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Tuesday, 10 January 2012

Happy New Year

Christmas 2011 is out of the way and it's 2012 and there's nothing like a New Year to inspire one's recovery.

Last time I posted in November, I was using a tennis ball to work trigger points out of the muscles beneath my shoulder blade. This helped somewhat but there's still work to do. So here's a summary of where we're at at 4 1/2 months after my rotator cuff repair and tenodesis.

Q. Does it hurt?
A. Yes, generally tha pain is about 2/10.

Q. Does it hurt what you move it or just hurt all the time?
A. The top of the bicep aches a bit when I raise my right arm, the cuff is generally uncomfortable regardless, althouth there are good days and not-so-good days.

Q. Is it getting better?
A. I guess it is. Although there have been some painful episodes. I frequently worry I have damaged the cuff repair as the pain comes and goes.

Q. What does the Surgeon think?
A. I went to the surgeon two weeks ago, he was on Holiday so I saw the registrar. Explained my worries and he referred me for an MRI, so at least we get to see if I'm panicking for any reason or not.

Q. Are you getting strength back?
A. Slowly. It's recovering about the same rate as my last recovery from Subacromial Decompression and I went through that recovery with a torn cuff and injured bicep. So you'd think strength would return more quickly after the repair.

Q. Are you restricted in what you can do?
A. To some extent. I can't do anything extreme like hang-gliding or play squash, but I can do most domestic and DIY tasks. I bought a bycycle too and can ride that without any problem. Painting tires it out after an hour or so.

Q. Is it affecting your sleep
A. Only some nights. Say 30% of the time

I have the added complication of a Chrondal lesion which I may need micro-fracture to treat. As the cuff and bicep heals, the symptoms of the chrondal lesion should become more obvious. Still a bit too early to tell right now.

Thursday, 17 November 2011

Week 12 - and it's all about Trigger Points

I've mentioned in previous posts about treating trigger points with a tennis ball. If this sounds surreal then I will explain.

Trigger points - so the experts write - are painful points, like knots, in muscles. They are a result of overuse or straining of a muscle and can cause actute pain that is difficult to pinpoint. E.g. you can have a pain down the back of your arm your caused by a trigger point under your shoulder blade. A trigger point can be released by pressing hard on it with a thumb or finger(s) or by rolling on a tennis ball. Typically it takes between 30 and 90 seconds of pressing for the pain to go - it's quite wierdly relieving!

The private physio therapy practice I visit treats trigger points whereas, in my experience, NHS pysios do not. In my last post I complained of continuing pain in the back of my shoulder. Some further googling found this article:

http://www.pressurepointer.com/Serratus%20anterior_trigger_points.htm

After rolling around on a tennis ball trying to push the trigger points out of my rotator cuff, it appears that most of the pain was caused by the Serratus Anerior which is partially covered by the shoulder blade. Three days of following the advice in the article above and things feel much better. I almost feel like there is an end in sight to my suffering!

Tuesday, 8 November 2011

Week 11 - Hard to gauge progress

Had a quick count up of the weeks since surgery; we're now in week 11, so we're 10 and a bit weeks in. This means I've been doing active exercises for nearly four weeks - feels a lot longer.

I'm certainly not free of pain. The shoulder gets stronger week by week, but I still have moments of paranoia that I might of damaged the repair. This is because at times, it feels like it did before the surgery!

In the last week or so the pain has subsided in the front of the shoulder (around the tenodesis) and left me with more pain in the rear of the shoulder (cuff repair), so I frequently worry that I've damaged the cuff repair.

In truth, it still feels stronger and I haven't experienced any sudden pain or loss of strength that would indicate damage - just paranoia!

I went to see an NHS physio for one session and I'm sad to say I won't be going back. The work I'd put in to my own recovery was ignored (I had 90% range at this point). I was given a set of rudimentary isometric exercises to do. The fact that I'd been doing these since week 5 and it was now week 7 was lost on her! I've since sought physio guidance privately.

The rehab physio that I'm doing involves small weights of between 1 and 2 KGs. I'm waiting until I'm beyond 12 weeks before I can start to crank up the weights (I have read that at 3 months the healing is advanced enough to permit a gradual weight increase).

Back to see the surgeon in another 6 weeks - I really do hope by then that the pain is subsiding.

Monday, 10 October 2011

Week 6 - Active Movement Allowed

Made it week to 6. It's now Monday, so we're into week 7 and progress is - touch wood - good.

Range of motion is coming on and is now around 85-90%. Getting into extremes of range requires plenty of warm-up and this is a phase I remember from previous recoveries. It takes a few weeks before certain muscles will stretch without being warmed up first.

I'm doing fairly gentle arm raises, not using any weights but I am using a light-weight resistance band. It's not pain free, but it's not as painful as I expected.

Generally the pain is getting easier to manage. The front of the shoulder is the most frequently painful (the tenodesis area) which hurts when I raise my arms out front.

The best news though is the improvements I notice each day. They're small, but this tells me the repairs have probably been successful. The aim is to continue the improvement without overdoing it.

Before the tenodesis, I was concerned that I may lose certain mobility of the shoulder from the change to my biceps arrangement. So far I can see no evidence of this, so lets hope this is the way it'll stay!

Tuesday, 27 September 2011

Week 4 - back to see the surgeon

Thought I'd save my next post until I had something to report. This is week 4 which is a key stage because I'm permitted to start passive physio and I went back to see the surgeon today.

I actually started passive physio very carefully a few days early, so I have four days under my belt. Passive means assisisted movement so no moving the arm under it's own volition. I can lift it up with the other arm or use a stick but no weights!

The range of motion is coming back steadily - probably at 75% already which is great news. The surgeon said carry on and come back in three months.

Painwise it's a different story. It does hurt - in particular, the rotator cuff repair. The tenodesis is less frequently noticeable. The pain really began after week 2 when I woke up thinking I'd broken the repair! I hadn't done anything to it nor slept on it, but it was much more painful. When I asked him today, the surgeon thought this was unlikely. Partial-thickness-tear repairs seldom come undone; it's larger tears where you have to be more careful.

Over time I've learned to work the pain out by rolling the shoulders and doing "pendulum" arm swings. I think the pain is caused by things binding together with the healing. You hear tiny cracking sounds as you move it around, followed by a feeling of relief. You have to do this four or five times a day to keep the pain at bay.

Another source of pain is trigger points in the tendons within the shoulder blade. These can be massaged out by laying on a tennis ball and pressing into the ache-spots in the tendons. Care is taken not to put any pressure on the repair site, but doing this once a day really helps.

It'll be another couple of weeks before any active physio starts, but make no mistake, this is and will be a painful ride.

Wednesday, 31 August 2011

Day 4 and my blog has no followers!!

Oh well, who wants to read about some griping windge-bag and his injuries anyway? I guess everyone's gone to twitter; blogging's so last week!

Seriously though, when I was looking for information on shoulder conditions, I was interested in outcomes. I wanted to read about people who had recovered, not folks who were in the middle of a painful episode of physio three weeks after surgery. Humans are optimistic like that :-)

If you're reading this, you're probably faced with a choice of whether to have a tenodesis or a tenotomy. You can Google what that is if you don't know but there is trade off between the two and I hope my experience helps you to understand this trade-off better.

Tenodesis
- longer and more painful recovery
- marginally stronger bicep
- minimal cosmetic changes

Tenotomy
- shorter and less painful recover
- marginally weaker bicep
- 'Popeye' looking bicep

I aim to share with you whether there are any other issues with a tenodesis. Like I said, there is little information about this online and now that I am living with one, I'll be sure to let you know what it's like.

Stay tuned :-)

Tuesday, 30 August 2011

Day 3 - how does it feel?

It's day three and other than the obvious frustrations of being in a sling, it's bearable!

I'm taking three doses of painkillers per day; each dose is 500mg of Paracetemol and 200mg of Ibuprofen. This takes the edge off of any sharp pain and just leaves me with a noticable ache is the front of the shoulder.

Feeling around the shoulder surface, the spot above the bicep is definitely swollen, which is hardly surprising really. More reason to keep taking the anti-inflammatories.

I do a light exercise routine 3 times a day which includes:
- making and releasing a fist (no pain)
- bending and straigtening the elbow (very mild pain when straight)
- pulling back the shoulder blades (no pain)
- turning the head to stretch the neck muscles (no pain)

I'm quite surprised how little it hurts to straigten the elbow; I expected this to hurt like hell!

I can lean over to the right and let my arm hang away from my side about 15 degrees with little discomfort. I figured this might be good for general mobility.

When the painkillers wear off it hurts, especially the biceps. I'm sleeping on my back or on my left side and when on my side I rest my right arm on a pillow positioned to my left. I got 6 or 7 hours last night - not bad.

This will all get more interesting when I start exercising properly. I'll post back with any notable changes in the meantime.