Monday, August 30, 2010

Around Our House: The Shoulder Incident

The two "bulletholes" on the front. It took three tiny incisions to get the job done.

The "bullethole" on the back.

So many of you may know that in June of 2010 I had shoulder surgery. Most of you probably do not know why, so here goes.

I have hypermobile joints, and I always have (fingers, knees, and shoulders). When I was about 10 I remember jumping into my aunt's swimming pool, finding that something was wrong with my arm, and barely making it to the edge of the pool. I am fairly certain this was the first time my shoulder dislocated (or subluxated). When my shoulder would dislocate, at first I could wiggle it back in joint, but in recent years, reducing (or relocating) the joint required traction. I can remember at least 12 instances of my shoulders dislocating. Here are a few examples of the activities during which dislocation happened:

Swimming (jumping in, and straight swimming)
Swinging on a Swing set
Playing air hockey
Sleeping on my belly
Making the bed
Getting up off of the couch
Lobbing the cat (i know i know bad cat mommy)

My list of things I wouldn't do kept getting larger and larger. When I was in high school, I actually had a doctor tell me that I was just looking for attention and that if my shoulder had actually dislocated, I would have been in the hospital. In 1998, I learned of a procedure where they would heat shrink the capsular tissues (the sock of tissue that surrounds the joint for stabilization) to create a tighter joint and prevent dislocations. I had this done on both shoulders. As it turns out, this procedure wasn't very successful for most people (a lot of people with recurrent dislocations are athletic) so they no longer do this surgery. For me, it worked pretty well. After the surgeries, I went almost ten years before my next dislocation.

The first of my most recent series of dislocations happened right after Beatrice was born. I was sleeping on an air mattress with a toddler and an infant (right after our move to Iowa before Scott arrived with our furniture) and the damn cat kept walking across us on the bed. I grabbed him and tried to lob him off the bed which caused my left shoulder to come out. It took a lot longer to get back in joint and I was completely freaked out. I took some advil and that was that. About a year and a half later, I was making Sylvia's bed and went to pull myself up and my shoulder went out inferior (down). All of my previous dislocations had been anterior (they went out the front of the joint) which is the most common type of dislocation. Inferior dislocations are rare and mine required traction to get it back in joint (thankfully I have watched a lot of medical dramas on TV, and had the sense to grab the bunk bed and pull down).

After the second time, I started seeing a physical therapist. Fortunately, he had been through the same type of issues, and was very informative about exactly what was going on with my shoulder. After about a month of therapy (with little improvement) i went to see an osteopath (Dr Honkamp). He did x-rays and an MRI and determined, that I had Hill-Sachs defect on the humeral head (which is caused from the soft head of the humerus butting up against bone during the dislocations) and that my caspular tissue was indeed "floppy". I was given the option to either have the surgery or not. On one hand, joints tend to tighten with age. Since I am in my mid 30s, there was a good chance my joints would tighten and this would no longer be a problem. On the other hand, random shoulder dislocations are scary and painful. I opted to wait it out. I decided that if I had another dislocation in a year, I would do the surgery. I lasted 14 months.

My last dislocation was the final straw. When my shoulder would dislocate, it was painful, but the worst result was the three months of painful back spasms and spinal misalignment that would follow. The last dislocation happened while I was stretching (I literally had my arms up over my head and the joint clunked out). I made my appointment with Dr Honkamp that day.

The surgery I had is called a Bankhart Repair. Basically what had happened in my joint was that as my humeral head came out of the socket, it had been pushing the labrum (a disc of cartilage that cups the head of the humerus on the scapula) off of the bone and stretching it out. In addition, the capsule (a cuff of tissue that fits over the entire shoulder joint) was loose (like a pair of socks whose elastic has failed). During the surgery, Dr Honkamp gathered up the loose edge of my labrum and re-sutured it to the scapula. He also added some very stylish pleats to my capsule to make it tighter. It was all done orthoscopically.

This is a before and after of my capsule. To the trained eye, you can see how terribly stretched out it was. For the rest of us, just imagine the blue stitches pulling the big pink center part tighter together.

This the the before and after of my labrum. The photo on the left shows a wispy translucent tissue. That is my labrum all floppy and floating around. The photo on the right shows the stitches reattaching the labrum to my scapula.

This is the backside of my humeral head. The white is cartilage (which should be covering most of the head). The pink is bone. I've had so many dislocations that the cartilage is significantly worn off.

When the surgery was done, I spent a few days in extreme pain. I had a bad reaction to the hydrocodone and had to take an anti-emetic with it to keep from throwing up. I slept a lot (propped up like a princess on ton of pillows). After about two weeks, I was able to function on Darvocet. It took a full month and a half to get down to regular pain meds like Advil and Tylenol. Now, about three months out, I do not need to take anything as the pain is minimal.

I had to wear an immobilizer for a full month (the one the gave me at the surgery center was so hot and ugly I had to make a new one - if you need a pattern to make one for yourself, let me know!) I was not supposed to drive while wearing the immobilizer, but honestly after about two weeks of being driven and being stuck at home with two bored kids, I did some driving. I started physical therapy to regain my range of motion after the first 4 weeks. After 2 months, I started doing a little strengthening. I currently have a good range of motion (I lack a little rotation) and hope to have it strong and normal in the next month or two.

This is a fairly major surgery. They treat the recovery as if the bone has been broken. It is more serious than a rotator cuff surgery. After the surgery, it will take almost six months to get the joint back to "normal". For me the most frustrating part at this point is the weakness of the joint. After a solid two months of atrophy, I find lifting and carrying to be difficult. Most of my pain comes from stress on the joint due to lack of strength. Hopefully this will improve as I continue with physical therapy.

If anyone out there is scheduled for this type of surgery or if you suffer from frequent dislocations, please contact me! I am happy to share my experience.