty Out. Sans Auto, one of the frequent commenters in this blog as well as the guy who set me on the right path to eating right with the “Intuitive Eating” technique, is conducting a research project on transportation preferences to find why people use the form of transportation they do. I’d consider it a big favor if you’d participate in the survey. Click here to get started. Caveats: you’ve got to be 18 or older, and you’ve got to work outside the home.
And once you’re done, be sure to type “Friend of Fatty” in the comments section. You know, so when all of Sans Auto’s classmates compare where all the entries come from, they’ll be able to see we totally dominated.
Comment by Heffalump | 09.5.2007 | 9:25 pm
I think it says you need a shoulder transplant, and you should start asking all your cycling buddies if they would be willing to be a donor.
Supraspinatus sounds very insulting…or like a cool martial arts move. “He went into a supraspinatus and took out everyone in the room!” I am going to try yelling that at people who cut me off in traffic. I had better practice first.
Actually the definition of supraspinatus is
Main Entry: su·pra·spi·na·tus
Function: noun
: a muscle of the back of the shoulder that arises from the supraspinous fossa of the scapula, that inserts into the top of the greater tubercle of the humerus, that is one of the muscles making up the rotator cuff of the shoulder, and that rotates the humerus laterally and helps to abduct the arm.
Sounds like you don’t need it unless you want to abduct your arm…
Comment by Chris | 09.5.2007 | 9:41 pm
So, I had my shoulder screwed up sort of as badly as yours, then I really screwed it up skiing (dislocated and torn up enough to require surgery). I took some picts of the aftermath: http://email.ops-netman.net/picts/shoulder-surgery-04-2004/ there are some inside picts before/after the fixing, and some outside picts of the unbandaging (I hadn’t showered in a few days, sorry about the hair). The initial recovery (to where I could move without the sling) was about 3 weeks, then PT started and after 3 months I think I was mostly normal again. The doc says a nuke’d have to go off in my shoulder to break it like I did last time though. :)
So, plan on 3 months of not riding offroad hard, and 1 month of probably not riding at all… and probably 3 weeks of no lifting with the fixed arm.
(YMMV of course)
Comment by Anonymous | 09.5.2007 | 9:50 pm
Fatty,
I just sent a copy of the report to my uncle (Your aunt’s son-in-law) who is an orthopedic surgeon. He should understand all of the medical mumbo-jumbo and be able to give some answers and advice. I’ll let you know as soon as i hear from him.
Comment by Rbrigman84 | 09.5.2007 | 9:51 pm
that last post was from me btw.
Comment by AllisonW | 09.6.2007 | 1:53 am
Hey Fatty,
never posted here before, but here goes:
Here’s a health warning – I read clinical reports for my job (pharmaceutical development) but I am SO NOT an orthopod, so translation by an expert is what you really want. And sorry for the long post …
So the report describes which bits of your should are affected and which aren’t, where they are, how big the damaged bits are and how bad they are. The main thing is you have a glenoid labrum tear. Check out these pages for some info in plain terms on what that is:
http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=255&topcategory
http://www.eorthopod.com/public/patient_education/6531/labral_tears.html
Grade 4 or severe grade 3 chondromalacia means the cartilage is in pretty bad shape (grade 4 is worst there is), and the cartilage will not be doing a great job of protecting your bone and the joint anymore. So not surprisingly, you also have periosteal stripping (bone covering is being worn away and it’s all grinding together in a lovely fashion) and osteoarthritis (bone inflammation). The tendon attaching one of your muscles (the supraspinus) to the top of your arm bone (the humerus) is starting to fall apart in two places (the full thickness perforation and and the ersion lesion of 30-40%) and some accumulating fluid. ‘Full thickness perforation’ means the hole has worn through to the other side – ie pretty bad – but at least it’s small!
You have some good news in that the other tendons and rotator cuff bits are OK for now.
So – how bad is it and what to do? Beats me! But it sounds like things are not utterly stuffed yet but are on the way. The actual injury itself is pretty bad, but the developing arthritis and other knock-on effects to the whole joint are what you really need to avoid is my guess. What I would want to know is what is the end-point of where this is going, how far along that path am I and at what point is surgery going to be too late? Surgery sounds like bad timing (Go Mrs Fatty!) but the alternative may be avoiding much/any choulder activity at all. Doesn’t sound like you, Fatty!
I hope this helps and all the best with it – looking forward to progress reports. I’m going to be obnoxious and tell you I’m off to Spain tomorrow to watch the Vuelta Pyrenees stages! Wahoo!
Cheers,
Allison.
Comment by Wonderdyke | 09.6.2007 | 2:01 am
Well, first of all – it’s a good thing your anterior glanoid labrum has all of that stuff going on – because with an unremarkable posterior glenoid labrum, well, I’m not sure how you could show your face. Oh the shame of it! Seriously, though… what the report is saying is that you have a tear which goes through the middle part of your shoulder socket, which is a cause of shoulder instability. My guess is that, with your acute acumen, you probably figured that out the first time you tried to pour yourself some oj. A SLAP tear is a tear of the rim of the shoulder above the middle of the socket that may also involve the biceps tendon. The biceps tendon is what connects your shoulder to your biceps, funnily enough, and without that being intact, you’d not be able to do those 12 oz curls I’m thinking you might enjoy. Of course, with any injury like this, the added bonus is the ostoarthritis which will serve as a life-long memory of every tumble you took. The rest of the mumbo jumbo says you’re eroding and you’ve got a few other tears. Sounds like surgery to me. Perhaps you just need to hire a competent houseboy/cyclist (perhaps Dug?) to do your heavy lifting for you for the next few months.
Comment by Big Mike In Oz | 09.6.2007 | 3:18 am
“heterogeneous” – that’s what got that bike rider chap, Hamilton, in trouble a couple of years ago. I’m telling you this as a friend, you steer clear of the heterogeneous or you’ll end up on the wrong side of the tracks.
Comment by Big Mike In Oz | 09.6.2007 | 3:34 am
Seriously now. I had a completely torn ACL when I was about 23. Since cycling (track and road) doesn’t involve much twisting I didn’t bother with it. Then I had kids and discovered that it was so badly injured that I couldn’t even swing a baseball bat without my knee dislocating. I had the surgery 5 weeks after I woke up to myself.
The post-op pain was sublime. Broader and deeper than anything I’d suffered from the original injury. It was slso more painful than when I double fractured my collarbone. Or when my wife rebroke it a week later. But it diminished quickly and by the end of week 2 was barely noticeable
The physiotherapist only added to the pain. A lot. But it was all worth it. Now, I can ballroom dance while playing baseball on snowskis. And I can kick or throw a ball with my kids without having to pull up short all the time. Like you said in the post about the tandem recently, whatever gets the kids and parents closer is a good thing.
Comment by TG | 09.6.2007 | 4:25 am
Fatty, I am no medical professional, but that is one of the longest MRI reports I have every seen! I’ve torn up my knees several times and my daughter broke her neck and had head injury in a car accident and none of those reports were as long as yours. this doesn’t look good. I suggest that since you are letting Dug ride “your” bike that you won fair and square in the Leadville challenge, that you enslave him and force him to act as your post-op heavy lifter. Have the surgery and leave the heavy-lifting to Dug.
Comment by Derek | 09.6.2007 | 4:43 am
I don’t know what any of this means, but I do know that he called you posterior glenoid labrum “unremarkable.” You going to just let him get away with that? Better get training that posterior glenoid labrum.
Comment by Derek | 09.6.2007 | 4:43 am
I don’t know what any of this means, but I do know that he called you posterior glenoid labrum “unremarkable.” You going to just let him get away with that? Better get training that posterior glenoid labrum.
Comment by Al Maviva | 09.6.2007 | 4:51 am
Well, I guess it means you’ll be doing some things with the other hand for a few months. Like hailing cabs, opening doors, and picking your nose. That’s about all I could think of.
BTW, I think a labrum is where scientists work. You may want to ask the doctor exactly what in the hell is going on in your shoulder, that scientists are working on it.
Comment by Big Boned | 09.6.2007 | 4:54 am
Give you some of the best advice I ever got (from a friend that is a doc): “When chronic pain gets bad enough to keep you keep you from living the way you want to, it’s time to do something to resolve it. Until then, keep away from people who want to cut you open, they might make it worse”.
Comment by Mrs. C. | 09.6.2007 | 5:05 am
Fatty, first of all, I think you KNOW what to do, you just don’t want to go there because you think you’ll be putting a burden on your family. You might just be cheating your family and friends out of the pleasure of helping you and Susan.
It sounds like you have a very close network of people that care about you and I bet they would be willing, some of them actually eager, to help the two of you while you recover.
You have teenage children (right?) so you have some built-in muscle right at home. Talk it over with them, get their support, but with a little planning you could make the recovery time work and you may be surprised to see who steps up when it’s needed most.
Comment by jaxpaw | 09.6.2007 | 5:32 am
1. The glenoid is where your humerus (arm) is oriented with regard to your shoulder, specifically your scapula (shoulder blade). You may think of the glenoid as the socket part of the shoulder joint but this socket is very shallow. The glenoid labrum is a rim around the glenoid which makes the socket deeper and therefore more stable. Superior-inferior means top to bottom. Anterior means the front, so you have torn the glenoid labrum from the top to the bottom in the front part of your shoulder joint. That aint good which is why your arm is just slopping around in whats left of your shoulder socket. Articular involvement means that where the arm and the shoulder meet (articulate) anteriorly, or toward t he front, you have some “involvment” (could be an affair or a one night stand) which means abnormal wear and tear of the surface. This will lead to some nice arthritis in a few years and your ability to predict changes in the weather will be a nice topic of conversation when you are sitting on the porch in the home. Periosteal stripping means when the labrum tore away from the glenoid it actually pulled some of the bone covering (periosteum) away from the bone. That aint good either.
Your rotator cuff is a group of tendons which hold your arm in the proper position in relationship to your shoulder. Surprisingly there is only 1 small tear in the top portion along with some wearing on the under side of this same top potion of the rotator cuff. When you have separated your shoulder as often as you have all these structures stretch out more and more. They are more plastic than elastic so they do not snap back to their original shape very well. The result is the joint gets looser and looser and it is easier and easier to dislocate.
2. It’s not going to kill you but it is going to get worse and worse.
3. If you want to use your arm without it popping out of joint more and more then you are going to have to get it fixed.
4. See #2. The longer you let it go the more that is going to go wrong and need repairing. For what you have done to it I am surprised the rotator cuff isn’t worse.
5. If rehab goes well 3-4 months. Shoulder rehab usually hurts initially, bad. Orthopedic surgeons tend to not dwell on this too much, when you are working with someone several times a week post-op you see their pain.
6. If you mess up the repair by falling on it, the fall would most likely have caused this type of damage anyway.
7. Physical Therapist with 10 years experience and I stay at Holiday Inn Express.
Comment by Kathy | 09.6.2007 | 5:53 am
Do you have a lot of boulders inside that you regularly move around the house? If not, I’m thinking your kids can handle most of the full-milk-jug type of lifting. Or switch to half-gallons. You can do this. You should do this. Just take it easy and don’t lift heavy stuff. Like sleeping dogs, let the heavy stuff just lie.
Comment by Susan (another one) | 09.6.2007 | 6:20 am
Just do it. Gonna have to do it sooner or later. Sooner is better.
Then you can write about the hospital, the drugs, the pain, and the inability to zip your own pants.
Comment by brett | 09.6.2007 | 6:43 am
HAAAAAHAHAHAHAHAHAHA
you have a “Very small subacomial enthesophyte”.
you should buy a sports car to compensate.
Comment by msk | 09.6.2007 | 6:44 am
ok, stand back people, bone radiologist coming through
i report mri shoulders (among other things, knees, hips etc) for a living and will give my 2 cents (the invoice is in the mail)
agree with alot of what jaxpaw said
the mri report sounds good quality – they seem to know what they are talking about
first off, excellent you had an arthrogram (ie they injected your shoulder with dye) – so much better for the assessment of the labrum (this lip (hence labrum) / rim of tissue that acts like a little wall around the glenoid – deepening it and helping with shoulder stability)
your labrum has torn (part of this deepening / stabilizing wall has fallen over) because of your inital dislocations
because of your labral tear (defect in your wall) you will continue to dislocate as the shoulder is unstable
because of your shoulder instability (recurring dislocations) you are wearing out the cartilage and tendons of your shoulder too quickly
given their description, age wise, i would estimate your shoulder to be in its’ mid to late 60s – but having said that we can see a similar appearances in young athletes (like yourself)
you may find that your current pain may settle in a few days / weeks – you maybe just stirred up things and made your shoulder a bit angry on the last fall
if it does not settle then maybe you took off a piece of bone the last fall – maybe worthwhile just getting an xray
ultimately you will be better off with surgery (done well) but this is not so urgent at present – as long as this new pain settles down
pick your shoulder surgeon well – you want someone to try and get your shoulder back to as near anatomically normal as possible
one thing the report didn’t mention was if you have a “hill sach’s defect” this is an impaction fracture of your humeral head and can also lead to more instability – your surgeon may also want to address this at surgery if there is one
also should you have surgery – i cannot emphasize the importance of post op rehab enough – it is often overlooked and is so important in getting you back to a normally functioning shoulder
any specific questions email me and i will try and answer
good luck
cheers
msk
Comment by Willie Nelson | 09.6.2007 | 6:52 am
I took the plunge last September and was glad I did, so was my wife (I stopped waking up screaming because my shoulder dislocated while I was asleep). I put if off for 3 years. The doctor did a bang up job of fixing me up and I was road cycling not long after, 2 and a half months, skiing in killer powder (without Dr permission) 3 months later and mountain biking 5 months later (with permission). I’m glad I did because the repeated injuries were doing damage that I will pay for later with arthritis. But with the buddies you have I’m sure you’ll have no problem getting them to help you guys out for 6 weeks. You might want someone to come stay with you the first week, it’s pretty rough getting used to the pain and slowed down process of dressing, eating, bathroom, showering. Knowing what I know and went through, I wished I’d done it years earlier. Best of luck.
Comment by Stewart | 09.6.2007 | 7:38 am
The way I see it you’re down to one arm for now anyway. Why not just get the bad one fixed and you’ll still have your one good arm during the recovery which is no worse than what you’re already dealing with? Just a thought from someone with no experience at all in these things.
Comment by BotchedExperiment | 09.6.2007 | 7:39 am
“I’ve still got one good arm to hold you with. . .”
Dr. Botched’s summary of MRI: Acute Appendicitis. Get it out as soon as you can; that thing could rupture at any moment!
Seriously, you’ll have one good arm with which to lift milk and spank women strange to you.
There is an axiom when it comes to things like this: When is a good time to have your shoulder surgically repaired? Never, that’s when. So then, you’re reduced to trying to find the least worst time to have it fixed. That least worst time is now (or at least after Fall Moab ‘07 in St. George).
Comment by jaxpaw | 09.6.2007 | 7:43 am
Just to emphasize what msk stated, “pick your surgeon well”. If it means going out of your insurance network then you’ve got to do it.
Comment by bikemike | 09.6.2007 | 7:48 am
stupid shoulder (kicks dirt, spits INTO the wind)
Comment by born4felt | 09.6.2007 | 7:56 am
Fatty,
I had the same problem (dislocation followed by multiple subluxations, labrum tear etc.) and had the surgery (Bankart repair) six years ago. It was the right thing to do. My shoulder no longer dislocates and that allows me to exercise without worrying about it popping out. Although I have some reduced mobility when I throw overhand, my shoulder is basically fine and I don’t think about it day to day.
Having your shoulder be so unstable that it keeps popping out is bad. Every time it pops out, you risk damaging your rotator cuff, which is bad news.
As for the surgery, it was not as bad as I had feared. I had to choose between arthroscopic and open surgery, with one doctor telling me that open was the way to go, and the other that arthroscopic was. The purported advantage of the open surgery was that the doctor could get in there and really fix things up; the advantage of the arthroscopic was that the recovery time–and associated pain–was much less. The surgeon who proposed the arthroscopic surgery also told me that he could do just as good a job. He was a sharp guy, so I went with him, and I don’t regret it.
All of which is to say that you need to shop your surgeon.
I don’t know if arthroscopic surgery is appropriate for your inury–I’m sure one of the doctors here could tell you more.
I spent two weeks in a sling, and rehabbed for two months. The rehab was not particularly painful, and probably wouldn’t be a problem for someone (like you) who’s used to being banged up. My understanding is that the period immediately after the surgery is crucial–that there is a period before the scar tissue develops in which there is a risk that the surgical changes will be undone (screws pulled loose, or what have you).
As for how to balance it with your wife’s needs, I don’t know. I think that if you had a family member come stay with your immediately after the surgery, you might be fine; you can do a fair amount with one hand in a sling.
Best of luck
born4felt
Comment by TimK | 09.6.2007 | 8:06 am
Sans’ Survey made me feel guilty about not commuting by bike or foot more often – thanks a lot.
Comment by Mehera | 09.6.2007 | 8:17 am
…And isn’t it better to recover from a surgery over the winter months? If you do it soonish, you make the call as to when. If you wait, and something happens and it gets increasingly injured–you may lose that option.
Pingback by RocBike.com » Links Of The Day: 6 September 2007 | 09.6.2007 | 8:22 am
[...] More About My Shoulder [...]
Comment by regina | 09.6.2007 | 8:25 am
do it now before there is ice an snow where you are, you will have a couple of good weeks of family and friend help, by then things will be getting better, and then you can torture your children with your infirmity. they owe you. Good luck.
Comment by chtrich | 09.6.2007 | 8:30 am
Topics on this blog could get interesting. Soon it could become a one stop medical / biking reference board.
Comment by Badder | 09.6.2007 | 8:45 am
I’m not a doctor but I play one on TV.
After reading through your report I don’t think it would be very good script material and therefore I believe the report is suspect at best. How could any director expect me to get all that mumbo jumbo out in one take!!
If I were you I would get a second opinion from a doctor who uses smaller words like “You tore something in your shoulder around here somewhere”.
I’m off to the Actors Guild to file a complaint.
Comment by BotchedExperiment | 09.6.2007 | 9:30 am
crap forgot to type “friend of fatty”!
Sans, in the comment section I wrote that one of the most important factors for deciding whether i’ll ride my bike to a destination is the quality of the route (regarding roads and traffic).
Comment by Dan K | 09.6.2007 | 9:46 am
Former Fatty,
I’ve been reading your blog on and off for years now (only off because I took a year off from the internet altogether). Why is today the day I decide to comment? I’ll never know. I think Al knows, but he won’t tell me. I should have commented long ago, I really enjoy reading your stuff. Anyway, in my professional opinion (and I am a professional, though not in the medical profession) you should go to Boston to have that thing wrenched on right after Fall MOAB. From what I hear, Boston has the best docs around. They’ve saved my life, my dad, my eye, my shoulder, my thumb and even saved me a wheelchair. When the Georgia doctors started talking about amputating my friends broken hand, he jumped the first flight back to Boston and they fixed it up like new. I think they even may have saved the bell.
Anyway, research the heck out of your surgeon. When you think you’ve found one, post their info on your blog and let those of us with connections in the medical field check the guy out. If you don’t feel comfortable doing that, at least email it to a few of us privately. Make sure he’s the best, since he’ll be working on the best. You don’t take a Bentley to Pep Boys, you don’t take the WOC to Wal-Mart’s bike repair department, and you don’t take an athlete’s shoulder to the local doctor.
If you do end up in Boston, let me know and you’ve got a chauffeur, a tour and some connects in the medical field. If possible, bring a mountain bike and arrive a day or two early to check out how we do it in the Northeast. Whatever you do, get well quick.
By the way, want to arm wrestle?
Comment by dailytri | 09.6.2007 | 10:01 am
You lost me at “As.”
Comment by Col | 09.6.2007 | 10:51 am
I agree with TimK. I also forgot to write Friend of Fatty like BotchedExperiment. My comment section mentioned that I go through lots of neighborhoods including downtown. I want to make sure FC gets a lot of credit.
Comment by DOM | 09.6.2007 | 11:19 am
The report means that you can lay claim to the same injury as countless quarterbacks and pitchers across the country. As a rule, presenting your condition in this light sounds better than the other most common group: those who fell down awkwardly. Practice your story now, the sling prompts endless questons.
After surgery, the surgeon will probably say to you, “I don’t know how you managed to keep in the socket any of the time.”
You get to keep the cool anchor/staple thingies the drill into collar bone to reattach the ligaments. Make it sound like important homeland security stuff when you ask about future exposure to metal detectors, MRI scanners, etc.
You’ll get to feel the stiffness that goes with having your hand strapped to your now flat belly for a couple of weeks. Maintaining this Napoleanic pose post-op is important for recovery, but a little alarming when they unleash you.
You’ve probably already developed the ability to do many activities of daily living with your “good” non-dominant hand. Heck, you won’t even have to try to comb your hair.
You have the option to schedule for the least inopportune time. There’s never a good time, but you can limit the inconvenience.
I had an open repair about 15 years ago. I completed a sprint distance triathlon (don’t start, the swimming was very good rehab) 5 months post-op. I swam in an arc because of lopsided strength, but I got through it none the less. If you can stop looking down your nose at triathletes long enough to see my point, recovery isn’t that long.
Rehab/PT can be fun. Hope you find a therapist with a sense of humor. I was fortunate to be sent to a pair who also worked as athletic trainers, so they were excellent at getting function back and we had a blast. I suppose others might not appreciate your sense of humor, but so many of us do.
Comment by Clydesteve | 09.6.2007 | 11:21 am
I am still concerned about your humerous. Lose that, and this blog won’t be worth reading, except to see how Susan is recovering.
http://portland07.livestrong.org/spete
Comment by Mrs. Coach | 09.6.2007 | 11:33 am
Here, I’ve taken out the fluff so its easier to understand:
My MRI Report
EXAMINATION: MR right shoulder
HISTORY: Recurrent shoulder.
TECHNIQUE: imaging following a procedure of the right joint.
FINDINGS: There is a dominant tear of the anterior. There appears to be inolvement of the cartilage. There is a appearance of the mid-portion with some stripping.
The posterior is unremarkable. The middle ligament is intact. There is a very small perforation of the tendon. No inferior projecting. Not mentioned above, there appears to be a second erosion of the tendon.
You’re welcome!
Comment by Mrs. Coach | 09.6.2007 | 11:36 am
oh, and I did spell check on your “report” and most of those words in there aren’t even real words. Maybe you should let Dr. Nick get back to the Simpsons.
Comment by Liz | 09.6.2007 | 11:52 am
hey there fatty,
i dig your blog and read it all the time, but have never commented. i feel compelled to do so now because i’m an atc…one of those vultures in khakis who runs out onto the field when a player is injured.
that your rotator cuff is still intact with such a complicated SLAP lesion is pretty amazing. you must be made of iron (or carbon, i guess). it won’t take much of a spill to blow out your rotator cuff if you don’t get things fixed in there at some point. i’d worry about the possibility of a pretty gnarly case of osteoathritis in the future.
that being said…it sounds like your bigger issues are quality of life issues. i’ll bet taking care of your wife is more important to you than riding, however, you’re probably better at taking care of her when you can ride regularly and blow off a little steam, right? as badly as your shoulder is jacked, it’s never going to be a life-threatening issue (unless you start killing people off because you can’t ride).
i would (but this is just me!) keep riding and get sliced and diced later. maybe hone your “aggressive roadie” skills in the meantime. that way, you’re less likely to eat it running over ledges, cliffs, woodland animals, bodies of water, crazed mountain men, etc.
good luck, and my regards to you and your family as you concentrate on your wife’s healing.
–Liz
Comment by KeepYerBag | 09.6.2007 | 12:02 pm
You don’t need a doctor, you need a lawyer.
As an expert in polysyllabic obsfucation, it’s obvious that they scanned your ankle instead of your shoulder. Rather than fess up they came up with all these important sounding but completely bogus words–and trust me, they’re all bogus–in a vain attempt to cover their tracks.
Or, as my son would put it: You have a bad owwie.
Comment by tigermouth | 09.6.2007 | 12:05 pm
I say get your shoulder repaired.
Then work really, really hard with a good physical therapist.
I base this on my experience with two ACL tears several years apart.
The first time I waited a year before surgery (because the doctor said I was too old, at 35), but my knee kept collapsing while playing tennis or doing karate, so I had the surgery and my life got much better.
The surgeon did a great job, but I am convinced the quick and full recovery is due to the physical therapy after the surgery. It’s painful and requires discipline, but the payoff in being able to resume your active lifestyle.
Comment by Rachel | 09.6.2007 | 12:08 pm
What’s life without risk? I think you should forego the surgery and see how long it takes for your arm to fall off. Make sure you blog about it and include pictures.
By the way, won’t you be able to lift more than 3 lbs. with your other arm?
Comment by lmouse | 09.6.2007 | 12:08 pm
OK, I’ve read the report but what I want to know is…How painful is it? Where would you put it on a scale of 1-10?
Comment by KT | 09.6.2007 | 1:08 pm
I’m a professional as well (okay, so it’s in payroll, big deal, I’m still a professional) and I think you should go with what the other smarter people are telling you here.
By my count, 50% think you should get it done. 25% think you should wait. 10% think you should do what the smart people are telling you. 9% think it hurts. 1% don’t know what you’re talking about.
Wait, that’s not adding up to 100%. Well, I’m not good with numbers. Close enough.
Go get it fixed. You’ve got teenagers, their purpose in life is to help their parents when said parents are sick. This counts as one of those times.
Here’s my medical qualifications: my dog tore his ACL in 2005, we had his knee re-engineered by a specialist ($$$$) and now he’s like new. Bionic, even; he has a titanium plate in his leg. Ti is so 2002, though, try to get carbon fiber if they give you an option.
Comment by Jeffy | 09.6.2007 | 1:41 pm
Get it done:
1. Between your other arm, kids, and supportive FoF (Friends/Family of Fatty) Susan will probably get more help than before you hurt it.
2. Although your entries won’t feature inhuman pain tolerance quite as often, we mere mortals won’t be as intimidated.
3. Besides, you’ll have a better excuse for the off-season weight gain than, “I guess I left my will power in Leadville.”
Jeffy
Comment by Jen | 09.6.2007 | 1:47 pm
I’d say do it right before Thanksgiving … more days to recover and less time off work. This is what I did (nearly completely detached bicep tendon). 1st week is pure hell (definitely get a continuous ice circulation cuff .. e.g. cryocuff — it’s a PITA, but totally worth it, it’s like icing 24×7). Second week is less hell. Fly in someone to care for you for the first week. You’ll be ok after that.
I was in a sling 4 weeks (some complications with screws not staying in my bone)
On the trainer around 2 months
Road around 3-4
MTB after 6 … fairly conservative but after going through that hell I didn’t want to undo anything
As messed up as your are, I’d do it now. The PT is intense or it should be. Potentially 3x a week with homework. Be sure you have time to do that.
What can do you in your downtime? Well, I fixed my completely wrong pedal motion (let’s just say I used to do the funky chicken on a bike) — I made my PTs happy after that. Sitting on a trainer gives you time to fix stuff like that. You can play games with your kids and do stuff for your wife. It’s not all bad. When you are back on the bike it will be like the heavens are singing and it will be even more precious and better than before — or so I predict.
Comment by Born 4 Lycra | 09.6.2007 | 1:53 pm
Yes it is Estonian. Unusual dialect I grant you but Estonian it is.
My advice as a professional (used to be paid to play Soccer) is get it fixed. You are wasting time if you don’t. A fully fit functional fat cyclist is the minimum that Sue deserves and that Team FC expects.
Comment by Dave | 09.6.2007 | 2:18 pm
It seems to me that the biggest question is when, not the what, how and why. I just went through the same scenerio. While commuting home from work last Nov. 30th a guy driving a Honda took a left in front of me and hit me head on. I hit the windshield with my left shoulder and it bent the shoulder bone (Acromion) down and was pinching the rotator cuff. My MRI read much shorter than yours, a level 3 acromion hook and some arthritis (yay). But after 8 months of not being able to raise my arm above shoulder height I had to make the decision: surgery now in August or wait until Fall or Winter. I didn’t have any bike trips planned (like Fall Moab ‘08) so I chose to have surgery on August 7th, figuring I had already had some good rides in the summer. All I had done was acromionplasty, basically the doctor had to go in and shave down under side of my shoulder bone (with a dremel???) to make room for my rotator cuff to move under the bone without any impingment. I will testify that it hurts. It hurts a lot. And I started liking the pain meds. Then I made myself stop taking the pain meds even though I still have some left. It’s 4 weeks now and it hurts pretty much all the time, and I am going to the physical therapist in about 30 minutes for the first time (I’m about a week late starting but anyway…). The good news is that I’m back riding my road bike. The doc said it would be months but I went crazy with not riding in our nice 90 degree weather and I found I could ride 9 days after the surgery. It hurt like mad and if I fell I was going to be in a lot of trouble, but I’ll take the risk.
My decision on when was simple. Do it now so I can start back to training as soon as possible so I can have a good year next year. Or wait until the winter when I’m not riding as much and have next years season delayed that much more. I chose sooner to get it over with and I’m glad I did. My only advantage is my wife isn’t battling cancer and can do all the heavy and light lifting. I say get it done so it doesn’t get worse. And tell your friends and family there will be the “Best Cake in the World” waiting for them when they are done with the chores.
Comment by Lins - Aust | 09.6.2007 | 3:04 pm
Choosing your surgeon… Where I am it’s pretty common knowledge that Dr A is best for shoulder reconstructions, Dr B for knees, Dr C for ankles etc.
Probably the best place to find out which surgeon is the best for your shoulder is to talk to physiotherapists (you call them physical therapists). They’re the ones that deal with the rehab so they’re the ones who can really test and feel the “quality” of a surgeons work. And probably best to make sure it’s sports specialist physios as they get to deal with these types of injuries/rehabs continually.
Comment by Nick | 09.6.2007 | 3:12 pm
You have a SHOULDER! LUXURY
Comment by Daddystyle | 09.6.2007 | 3:36 pm
What can I say that has not been said…. Youch, that’s gotta hurt.
Giter Done I say.
I remembered to say friend of Fatty.
Recover on
Comment by Moondoc | 09.6.2007 | 3:38 pm
Fatty, Questions to ask.
1. How often do you do this procedure? (makes sense right? Some orthos specilaize in joint replacement or just do hands. You want one who just does shoulders, perhaps a sports medicine type. Choose a specilaist.)
2. What is your success rate, measured as moderate or complete recovery? (other orthopods or physical therapists could help here since all us doctors think all our patients do fabulous!)
3. What is the durability of the repair? (What will my shoulder feel like in 20 years? Provided you expect to live that long.)
4. What will my post-op limitations be?
5. Lastly, “Doc why I haven’t I had it done yet?” The pain will tell you when to do it. It will probably not get any better. Your family needs may only increase with time also. Best Wishes.
Comment by In Oz during the Bush years | 09.6.2007 | 3:50 pm
I was hit by a Wells Fargo Bank Truck. Destroyed AC Joint, two broken ribs and broken acromion bone. It took 3 surgerys and about two years of PT. Make sure you get the right Surgeon and don’t try to ride to soon after!! This resulted in surgery 2 and 3, but 15 years later I am feeling good and still riding.
Comment by LanterneRouge | 09.6.2007 | 4:35 pm
KT, with your math skills I’m beginning to suspect that you do the payroll for my company.
Fatty, I also have run into a problem that is threatening to decrease my riding time. You see my wife, who is perhaps the greatest living female on the planet, just bought us a 46″ wide screen HDTV. Did I mention how great my wife is? You begin to see my problem. Please advise.
Comment by Dave | 09.6.2007 | 4:49 pm
Ok, I just got done with my first round of physical therapy. Um, ow. I may just sit here for awhile and not move. And all they did was stretch my arm. I can’t wait until they start weight training.
Ow. Shoulder injuries suck.
Comment by cyclingphun.blogspot.com | 09.6.2007 | 5:18 pm
I have a theory here, but your not going to like what I have to say. The way they do it is as such:
The more crazy “Estonian” language that they give you the worse it is. In your case on a scale of 1-5 I’d say you’re ______! Six letters sounds like, well, you get it right?
My humble opinion is GET IT FIXED AT ANY COST! I’d say at this point if the pain keeps up your not going to ride anyway. It sounds like you’re unable to ride right now as it is. From past blogs you sound as though you are Blessed with great family and friends, beg plead and pay (if you need to) for help. But if it gets worse you could be off the bike for good. Prayers going out to you guys for your wife and your situation with your arm. Hope all gets better real soon!
Comment by DOM | 09.6.2007 | 5:50 pm
Another thought: this will prove to be an interesting linguistics test for you. How many words do you know that only use the letters on the left side of the keyboard?
Comment by Jacksuey | 09.6.2007 | 5:54 pm
Elden-I would have to advise skipping surgery for an indefinate time. It’s way more painful than you would think, overall didn’t really solve the problem, and more importantly, if you are a righty, you have to wipe your butt off-handed for several weeks. I don’t know about you, but if I can’t do a good job of something, I don’t want anything to do with it…If you would like, I can mail you the video of the operation that my Doc gave me. Apparently, it’s no problem to shove some sort of tiny spy camera down the arthroscopy portal while they are grinding, sucking, etc. And if you can ride bikes fine, is it that much of a problem?
Comment by formertdffan | 09.6.2007 | 6:04 pm
hey fatty,
don’t have anything to add that other brilliant folk haven’t already discussed
A decade ago, McFarland was the shoulder guy at Hopkins, if he is still there, he would be the one to go to in Baltimore
good luck!!!
Comment by Walter | 09.6.2007 | 6:25 pm
Elden,
can’t add anything useful or accurate on the medical stuff, other than that I’m pretty sure the post-op rehab *must* include some kind of shiny new bike thing in order to truly be effective — (corollary to the “hair of the dog” theory, I think). More seriously, having had some experience on the receiving end of orthopedic (and other) surgery, the only thing I’d add about researching the surgeon is that, best I can tell, experience with the specific procedure (with low complication rate) seem to be critical factors. It may feel odd, but I’ve asked prospective surgeons both questions outright, and they don’t seem to mind being asked. Good luck!!
Comment by Norman | 09.6.2007 | 6:58 pm
I take all my medical questions first to my chiropractor, who has kept me able to pretend that I’m still young for 19 years now – I’m 51 and a horseback/construction/motorcycle etc. veteran.
He says rehab it BEFORE you do surgery or the surgery is often wasted. Then rehab it AGAIN.
Just a word to the wise…
Comment by Tikki | 09.6.2007 | 7:05 pm
Hi Fatty,
As a person who studies alternative healing methods, I like what BigBoned had to say. I think you should explore all options before going under the knife. The scar tissue caused by the operation can further complicate things later. Talk to some experts in massage and chiropractic therapy before making a final decision. Heck, talk to a TCM practitioner if you know of one!
Take care.
Tikki
Comment by Co | 09.6.2007 | 7:33 pm
I’m kind of with Rachel. Wait a bit and see if the arm falls off. It’s weight-reduction, after all. You could even offer a challenge – see who’s arm falls off first – that you might win.
Comment by Solo | 09.6.2007 | 9:11 pm
Well Fatty, admittedly didnt take the time to read thru every one of the above comments, partly out of impatience but mostly out of the medical assurance that somebody else’s thought on an injury will always skew your own. So with that in mind………… Get cut on……… I work in sports medicine and have worked in professional sports if that has any merit. For you the millions of lost income and future stud fees wont be a factor but quality of life will be. In shoulder english…. the cartilage (labrum) that makes the socket (glenoid) deep enough to actually (almost) hold your arm (humeral head) on your body in a fashion where it can be useful isnt making it useful any longer. The bad part isnt the labral tears as much as the articular cartilage (surface of the humeral head) is pitted like a golf ball (not so smooth any longer) due to all the subluxations (shoulder poppiing out but you can put it back in “easily”). The subluxations that have “not given you too much issue” have now golf balled your humeral head’s articular cartilage but also as a bonus behind door number two kindve prize given you a nice partial thickness tear to your supraspinatus ( the cuff muscle repsonsible for around the first thirty degrees of abduction (uh………. lifting your arm to the side)), usually an important trait for an arm. Without your supraspinatus your deltoids will essentially just shrug your shoulder up into your currently sans osteophyte (picture a stalagtyte in a cavern) acromion (a small cliff of bone that is the sole connection of your entire arm/shoulder connection to your body via bone) Surgery from the report is actually pretty simple…. poke a few holes in your shoulder for the scopes, fill it with saline (to better to see you with) put in a few anchors (screws with cables attached they will use to hold down your labrum), doubt three but with a 12 to 5 tear at least two. Clean up the divots with a small grinder, maybe stitch a couple of bits of your supraspinatus back together and bada bing….stable shoulder. Surgery once they poke a few holes in you could change but the report sounds about right for the amount of instability you describe.
(I actually knew much of it prior to reading the report just from your history….) Would be more then happy to discuss it further if you wish……… I’ll do my best to not go back and forth english to medical too much……..but its both a gift and a curse………. and yes I peeked……. but the rehab it first crowd hasnt had a torn labrum……(I have and still do)……not too much to rehab with if your level of stability (or severe lack thereof) is that bad, some manual therapy maybe but alot more work could just cause more articular issues, finish off your superior cuff and bada bing (again) we can just call you lefty……. although one thought is to make it as pissed off and pink as possible so they know what to fix when you do get cut on………
SS
Comment by Anonymous | 09.6.2007 | 9:58 pm
Hey Fatty, long time reader, first time commenter.
Thanks to being not so good at skiing, mountain biking, or descending spiral staircases while hungover, I’ve been there and done that TWICE.
Surgery #1: Right shoulder open Bankart repair (after many years of putting up with subluxation and dislocation). Surgery and post-op were a breeze. I stopped wearing the sling after about 10 days instead of 6 weeks. The real pain started with physical therapy. The surgeon overtightens the capsule and forces you to stretch it to regain normal range of motion. After the surgery, I could raise my arm in front of me to about the level of my chin (about 100 degrees). I had to get to more than 180 degrees, and the way that’s done is by stretching on your own and being stretched by a physical therapist. PT sessions were much more painful than the injuries or the surgery.
For 3 glorious years, I had two stable shoulders (and took them for granted)! Then one morning as I tried to keep myself from tumbling down a spiral staircase, I once again felt that sickening sensation of the ball pulling out of the socket. That injury made it all loosy-goosy again, and after many more subluxations and dislocations over the next 7 years, I decided that surgery was probably once again the only option.
Surgery #2 was an arthroscopic procedure, using more advanced and less invasive techniques. He removed the metal anchors from the first surgery, and re-anchored everything with a different technique. This time the post-operative pain was worse, but I was still out of the sling after 2-3 weeks instead of 6. And this time, I went to a physical therapist who does only cranio-sacral (pressure point) treatment. I highly recommend this type of treatment! My range of motion came back just as quickly, and with no painful stretching. I started riding my road bike at a moderate pace (never told the surgeon, of course) after about 3-4 weeks. Admittedly, that was stupid, because if I had crashed I could have ripped up the still healing repairs. But even if you are not so foolhardy, you could be safely riding at home on the trainer after just a few weeks.
After the recovery, you’ll realize how much you’ve missed having a stable shoulder for all those years! You’ll be amazed by all of the little ways you’ve compensated for your bum wing — sleeping, reaching to get something from a high shelf, reaching back to grab something behind you, scratching your back, putting on a coat, etc.
One other comment: with your shoulder as messed up as it is, it’s just a matter of time before one of your crashes makes it even worse. You could tear your rotator cuff, or have a posterior labrum tear (so much for your unremarkable posterior such-and-such!). From what I understand, you could be looking at 6+ months recovery from those surgeries rather than 3.
So just have the surgery! I guarantee you’ll wish you had done it sooner.
Comment by Kitchen Sink | 09.7.2007 | 12:03 am
Fatty,
I might have missed it already, you should ssk Susan when she thinks you should get it done. She’ll know what she can cope with. Heck, she might even like the idea of having you at home a bit more during rehab…
Comment by Rev, Rocks | 09.7.2007 | 4:47 am
I tore the anterior glenoid labrum several years ago, and the surgery was the best thing I ever did. Yea you have a sling and stuff for a while, and the therapy can be painful sometimes, but the end result is worth everything. I can live without pain, which rocks. The pins and such they use now are plastic and mine were the kind that break down after a while so you’re newly repared tendon does its job properly, so you don’t even have to worry about having metal in your body.
Seriously Fatty, I say that you should go for it, if it works for you and your family.
Comment by Clydesdale | 09.7.2007 | 12:26 pm
Get the surgery as soon as possible that won’t interfere with being a good husband/ father to the point of all family members suffering when not necessary.
That should be vague enough!
Sans Auto – count another survey dun!
Comment by formertdffan | 09.7.2007 | 6:41 pm
darn, also forgot to put “friend of fatty”
Comment by Bitter (Lissee) | 09.8.2007 | 7:43 pm
I echo Botched’s CRAP! Sans – If you’re reading this, I forgot to put friends of Fatty in the comments section. I’m the one who mentioned that I’d drive to work if I didn’t live close enough to public transportation. (NYC)
Fatty – Ask Susan, and my vote is to get it fixed.
I’m just a professional (like KT, but I don’t have a dog).
Comment by TimK | 09.10.2007 | 6:57 am
I had my fourth year med student wife read your MRI and somewhere during the reading she said, “his shoulder is basically like a pair of underwear with the waistband worn out.”
So, I guess what it comes down to is a simple question, are you the type of guy who will wear the same ol’ ratty boxers/ briefs (ewww) until they rot off?
Comment by flatlander | 09.14.2007 | 8:37 pm
Fatty, by all means have the surgery done. But be realistically prepared for the pain of rehab. After I crashed in the Towne Bank Criterium on April 1 (no jokes, please) I broke my right collarbone and upper right rib, and whacked my right hip and elbow so hard I was in a wheelchair for three weeks and using a cane for two after that. Thank God the hip healed by itself over time, but the right clavicle had to be reassembled from multiple pieces with screws and metal. Never would have make it without friends and neighbors coming over to carry me up and down the stairs before I got situated with a Lazy-Boy recliner right in front of a new 1080p LCD HDTV. Jon Stewart is absolutely hilarious after two Percocets.
Then rehab aka torture started. Then later the metal plate started to peek outside the skin for a breath of fresh air, so another surgery 7 weeks post op first surgery, to remove everything. Then more rehab, then the massage therapy. Don’t think relaxation. Think of the pain of having your fascia separated from unused underlying structure in your body. Yep! It feels just like ripping the flesh off your body and injecting liquid fire to take it’s place, except not quite as good as that. And most of the lingering problem is the shoulder and elbow that got whacked when the bone snapped apart, but Dana, my (deep neuromuscular) massage therapist knows how to get those working again: her attention, my pain, then time and extended motion. Continuous improvement, but lots of discomfort.
So after all this is “over” all I get is a lumpy clavicle, a weaker shoulder that I’m trying to build back up over time, and a real bitchin’ scar that most cyclists at a pool party recognize immediately. I suppose that, if for nothing else, the surgery was good for that.
But the rehab really is working amazingly well. I’m only three months post 2nd op, and I was able to ride the Blue Ridge Extreme (Metric) Century ride in late August, which leaves from Afton Mtn, VA, cruises southwest into the valley, soars up from Vesuvius to the Blue Ridge Parkway, and then takes you crawling and screaming back to Rockfish Gap at Afton. Only about 7500+ feet of climbing, so it’s wimpy where you come from, but quite different for us from those flat sandy beach boardwalk rides.
Naturally I was 17 minutes slower this year than last, but my adjusted performance goal was just to finish while not losing control over the bicycle at 40+mph with no guardrails. Good thing my wife doesn’t read your Blog…
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Comment by Dean | 11.15.2008 | 12:52 pm
Fatty,
I also had a SLAP tear, but on my right shoulder. It went miss diagnosed for over a year! The only way they new about the tear was when they went in orthoscoptically to do a simple “Mumford” procedure. The Doctors botched the surgery trying to fix it and now I’m worse off than I was before!
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