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...