Thursday, April 24, 2014

Around Our House: The Shoulder Incident Bankart Repair Part 2


A few hours after surgery.
On March 3rd, 2014, I had a Bankart Repair to my right anterior glenoid labrum. For those of you who know me, you may remember me having the same procedure done four years ago on my left arm. Here is the post I wrote about that repair:
http://handmadepretties.blogspot.com/2010/08/around-our-house-shoulder-incident.html

I wanted to write about this repair because the recovery was so much different.

To start, my right shoulder was not as bad as my left. My left shoulder was coming out so easily which was scary and unpredictable. After the surgery and PT, I worked very hard to strengthen both shoulders to keep the muscles strong, therefore reducing the chances that dislocations would happen again, particularly to my unrepaired right shoulder.

The history on my right shoulder is that it would dislocate when I was in my early 20s. I specifically remember it dislocating while playing air hockey, getting up off the couch, and swimming. I had a capsular shrinkage done on the shoulder in 1999 which stopped the dislocations, and since I was NOT active, the surgery worked fine for me. This type of surgery did nothing to repair the labral tears that were a result of the recurrent dislocations.

The labrum is a ring of cartilage that sits atop the scapula where the head of the humerus connects to the body. Its function is to add surface area to the joint to stabilize an otherwise very unstable joint. Attached to the labrum at the top is the biceps tendon and off the edge surrounding the entire shoulder joint, the capsule. When shoulders dislocate, the humerus slips past this ring potentially tearing the cartilage away from the scapula. The more often the shoulder dislocates, the worse the tear and the weaker the cartilage become. The head of the humerus can bump up against the scapula and damage the smooth soft surface of the humeral head (known as a Hill-Sachs defect) and wear the cartilage off of the backside of the bone. Labral tears can lead to recurrent dislocations or in my case significant pain.

Fast forward 15 years, After my last surgery, I started swimming, lifting weights, and running. My left arm was strong and I could tell the different between the two. My right arm couldn't keep up. I was experiencing pain with certain movements (like front crawl, triceps dips, push ups, etc). The more I worked my arm, the weaker it became. Being in my mid 30s, I wasn't ready to stop doing these things. Dr. Honkamp did a contrast dye MRI on the joint and discovered a labral tear. There was also some fraying to my rotator cuff due to the inherent instability caused by the tear. It was a hard decision this time because is was NOT dislocating again, but my activities were being limited, and I decided to go for it.
My inner shoulder before. The pen marks on the labral tear photo indicate how tall the cartilage SHOULD be.

The After. The penmarks show how the labrum was gathered up and reattached to the bone with anchors and sutures.
The stitches. There is another matching hole on the back.

Going into the surgery, I was working out 4-6 times a week. Typically running at least 5 miles at a time, swimming for a hour, or taking weight lifting classes like Body Flex at the gym. I was in really good shape and my arm was as strong as it could be.

I had the surgery. During my surgery, they completely detached the labrum from my scapula and anchored it back with four sutures. It was painful as expected for a few days. Then, I became allergic to the Vicodin (severly itchy skin, hallucinations, and urinary problems) so I stopped taking it. Unfortunately, this was a weekend, so I went the whole weekend only using Advil for pain (I also tried Tramadol which made me CRAZY so I couldn't sleep). I spent a few awful nights, but by early the next week, I was doing ok. The doctor gave me a Percocet prescription which I used sparingly at night. Once I switched off the Vicodin, my head was clearer, which allowed me to get to the gym.

One week out, I went to the gym. I took it easy, did some walking, rode a recumbent bike, did some more walking. A few days later, I went back. This time, being completely pent up and unable to sleep (keep in mind I had been exercising very regularly, so my body wasn't used to resting so much!), I did a few test laps at a very slow easy jog. I had been grilling my doctor and physical therapist regarding running. The verdict was that running would not damage the repair so long as I was tightly restrained in my sling, but that it would likely hurt so bad that I wouldn't want to do it. The running did not really hurt. I ran about a quarter mile, and then finished up on the elliptical ( this was about a week and a half past surgery).
One challenge: how to tie a shoe when you can't reach it... I ended up pulling my foot in to my chest and tying it upside down.
All strapped in and ready for a run. My hand had an unfortunate resting spot!
The more attractive/comfortable immobilizer I wore at night and during the day, allowing my forearm to move freely while pinning my upper arm to my side to protect the repair. My pain was worse if I kept my forearm bent all day long.

Each time I went to the gym I did a little more. I found that if I strapped my arm in tight with my immobilizing sling, I could run ok. The body mechanics were off, but it felt good to sweat. At two weeks I ran two miles. At three weeks I ran three. I was running once or twice a weeks with strength training exercises and elliptical in between. I could do lunges, high knees, frankensteins, butt kickers, speed skaters, and squats. I was occasionally taking Advil at night to sleep, but nothing during the day. Since I had started running and exercising, my pain tolerance has significantly improved, so I am not sure how I would have handled this pain four years ago.

I decided to go ahead an sign up for Dam to Dam on May 31st, 2014. It is a half marathon that was happening exactly three months post surgery. My goal was to be running six miles at the six week post surgery mark. I made it. At six weeks out, I stopped running in my sling. At 6 weeks, we also started working on my range of motion in PT. This made my shoulder sore, but I found that running actually made it feel better.

I am currently about 7 1/2 weeks post surgery. So far this week I have done two 4 milers, a 2 mile tempo run, an 8 mile long run, and an hour long session on the high school bleachers. I can do a very slow one armed breaststroke in the pool (which I do to keep my hips happy). My pain is manageable. My range of motion is about 75% back, my proprioception is good, and I JUST started using weights in PT. My therapist thinks the running has significantly helped me bounce back from the surgery.
7 weeks post surgery, i can raise my arm!!!
Most information on the web says NO RUNNING for 8-12 weeks, so if you are facing this type of surgery, definitely talk to your doctor before taking off. If I were going into this again with the goal of running in the first six weeks, I would look into getting a sling from this website:http://www.ubpn.org/resources/athletic-arm-slinghttp://www.ubpn.org/resources/athletic-arm-sling. They are designed to hold the arm in tight to avoid jarring the joint.

In contrast, the last surgery, it took me six weeks just to get back to the gym to WALK!

4 comments:

Sadia Mou said...

rotator cuff tear

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Lindsey Caldwell said...

Hi there, I'm Lindsey! I have a question and would love to speak with you in regards to your medical journey. Please email me when you have a chance, thanks so much! I look forward to hearing from you :)

lindseyDOTcaldwellATrecallcenterDOTcom

Anonymous said...

Hi Lindsey, I am hopeful now in reading your blogs. I had my last dislocation in January and my shoulder never really recovered (lots of tightness and pain behind shoulder despite PT and strengthneing). Now, I'm 16 wks post right labrum repair with 3 anchors and I believe capsular shrinkage. I have practically full range of motion but find it stiff and awkward and sometimes painful to try to reach behind my back to pull up pants or reach sideways/upward to place my hand on someone beside me. I've been doing lots of walking as I don't believe my surgeon has cleared me for resuming running. Will definitely ask about running at my 24 wk appt. Despite getting back most of my range of motion, its still frustrating as my arm tightens again after exercise or activity as well as becomes quite sore and even more stiff as the day progresses. My scapula has become hypermobile to compensate for my stiff shoulder and its doing all sorts of snapping and cracking. I find this is quite a lonely and sometimes uncertain journey. My surgeon doesn't want me to return to work until after 6 months and I probably wouldn't have the stamina at this point. Anyway, any further insights or words of wisdom would be appreciated. Thanks V

Sunil said...

Our shoulder is best described as a ball and socket joint that allows flexible movement in various directions. However, there is a direct trade off between flexibility and stability. Due to the extreme flexibility, it is unstable and is very prone to injuries and dislocation. bankart repair surgery For Shoulder Dislocation.