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HELP - Complications Post Shoulder Recon

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  • HELP - Complications Post Shoulder Recon

    Hi, It is long, but I am really hoping somebody out there has had a similar experience & can help me. I have had 2 Recons - 1 on my left in Feb 2006 & May 2006 for my right - both global arthroscopic recons for bilateral instability & pain in my left shoulder.

    The Left showed a SLAP tear & anterior Bankart tear & was the tears & posterior plications were treated using 2 bioknotlers anchors.

    Right had partial thicheness tear under surface of supraspinatus, SLAP tear but no bankart teat. 6 Bioknotlers anchors & capsular shift was done.

    Saw the Surgeon about 1 month ago for a check up & told him of complications I'm having. I'm back on my anti-inflams & on pretty good pain killers for the pain in my left shoulder. He examined both shoudlers & found that they both still sublux out the back.

    He can't explain why the aching is back in the left shoulder & said "he doesn't know what to do", & all I can do is keep doing my propioceptive exercises. The only thing my physio has suggested to him is for 2 cortisone injections - 1 in the tendon & 1 in the glenohumeral joint. He said that the option of another recon on the left is out because if he was to go back in chances are I will loose a dramatic range of movement & the shoulder will still be unstable.

    Has anybody had this problem after surgery......I don't know what to do. I've asked my GP for another referral to another Shoulder orthopedic, however in Brisbane there are only a few available & appointments are scarce with Christmas approching & he said I am with the best!

    I am getting the cortisone injections on Friday (24/11/06) & the surgeon, phnysio & GP have already told me that chances of it working is minimal. I maybe lucky to get 1-2 weeks of relief it why am I having it done! I am at a real stuck point because I am a Fitness Instructor & it is interferring with work, social life & my sleep! When a Dr turns to you & says "I don't know" your heart sinks because you think you are going to spend the rest of your life in this pain.....I've read some info on Thermal Capsulorrhaphy, shoulder replacements etc however I'm only 23 & I don't think a replacement is an option??

    Sorry to write a book, but any advice will be greatly appreciated.

    Thanks for reading,

  • #2
    Hi Mary,

    'Sorry to hear about your shoulder problems. Has the possibility of a frozen shoulder as a result of the surgery (secondary capsulitis) been considered as a reason for the pain in your left shoulder? A good sports physician who specialises in shoulders would be able to tell you if this was the problem and a good sports physio who specialises in shoulders (and especially mobilisation; also taking into consideration your other issues) would be able to help with treatment.

    Frozen shoulders are characterised by an unrelenting ache / pain such as you describe, which anti-inflamms barely scratch the surface of. [The pain tends vary a bit over the course of the frozen shoulder - they tend to have three main stages - freezing (increasing pain, decreasing global mobility), frozen (very stiff, very limited range of motion, a bit less pain), thawing (gradually recover ROM and pain gradually subsides). The length of the stages and the overall course of a frozen shoulder vary from person to person but the whole process takes on average eighteen months.

    While frozen shoulders are most common in women 40 plus , they can occur in people of all ages, especially after surgery/any period of immobilisation. Worth considering as a possibility. (Not sure what influence your other instability issues would have on this).

    I developed a frozen shoulder (secondary capsulitis - secondary just means it developed in response to something else, e.g. injury or surgery) following a skiing accident which tore my supraspinatus tendon. Had increasing pain and decreasing mobility over a period of 4 months, it was then diagnosed as a frozen shoulder. Had a cortisone shot (ultrasound guided to ensure they got exactly the right spot) at 5 months. Gave me relief for 4 weeks and during that time we made a breakthrough with physio and I got progressively better. If this is your problem it is important that you have a good sports physio who really understands this problem and is good with mobilisation (will also need to understand your other instability issues). If they also have a manipulative therapy qualification even better! I found the frozen shoulder gave me alot of upper back muscle spasm which seemed to "throw my upper back out" (for want of better terminology), because both the physios who treated me (my time was split between Canberra and Sydney for work reasons) had manip therapy qualifications in addition to being sports physios, they were able to resolve this too.

    'Hope this helps. Let us know how you go.




    • #3
      Hi jb,
      Thank you for your response. I actually got a work collegue who knows a Professor at Westmead Hospital a call today & he has put me in contact with a Sports Physician at the Brisbane Private - he actualy got me in for tomorrow before I get the cortisone injections at 3pm! I'll give him a go & see what he says - fingers crossed.

      Thanks again


      • #4
        HI jb,
        I went and saw the Sports Physician yesterday, as a matter of fact he use to work with my surgeon & physio very closely & knows them very well.

        He was the first Dr since my surgery and my problems that turned to me & said, "so what tests have they ordered for you?" When I turned to him & said none, you should have seen his face!

        He agreed that I get the cortisone injections yesterday, & said that no damage can really be done, only the bill! I told him where they wanted to do the injections & he said I got the "wham bam thank you mam!" dosage & that they covered EVERY aspect of the shoulder. The dosage they gave me is 3 times what they normally give, so that scared me a bit. he said I will feel the true results in approx 48 hrs, but I woke up this morning & already the pain has decreased damatically - for how long is not sure...maybe 1 week, maybe 4 at the best!

        The sports physican i saw is Dr Mark Young. Have you heard of him? He has also ordered an MRI for me to get done early December because he said there definately is a posterior problem & lots of bilateral instability - even in both. He actually said that if I had gone to him & not told him that I have already had 2 recons, he would have suggested I get surgery on them to fix the instability - just shows how loose they still really are!

        Another interesting thing he found he that he did a plain Xray becuase he said with the 2 bioknotlers anchors an MRI will only show up the screw & not give a clear reading. To his surprise & mine, there were not screw, no holes in the bone! This is stupped him & me!!

        Thank you for all your help. I'll keep you informed.



        • #5
          Hi Mary,

          'Glad to hear that the cortisone shots worked - hopefully they will give you a few weeks relief!

          Re the sports physician you saw (Dr Mark Young), I can't help you there (I don't know any sports physicians in QLD) but someone else who does know may post and let you know. One good thing, however, is the fact that your OS, sports physician and physio all know each other well - if they also communicate wth each other about your case that can be helpful.

          Re the xray results - surprising as you say! 'Will be interesting to see what the MRI shows!?

          Re your OS's comments - one of the other people who posts on this site has the same multi-directional instability problems as you (kjwilkin). She (?) will no doubt reply to your post soon (she was having her own surgery last week and wouldn't have seen your original post).

          Re my frozen shoulder comments - I only raised that as one possibility. You are doing the right thing by seeing a good sports physician - they tend to be far more thorough and informative than any OS you'll come across. (I am about to take the same step after two only partly successful knee 'scopes and continuing knee problems). Your sports physician seems to have ordered some tests that may provide some answers to your current problems and some ideas about the best way forward. A step in the right direction. Good luck with it all! Let us know how you go.




          • #6
            Hi Mary,

            I've replied to your multi-directional instability posting.

            Totally agree with JB re seeing a good sports physician. It really makes a big difference if your OS has a good relationship with a sports physician. Currently I see two different ones in Melbourne at Olympic Park Sports Medicine Centre as they work strange hours. They both think along the same lines and have helped me get to where I am today.

            You may like to seriously consider coming down to Melbourne to see a good surgeon surgeon.

            Matt Hislop used to be a sports physician at Olympic Park Sports Medicine Centre in Melbourne and has now moved back to Brisbane. Just not sure where he practices now. He would know a lot of the Melbourne shoulder surgeons. I can find out where he practices if you'd like.

            Good luck !!!


            • #7
              Hi Mary

              The anchors in your shoulders are made of PLA, they are absorbable over time. As such they are not metallic so will not interfere with an MRI nor will they show up on XRay!

              The fact that you describe both your shoulders as very loose would seem to rule out 'frozen shoulder'!

              Good luck