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"Hard is not hopeless." - General David Petraeus

Thursday, July 4, 2013

On the Journey to Rotator Cuff Repair

I debated about whether to blog about my shoulder problems since there is already so much info on rotator cuff problems online.  But since I found the online information (both personal accounts and medical summaries) so very helpful, I decided it was worth adding to the volume of data available on the web.  Also, there are fewer reports of women going through rotator cuff surgery than for men.  Additionally, I have found my presentation of symptoms to be different than many accounts I have read.

Background: For several years I've had mild annoyance with my shoulders--for example, arms getting fatigued holding them over my head to work in shampoo, having my arm freeze as I reach for the overhead compartment in an airplane etc.  All things considered, those were relatively minor and did not occur consistently so I blew them off.

Fast forward.  I'm 47, have spent almost 30 years hunched over a desk/computer, and am also very active physically.  I played tennis intensively for several years in my 20's.  I also walk and hike a lot (with intermittent breaks due to back pain issues).  More recently, I've been very into weight training (which is, by the way, the best medicine for back pain) and kickboxing, both of which are obviously very demanding of your upper body in particular. 

I've been weight training intensively for about 13 months.  Having had life-long upper body weakness that has been very dissatisfying, I've been on a program to build upper body strength.  Despite eating healthy, trying to get adequate sleep and exercise with good form, I just didn't make the strength gains I felt I should make, particularly with shoulder-based exercises.  Building strength takes time, especially for a woman, it seems, but it seemed like it was taking too long, even taking that into consideration. But I thought I just had a wimpy body.

Last October I began kickboxing--a very addictive sport, and very physically demanding.  By the beginning of this year, I was noticing some discomfort, though I didn't pinpoint it to my shoulder at the time.  It was more like an overall arm weakness.  Several minutes into a kickboxing class, I'd have to stop and just let my left arm dangle at my side.  Throwing hooks continued to be the most difficult punch to throw because that bothered my arm more than jabs and crosses.  While my left shoulder is the primary culprit, I feel the symptoms to a lesser degree in the right shoulder.  Even things like using a pre-inked stamp at work fatigues my arm.

The problem began to get worse.  In reading people's personal accounts of shoulder problems online, they are usually primarily based on issues of pain and severely limited range of motion.  Mine has presented without too much limitation on range of motion but an abnormal amount of weakness in the arms that has gradually worsened.  Doing door jam stretches causes tingling in my shoulders. 

Frustrated at my inability to move forward with my physical training goals, I swallowed my cynicism about medical care (longstanding reasons I won't go into here) and went to the PCP in January.  PCP did a general x-ray and said they couldn't find anything and I was dismissed.

The problems persisted so I bypassed the PCP and went to an orthopedic doctor in March.  They did more thorough x-rays, but still ONLY x-rays, which are of marginal use.  He appeared unimpressed by lack of pain symptoms and the fact that I had pretty good range of motion, felt maybe I had a slight impingement and recommended 6-8 weeks of PT.  I was not happy that they didn't opt for a more definitive diagnostic evaluation (such as MRI), but being the easily pushed around sort, I agreed to PT and worked hard at it for 10 or so weeks.  The problem was, while doing the specific PT exercises, the problem appeared to improve, but when doing things I loved, such as kickboxing, there was very little improvement. (At the same time I was getting PT for my knees--and PT has worked great for the knees, just not the upper body). 

I kept telling the PT (very nice person BTW) that something just wasn't right in my shoulder.  But since both he and the ortho were going on guesswork based on a measily X-ray, there wasn't much help to be had.

But in the first few weeks of June, the shoulder took a turn for the worse.  It literally felt like something had slipped down the outside front of my arm, and there was discomfort at the front of my shoulder, and stiffness in the back of my neck.

So back to ortho in June, and he finally recommended an MRI w/contrast.  Which, as it turns out revealed a partial tear of the cuff, and with the worsening symptoms, there is suspicion that it could be a full tear.  Obviously they won't know exactly till they go in and have a look.

At this point in the program I'm pretty frustrated.  Six months of my life has blown by, we've wasted time, money, and almost half of my allowed PT visits under my insurance plan, when it seems like it would have been a lot simpler, definitive and cost effective to have done the MRI FIRST.

I was not interested in cortisone shots since everything I have read indicates a tear does not repair without surgery, and multiple cortisone injections can weaken the muscles.  Likewise, physical therapy and cortisone are prescribed to give "adequate" strength and functioning of the shoulder.  I don't want adequate.  I want top level functioning. And I was tired of throwing treatments at the shoulder and tired of guess-work.  I wanted definitive help and elected arthroscopic surgery.

That in turn leads me to the last 2-3 weeks as I prepare for surgery.  And THAT will be the subject of my next post, because that deserves plenty of detail all on its own.

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