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!

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)
Skiing
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)
Stretching

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.