# Anyone had shoulder surgery??



## EddieC (Apr 11, 2006)

*Had the same surgery*

Had the same injury, had surgery thru Steadman Hawkins in Denver. Steadman Hawkins Orthopaedic Clinics - Denver CO - Home

And did physical therapy with Jen Hide at http://www.leadingedgephysicaltherapy.com/
The physical therapy is soooo important and Jen was awesome. What ever doc you wind up using really consider her for your PT. 

I had the surgery in August 2007 and was boating in Chile the following February. I would say it really takes a year to get as strong as you are going to get. You will want to really keep on top of the physical therapy and do the same strengthening exercises before each boating season. That being said paddling has always seemed like the best exercise for my shoulder. 

I actually tweaked it a bit this season because I didn't work on it prior to the season and went for a nice side surf that strained it. Hoping I don't need to go in for a second time.


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## Crazy Nate (Aug 29, 2008)

I had a boney bankhart fracture with a SLAP lesion (requireing labrum debridement) secondary to an anterior dislocation repaired by Dr. Paul Abbot of Vail Summit Orthopedics (VSO) last June. Dr. Abbot is renowned in the field and is one of the best shoulder surgeons in the country. He has worked on other kayakers I know all with excellent outcomes. One year later and I am kayaking as well as ever. I actually wish both shoulders felt as good. I also agree rehab is paramount. Good luck! 

Bottom line surgery sucks. If you can rehab with physical therapy and avoid surgery you should. If you choose to have surgery pick a surgeon who specializes in shoulders and you should have a good outcome. Alot of shoulds because there are alot of complications in surgery...making it suck...


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## adgeiser (May 26, 2009)

i had a labrium tear followed by a surgical repair.
....it sucked!!! and still does, my surgery was not successful 
i have elected to not undergo a second surgery (the first sucked that bad)

i currently live with pain rating from 2-3 out of 10 daily.

with that said kayaking a long HARD day usually only brings it up to 3-4 at the most.
Biking on the other hand is way worse. i have had to give up road biking. i traded my DeRosa Planet for a cyclecross bike (the positioning is more upright and puts less weight on my shoulder) that said long rides still make my arm go into first pain then numb then back to very painful.... it stays at a 4-5 for the next day or two.
MTN Biking does not hurt as much but raises my pain level.

Just remember that shoulder surgeries have the lowest success rate of all ortho surgeries. My surgeon wrote mine off as successful after 6 months of recovery, with me telling him the pain was still there after 6 months we did another MRI which showed the tear never healed... you can see the anchor and very clearly the tear. he then wanted to do another surgery.

yes, my doc should not have reported it as successful.
no, not all docs would have reported it this way.
and...
yes the doctors are rated by their success rate.


so listen to crazy nate's last paragraph.


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## GAtoCSU (Apr 18, 2005)

Had a 6 to 12 o'clock labrum tear. Good stuff. Got it fixed and a glenoid capsule reduction. I'm 8 years out and solid. No sublex's or anything. 

Did mine in Ga though so that won't help. Shoulder's aren't the least successful orthopedics surgery. Not sure where you heard that, but it's incorrect. Labrum tears are common and the repairs are also very common. We do them almost daily here at my hospital. Get a proximal nerve block with a pain pump when you do yours. It'll keep you pain free for the first 72 hours. Get aggressive with your physical therapy schedule and do your work at home. Get full strength and range of motion before you do anything that could mess it up again. 

Also remember this, not all shoulder stuff is the same. Out of the 4 people in this thread that have had a labrum tear there isn't two of us that have the same shoulder joint, cartilage, tendons, bursa, bone spurs, etc. There are a lot of reasons why people have recurrent pain and there's no telling why someone is without actually seeing them in practice. Hell, a good 1/3 of the time we still don't know exactly what specifically is causing the pain. 

Bottom line: In the presence of a labrum tear the shoulder is innately weaker than it ever was prior to the injury and it will never be the same without surgery. Over half of the head of the humerus is held in the joint by the labrum itself, not the bony articular surface that you may think does it. Strengthening will help, but it isn't the solution to the problem. It's like adding air freshener after your kid pooped all over the floor. Does it help? Sure does.. but there's still smelly shit on the floor that'll eventually creep out again if you wait long enough.


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## PattyNYCO (Mar 21, 2005)

*Dr. Eric McCarty - CU Sports Medicine.* He is the best. I will tell you, however, it takes 8 or 9 months to become fully functional again. I had mine done last Sept 2011 thinking I would be back in my boat by May. It took me until last week to get my confidence back enough to do even Shoshone. Plan ahead........


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## jimmyihatetoregister (Jun 3, 2012)

*rotator cuff*

I just got an MRI and it shows I have a 2 cm full thickness tear of my supraspinatus tendon. I went to see *Dr. McCarty* and he has recommended surgery. I got it from playing ice hockey. 

My best friend who is a PHD PT said, you should consider conservative treatment. I have a huge range of motion, can cycle, kayak (I'm a newbie), carry a kayak, and do all kinds of other stuff. Yes it hurts. My shoulder definitely hurts, especially if my arm is by my side for a long period of time. Like sleeping or in a seat on an airplane. The more people I talk to, the more say, go conservative. My PT thinks he can get me back to a great range of motion pain free. 

We shall see, but look at your options. 

Jimmy


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## PattyNYCO (Mar 21, 2005)

Depends on what you want and what you can live with. If the pain is not too bad, my advice is wait as long as you can. If you have a good PT - try that route first IF you are not doing more damage, of course. 

Make sure if you do have surgery, you get into a good PT right away (sounds like you are set on that). Stay aggressive with it and don't slack off. Otherwise, you will have to have manipulation surgery (a second surgery where they knock you out and manipulate your arm into positions you would not normally be able to get into to rip all the adhesions that have healed wrong). I had a BAD PT when I started off after the first surgery and I paid dearly for it. I had a really good one after the second surgery - thank GOD or I would have been in serious trouble. 

PT. PT. PT. 

PS McCarty is a great doc, IMO.


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## jimmyihatetoregister (Jun 3, 2012)

*follow up*

Dr. Mc... comes highly regarded, and I have no doubts he is a good surgeon. Having said that, he did not give much consideration to conservative treatment for me. About 30 seconds worth, in our conversation at his office... 

I am going with PT. A hockey teammate with bi lateral labrum tears told me he resolved it with PT, and he is still playing hockey.


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## mrett (Feb 17, 2012)

Have the same PT feedback as others. Torn bicep tendon, torn labrum, etc. Surgeon did a great job, follow-up appt. and PT not nearly aggressive enough. You got it anesthesia and manipulation. More PT- 1 year later, strong, pain free and rowing class 5. PT will make you or break you !!


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## burnor (May 13, 2010)

I'm a family doc and get alot of questions about shoulder injuries and paddling and here's a response I posted in another forum once upon a time... might come in handy and guide some decision making:

*Rotator cuff tears:* First off, to alleviate confusion... the rotator cuff made of 4 muscles. It's not necessarily a singular structure, and it is in a very confined space. Any one of them can tear, although the lions share is the supraspinatus muscle... the most susceptible to injury. Yes MRI is the best variety of imaging, but it still has limitations. The best is when they get the scope in the shoulder and actually look at reality. The reason I bring this up is that often I have seen surgeons need to change their plans once they get a scope in, because despite MRI, they found something unexpected. Unfortunately once they get in there, you probably wouldn't want the expense or risk them waking you up and ask you what you want to just to put you back under again.... so this under scores the need to trust your surgeon. 

Now, there are _a lot_ of people in the world with rotator cuff tears (Cadaver studies show 20-30% of the population have tears)... so who is it, that needs to have surgery? Well it depends on the extend of the tear... obviously full thickness tears need it. So if you're not completely torn the evidence is: 50% or greater tear deserves surgery...widely accepted. However it is grey in the 30-50% range and varies from surgeon to surgeon. Should we have a lower threshold as kayakers for surgery??? I'm not a surgeon and that's really hard for me to answer???? I'm not certain the strength and capabilities of repair methods, etc... 

The next question is how do they tell how torn the cuff is: the MRI.... but this it really an estimate and not precise. It is truly backed by the surgeons experience between correlating imaging and the actual findings they have seen with other pt's when the go in with a scope. Secondly, it's base on physical exam....people in which half of their muscle is torn, they're pretty weak when you isolate the specific muscles in question. Lastly it's based history... when does the thing give you problems... what movements, what ranges of motion? So you really wanna probe your potential surgeon for how torn they think things are and what makes them think that degree of damage is present. If the surgeons physical exam is minimal or they barely ask for the story about it.... I would question their decision making. Another question, that I do _not_ have the answer to: how many times can you have surgery on it? Is it once and done? That will definitely change your decision making.

What will be helpful to every one is the treatment algorithm I have attached to this post.... this is the process that us docs should be following. 











*Labral Tears:* So what is the labrum? Picture a suction cup on the ball of the humerus bone...that's basically it. No, it doesn't actually "suck" on there but it provides the surface for the shoulder to articulate and some lesser degree of stability. So if your shoulder get's unstable, or gets trauma... if it get's subluxed or worse fully dislocated, you can imagine how this would tear. So what is the problem with a tear: well it's not necessarily a stability issue (or to a much lesser degree) as it is a movement/discomfort issue. It is a very confined space in the shoulder and a flapping tear or cartilaginous junk hanging around can cause a lot of inflammation and narrowing of space in there... but it's mostly pain/stiffness, and less to blame for instability. So inferior-anterior tears (the bottom-front most part of labrum) are more associated with subluxations/dislocation, whereas superior-posterior lesions are more likely found in relation tear to the cuff in that area. Anyhow, so why do surgery on the labrum: pain and stiffness. What kind of surgery do they use: depends on the tear. If it's just a little nick in it or small tear they try debridement (they shave off and vacuum up the cartilage). Otherwise if it's a large tear and there's a big piece hanging in the wind... they're tack it down to the bone. 

The evidence is not that good for debridement long-term.... studies show that in 2 years post-surgery only 7% of pt's had good symptom relief!!! Secondly, you just lost a bunch of cartilage you would have normally have... and I would argue that's going to predispose you to arthritis some day. So the question is, how big is the labral tear? Again MRI is the best... but in correlation with the surgeon's experience,exam, and history is going to determine the most. If it's relatively minor and you're not in a lot of pain... debridement isn't going to help much and may even be detrimental in the long run. Otherwise if tacking is needed, then evidence suggests benefit in improving symptoms. 

*To get a good surgeon:* Know your shit... hence this terribly long post. Make sure you know the questions to ask. Don't put up with any bullshit... if they aren't giving clear and understandable answers... find a surgeon who does. Also, always see more than one.... ascertain whether multiple surgeons are coming to the same conclusion or different ones. Make sure they are listening to you... we're paddlers, we have specific needs and demands on our shoulders. Make sure they get a full history and physical exam from you. If not, I'd look elsewhere. 

Hope that helps everyone in the future about shoulder stuff....


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## GAtoCSU (Apr 18, 2005)

burnor said:


> I'm a family doc and get alot of questions about shoulder injuries and paddling and here's a response I posted in another forum once upon a time... might come in handy and guide some decision making:
> 
> *Rotator cuff tears:* First off, to alleviate confusion... the rotator cuff made of 4 muscles. It's not necessarily a singular structure, and it is in a very confined space. Any one of them can tear, although the lions share is the supraspinatus muscle... the most susceptible to injury. Yes MRI is the best variety of imaging, but it still has limitations. The best is when they get the scope in the shoulder and actually look at reality. The reason I bring this up is that often I have seen surgeons need to change their plans once they get a scope in, because despite MRI, they found something unexpected. Unfortunately once they get in there, you probably wouldn't want the expense or risk them waking you up and ask you what you want to just to put you back under again.... so this under scores the need to trust your surgeon.
> 
> ...


Labrum repairs for pain? With all the ortho docs I've worked with and lectures I've seen it's all about instability. I dislocated over 15 times before I had my labrum anchored back down, and haven't had a single problem in 8 years. All the literature I have read also agrees with this.

I'm in an ultrasound lecture atm so I don't have time to pull the SLAP articles, but Hopkins has a simplified talk on it here labrum tear Johns Hopkins Orthopaedic Surgery


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## Roy (Oct 30, 2003)

I've also had multiple labrum repairs specifically for stability issues. In each case, they tacked it down to the bone, in addition to cleaning things up. Last time he (Dr. Boublik @ Steadman Hawkins) was in there he said my rotator cuff looked great--the instability was due to the cartilage damage (labrum), although it extended into the biceps tendon, which they also tacked down.


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## lookinathesun (Feb 20, 2008)

*Labrum tears*

I've had both shoulders repaired for labrum tears. One was an old school open surgery in the 90s (two days in the hospital) and most recently an arthroscopic surgery about 5 years ago (home by noon). I had multiple dislocations after the second injury before a major tear and the decision to have surgery to finally fix it.

After my second surgery and watching a video of the surgery showing my shoulder innards, I can say I should of had the surgery to fix the problem after the first incident. Every dislocation chipped away at the cartilage on the ball of my shoulder joint, which doesn't heal. Now I have a click in my shoulder due to this scarring. 

That said, surgery sucks, and the first few months following surgery were a major bummer. Stick with your PT and your shoulder specific exercises afterwards. Good luck!


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## melcol (Jul 5, 2004)

*Thanks for all the awesome advice!*

I knew I would get results here on the buzz  The thing is, I hurt my shoulder two years ago and it has never been the same. Putting up with it I am always in pain but with massage and strecthing I have dealt with it. This year I pulled it again and dumb ass me I gave it a few weeks and then decided to wakeboard...well that was a big mistake and heard a loud popping in my sholder while I was being jerked over a wake of another boat. Instant severe pain I couldnt even get back up. For the next two weeks anything I did but paddle (Thnk god ) would inpinge it to the point that it would send me to the floor. As time has gone on the inpingement happens less frequently but I dont use my arm to lift or do sideways movements. I cant even lift my boat on the car. Thank god for a old beater that I can slide it over the hood. So, luckily I can paddle but not playboat and I really feels like it helps keep the arm moving but the inpingement can happen lifting a chair up or moving it the wrong way.

Went to see Dr Hackett with Steadman in Frisco and he wants to do the debridement where they clean up loose cartilage and trim the tear. I was told as well it will never be the same wothout surgery becuase it is cartilage and it is a mechanical problem were the bicep tendon is being inpinged by the labrum tear. But, he says that I will be snowboarding and kayaking in two months.

waititng on a second opinion appt and just to really let it sink and do what I feel is best.

Also, my thoughts are that if I let it go this way and wait for the worse case and tear it more wont it suck to have to go through all the pins and the long road of recovery with the more invasive surgery?? Yeah, I know that is the worse case but I am a kayaker and I play hard and based on my track record of injuries it is more then likely could happen.

Thanks again for all the help. You guys rock!


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## GAtoCSU (Apr 18, 2005)

melcol said:


> I knew I would get results here on the buzz  The thing is, I hurt my shoulder two years ago and it has never been the same. Putting up with it I am always in pain but with massage and strecthing I have dealt with it. This year I pulled it again and dumb ass me I gave it a few weeks and then decided to wakeboard...well that was a big mistake and heard a loud popping in my sholder while I was being jerked over a wake of another boat. Instant severe pain I couldnt even get back up. For the next two weeks anything I did but paddle (Thnk god ) would inpinge it to the point that it would send me to the floor. As time has gone on the inpingement happens less frequently but I dont use my arm to lift or do sideways movements. I cant even lift my boat on the car. Thank god for a old beater that I can slide it over the hood. So, luckily I can paddle but not playboat and I really feels like it helps keep the arm moving but the inpingement can happen lifting a chair up or moving it the wrong way.
> 
> Went to see Dr Hackett with Steadman in Frisco and he wants to do the debridement where they clean up loose cartilage and trim the tear. I was told as well it will never be the same wothout surgery becuase it is cartilage and it is a mechanical problem were the bicep tendon is being inpinged by the labrum tear. But, he says that I will be snowboarding and kayaking in two months.
> 
> ...


No one can make the decision for you to go under the knife. With that said though, if I was having the level of pain that you are constantly having and I was unable to do the activities that I enjoy, I would be much more likely to go under the knife than I would be if these factors were not present. I don't regret having shoulder surgery, and as a guy that has seen his fair share of neglected injuries in the OR I can tell you that the sooner you do something about an injury that will need a fix (inevitable) the better. Simple surgeries have a much higher success rate and rehab period than complex procedures that require hardware to be left in.

Non of us have seen your films, examined your shoulder, etc.. so I'll fall back to my qualifier that I originally put when is that all injuries are different and that only the patient can really tell when they are ready for surgery. What you don't want is a total shoulder replacement b/c you have torn up the articulating surface of the glenoid fossa and eroded the head of the humerus (which can happen after prolonged irritation from floating debris in the joint space and repetitive injuries), both of which may have been preventable if you acted sooner rather than later (10 years for example). We see this with hip replacements quite often. What could have been an acetabular resurfacing procedure turns into a total hip b/c there was so much damage accumulated by deferring the procedure for years on end.


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## melcol (Jul 5, 2004)

Thanks GAtoCSU that is how I feel about it as well. I am going to hear from my doc on Monday and have a second doctor appointment on Tuesday as well. HAve a great weekend!


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## kaya dog (May 26, 2009)

hello all, I had 2 done and need 1 more. all on same side. dam sleds. lol
open bankart, stabilization. failed 2 years. 
open Latarjet 6 months ago. still hurts like a _--__-. doc wants to pull screws in a few months. still having subluxtion's and crazy painfull pops
find a really good shoulder guy. 
i was lucky to find this guy Patrick J. Denard, MD - Southern Oregon Orthopedics
hope that link works.
good luck


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## melcol (Jul 5, 2004)

*shoulder surgery*

So I went to dr. Gottlob and Dr Schneider and they came back with the same answer but different ideas on surgery. The supraspiantus is almost torn 50% so they both recommend a clean up of the area with hope of not repairing. The labrum is torn and this is were the doctors have different ideas. One wants to go in and hopefully only clean up with a possibilty of a repair and the other feels it needs repair and his belief is to be more aggressive so I can come back as strong as possible. He says he uses a stonger and smaller set of screws and that recovery is three not four months. They both agree that if the Supra needs repair that is 6 months recovery. Then, the bicep does show some damage but they both say they cant tell how much until they go in. The one doctor, the more conservative one would want to do bicep tendosesis, which is moving the bicep lower and pinning to the bone and the more aggresive doc wants to only clean it up since he doesnt recommend moving it. Again, he says this will make the bicep stronger in the long run. 

So, I feel better knowing that I do have issues that warrant surgery but now I am utterly confused on which doc. I really like both and feel comfortable with both but I do lean towards the conservative procedures over the more aggresive one.

Think I am going to bite the bullet and get it done in the next week or so since water is low and I got to stop paddling sometime right  

Any thoughts??
Thanks Melanie


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## mrett (Feb 17, 2012)

Good Luck, In my limited experience (once) the Dr. will make some decisions after the procedure has started.


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## mrett (Feb 17, 2012)

A certain amount of trust and upfront communication required. Sure beats being injured !!


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## burnor (May 13, 2010)

Boy this is a tough decision... and impossible for anyone to answer without having seen your images and doing an exam. I understand both perspectives... if you are hard on shoulders as it is and are you going to end up tearing your damaged labrum anyway... thus indicating a more aggressive approach? Tough to answer. 

In terms of the biceps: tThe insertion of the biceps is two fold (hence the "bi" prefix) have a long head inserting in the shoulder joint and the short head inserting on the corcoid process of scapula (http://healthtwo.wikispaces.com/file/view/biceps-brachii.gif). Doing a long head tenotomy or tenodesis does not have strong indications other than pain relief. At this time far they are unclear of the exact function of the long head of the biceps. Thus it has been subjectively found in pt's with pain despite initial arthroscopy that if there is damage to biceps tendon transecting it will provide symptom relief.... and only minor functional deficits. Thus if one's pain goes away and function is reasonable... patients are happy. In younger pt's (<50 years) tenodesis is indicated but in theory only... the idea is that you still get function benefits of long head of biceps by tacking it down to the bone. However there are few good studies that tenodesis has better results functionally or pain wise than tenotomy. 

Overall, it's probably going to be a gut decision for you. Thoughts to have is: How well do you feel each of these fella's understand the demands you are putting on you shoulders? How well did you feel like what their assessment, recommendations, and discussion match with how your shoulder feels? How closely does the surgeon's thinking and philosophy mirror your own?

Tough decision in the least, but I think overall either way you will find a benefit!

~B


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## melcol (Jul 5, 2004)

*shoulder surgery*

Thanks guys!

Burnor, Very good points and defiently questions I will ask tomorrow. Thanks so much and I do know it will come down to what my gut says...

Mel


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