01 April 2011

shoulder update

I had an MRI of my left shoulder on Sat, almost a week ago. Found out from the Dr office on Mon that I have a labral and a rotator cuff tear. The labrum is a ring of cartilage that helps form a socket at the shoulder. A big tear in it is usually caused by falling on an outstretched hand (e.g., skiing), pitching fast balls, driving a golf club into the ground, etc. Normal wear and tear on the joint can fray the edges and a big tear means the cartilage has pulled opened. Surgery is used in both cases because it doesn't heal by itself. In the minor tear case, the surgery is to smooth out the edges. For a big tear, one option is to stitch it back together, however, I'm too old for that.

Biceps tenodesis is the medical term for the surgery to fix a superior labral tear anterior to posterior (SLAP). The long tendon at the upper head of the biceps attaches behind the head of the humerus along with the cartilage (like the labrum) and other parts of the rotator cuff (muscles and tendons and support the shoulder). In my case the injury tore the labrum due to the biceps attachment there. Because the cartilage will not repair itself, the solution for someone my age is to cut and reattach the long head of the biceps tendon onto the front (lateral side) of the humerus. This will relieve the strain on the labrum and allow it to ... recover its shape, etc. I can understand relieving the strain from moving the attachment, but I'm kind of vague on the labrum recovery.

Three weeks in a sling, months of physical therapy while the attachment establishes, then see what can be done with the other shoulder. Surgical recovery involves a month in a sling, physical therapy, and then rehab. physical therapy while the attachment establishes.

If the other shoulder has a tear, which it seems to have, that's another round of surgery and recovery when the first is done. It's not the same symptoms, so potentially a different type of tear. Three or four months of no training.

A number of years ago I read an article in Yoga Journal in which the author started writing about tears during her yoga class practice. I'm thinking tears as in something being torn, like a rotator cuff, but no, she was referring to tears as in CRYING because she was having an emotional experience.

So far my shoulder tears haven't caused any tears.

Had a pre-op physical with my primary Dr on Wed. We talked some about the surgery and the recovery. He didn't know how the different attachment will change the way the biceps are involved in movements like pullups. I was curious if the load changes more to the shoulder if the attachment point shifts, because the biceps will no long be able to help with the pulling, just the bending of the arm. I don't the mechanics well enough, neither did he.

He did say that the shape of the muscle will be different, perhaps that's just cosmetic. I am curious about the effects on my training. How long will it take for the surgery arm to recover strength similar to the other arm? Will I be able to do the movements I've been doing because the left arm is different? Overhead press? Pullups? Will similar surgery be needed on the right side? I won't know what the new arm configuration/mechanics is like for months. Messy.

Meanwhile, our daughter has a cold. She had a fever, then a sore throat, now she's stuffy. I hope I don't get it, because the surgery would have to be postponed and the next opening is a month away.

The pain in that shoulder is usually just an annoyance when doing a number of different every-day motions. Other things like push ups and bench press are more painful. The justification for the surgery is that those annoyances aren't going away because the cartilage won't heal.

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