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    bone spur fraying rotator cuff

    I need some advice here. I have a bone spur under my L. rotator cuff, and is suspect there is one under my R. rotator cuff as well. I've already had an injection on the L., and x-rays revealed the fraying. The injection lasted about 4 months and I'm getting another one on Wednesday. The injections only mask the pain, but without it, my transfers are affected and I've almost fallen several times. I did fall on several occasions before the first injection.

    Is there some way to treat the spur? Is there a laproscopic procedure? Is it better to treat it earlier? I need both arms to function independently, and I don't want to go to a nursing home for rehab. I will be getting both shoulders x-rayed again on Wedneday, so I'll know what I'm up against.

    #2
    It will depend on what the xrays show as to how yu should proceed. It does seem as though they are effecting your function, so something a little more permanent than injections may be the next step.
    Shoulder surgery can be done with a scope however it depends on the amount of damage, any scar tissue that may be present from previous injuries, etc.
    You may not need to go to a nursing home for rehab, but you will definitely need assistance after the surgery. You should plan on a couple of months of not being independent and needing help. It may not be that long, but I would prepare for longer versus shorter. If you can not find home ccare/services, you may need to go to a subacute or acute rehab.
    Se what the doc says on Wed and if you are not satisfied with his responses (or even if you are), you may want to get a second opinion. It never hurts to have a second set of eyes look at the films and examine you.
    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.

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      #3
      Seems like sound advice to me, KLD. Thank you. As of my last x-ray 4 mths. ago, the damage was minimal. My SCI is covered by w/c, so getting home care shouldn't be a problem. However, I've never had home care. I've never even been hospitalized over night. I know we have to do what we have to do, so I will get the best medical advice available. I had bilateral carpal tunnel surgery (6 weeks apart) and was able to maintain full independence, but this pain prevents me from straightening my arm when I transfer. I'll post again after Wednesday.

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        #4
        Sounds good. Keep us posted.
        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


          #5
          Saw the doc yesterday, and he gave me injections in both shoulders. Of course, I feel stronger and back to normal regarding transfers. The injection I received on the L rotator cuff lasted about 4 months. R rotator cuff also showing some shading. L rotator cuff is about the same. Since he isn't sure what it is happening with the R, I am getting MRI's on both shoulders. If surgery is recommended, either now or in the future, I will get two opinions. KLD, here's a question I will need to ask. Maybe you can comment, and provide some other questions I should ask. I am in my 60's now, 43 yrs. post. Is it better to have minimally invasive surgery sooner rather than later, before the damage is too bad, or should I keep getting injections and wait until the situation is more dire and I am older? I know the older I am, the more difficult it will be to recover. Oh the joys of aging with SCI.

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            #6
            Not only the joys of aging with a SCI, but the joys of aging! I would ask your doctor what he recommends- and why. Will the minimally invasive surgery be able to correct the problem? It is not only the length of time you have the issue, but what exactly the issues are AD to whether minimally invasive techniques will be appropriate.
            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.

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              #7
              My biggest fear is losing independence, even for a short period of time. I have never had personal care assistance since leaving rehab in 1972. I've willingly suffered the indignities of colonoscopies, urodynamic testing, and young nurses checking all of your orifices. These go with the institutional territory. However, I have never had someone help me in my home, including my wife. I'll know better after the MRI's, but if there's a chance my shoulders will outlive the rest of me, I'll forego the surgery. I'll be in touch.

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                #8
                Originally posted by tasty View Post
                Saw the doc yesterday, and he gave me injections in both shoulders. Of course, I feel stronger and back to normal regarding transfers. The injection I received on the L rotator cuff lasted about 4 months. R rotator cuff also showing some shading. L rotator cuff is about the same. Since he isn't sure what it is happening with the R, I am getting MRI's on both shoulders. If surgery is recommended, either now or in the future, I will get two opinions. KLD, here's a question I will need to ask. Maybe you can comment, and provide some other questions I should ask. I am in my 60's now, 43 yrs. post. Is it better to have minimally invasive surgery sooner rather than later, before the damage is too bad, or should I keep getting injections and wait until the situation is more dire and I am older? I know the older I am, the more difficult it will be to recover. Oh the joys of aging with SCI.
                Even in the best scenario, if you continue to do push ups, unaided transfers, and manual wheelchair wheeling you are likely to end up with constant, severe pain like I have. These activities really stress and damage the shoulder joints. I do not know how you do these activities, but I urge you to read the manual on preserving upper extremity function that is accessed by clicking the SOS link near the bottom of my post. If not already using a power assist or full power wheelchair now is the time to seriously consider this change. I did not have the power assist options that are now out there and am really suffering the consequences.
                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


                  #9
                  Totally agree with the above post. Constant use of the shoulders only leads to problems.
                  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


                    #10
                    All suggestions are appreciated. Before the spur developed I had no problems with transfers, and minimal discomfort for 43 yrs. post. Will have MRI this week. We'll see what happens.

                    Comment


                      #11
                      No word on my shoulders yet, but the MRI was nothing like I expected. I've had them before, but the doc wanted me to go to a facility with better magnets. You go inside the tube. Forget it if you're claustrophobic. Start searching for an open MRI if you are. My knee is contracted so it was constantly against the side of the tube. You cannot move or you'll create shadows on the films. Since I needed MRI's on both shoulders, I figured I'd get them out of the way at the same time. Big mistake. I spent an hour in the tube with a couple 1 minute breaks. You have to use ear plugs to minimize the constant noise. Here's the worst part. The room is cold and they offer you a blanket. However, the MRI tube is HOT. Good thing I didn't accept the blanket. The heat comes up from the bottom of the tube and you sweat and it drips and you can't move. It's not waterboarding, but it feels like torture in the name of medicine. I'm going on vacation. I'll worry about the MRI's when I get back.

                      One more thing: Make sure you inform the staff if you will need assistance with transfers. Your w/c is made of metal, so you can't take it in to the MRI room. They transfer you to a gurney outside the room, and then you have to transfer again from the gurney to the tube.

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                        #12
                        The RF is not free radio waves, but induction from lower f pulsed gradient coils may stimulate giving warm sensation. I keep getting woken up as I find the mad daemon hypnotic. The contrast is relaxation time quantum weirdness. Read up first and enjoy the adventure.

                        Put me in dark drain pipe or hood on my head and I nod off.

                        The gurney must be made of special materials. Hear of botched MRI where oxygen cylinder ended up where kid's head was?
                        Last edited by zagam; 8 Dec 2014, 6:49 AM. Reason: caution magnet
                        http://zagam.net/

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                          #13
                          I am 48 yrs post injury, t-12, had L rotator repair done in '97 and R on 2002. I am 63. Unless I abuse my shoulders by doing things I shouldn't do (washing windows, carrying something heavy without my elbow tucked into my waist) my shoulders are doing pretty good after the surgeries. I will share some experiences and opinions and hope they help you make your decision.

                          I also had cortisone shots but my surgeon warned against them as they will inhibit healing after surgery, and he refused to give me a shot on my R side as he knew surgery was imminent and we were discussing having it done five months down the road. Other doctors (physiatrists) were more than willing to give them to me. Your right, the shots will only buy you time, they will not fix the damage. And if you feel no pain you may continue to do things that may cause more damage which may eventually be harder to repair. I do know some para's who waited too long and could not have surgery due to too much damage.

                          As far as laproscopic surgery, some surgeons do a repair via this method. My surgeon likes to have more space to see and work so he does not do laproscopic. My incision was only about an inch long. I don't think it matters how they go in as much as what they have to do once inside.

                          After surgery expect to not use your arm for "anything" except physical therapy exercises which are pretty limited the initial few weeks. I guarantee that you will not be doing any transfers, or putting any significant weight on the shoulder for up to 6-8 weeks depending on what repair they have to do. I rented a motorized wheelchair for that period of time and maybe a couple of weeks longer. That was a godsend for mobility but I don't own a van so going anywhere was limited. Initially your arm will be in a sling, then you can have it out of the sling but only resting at your side or in your lap. No weight bearing on it at all and very limited movement. So you will need assistance for all of your transfers.

                          The first time my insurance company negotiated an agreement with the hospital to allow me to stay in the rehab unit for 8 weeks instead of a nursing home. I think they took sympathy on me due to my age and as I understood at the time, the hospital agreed to accept a lower rate of pay from the ins co as they had many empty beds and so my taking a bed meant some income to them vs none. I think the rate of pay was at nursing home rate. There was a clause in my insurance policy that allows for special negotiations. I utilized that time in Rehab by seriously using the PT room to strengthen my other shoulder and for PT for the repaired one. It was hard not being home but as with most rehab units, you make relationships with other patients, and the staff and the time actually passed quickly (that is?.looking back, it didn't feel that way at the time). I was also able to get passes to leave for a few hours to out to dinner etc. so that helped.

                          The second time, the ins co agreed to allow me in home care to get me out of bed in the AM, showered and dressed, etc and for a Physical therapist to come in to teach me the exercises I needed to be doing from week to week. Although it was great being home, living in the country i was quite isolated from people and my personal care assistant lived quite a distance so if I needed her unexpectedly it wasn't guaranteed that she'd be here for me. Both situations has its plus and minus's. If I had to do it over again I think I would opt to go to a nursing home vs being home as I was socially isolated, did not have family or friends around, husband was working long days, and there was the added stress of worrying about needing to get on the toilet and not being able to due to no attendant being immediately available. My husband assisted me getting to bed at night, but during the day if I wanted to lie down I couldn't as I had no assistance to get into bed. That at times was very uncomfortable and exhausting. You will also need to figure out how to sit up and roll over in bed using one arm in order to avoid pressure sores. After the first few days, i generally did not have a lot of pain, but when I did it was usually at night and one has to find a way to support your arm shoulder with pillows etc. One other important factor is weight gain. If you are pretty active now, you won't be after the surgery. I had to really watch my diet. When I was in the hospital they put me on a 1200 calorie diet as I had gained six pounds after two weeks (just sitting in a motorized chair) , and there was no way I could continue to gain that weight and go home on a weak shoulder and do transfers. So watch what you eat.

                          Maybe a consideration would be to go to a nursing home for the first two/three weeks until you see how it all comes together, and then go home for the rest of the time. Good luck, feel free to ask any questions, more than willing to share my experiences.

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                            #14
                            Thanks, Blue Dog. You summed up my concerns accurately. I will be in touch with the shoulder doc this AM to schedule an appt. to review the MRI's. As I stated, I'll keep everyone posted.

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                              #15
                              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.

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