Shoulder Surgery Next Friday

[Mike Antonio]

 Good day everyone. So I’ve been having an issue with my Dominent shoulder due to a small tear in the labrum (slap tear).  I attempted physio and other treatments over the course of approximately a year and a half with very little Progress. 

So im scheduled next Friday for a possible labrum repair or possible bicep tenodesis with some rotator cuff maintenance as well. I have the surgeon free range to do whatever he feels is best once he looks inside. My shoulder hasn’t made much progress up until last week. Now this could be my brain f’king with me but I am able to get into positions that I couldn’t get into last month. Like foot supported planche lean, hspu and even a few dips. Keep in mind my job has been extremely time taxing lately so training has very been minimal. My physio guy and I assume that once I start training regularly again I will likely aggravate the shoulder and be back to wear I was a few months ago if I don’t do surgery. I guess I’m just looking for a little reassurance as I feel like I’m possibly risking surgery for minimal results. I do still have some pain when performing internal and external rotation (no weight) at the end ranges. Although I’m really looking forward to 4 months off of work and almost feel like that’s half the reason I’m looking to do this. I’m hoping to be able to still train at somewhat of a high level. I have goals of planche, strict ring muscle ups and press to handstand. 

Any thoughts are appreciated. 

Thanks,

 

mike

 

 

[Pauline Taube]

Hi Mike,

Thanks for reachint out.

Unfortunately we cannot give you any specific advices behind a monitor. If you are having any doubts I recommend to get a second opinion by another medical professional. An in person diagnosis is definetely the best an safest way to go.

Please keep us updated on how you go!

[Nick Murray]

I think one of my posts on post-shoulder stabilisation and slap repair ought to be stickied. Anyway: here's the short version.

Right shoulder (2012): slap tear (large), complete labral avulsion (pulled off glenoid) from 3o'clock to 9 (looking at glenoid from right side). Multidirectional instability. end stage osteoarthritis in the middle of the glenoid.

Surgery: stabilisation via plication (tightening the shoulder capsule), leading to huge ROM loss. Also capsular shift: tightening the bottom of the capsule to move the humeral head upwards a bit to avoid the osteoarthritic area, again reducing ROM especially end-range shoulder flexion. Long head of biceps OK (amazingly enough).

Left shoulder. (2013. Small slap + multidirectional instability. Plication and slap repair, ***asked the surgeon to NOT tighten as much as for the right shoulder, and to please give the right shoulder a bloody great yank while I was under anaesthesia. he did, and I had another 15 degrees of external rotation & 5 of flexion for a while.

Post surgical rehab, right: nothing for 6 weeks. Huge loss of muscle from R biceps, triceps, infra/supraspinatus, then pendulumns and some band work, progressively weighted ER and scapula stabilisation (retractions, protractions, elevations, depressions). I was NOT happy with surgical guidance nor the physio I had. More in a minute.

Post surgical rehab, left: began the moment I awoke from surgery: VERY small amplitude internal/external rotations and shoulder flexion/extension, this continued for the first week until stitches came out. Unweighted (arm weight only) pendulumns & passive movements (unweighted) into IR/ER, flexion, extension. Very small amplitude for the first two weeks, guided mainly by pain and how "tense" the end-range movement was. Progressed to light theraband work (initially isometric until pain decreased, then concentric/eccentric).

BOTH shoulders: both physios (different physio for each shoulder) missed atrophy of subscapularis, so a LOT of theraband work for this: hold arm out in front, then a resisted movement of arm across the front of the body. Much faster progression after I figured this out myself and added it to the rehab routine.

(btw full muscle-up in early 2017, 4 years post op, just for reference. Bulgarian pullups on rings early 2018).

So here ARE some specific things to tell your surgeon and physio:

* tell him/her that you want to return to gymnastics.

* tell him/her: as much as possible, preserve range of motion in whatever is fixed

* ask surgeon and physio for a plan for weeks 1-6 post surgery, then broader aims for each following month up to six months. Different surgeons use different techniques, and some movements or rehab might be contraindicated during the first few weeks.

* Make sure any rehab addresses ROM, scap stabilisation AND shoulder (glenohumeral) stabilisation. And don't forget subscapularis: it's the forgotten rotator cuff muscle.

I returned to proper training at 3 months, with lighter weights and a lot of repetitions for the first 4-8 weeks, then I started progressive resistance. I started GB in December 2014.

The biggest problem with most physios is that they don't understand the types of movements we (as GB trainees) want to do.

Any questions please let me know.

[Mike Antonio]

8 hours ago, Nick Murray said:

I think one of my posts on post-shoulder stabilisation and slap repair ought to be stickied. Anyway: here's the short version.

Right shoulder (2012): slap tear (large), complete labral avulsion (pulled off glenoid) from 3o'clock to 9 (looking at glenoid from right side). Multidirectional instability. end stage osteoarthritis in the middle of the glenoid.

Surgery: stabilisation via plication (tightening the shoulder capsule), leading to huge ROM loss. Also capsular shift: tightening the bottom of the capsule to move the humeral head upwards a bit to avoid the osteoarthritic area, again reducing ROM especially end-range shoulder flexion. Long head of biceps OK (amazingly enough).

Left shoulder. (2013. Small slap + multidirectional instability. Plication and slap repair, ***asked the surgeon to NOT tighten as much as for the right shoulder, and to please give the right shoulder a bloody great yank while I was under anaesthesia. he did, and I had another 15 degrees of external rotation & 5 of flexion for a while.

Post surgical rehab, right: nothing for 6 weeks. Huge loss of muscle from R biceps, triceps, infra/supraspinatus, then pendulumns and some band work, progressively weighted ER and scapula stabilisation (retractions, protractions, elevations, depressions). I was NOT happy with surgical guidance nor the physio I had. More in a minute.

Post surgical rehab, left: began the moment I awoke from surgery: VERY small amplitude internal/external rotations and shoulder flexion/extension, this continued for the first week until stitches came out. Unweighted (arm weight only) pendulumns & passive movements (unweighted) into IR/ER, flexion, extension. Very small amplitude for the first two weeks, guided mainly by pain and how "tense" the end-range movement was. Progressed to light theraband work (initially isometric until pain decreased, then concentric/eccentric).

BOTH shoulders: both physios (different physio for each shoulder) missed atrophy of subscapularis, so a LOT of theraband work for this: hold arm out in front, then a resisted movement of arm across the front of the body. Much faster progression after I figured this out myself and added it to the rehab routine.

(btw full muscle-up in early 2017, 4 years post op, just for reference. Bulgarian pullups on rings early 2018).

So here ARE some specific things to tell your surgeon and physio:

* tell him/her that you want to return to gymnastics.

* tell him/her: as much as possible, preserve range of motion in whatever is fixed

* ask surgeon and physio for a plan for weeks 1-6 post surgery, then broader aims for each following month up to six months. Different surgeons use different techniques, and some movements or rehab might be contraindicated during the first few weeks.

* Make sure any rehab addresses ROM, scap stabilisation AND shoulder (glenohumeral) stabilisation. And don't forget subscapularis: it's the forgotten rotator cuff muscle.

I returned to proper training at 3 months, with lighter weights and a lot of repetitions for the first 4-8 weeks, then I started progressive resistance. I started GB in December 2014.

The biggest problem with most physios is that they don't understand the types of movements we (as GB trainees) want to do.

Any questions please let me know.

Yes I’ve read your older post over and over.  Great post and I thank you for being so detailed. I really gave it a go on the rings yesterday which brought back a lot of my previous internal and external rotation pain so I am confident that surgey is the way to go. 

 

I have a really good physio therapist. He suggested I start treatment with him 3 days after surgery. He said the least we can do is keep your elbow and wrist moving. But he wants to get my shoulder moving as soon as possible which will be based on a pain threshold. I think you’ve just about covered any questions I have but I will likely reach out during my rehab. 

Did you by chance use any particular supplements during your rehab that you feel contributed to a quicker come back. 

[Nick Murray]

Not getting surgery and using conservative management is ok if you just want your shoulders to be "good enough". I didn't want to be "good enough". This is my opinion of course.

Great that your physio wants to keep elbow and wrist moving - keeping your grip strength up will help with recovery.

Supplements? To be honest, at that time (the month after surgery) I ate a LOT of 85% dark chocolate, broccoli, and chicken (with a pesto dip to give it some flavour). A few other things, but this was the main part. I  supplemented with protein isolate as I don't each much red meat.

The other thing that helped the left shoulder and that I didn't do on the right was get manual lymphatic drainage. My right arm (especially forearm and hand) swelled up a lot in the first two weeks - it was pretty painful. No doubt it was compromise of the lymphatic system around the shoulder. So after the left shoulder surgery I had lymph drainage the day after, and twice more in the following week and a half.No problems with swelling at all.

[Mike Antonio]

Well I’m ten post surgery. So far recovery has been great. I was off pain meds after day 3. I have no pain at rest at all. Can almost lift my arm parallel to floor front and side. That game ready ice machine I think played a big role In getting the pain gone early. 

[Jeffrey Bittner]

Glad to hear that you're on the road to recovery, Mike!

[Mike Antonio]

10 hours ago, Jeffrey Bittner said:

Glad to hear that you're on the road to recovery, Mike!

Thank you. Started physio this week so hopefully progress will continue. I’m not even sure what surgery was performed yet. I’m guessing I hadn’t a bicep tenodesis. Back to surgeon on Thursday to get my stitches out. Find out then. 

[Nick Murray]

Hah. My surgeon appeared at my bedside in the recovery room, and explained what he'd just done. Of course, with residual anaesthetic still sloshing around, I couldn't remember a thing about what he'd said, so the one-week follow up was also a good time to find out what he'd done.

[Mike Antonio]

21 hours ago, Nick Murray said:

Hah. My surgeon appeared at my bedside in the recovery room, and explained what he'd just done. Of course, with residual anaesthetic still sloshing around, I couldn't remember a thing about what he'd said, so the one-week follow up was also a good time to find out what he'd done.

Funny you say that because someone said he talked to me after surgery but I have no recollection! Been dying to find out if I got labrum repair, bicep tenodesis or just a decompression surgery!

[Nick Murray]

After my left shoulder was done a year after my right, I had the post-op routine down. Just to test things, I jumped off the trolley about 5 minutes after I woke up to see if I could do single leg squats (partials, anyway). My balance was pretty good, but I still couldn't remember what the surgeon told me :/