# Shoulder Injury



## Argo (Feb 25, 2010)

Do the surgery, you will be down for 4-6 months with rehab until your 90-95%. 100% will take a lot of work and by that time, if you rehab properly! you will be in overall better shape than you were to start. 

We probably fix 6-7 of these a week here. The results are way better than when you just try to rehab.


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## West Baden Iron (Jan 31, 2013)

Argo said:


> Do the surgery, you will be down for 4-6 months with rehab until your 90-95%. 100% will take a lot of work and by that time, if you rehab properly! you will be in overall better shape than you were to start.
> 
> We probably fix 6-7 of these a week here. The results are way better than when you just try to rehab.


Ok. What can I expect to be able to do during the second half of the recovery? I'm 40 and have never had a major injury minus concussions. Somehow I've escaped relatively scotch free through all these years of snowboarding, mountain biking, motocross, football, baseball, etc. I realize a lot is up to the individual, but I'm a little concerned about quality of life for those 4-6 months. It won't affect my decision about surgery, just concerned as I am an active person and I do a lot of physical labor around the house that I'm sure will cease for quite a while.

Thanks for the response.


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## jml22 (Apr 10, 2012)

Hey
What kind of pain are you having and where abouts?
Unless it's a really bad ac sprain you don't necessarily need to have surgery. Good rehab Will fix most of it, most of the time. I say do the rehab first because it improves post surgical results.... and regardless you'll have to do rehab with a surgery.

Best to try what you have to do in the long run right now and you'll probably find the pain goes away.


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## Argo (Feb 25, 2010)

After the first 6-8 weeks of being immobile, you will be weak and lack full range of motion. The rehab after that will be to regain the range and strength lost while the BT and RC heel from surgery. 

Typically you will not heel from this kind of injury on your own, the PT/OT is more to strengthen every thing around it and help you compensate for the injury. That injury will remain and it will pop up throughout your life, especially if you slack on working it out.


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## jml22 (Apr 10, 2012)

When someone says torn ligaments there are grades of tears
If he didn't separate his shoulder, if he didn't break anything, if he didn't dislocate it, they aren't completely torn and most likely healed by now. He needs mobility and strength not to loosen the ligaments up.

Trust me, they want to do surgery to do a subacromial decompression and scrape all the bursae and stuff away. They're not gentle in there and you'll have to do rehab and exercises anyways.


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## West Baden Iron (Jan 31, 2013)

jml22 said:


> Hey
> What kind of pain are you having and where abouts?
> Unless it's a really bad ac sprain you don't necessarily need to have surgery. Good rehab Will fix most of it, most of the time. I say do the rehab first because it improves post surgical results.... and regardless you'll have to do rehab with a surgery.
> 
> Best to try what you have to do in the long run right now and you'll probably find the pain goes away.


I just finished 8 sessions of OT over 4 weeks and the pain has gotten worse. When I started rehab, the pain was about a 1 all the time and would go to a about a 3 during certain movements, especially behind my back and extended reaching. Now it is a 3 all the time, especially at night and is going up to a 5 or 6 during the same movements and my range has decreased since the start of therapy. The pain is deep in my joint and on my shoulder blade area.



Argo said:


> After the first 6-8 weeks of being immobile, you will be weak and lack full range of motion. The rehab after that will be to regain the range and strength lost while the BT and RC heel from surgery.
> 
> Typically you will not heel from this kind of injury on your own, the PT/OT is more to strengthen every thing around it and help you compensate for the injury. That injury will remain and it will pop up throughout your life, especially if you slack on working it out.


Thanks for the insight. The OT told me the same thing I think, just not explained as well as you just said. I was under the impression the therapy would heal the tendons, but she said only surgery will heal them. The therapy was only to help ease the pain, which obviously hasn't worked so far.


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## jml22 (Apr 10, 2012)

Popping clicking in your shoulder? is that popping and clicking painful?
Do what you want, i've been through two shoulder surgeries. Both now that i've learned we're completely pointless, as are most shoulder surgeries.
Unless something is ruptured, broken or (torn labrum), Surgery will just remove the inflamed areas that are causing the pain. The inflamed areas mean your body is trying to heal the area, they are not the problem.

Go see a PT certified in SFMA or FMS not an OT.
The whole point of rehab is to fix imbalances not compensate for an injury like you just said. That is a 30 year old model and is out of date. It does not belong in healthcare. 
GO see someone competent.


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## Argo (Feb 25, 2010)

Yeah, if that BT is pulled off at its insertion, we would drill an anchor into the bone and strap it down with a thick non absorbable stitch(cord). If it is torn in the middle we stitch it back together with the same kind of cord.... Typically we use a product called ethibond and it feels like a soft nylon cord..... That tendon is large and tight and won't just heel on its own.

RC will wear away more which helps pain go away eventually but you have a loose shoulder. With repair it will be tight and able to strengthen without pain or further dislocation as well as gain full range of motion. The cuff is basically a muscle group with four tendon attachment points that keep shit together. Getting it fixed is similar to the BT with smaller anchors or cord used for repairing.

I also agree with the PT, OT has their place but not in sports medicine.


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## Argo (Feb 25, 2010)

The keys to my suggestion for surgery were you saying you have a "severly torn BT and a partially torn RC". That won't fix itself...... 

The facility I work at is a world renowned sports medicine center..... Both for surgical repair and rehabilitation.....


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## West Baden Iron (Jan 31, 2013)

jml22 said:


> When someone says torn ligaments there are grades of tears
> If he didn't separate his shoulder, if he didn't break anything, if he didn't dislocate it, they aren't completely torn and most likely healed by now. He needs mobility and strength not to loosen the ligaments up.
> 
> Trust me, they want to do surgery to do a subacromial decompression and scrape all the bursae and stuff away. They're not gentle in there and you'll have to do rehab and exercises anyways.


I'm sure I'm not explaining it very well. Like I said before, I've never had a major injury so this is all pretty new to me. The surgeon said the rotator cuff tendon was just a partial tear and the bicep tendon was either severly partially torn or fully torn, he couldn't tell for sure. He didn't tell me the grades of the tears.

I haven't looked up the difference between a seperated shoulder and a dislocated shoulder so I'm probably explaining that wrong. All I know is that when I get up from laying on the ground, my shoulder was hanging down and to the front by a significant amount. I couldn't move my arm until it popped back in when I thrust my body forward trying to shift my truck.



jml22 said:


> Popping clicking in your shoulder? is that popping and clicking painful?
> Do what you want, i've been through two shoulder surgeries. Both now that i've learned we're completely pointless, as are most shoulder surgeries.
> Unless something is ruptured, broken or (torn labrum), Surgery will just remove the inflamed areas that are causing the pain. The inflamed areas mean your body is trying to heal the area, they are not the problem.
> 
> ...


My shoulder pops and clicks a bunch, especially during the exercises in therapy. Enough that the OT cringes and asks if it hurts when she hears it. It is painful, probably a 5 on the pain scale. Not sure how this applies, but when doing the MRI, the guy took 3 tries to get the dye injected because of all the inflammation. He said he hadn't seen one that bad in while, whatever that means. Maybe that is normal for my type of injury.


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## jml22 (Apr 10, 2012)

Ah ya, maybe need surgery then. Most likely a decently sized labral tear.
I figured if they did an MRI they would have told you that you need surgery to fix it.
I just hate people jumping into surgeries. Too many surgeries done here that we're done just because the surgeon had an open spot. 
This sounds a little more serious enough.
I've had labral repairs done and an AC sep. I left the AC sep because i didn't want the hardware in my shoulder. It's not that bad. I think the wrost was people hitting my shoulder after surgery when i was in a sling. People always think it's your elbow or wrist that's injured when you're in a sling.


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## West Baden Iron (Jan 31, 2013)

Argo said:


> The keys to my suggestion for surgery were you saying you have a "severly torn BT and a partially torn RC". That won't fix itself......
> 
> The facility I work at is a world renowned sports medicine center..... Both for surgical repair and rehabilitation.....


Would you suggest a 2nd opinion before I procede or does it sound like I am on the right track? Nothing world renowned here except the legend of Larry Bird.


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## West Baden Iron (Jan 31, 2013)

jml22 said:


> Ah ya, maybe need surgery then. Most likely a decently sized labral tear.
> I figured if they did an MRI they would have told you that you need surgery to fix it.
> I just hate people jumping into surgeries. Too many surgeries done here that we're done just because the surgeon had an open spot.
> This sounds a little more serious enough.
> I've had labral repairs done and an AC sep. I left the AC sep because i didn't want the hardware in my shoulder. It's not that bad. I think the wrost was people hitting my shoulder after surgery when i was in a sling. People always think it's your elbow or wrist that's injured when you're in a sling.


The surgeon was pretty open to my feelings on whether I wanted surgery or not. He thought therapy was a good idea to try first, but in the end I think he thought I needed surgery. I was pretty adament that I didn't want surgery unless it was completely necessary. I was really hoping my body would heal itself, but it has been 4.5 months since the injury and I'm definitely worse than I was 4 months ago pain wise.


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## Northriver1 (Nov 24, 2013)

WBI... Good luck and hope you have a speedy recovery! Seems like injuries are kinda the theme around here lately...


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## jml22 (Apr 10, 2012)

It really depends, on what it is. You could ask what the specific diagnosis is and what they're going into repair. 
It really depends. 

I can give you my experience
I had a big posterior inferior labral tear that was causing pain for a couple months. That pain went away and i was left with an inflamed bursae that "needed" subacromial decompression surgery to get rid of it. 
Now i've come to learn that it was something called subacromial impingement syndrome, secondary to my AC sprain. 
So needless to say, they "repaired" the labrum scraped away everything and after 6 months of rehab and stuff things still didn't feel right. It wasn't until last year, I did some actual legit rehabilitation that i can now catch a basketball with my left arm and not feel like my shoulder is going to fall out of it's socket. I also have learned that impingement syndrome, the problem are muscle imbalances 99% of the time. 

So given we don't know your specific diagnosis it's hard to give you specific advice for you.
If your surgeon says stuff like, you have a bankart lesion, you have a grade 3 tear or rupture of ____ muscle/tendon. Yes you will probably need surgery. 
I definitely don't consider most OT "rehab" to be legitimate rehab by today's standards. I can't say specifically on your experience but my general experience with them has NOTHING to do with injuries and sports.
The fact that you have "shoulder blade" pain means one, exercises they gave you, they didnt' coach you properly how to do them and you just aggravated it more. Also a loss of ROM = they were done wrong.
The advantage of other therapists who are involved with sports is they will do legit manual therapy on you as well as the exercises. Both are very important in this.

I would personally find a good PT/Sports med person to get a second opinion.


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## West Baden Iron (Jan 31, 2013)

jml22 said:


> It really depends, on what it is. You could ask what the specific diagnosis is and what they're going into repair.
> It really depends.
> 
> I can give you my experience
> ...


Ok. Thanks for the info. The surgeon I'm going to specializes in Sports Medicine so I will ask him about PT rehab and a more specific diagnosis and surgery details.

You guys are helping me with this and I appreciate. If nothing else, you are giving me some better questions to ask. I just feel like a jackass second guessing people like this. I realize it's my body and my call and nothing is ever certain in medicine, so it never hurts to get more opinions.


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## jml22 (Apr 10, 2012)

Nah, it's ok to ask. It's your body. You need to question people.


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## West Baden Iron (Jan 31, 2013)

Northriver1 said:


> WBI... Good luck and hope you have a speedy recovery! Seems like injuries are kinda the theme around here lately...


Thanks. Definitely a lot of injury talk lately.

I want to get this done and be ready for the start of next season if possible.


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## Northriver1 (Nov 24, 2013)

West Baden Iron said:


> Thanks. Definitely a lot of injury talk lately.
> 
> I want to get this done and be ready for the start of next season if possible.


Same here my season ended due to a work injury the beginning of march... been in PT for about 3 weeks now and hate to say it but actually looking forward to going back to work in 6 weeks.... if lucky... being active the hardest thing has been not being able to get around like normal.... Just looking forward to next season for sure, I bet you'll be back at it next season stay positive and listen to the docs!


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## Mizu Kuma (Apr 13, 2014)

Like Argo suggested, I'd go and get the surgery done!!!!!

Whilst I'm no medical expert, I'm pretty sure any torn tendon is not goin to heal if you continue to mobilise it????? Much like a bone repairs itself when it's immobilised, tendons and ligaments are no different!!!!!

When I dislocated my shoulder I luckily kept it immobile until I had the Doc pop it back in properly!!!!! Whether you did further damage by tryin to use it is anyone's guess, but it's too late for assumptions like that anyways!!!!!

Based on my Achilles (I'm guessin that all tendons will behave in a similar way), I'd get it all stitched and anchored, then keep the shoulder COMPLETELY immobile for at least 8 weeks!!!!! From that point, it'll all be about gettin movement back by stretching the very same ligaments and tendons back to where they will give you complete movement to how it used to be!!!!! This can be the hardest and the most painful part of the process, as this is where the extent of you're recovery is completely up to you!!!!!

The healing stage is the most important period though, as I've seen so many of my mates think that it was okay to use their broken wing on the odd occasion, and some to the point where they were then facin another bout of surgery due to the tear not only bein unable to heal properly, but in most cases reopening and puttin everythin back to where they started!!!!!

Maybe a load of rubbish in there, but I wish ya a full recovery whatever way ya read it!!!!!


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## rambob (Mar 5, 2011)

Welcome to the world of: 'I have a F'd Up Shoulder'..... The shoulder is by far the worst/complex of all the major 'hinges' (knee, hip, ankle) to fix and in turn rehab. I'm not a Dr and I dont play one on the interweb, but I've got one partial joint replacement in my right shoulder and a left one that we (me and my ortho surgeon have kind of written off cause 'I can live with it (the discomfort). My perspective is no matter what course you take it will take a long time to get your shoulder back to a good level of comfort/performance/strength or whatever you use as a measure. I also feel that once you substain a injury (no matter how or what you do to fix it) it will get hurt easier: Most Drs I've talked to believe this as well. l also believe in 2nd, 3rd , and 4th opinions on surgeries, PT, rehab, diet and anything else that relates to the body part that is hurt. Me and my insurance companies have spent about $200k on my shoulders on and off since I initially did my first 'big hurt' in 95 and the will never be 'as good as they were before'. Good Luck and have patience!


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## racer357 (Feb 3, 2011)

When I quit racing MX, my shoulders were junk. I had dislocated both of them so many times without rehabbing they would basically fall out if I sneezed wrong.

My doctors thought that if they tightened them where they were coming out, they would just go out the other direction.

Two years of bi weekly PT and they were strong again and haven't came out since 2000. 

I am 41 yo, and if one was to dislocate today, I would have surgery and be done with it by the time next season starts.


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## purekarma (Mar 9, 2013)

I destroyed my shoulder 14 months ago. Severe dislocation, pulverized the humerus, and torn labrum. I was treated by Dr. Randy Viola, of the Steadman clinic, who is one of the best around. I did not have to have surgery, but because of the severity of the fractures I was in a sling for 2 months. When I got to take that sling off and start PT I had horrible muscle atrophy, only 7 degrees of movement in the shoulder. 

I really don't know what to tell you when it comes to the surgery. I am 38 years old, and can tell you that you need to be prepared to put some serious time in with you PT I and strength training if you want that shoulder to be back to what it was. I did 7 months of rehab on mine to get it to 90%, and still go 3 times a week with a strength coach. I would say I am at 95% right now, in way better shape, and much stronger than I have ever been. You need to be very dedicated to your rehab, and be prepared to have lots of down time.


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## Argo (Feb 25, 2010)

Viola is a fellowship trained hand surgeon and ortho trauma surgeon. He is great at those. His partners specializing in shoulder sports medicine are Peter Millet and Tom Hackett, all of which I work with regularly. Hackett is the.US snowboard teams surgeon and actually has a line of Burton jackets named after him. Both are amazing shoulder sports medicine guys.... 

I could not classify your injury in the same fashion as a BT/RC tear..... We also see tons of proximal humerus fractures during ski season and Randy is great with those broken bones!


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## West Baden Iron (Jan 31, 2013)

Thanks for all the replies guys. I will have a long talk with the surgeon on Wednesday and see what he thinks the next steps will be.

There is another sports medicine clinic close by, so I may get a 2nd opinion from them, if I'm not satisfied after talking to my surgeon.


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## West Baden Iron (Jan 31, 2013)

I went back to the dr on Wednesday. We had a long discussion and he is a little hesistant to do surgery at this point. He thinks I am causing myself pain (mostly in my shoulder blade area) because I am overcompensating for the bicep tendon tear.

He gave me a steriod shot in the tendon and wants to see how that affects my pain. I am scheduled to go back in 2 weeks to make a decision the future. 2 days later and my shoulder is almost pain free. I worked fairly hard at work yesterday doing things I never could have done last week. I didn't push it, I just had much better movement and seemingly more strength, especially extended reach strength.

I'm hoping this will be part of the solution along with some PT, rather than surgery. I guess in a few weeks I will find out what the doctor thinks. I am trying to schedule an appointment with another doctor in the sports med clinic, but I can't get in for a month or so as of now. I'll probably wait until my next appointment to decide if I will get a second opinion, especially if the first opinion says surgery is the next step.


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