Shoulder Surgery for Rotator Cuff Tear and Calcific Tendonitis – My Story

Shoulder Surgery for Rotator Cuff Tear and Calcific Tendonitis – My Story

By Discovery Lean Six Sigma

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http://kevinmeyer.com/blog/wp-content/uploads/2018/08/shoulder-calcific-tendonitis-300x111.jpg 300w, http://kevinmeyer.com/blog/wp-content/uploads/2018/08/shoulder-calcific-tendonitis-768x284.jpg 768w, http://kevinmeyer.com/blog/wp-content/uploads/2018/08/shoulder-calcific-tendonitis.jpg 1495w" sizes="(max-width: 1024px) 100vw, 1024px">This is the story of my journey through shoulder surgery.  I’ve been helped by many such stories, so I thought I’d try to give back by sharing my own story with some tips and recommendations.

Background

In early 2010 I yanked a bag out of the overhead compartment of a plane and felt a sharp pain in my shoulder.  I didn’t do anything about it thinking the pain would go away, which it did over the next couple weeks.

A little over a year later I realized that the range of motion of my right shoulder and arm was much less than my left.  There wasn’t any pain, I simply couldn’t move my arm behind my back like I should be able to.  I went to the doctor and after an MRI with contrast I was diagnosed with frozen shoulder.  Basically since I didn’t do anything for the original pain a year earlier, I subconsciously didn’t move my arm through the full range of motion to avoid pain, so it “froze” in the injured configuration.  A cortisone shot and three months of physical therapy restored near full range of motion.

Six years after that I began to notice increasing pain and limited range of motion (limited more by pain than a physical stop) in that same shoulder.  After another MRI with contrast and an ultrasound I was diagnosed with calcium deposits.  Apparently when a tendon is injured the body will sometimes replace the tendon tissue with calcium.  It usually realizes the mistake and reabsorbs the calcium (which is actually a painful process).  In my case that wasn’t happening – the calcium was increasing.  I’ve always known I had issues with extra calcium, be it from needing to have my teeth cleaned every three months to issues with my eyes to even the multiple very strong baby teeth I still have.  It’s one reason I stay away from dairy when possible.

I lived with the pain for a couple years but it has had an increasing effect on my workouts and general living.  Anything that puts strain on the shoulder, be it pull ups, push ups, planks, even downward dog in yoga, has become very painful.  In mid-2018 I saw the orthopedic surgeon and we agreed it was time to remove the calcium deposits.

Preparing for Surgery

I knew that the surgery itself was arthroscopic and wouldn’t be too bad, but that the recovery would be tedious – though with a high probability of success.  My wife had had a much more difficult shoulder surgery less than a year ago to fix a very rare condition where the rhomboid muscles detach from the scapula.  In fact, there are only a couple surgeons in the country that perform that surgery.  So I knew from helping her what life would be like with a sling, how difficult sleeping and daily activities would be, and how long physical therapy would take.  Her surgery was successful, by the way.

Since I was over 50, a battery of lab work was required to ensure I could safely undergo surgery.  I had had surgery before – strabismus surgery to correct an eye alignment issue – so I knew I tolerated full anesthesia well.  I had an EKG, chest x-ray, and blood work done at a local medical center, which was then reviewed and signed off on by my primary care doctor.  All looked good.

I spent the next couple weeks working on tasks and projects around the house that required two good arms since I knew it would be several months before I’d be able to do them after surgery.  Cleaning up the garage, doing some gardening, and so forth.

sleeping uprighthttp://kevinmeyer.com/blog/wp-content/uploads/2018/08/bed-768x576.jpg 768w, http://kevinmeyer.com/blog/wp-content/uploads/2018/08/bed-1024x768.jpg 1024w" sizes="(max-width: 300px) 100vw, 300px">A week before surgery I had my pre-op with the surgeon where he verified that my lab worked good, fitted me for a sling (one of the large ones with a pillow to keep the arm several inches away from the chest), went over the details of the surgery, and gave me a couple prescriptions for pain meds (Oxycontin and Naproxen).

A couple days before the surgery I picked up the two prescribed pain meds.  I also set up the bed for sleeping upright.  Many people choose to sleep in a recliner, but I thought a bed with a tall wedge pillow and a “pillow fort” around me would be better.   I also plugged in an iPhone/iPad charger with a long enough cord so I could use it in bed, cleared off the night stand, and so forth.

Surgery

My surgery was scheduled for 1pm, with arrival at the surgery center at 11:30am.  They expected that I’d be released around 3:30pm.  No eating OR drinking after midnight, so we had a nice big dinner out the night before.

The surgery center is about a half hour drive from my house so my wife drove me and planned on running errands while I was being worked on.  I wore elastic-waist shorts, which I’d end up wearing for a long time since buttoning/snapping/etc would be nearly impossible.  I also wore a button-front shirt to make it easy to get dressed after surgery.

http://kevinmeyer.com/blog/wp-content/uploads/2018/08/Day0.jpg 480w" sizes="(max-width: 225px) 100vw, 225px">I was checked in, taken back to the prep area, changed into a gown, and an IV was started in my left hand.  I’m fortunate that I have huge veins with very little fat on my hands so that was a piece of cake.  The nurses each verified that I was having my right shoulder worked on.  The surgeon came in and also re-verified this, signing his initials on that shoulder.

We went over the surgery plans again, and he mentioned the anesthesiologist would give me a choice of full heavy anesthesia, or lighter (but still full) anesthesia but with a nerve block on my right shoulder and arm.  The advantage of the nerve block is that anesthesia could be lighter which could lessen nausea, and it would also keep the surgical area completely numb for 12-18 hours which is the most painful period.  Seems like a no-brainer so when the anesthesiologist stopped by I opted for that.  He did say I’d already be sedated before he used a needle to deliver the nerve block, so I wasn’t concerned.  I’ll tell you more about the nerve block experience in the next section.

I was wheeled into the OR at 1pm sharp.  The cuffs around my ankles were connected to a machine to apply pressure so I wouldn’t get blood clots.  The sedative was added to the IV, and that’s the last thing I remember before surgery.

I woke up pretty groggy with the nurse and my wife trying to get me to sip some apple juice.  I did, and remember that there was very little pain – just a lot of pressure on my right shoulder.  I was already dressed with my sling on.  They helped me go to the bathroom (apparently a full two liters of fluid was pumped into me!).  By 4pm we were on our way home, and I crawled into bed (upright!) by 5pm.

The surgery took a bit longer than expected because, in addition to the expected calcium removal, they found and removed a bone spur, cleaned the labrum, and repaired a partially-torn rotator cuff.  So much for a quick recovery – rotator cuff repairs apparently take a lot more PT.

Since I hadn’t eaten since midnight I was pretty hungry, but the effects of the anesthesia caused anything in my mouth to dry out.  It seemed like I couldn’t drink enough to keep crackers from creating a cement-like mixture in my mouth.  But I got a few down.

Week 1 After Surgery

The first night was rough, very rough.  Not because of the pain, but almost because of the lack of it!  The nerve block, which sounded great initially, started to freak me out.  Imagine your entire shoulder and arm feeling like your mouth does when it’s numbed for a tooth to be pulled, but for 12+ hours.  I’m somewhat claustrophobic, so having no feeling in such a large part of my body was disturbing – especially in a very tired state.   Next time I may opt for regular anesthesia instead.

The nerve block wore off somewhat suddenly around 5am, and I downed a couple oxycontins and a naproxen.  It took about an hour for those to kick in, and they made me pretty drowsy so I actually dozed off for a couple hours.

I spent most of the first day wondering if I had done the right thing.  30 days in a sling sleeping upright felt like it was going to be a nightmare.  Did I really have sufficient pain to warrant surgery?  Yes I did, and it was only going to get worse, but at the time I was second-guessing myself.

http://kevinmeyer.com/blog/wp-content/uploads/2018/08/Day1-768x576.jpg 768w, http://kevinmeyer.com/blog/wp-content/uploads/2018/08/Day1-1024x768.jpg 1024w" sizes="(max-width: 300px) 100vw, 300px">

The pain meds were very effective – I never felt much pain.  I did feel like there was a heavy brick on my shoulder though!  That was from the big compression bandage, as well as the large amount of fluid pumped into the shoulder to open it up to make surgery easier.

The second night was better.  I took the pain meds right before I crawled into bed for the last time, and they made me drowsy enough that I fell asleep for a couple hours.  I made sure to have pillows and a yoga bolster on both sides so I wouldn’t slump or roll either off the bed or onto my bad shoulder.  “Better” still meant being up most of the night though.

The second day was fairly productive, and I even got in a short walk.  I was eating normally, but noticed that, as I was warned, the pain meds were slowing down “the pipes.”  A little Dulcolax resolved that.

I tried typing and doing some small movements with my right hand, but after a few minutes my arm and shoulder would start hurting, so I decided that was a bad idea.

http://kevinmeyer.com/blog/wp-content/uploads/2018/08/Day-3a-768x563.jpg 768w, http://kevinmeyer.com/blog/wp-content/uploads/2018/08/Day-3a-1024x750.jpg 1024w, http://kevinmeyer.com/blog/wp-content/uploads/2018/08/Day-3a.jpg 1541w" sizes="(max-width: 300px) 100vw, 300px">

The third night was easier, thanks to a tiny sliver of Xanax, maybe 0.1 mg.  Just that small amount relaxed me enough to sleep almost through the night.  That morning I took the last dose of pain meds and have had very little pain since.  Being on pain meds for just over two days feels pretty good to me.

I was also able to take off the heavy compression bandage on the third day, which was a huge relief.  I could then finally see the four sutured cuts for the arthroscope instruments – two more than they expected thanks to finding the bone spur and rotator cuff tear.  All looked good so I put simple bandages on them for a few more days.

What was a bit more freaky was the bruising down my arm and especially bicep.  This continued to get worse for a few days, but I had read online that it was normal.

http://kevinmeyer.com/blog/wp-content/uploads/2018/08/bicepbruise-768x576.jpg 768w, http://kevinmeyer.com/blog/wp-content/uploads/2018/08/bicepbruise-1024x768.jpg 1024w" sizes="(max-width: 300px) 100vw, 300px">The next few days became increasingly easier.  I was able to type and do office work by the end of the third day, do some small house projects, and by the sixth day I even took a shower instead of a sponge bath – though I did cover the stitches.  I am allowed to have my arm hanging at my side for brief periods.  Showering with one arm takes some creativity, but isn’t too hard.

The sling is a bit of a pain, but I was getting used to it.  As requested on the post-op instructions, I took my arm out three times a day to do “pendulums” – just leaning over and swinging my arm in circles with no active muscle movement.  This is important to avoid scar tissue buildup, which will limit range of motion.  I did notice that the range of motion was pretty limited, especially in the upward direction, but I had been told to expect that.  After I started walking longer distances I found my arm would sweat quite a bit in the sling, but it can be easily washed.

I started driving short distances a day after I took my last pain pill.  Some docs will say to wait until the sling is off, but others say it’s ok to drive short distances with an automatic transmission as long as you’re not on narcotics.  Since it’s my right shoulder, fastening the seat belt is a bit of a chore and the twisting hurts a bit.  I also find that using just one arm can be fatiguing, so it will be short distances for quite a while.  I’m in a small coastal fishing village of just 10,000 people, so driving isn’t exactly difficult.

Holding any kind of weight your surgical side hand is difficult and not a good idea, even with the arm in the sling.  Even a coffee will cause some pain the first few days.  This became easier toward the end of the week, perhaps too easy as it’s still not a good idea since you need to protect the arm and shoulder.

I also started walking a lot to get back up to my 10,000 steps a day.  I had spent the last several years getting into pretty good shape and I was worried that the surgery would kick me off track.  I knew my upper body strength was going to suffer from several months of recovery, but I want to stay in as good of shape as possible.

One key event of note was bumping into (thankfully not literally) someone on the street who said he had had the same surgery just two months ago.  He was out of his sling and moving his arm, though he was still working on raising it higher than his shoulder.  Talking to someone who was on his way back to normal was a big motivator.

My first followup appointment was on the seventh day after surgery and went well.  The stitches were easily removed and I was reassured that the bruising was typical – and actually less than normal.  Apparently sometimes it spreads across the chest as well.  A prescription for physical therapy was also called in, to start in a couple days.  I was told to expect 3 months of range of motion therapy followed by 3 months of strengthening therapy.

Ending my first week I’m not excited about three more weeks in a sling, sleeping upright, and months of PT.  But since I am sleeping better I feel I can get through it (like I have a choice…).  The pain has been minimal and I’ve been able to return to my work – though I’m lucky to work from a home office.

Week 2 After Surgery

PT starts on Monday!  I’ll keep adding to this post over time.




Original: http://kevinmeyer.com/blog/2018/08/shoulder-surgery-for-rotator-cuff-tear-and-calcific-tendonitis-my-story.html
By: Kevin Meyer
Posted: August 12, 2018, 9:05 pm

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