I had outpatient laproscopic surgery to repair my rotator cuff. Sugery lasted about 2.5 hours and I was left with a dressing over 6 holes in my shoulder. The pain service had done a scalene block of my brachial plexus which gave me a sense of what it might be like to have a stroke. I did develop a Horner's syndrome on the right along with some hoarseness which means that there was probably some anesthesia of the recurrent laryngeal nerve.
The First Night
I was warned to pretreat for the pain which would return when the nerve block wore off. What I was NOT warned about was how it would return with a vengeance. The pain came back unabated by multiple doses of oxycodone, Celebrex, or ibuprofen. I found myself pacing around the first floor of the house and eventually out of the house up the street all in an effort to distract from the pain. There were thoughts of having to go the ED just to get some relief from the pain for a short period of time. When fatigue and pain meld together, it can be a powerful motivator and distractor. Fortunately, I was finally able to dose off in one postion. When the pain would awaken me, while sitting in a recliner, I would move to find a less painful angle and doze off again. This went on for a couple of hours after starting at 0500. Tough night.
Subsequent nights have been better in that there were longer periods of rest before having to move. On the second night, I started in a bed laying on my left side and ended up in a recliner with persistent pain. The third night was more of the same but less time in the recliner. On the fourth night, I was able to flop around in the bed the whole night.
Pain control
The base has been oxycodone which takes the edge off and makes me sleepy. It has also clearly slowed down the GI system. I have used Celebrex to try to prevent any GI symptoms, hopefully not long enough to get any of the cardiovascular complications! As of the fourth day, I am down to one 5 mg oxycodone at night and ibuprofen three or four times a day.
Exercise
Saw the orthopedist on the second day and have been assigned passive ROM with hanging arm, finger walking up the wall (which does not seem to be all that passive), laying down up over the head, and shoulder rolls. As of day 4, having more flexibility but it is still difficult to finger walk up the wall.
Friday, October 21, 2011
Rotator Cuff Injury
I fell off of a wall.
Was on the way to a dinner when I tried to pummell horse over a metal railing and my leather loafers slipped. I landed on my right (dominant) side wrist and then shoulder. On the way down, I remember thinking, "I hope I don't break my neck". When I got up after the fall, I first thought that I may have dislocated the shoulder but was able to rotate it externally. But I knew that something had happened, perhaps a subluxation. This probably when I tore the subscapularis off of the humerus.
Anyway, it hurt pretty much every night which is what eventually prompted me to have it repaired. When I would try to sleep, it would seem that the muscle tone surrounding the shoulder would relax and the humerus would move out of joint subsequently putting pressure on the joint leading to pain. At the beginning, I would have to put the arm above my head for comfort. But as the months wore on, the shoulder became stiff and I was less and less able to raise it above my head.
MRI
Had a MRI arthrogram of the shoulder which was the diagnostic test of choice for these injuries as it allows visualzation of the injury. It showed a tear of the subscapularis muscle along with some chronic changes.
While in the MRI, it was an uncomfortable process because of the positioning that they wanted you to be in. I can certainly see why it would be uncomfortable for some to be in that small space. Having large amounts of cool air blowing across your face is an important design feature. Listing to some music would have been nice.
Was on the way to a dinner when I tried to pummell horse over a metal railing and my leather loafers slipped. I landed on my right (dominant) side wrist and then shoulder. On the way down, I remember thinking, "I hope I don't break my neck". When I got up after the fall, I first thought that I may have dislocated the shoulder but was able to rotate it externally. But I knew that something had happened, perhaps a subluxation. This probably when I tore the subscapularis off of the humerus.
Anyway, it hurt pretty much every night which is what eventually prompted me to have it repaired. When I would try to sleep, it would seem that the muscle tone surrounding the shoulder would relax and the humerus would move out of joint subsequently putting pressure on the joint leading to pain. At the beginning, I would have to put the arm above my head for comfort. But as the months wore on, the shoulder became stiff and I was less and less able to raise it above my head.
MRI
Had a MRI arthrogram of the shoulder which was the diagnostic test of choice for these injuries as it allows visualzation of the injury. It showed a tear of the subscapularis muscle along with some chronic changes.
While in the MRI, it was an uncomfortable process because of the positioning that they wanted you to be in. I can certainly see why it would be uncomfortable for some to be in that small space. Having large amounts of cool air blowing across your face is an important design feature. Listing to some music would have been nice.
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