Day 100 Post Op (14 weeks 2 days)

If you want to know how long it takes for the shoulder to stop aching and to really turn the corner after rotator cuff surgery, it takes exactly 12 weeks and 2 days!

Now you know.

At 12 weeks and 1 day I went to a party, had a few drinks and was dancing to the DJ.  I thought for sure the next morning I would pay for it, but it really felt fine the next day.

That was the turning point in the recovery.  It feels pretty good, and I can use it for most daily activities (except for carrying things).

I saw the doc last week and he says I am now right where I should be with range of motion.  I can lift my arm straight over my head (passively using a pulley or wall slide).  The external rotation is still lacking, but it is not stuck - it's progressing, but just slowly.

In the last week I started strength training with  rubber tubing.

The only part of my shoulder that really gets sore now (especially from strength training) is right above my AC joint.

My theory on why the rotator cuff and biceps tendons tore so easily is that years ago I fell with my arm outstretched and separated my shoulder (AC joint) and never had it treated.

Eventually it caught up with me...

Day 79 Post Op (11 weeks 2 days)

It is a long road.  After spending 4 days on the road, my shoulder still aches, it fatigues easily, and my right hand is still red, warm, and slightly swollen.  The ROM is improving, though.

For home PT, I am sliding my arm out in front of me on the counter, raising it up on the door frame, and doing elbow abduction on the door frame.

I only had one day of PT last week (on Monday), and today is Sunday, so getting 6 days without PT definitely helped to let my shoulder cool down. I see the doc again in 2 weeks.

Day 71 Post Op (10 weeks 1 day)

It took about 10 or 11 days for my shoulder to calm down after the handshake incident.  I have been pretty concerned that I did some damage to the repair, but the PT and the doc both think it's OK.  It definitely set me back in terms of pain and range of motion.

This past Monday I went in to see to doc.  He said the shoulder is stiff, and I am behind on ROM.  He gave me some new exercises to do to stretch it out (imagine holding on to the top of the door and letting the arm pull up out of the shoulder socket) and wants my PT to really push the ROM.

Since then, the gains have been coming fast, although the PT and the stretching is making me quite sore.

For the past few days, I finally feel like I can use my arm again for the first time since before the surgery.  I am still not allowed to carry anything heavier than a cup of water for another four weeks, but now I have no restrictions on carrying anything in my left hand now (up to now there had been a 10 lb limit on my left side).

DON'T SHAKE HANDS

Today I am 8 weeks post op, exactly.

On Tuesday I attended my son's school for parent teacher conferences and shook the teachers' hands when I met them.  One of the teachers was a pretty big guy with a big handshake.  I immediately felt the sharp pain in my shoulder when he shook my hand.  Ouch.

Since then I have had alot more pain and reduced ROM.  I have an ache in my shoulder and arm all the time now.  Hopefully it calms down soon.

Even if your PT tells you to shake hands and use your arm/hand more, be careful.

Lesson learned.

Day 53 Post Op (7 weeks 4 days)

The range of motion (ROM) gains have been coming steadily.  Most of the motion is intended to be passive, but I can actively move my arm to take care of most functional activities (typing, dressing, eating, etc.).  Passively, I am able to get my arm up in front of me about 45 degrees above horizontal (using a rope/pulley device), and horizontally I can move it 90 degrees to the side (also passively using the pulley).

I still am not carrying anything heavier than a cup of coffee in my right hand.

My right hand is still weak and slightly swollen.  It's red and I still can't make a tight fist yet.

My shoulder aches from use.  I am icing often for pain.  It's not a sharp pain but a dull ache from the PT and the everyday use of my arm.  It's annoying, but not interfering with daily activities.  It's important to keep at the PT to get the ROM gains now while they are still coming.

I am also still not sleeping.  I'm usually up by 4 am.  Last night I was up at 2 am with intermittent sleep even with an Ambien.

Day 44 Post Op (6 weeks 2 days) - Sling Free Living

I have now been out of the sling for 4 1/2 days.  The ability to work (type on a laptop) is so much easier now, and just having my arm hang naturally, and swinging it naturally while I walk is helping to regain some ROM.

The downside is that my shoulder and my arm get tired and sore quite easily just from being out of the sling.  My muscles in my hand, wrist, forearm, biceps, shoulder, etc. have all gotten very weak.

Trying to regain ROM through PT (and daily activities) is challenging and kind of painful, but the gains do seem to be coming.  I have much better ROM now than when I was in the sling, but I still have miles to go.

My right hand is swollen and puffy, and I cannot make a tight fist.  It's as though blood was pooling in my hand for the past 6 weeks and it's not quite back to normal yet.

Also, I still have to sleep on my back, so I can usually only sleep until about 4 am.

Day 39 Post Op (5 weeks 4 days) - Follow Up with PA

Today I had my second follow up appt with the surgeon's office.  I met with the doc's PA and a student.

The good news is I can now wean myself from the sling!  It's pretty great to be out of the sling and able to use my arm/hand again.

The bad news is that the PA commented that my range of motion (ROM) is very poor - in the bottom 10% of where it should be at this point.  She said that I should have full ROM by now.  She had me spend some time with their physical therapist and he gave me some exercises to do, updated my PT protocol to give to my physical therapist, and updated the number of prescribed PT sessions from 2x/week to 3x/ week, with stretching exercises to be performed at home / work every hour.  

I don't know that I could have done anything differently to have gained more ROM, as I had my arm in a sling for the past 5 1/2 weeks with a little PT that just recently began.  I guess how aggressive you are during the first 6 weeks is a tradeoff betweeen strength of repair and ROM.  Don't know, but hopefully this just means that the repair is strong, and the ROM gains will come now.

According to the PA, I can now use my arm to do any active range of motion, as long as I don't lift, push, or pull anything.  I am not allowed use the arm to support my body weight, or to use it hold on on a train (or boat) that is being jostled.  The maximum I can safely lift is a cup of water or coffee.  I am not sure how I will remember not to use my arm for lifting/pushing/pulling for the next 8 weeks now that I am out of the sling and using my arm and hand.

It's shocking how weak I am.  I can't lift my arm out in front of me more than about 6 inches.  When I go to scratch my nose, my hand stops about 12 inches short of my face!

The PT is painful now.  Extending the ROM hurts.  But they say that the first three months is when the gains in ROM come, so I have the next 6 weeks to push it to get to full ROM.

I have a follow up with the doc in 4 weeks.  The PA wants me to see the doc (it will be the first time I see him since the day of surgery), likely to evaluate where I am with ROM and decide if he needs to do some sort of intervention before we wait too long.

Day 25 Post Op - Physical Therapy #1

The recovery has been going smoothly so far.  There is no pain - my arm is immobile and has been in the sling full time.  I am able to type with both hands as long as I  don't rotate my elbow, which has made it easier to get work done.  Also, I am able to drive, although I am not sure if it is legal to be driving with just one arm. Sleeping on my back propped up on pillows is still a hassle, and I am not allowed to carry anything more than 10 pounds in my left hand, which makes travel - or even bringing more than a laptop back and forth to work impossible.

Today I had my first PT session.  It was pretty painless.  The therapist did a lot of measuring - I assume it was to establish a baseline.  He gave me three exercises to do:  pendulum hangs - although I need to cradle my arm at the elbow to avoid putting the weight of my arm on the repair; assisted elbow bends from 90 degrees to as high as I can manage; and shoulder shrugs to counteract the hunching I have been doing since the surgery.

PT sessions will be 2x per week for about 3 months, with exercises done ~3x per day at home.

Day 11 Post Op - First Follow Up Visit

I feel like I started to turn the corner around day six. Around then, the pain was pretty much gone except for moving around, or especially if I made any unexpected movements. I am off the oxycodone except at night - to help me sleep through the night, and I'm just taking 1000 milligrams of extra strength Tylenol every eight hours. Still icing pretty constantly. I am working out of my office (phone, laptop, voice emails and texts on the iPhone) and able to get work done although it's pretty tough not having use of my right hand.

Yesterday, somebody came to the door and my dog flipped out and started barking violently which startled me and sent massive shooting pain through my shoulder, followed by an ache which lasted for about eight hours. I guess setbacks are to be expected.

Today I had my first follow up appointment at the hospital. The doc said that everything looks good and my recovery is coming along on schedule. Because of the severity of the rotator cuff tear, and the biceps tendon damage, they did not want me to do any physical therapy (e.g. pendulum hangs) at all after surgery. The doc wants me to schedule my first session with physical therapy starting after three weeks post op.

Day 3 Post Op

Moving hurts. Generally it just sucks. I'm in a sling and I'm sore and uncomfortable. I don't like sleeping on my back. I'm taking the pain meds religiously on schedule, but moving in the chair and in the bed is really painful. Pretty much any movement might cause shooting pain in my shoulder.

I was able to take my first shower today. It was pretty awesome. Here is a picture of the shoulder and biceps after surgery. Notice the reattached biceps tendon. That's pretty amazing...

Surgery

I had the surgery on Friday morning. They found a large full thickness tear and a delamination of the supraspinatus tendon. The surgeon was able to repair the delamination of the two strata of the supraspinatus, and repair the tear. He was also able to successfully reattach the biceps tendon. He said the biceps tendon appeared to have exploded inside my arm. There was also a full thickness tear of the infraspinatus tendon and a labral tear that were both repaired.

They gave me a nerve block in my neck to make my shoulder and arm completely numb prior to surgery.

The nerve block wears off after 16 hours. For anybody that is considering doing this, that is an important piece of information. When the nerve block wears off the pain is excruciating. I was advised to stay ahead of the pain, taking two oxycodone tablets every four hours. When the nerve block wore off, it was clear that this was not enough. I increased the oxycodone dosage to three tablets every four hours, plus I started taking 1000 mg of extra strength Tylenol every eight hours. This was about the right amount of pain medication to make the pain tolerable.

Moving hurts. The joint does not appreciate any motion from me, especially repositioning myself in the bed or in a chair.

I believe the pain results at least in part from the pumping of saline into the joint during surgery. I believe they do this to expand the joint to make it easier to perform the procedures.

I am icing constantly and keeping on the pain med schedule. The ice cuff machine they sent me home with is useless. I keep knocking it off the table, it's not cold enough, and the recirc keeps getting stuck. I'm icing with lots of ice in ZipLoc freezer bags - works much better. {Edit - to use the ice cuff machine, connect the hose to the cuff, have someone raise the cooler about 18 inches above the cuff, turn it on and let it fill. Then turn it off and disconnect it. Refill every 30 minutes or whenever it needs to be re-cooled. This would have been nice to know before leaving the hospital.}

MRI Results

The MRI showed that there was a full thickness retracted tear of the supraspinatus tendon in addition to the full tear of the biceps tendon. While it is not really necessary to repair just the biceps tendon, the thinking is if the rotator cuff needs to be repaired anyway, it makes sense to do both procedures now, before the biceps tendon atrophies. I probably have another two weeks to have the procedure done before the biceps tendon becomes inoperable.

The surgeon believes that the rotator cuff tear is acute, it just happened, and the muscle will retract and get weaker, atrophy, and begin to cause pain soon. “If you don't fix it now, it will get bad fast.  Best results are within six weeks before the muscle retracts.  After 1-3 years, it may become inoperable.”

The rehab looks tough. I will be in a sling for six weeks, unable to use my right (good) arm.  I won't be carrying anything heavier than a cup of water for eight weeks, a 5 pound weight for 12 weeks and a 10 pound weight for 25 weeks. That's six months before I can lift anything more than 10 pounds with my right hand.

I am scheduled for surgery in two days.

Here are pics of my right arm biceps muscle without the tendon:

Injury and Diagnosis

I am a 55 year old, active athletic male. Last week while playing tennis, I felt a sharp pain in my right shoulder. I stopped playing and rested my shoulder. About three days later my shoulder felt better, so I went to the driving range to hit golf balls and felt a sharp pain while hitting balls. About three days after that I played a round of golf, with no pain, but at the end of the round I noticed what is referred to as a "Popeye muscle deformity" in my right bicep.

 After a bit of research online, I assumed that I had torn the long head of my biceps tendon.

I was able to get in to see an orthopaedic surgeon the next day, who confirmed the dx. Initially he told me that they don't usually repair the biceps tendon, but after considering that I am very active he thought that the cramping and weakness associated with not repairing the tendon would probably bother me, and he suspects rotator cuff damage, so he changed his opinion and suggested that we repair it. He took an X-Ray and an MRI, and connected me with an orthopaedic surgeon in Boston that specializes in these kinds of repairs.

I have the initial consultation with the specialist next Wednesday, and I am scheduled for surgery on Friday.

For background, my shoulder problems began around 1990 from crash(es) with my arm out in front of me skiing. I never had surgery, but over time I lost overhead range of motion affecting tennis serves and making overhead presses with dumbbells painful. While inconvenient, this was never serious enough for me to consider surgery.

I am trying to read everything I can in advance of the surgery, and since I am finding a wide range of outcomes and recovery times, I thought it would be helpful to others to document my experiences here...