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    #16
    Originally posted by tasty View Post
    Met with the doc to review MRI's yesterday. More good news than bad. Bad is that there are several small tears in both shoulders. Good is that surgery is not recommended now and won't be considered unless I initiate it. I have no plans to get surgery. There is a 30% chance that surgery will not be successful and may make condition worse. As KLD indicated, even successful surgery would require 2-3 months of rehab with no transfers. PT to strengthen rotator cuff and topical NSAID gel were prescribed. Given my age there is the chance that my shoulders will outlive me, if you know what I mean. That's a good thing.
    They can last if you take care of them.
    You will find a guide to preserving shoulder function @
    http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

    See my personal webpage @
    http://cccforum55.freehostia.com/

    Comment


      #17
      They can last if you take care of them.

      I plan to take excellent care of my shoulders. When you're younger you have to build a life; work, family, exercising to stay in shape. Now it's a matter of holding on to what you have and not living a totally sedentary lifestyle. Unfortunately, life for paras and some lower quads is a series of transfers. You have to do them. BTW, Merry Christmas to all.

      Comment


        #18
        Tasty, I have lots of questions for you.

        May I ask how old R U that you think your shoulders will outlive you, how many years with SCI, and what level of SCI do you have?

        What is your plan for taking "excellent care" of your shoulders?

        Why is surgery not recommended now? If the tears are small, why would surgery make the condition worse and not be successful? And final question, what kind of doctor are you seeing who is giving you this advice? Is this a General Practitioner, or a Bone and Joint Doctor? It is pretty common to recommend PT before advancing to surgery (often an Inusurance and W/C requirement)

        Comment


          #19
          Hello, Blue Dog. The answers to your questions: I am 63 yrs. old; 43 yrs. post. My injury is T11 incomplete.

          Because my father had coronary artery disease, concerns about heart attack or stroke have motivated me to stay super-active in order to maintain cardio-vascular health. Besides 40 yrs. of wheelchair sports, 27 yrs of FT employment, and multiple recreational activities, I have always pushed myself to live vigorously and pushed my body to its physical limits. I cannot do that anymore. The risk to my shoulder is too great. For people with SCI, life is measured in transfers. You only get so many. I have to save myself for transfers mandatory for daily living. Therefore, I have to restrict the optional activities. Without going into detail I recently fell while participating in one of these optional activities. I put out my arm to break the fall and drove the spur further into my rotator cuff. The pain has greatly increased and my ROM greatly decreased since then.

          I am working with the foremost orthopedic group in my area. They serve as team doctors for all the professional sports teams. My doctor and his PA specialize in shoulders. That's all they do. Given my age, he believes that I can get by with injections every 3 or 4 months for an indefinite period of time for the rest of my life. The alternative of surgery, even if it's performed laproscopically, would prohibit doing any transfers or self-care for 2-3 months. This would be intolerable to me as I have had no assistance with ADL's since leaving rehab 42 yrs. ago. Even my wife has never assisted me. According to the dr., there is a 30% chance that there would be no improvement. The surgical incisions might even make the injury worse. Of course, there is a 70% chance that I could get better.

          BTW, I have found that Voltaren Gel provides significant relief, if you can tolerate NSAIDS. Think of it as ibuprofen in gel form. It can be applied up to 4X per day as directed, and does not cause any gastro-intestinal distress. Hope this helps.

          Comment


            #20
            Tasty, Your history and mine are very similar?age (by the way if your Birthday is in fact tomorrow, so is mine?.Happy Birthday!), length and level of incomplete injury, no ADL assistance, FT employment, family medical history (I have early familial deaths by heart attacks), high value of being independent, etc?

            When we rehabbed forty plus years ago we were taught that "if you didn't use it, you would lose it'. I was never taught anything about aging and overuse. Only until I developed shoulder pain and the internet became available did I learn anything about aging with a SCI. And of course when your young you never relate to seeing your self as getting old and having other issues. I was sent home from rehab in 1968 without a bathtub bench and I transferred into the bottom of a bathtub everyday since my injury until Jan of 1997. It just never occurred to me to get a bathtub bench to make bathing easier, and no one ever suggested it, until after my rotator cuff repair. Now I wish i had one forty+ years ago! It was nothing for me to lower myself to the floor and crawl or scoot into an inaccessible bathroom or to play with my dog, and then get back into the chair from the floor. I used to hike myself up on my kitchen counters so I could clean the inside of my upper cabinets. Why? Because I could. My poor shoulders, what abuse!!

            So I thoroughly appreciate and have lived with the same values that you have regarding being independent. Like you, no one had ever assisted me with personal cares or getting groceries etc. However I am wiser now, and have adjusted and re-organized my priorities which include asking for and accepting assistance in order to save my energy and shoulders for future transfers that are critical to maintaining and extending my independence. I have made an active decision to sacrifice some of my pride and to ask for help so that I can extend the longevity and quality of being independent. And having done so I don't feel less of a person, and my ego hasn't been injured.

            I would urge you to get that second opinion that SCI Nurse recommended, and hopefully one of the opinions is from a surgeon, and one who fully understands the kind of lifestyle that you personally desire to live as a SCI person and the day to day demands upon your shoulders.

            Sorry, but I am skeptical about doing cortisone shots every three to four months for several years in the future. I guess doctors vary on that opinion cuz mine would not approve of that. Or perhaps your injuries are much different which allows for it.

            My reasons for being skeptical are:
            One, the shots will reduce your pain which is great but that will also give you a false sense that your shoulders are doing ok. Given your pride and need to be in control and independent I suspect that you will push your limits due to no pain thus potentially causing more injury.

            Two, the shots are not going to heal the damage already done, and if the cortisone ever stops working you will be faced with surgery anyhow, that is if there isn't too much damage at the time to do surgery.

            Three, you have a better chance at recovery as a younger person than an older person due to a better blood supply for healing the area operated on.

            Four, you have no guarantees that you will die before your shoulders give out on you. I call that wishful thinking.

            Five, In our area nursing homes have a rehab unit for people who need recovery time and physical therapy/rehab for that recovery, and the unit is separate from those patients who will never go home again. So the atmosphere is not as depressing as one may think. As I stated in an earlier post, you could possibly consider going there initially for a short time and then continue receiving care at home with someone coming in to assist you as needed.

            Yes, I have used Voltaren, mostly for arthritis in my hands. The last time I read the insert no studies have been done on the use of the med on shoulders. I am sure you have read the side affects and warnings, one of which by the way addresses heart disease etc. The drug is not something that I personally would want to apply several times a day on a daily basis.

            For me, without a doubt the surgeries were worth the humiliation of temporarily loosing my independence. None of my family or friends think less of me due to my temporary loss of independence. The people caring for me at the time did not think less of me. At the time, my ego was knocked down a notch or two which was totally humiliating as it took me back to the early days of my injury and feeling like a child all over again being so dependent on others...?quite difficult to endure at the time. BUT I was able to re-gain strength and full use of my shoulders. So a few weeks of being dependent was totally worth the years of pain free independence that I gained.

            Tasty, I really wish you luck in your choice, and hope you keep us appraised of how things work out for you.

            Comment


              #21
              Just as a FYI- Voltaren Gel has les of the side effects of the oral medication. This is due to the fact that it does not enter the system, but rather hits the area directly. That is not to say there couldn't be issues, just more likely not to be.
              ckf
              The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

              Comment


                #22
                Blue Dog, you raise many issues, and our issues ARE very similar. Let me point out that I did not expect to live this long. I was told plainly by my ins. adjuster that I could expect to die (as per actuarial tables) in my mid-fifties. Like you, I did the bottom of the tub transfers until 10 years ago, when I converted the tub to a shower. I hopped on the kitchen counters when I couldn't reach something, and I have been transferring in and out of boats for the past 35 years.

                I think all your concerns are valid. However, my in-patient experience, which lasted a year, was traumatic for me. I am a very private person, and having 19 yr. old nurses give enemas to a 20 yr. old new para has haunted me for the past 40+ yrs. I could give you a page worth of reasons for my attitude, but I don't think it's necessary. I will get a consult with a surgeon. I have been using pain meds minimally, and I note some slight improvement. Pain or no pain, I am committed to making those lifestyle changes that will minimize the strain on my shoulder(s).

                My next appt. is in 3 weeks, then I head south for 6 weeks. I will update you guys on my progress, or lack thereof.

                Comment


                  #23
                  Take care and keep us posted.
                  Safe travels.
                  ckf
                  The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                  Comment


                    #24
                    I am seven months post surgery for what should have been a relatively uncomplicated procedure. My MRI showed a subacromial bone spur, as well as AC joint arthrosis, which is no big deal. While the doctor was doing the procedure, he decided to do a biceps tenotomy, in which one of the biceps muscles is surgically released, which supposedly dramatically reduces anterior shoulder pain. He did a Mumford procedure (subacromial decompression) which trims off the end of the clavicle at the AC joint. He removed the subacromial bursa, a bursectomy. Then he debrided the area. After seven months of physical therapy I have more pain now than I had before the surgery. I've lost the ability to transfer, as well as manage myself overnight independently. In addition it hurts to do anything such as drive or eat etc. My rotator cuff was essentially intact with no need for repair.

                    For me in retrospect it was a risk I took and I lost big time. The surgeon, after six months did not want to deal with it anymore and when I mentioned whether an MRI should be obtained to see if there is something going on, he demurred, saying it would not affect his decision-making process, which meant he was not about to go in a second time on someone with a higher chance for failure, such as quadriplegics.

                    Nonetheless, I pursued the request for the MRI, this time he said that most of the work it was bony and therefore the MRI was of limited value. I replied by saying that I had worked on my biceps tendon and bursa which are all soft tissues and can be visualized on MRI.

                    Believe it or not, my shoulder problems started when I got my power chair, a permobil C 300 with tilt and recline. The high back design prevents you from retracting your shoulders properly to avoid rotator cuff impingement, which started soon after I got the chair. Still, I put faith that my shoulder pain was not due to the chair and that with the surgery I like to be put back on a somewhat decent trajectory. Now the rest of my life is looking to be an utter nightmare, functionally as well as financially since I now need overnight care.

                    Signs/Symptoms sometimes do or don't correlate with radiography. Meaning a really nasty looking MRI could be found in someone with no pain. Then someone could have a lot of pain with a relatively normal MRI. My experience last few years with surgeons however has been that they do not do adequate physical exams and simply rely on radiography for surgical rationalization. In a population such as ourselves where the consequences of poor outcome could be catastrophic, it really behooves one to proceed cautiously before getting shoulder surgery and to really look at shoulder mechanics, home and work environment and the seating system. Most disturbingly, my seating therapist and vendor of both repeatedly discounted that the cause of my shoulder pain could be the chair, because that would mean more work for them.

                    When I'm in my power assisted chair with a lower back I have less pain.

                    Comment


                      #25
                      crags, sorry about your nightmarish experience. You've articulated the situation I am trying to avoid. Since you are quadriplegic, I really can't offer any advice, not that you've asked for any. With SCI any decision regarding surgery has to be a last resort.

                      Since the last time I posted, my pain increased significantly. I decided to reduce my use of ibuprofin Voltaren gel in order to get an accurate assessment of my shoulder pain. To my surprise, after a week or so the pain began to diminish. I only do necessary transfers and stopped all strenuous recreational activities. Today I'll call PT so I can start therapy and learn the exercises to improve function.

                      Comment


                        #26
                        Started PT today. I'm surprised, but I feel better after first session. See the doc next week. I'll post update.

                        Comment


                          #27
                          I'm about eight months post shoulder surgery for what should have been a relatively uncomplicated procedure and unfortunately I am now much worse than before the procedure. I had on MRI, a subacromial bone spur as well as some bursitis and AC joint arthrosis, the last two items being common, but not necessarily indicative of a need for surgery.

                          I have what is known as a subacromial decompression, which involved a procedure known as a Mumford procedure, and the surgeon also did a bursectomy (removal of the subacromial bursa), as well as a surgical release, known as a tenotomy in which the long head of the biceps tendon is surgically released. Personally, I think the surgeon did too much and now my shoulder is less stable and I have lost most of my precious little independence that I had.

                          My problem started counterintuitively, when I got a power chair with tilt and recline, but whose back put me in a posture that I led to increased impingement upon my rotator cuff. When I have a lower back I have less pain. I put my faith in the surgeon and that my problem was not the chair, but was based upon the anatomical findings. Now, postsurgery, I still have more pain in the power chair than in my other chair, only now I lost almost all of my functional abilities.

                          My experience is that most surgeons do not do a thorough physical assessment and instead rely almost exclusively upon radiographic findings. If they can see something, they can rationalize procedure. However, that does not mean the finding is the cause for the pain, as there are people with no pain will have positive radiographic findings. Instead, a thorough physical assessment needs to be done to correlate the problem with the film. I do not think my bone spur developed that quickly, yet my pain did. However a postural change can cause pain whereas previously it laid dormant.

                          One thing I would highly recommend immediately is to get, if you can afford it, and overhead track lift system such as a surehands. If you're going to try to avoid surgery, which I recommend highly, you need to minimize the stress loading of transferring. If you want to be independent in your transfers, then the surehands system can be tough to use. They have a quick in/out lifting bracket which is your best option for independence, but in my experience if you have any shoulder problem you will not want to use this, as I did and it was extremely painful. You will instead want to use one of their standard body slings which distributes the lifting pressure over a much greater area and does not drive pressure upward into the shoulder joint. However, using the slings requires a second person.

                          I would proceed very cautiously and do everything you can to see if you can alleviate your pain. This would include biomechanical reeducation, myofascial therapies, ADL examination (tub transfer versus shower chair), driving (driving from the chair versus transferring) and workspace evaluation (ergonomics of keyboarding etc.). The surgery offers no second chances for people like us and poor results can be devastating. I lost the ability to live alone and now need much more help including overnight help. In addition to the physical cost, the financial costs have been devastating.

                          I'll be glad to share any of my postsurgical experience as well as any other information I can share.

                          Comment


                            #28
                            At this point no one is considering surgery; not met, the doc, or the PT. I continue to make minor improvement with PT. I'm hoping to get another injection after PT on Monday. I can perform all ADL's with little discomfort. I just have to remember not to lift anything with my left arm. Most importantly, I decided to get a van with a lift shortly before I started having severe problems with the rotator cuff. Not having to lift the w/c in to my truck has been so helpful. For now, my advice is that we should be pro-active and begin the RC strengthening exercises before we absolutely need them.

                            Comment


                              #29
                              After PT, saw the doc yesterday. Continuing to make slow improvement. Surgery is definitely off the table indefinitely, hopefully, forever. PT does help. In the past PT has done very little outside of some comfort with the heat. I did get two more injections in the scap and the trap. I didn't get another one at the site of the spur. I do feel better and hardly took any pain medication, including Voltaren for the past couple weeks. I realize this is a matter of lifetime concern, so I have to be careful with transfers and lifting, despite the lack of pain. My greatest takeaway for newbies is to begin a shoulder strengthening protocol ASAP. Live your life actively, but avoid the crazy things we do when we're young. Do not participate in any strenuous recreational activities without performing prescribed shoulder exercises. Hope this helps.

                              Comment


                                #30
                                Good advice. Unfrotunately, once you have a spinal cord injury, you ned to rely on joints that were not made for the work that they now have to do. While being independent and mobile is important, it is sometimes better to ask for a little help to save that shoulder, elbow, etc. I know how hard that can be. I am not good at it. But, these joints have to last you a lifetime. So use them with intelligence.
                                CKF
                                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                                Comment

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