rotator cuff repair

Mr J

Michael Peterson status
Aug 18, 2003
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Regional Vic, Australia
4 days ago I had a subscapularis repair and bicep tenodesis (re-attachment of tendon at a different point from its original insertion).

Background to this is a surfing mishap in September last year. After re-habbing my left shoulder from my nerve damage skateboarding accident I was trying to transition myself from my foamie re-hab boar back onto my fibreglass shortie. While I didn't find the 4' 8" foamie particularly easy to ride I was by now well in tune with it and its broad width and rectangular planshape meant it was at least a stable platform unlike my 18 3/8" local custom. I had lost my pop up.

I twisted my body to face the wave during a very awkward pop up and ended up putting all my weight onto an inwardly rotated adducted across my body right arm. I suffered a posterior "instability incident" which according to an MRI diagnosis had caused a cleft in the subscapularis and a displaced long head bicep tendon sitting in that cleft.

I went thru the usual rotator cuff re-hab and over a period of weeks/months all symptoms went away. There was a long wait to get the surgeon's opinion. In the meantime, I practiced the pop up rigorously on the floor and figured out exactly what I needed to do and got my pop up back. I tested either stronger or equally strong to my left shoulder in all directions, the physio didn't think I was going to need surgery.

Had my surgeon's appointment mid december and the verdict was surgery needed, not urgent but unless I did it the displaced bicep tendon would eventually saw through the suscapularis. I told him that it felt like my bicep had gone back into the groove and was told that was impossible. I promptly booked surgery for end of january because I didn't want to cancel my Thailand holiday with my wife.


On holiday surfing in the gulf of Thailand where I was feeling no pain, heaving suitcases etc with no symptoms, my wife asked the very reasonable question "do you need surgery?".

I remembered this from our in-house doc on the hills-sachs thread.

Trust your orthopedic surgeon.
Despite this a gnawing doubt grew each day and upon return I made an appointment with my physio to get his opinion - he does not second guess the surgeon (who he works with). His strong advice was go ahead with surgery. Still there was doubt in my mind so I made an appointment with a sports doctor who I had seen before and trusted. He gave me some tests on which he didn't comment. He then looked at the MRI and told me it might not be causing me problems now, but at some point in the future it probably will "good insurance policy to get it repaired now" he said.

So glad I got that second opinion, made the remaining few weeks wait for surgery more bearable and removed that nagging doubt about whether I needed it. I am taking the long term optimistic view that I want to be surfing at 70 because its going to be many months before I can return to surfing.
 

One-Off

Tom Curren status
Jul 28, 2005
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Good luck with the surgery Mr J. I’d do as much strength training as I could beforehand in anticipation of the eventual deconditioning.
 
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Mr J

Michael Peterson status
Aug 18, 2003
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cheers @One-Off , I did do that pre-hab you are talking about. At home now with my arm in a sling, remarkably little pain unless I accidentally activate a muscle. Can't do any exercise except a gentle walk, but I can at least try and eat healthy.
 
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One-Off

Tom Curren status
Jul 28, 2005
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It’s late here. I’m up because my daughter woke me up because our roof is leaking. Not much I can do right now. I didn’t realize you already had the surgery. Wishing you a speedy recovery and return to normal activities. The tendon bit sounds like it would be a long healing process before you gain full strength.
 
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slipped_disc

Billy Hamilton status
Jun 27, 2019
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Good luck with recovery Mr J! Any idea how long you’ll be out of the water?
 
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Mr J

Michael Peterson status
Aug 18, 2003
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@slipped_disc cheers! Just an idea at this stage, the physio who I have been seeing said allow up to a year because of stiffness whereas the sports doc I saw said lets hope for closer to 6 months because he didn't think stiffness was going to be a big problem as I wasn't having any capsule tightening done, just re-attachments of the torn bit of the subscapularis and long head bicep tendon and that "glueing" back onto the bone takes a long time as One-Off correctly noted.

The problem with my joints is the opposite of stiffness, I'm hyper mobile, flat feet, can easily touch my toes even if I don't practice stretching etc. A normal person would have got away unscathed from that messy tangle of a takeoff that I got myself into which caused a posterior dislocation. I did have a capsular tightening 20 years ago and getting back the mobility was not very hard, although I'm older now.

I liked the optimism of the sports doc who pointed out my labrum survived the incident. The surgeon has lined me up with a different physio for the post surgery re-hab, first appointment tomorrow. The various physios I have seen over the years for injuries have all been good and have their own special techniques so I learn more about what exercises keep me intact that way, so I see it as a positive that I'm getting a different physio this time.

On a personal optimistic note I put a lot of work into getting my pop up right prior to surgery. Certainly my latest incident is partly due to increased incompetence due to getting older, I can't get away from this, but I have made a refinement to the chicken wing technique with the staggered hands on deck approach (trailing arm placed further down the boar than leading arm, I'm regular foot, so that's my right bad arm). Not only does it put me in better alignment it allows me a neutral/slightly outwardly rotated right arm thus avoiding that vulnerable inwardly rotated/adducted situation. So I won't be relying entirely on muscle memory and getting my rusty reflexes back. I know what I need to do. It's like the wave-ki popup program you did - you know what you need to do, which is better than just mindless repetition.
 

slipped_disc

Billy Hamilton status
Jun 27, 2019
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Sounds like you’ve got a good plan on good people on your side. Rooting for you!
 
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Mr J

Michael Peterson status
Aug 18, 2003
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I am 16 weeks post surgery now. The strengthening phase started last week, could have been a little earlier but I was busy with various things and didn't get my appointment with physio until then.

A repair to small medium sized tear in the subscapularis (front rotator cuff muscle) and relocation of long head bicep tendon which had come out of the groove in the humerous. The bicep relocation involves cutting it and pinning a new insertion point in the groove (normally it attaches to the top of the labrum). Other easily damaged parts of the shoulder such as supraspinatus rotator cuff and the cartilage labrum were intact. So overall not considered major work, but a completely re-attached bicep tendon is vulnerable to re-injury during the recovery phase.

6 weeks in a sling, the only thing I was allowed to do was hold up to 0.5kg in my hand (eg phone) or use a spoon to eat or electric toothbrush - I didn't even do that. I didn't need any pain killers, because as long as I didn't move it, it didn't hurt, so I took the not move it all approach. This is not comfortable as maintaining posture while keeping the arm and shoulder relaxed is a continuous struggle

At 7 weeks I started swimming, more like waving my arm around in front of me than proper swimming to start with. Just 10 minutes a day, twice a day in the sea. The sea was manageable without a wetsuit when I started. When it cooled I was glad that I had some oversized wetsuits that had been abandoned due to too much flushing. Now I can get any wetsuit on with no trouble and it feels normal threading my arm through the sleeves of a chest zip.

I'm, now doing a mixture of swimming and paddling the boogie board. Breast stroke seems the best complimentary exercise coz it works the delts more than freestyle, although I can swim freestyle with no pain at all - was able to do that at a reasonable pace maybe 10 weeks in. I'm surprised that I can swim 5 days a week up to twice a day for a max of 30 minutes a session. However there has been no sign of flare ups or pain that suggest I am overdoing things from that. There is a big difference between swimming and surfing in terms of strain on the shoulders - duckdiving and sprint paddling for a wave put far more load on the shoulders than say a steady freestyle. I'm a projected 2 months away from re-starting surfing.

My surgeon does only shoulders, he gets about 5 or 6 repair failures every year I'm told. Almost all before the first 12 weeks and usually from someone having there arm out of the sling too early and doing a reflex action such as trying to catch a falling object or from lifting something too heavy. After 12 weeks the failure rate drops to 3% - still a moderate chance of failure. My physio said that some peoples repairs just fall apart for no obvious reason. So far I've only had one incident of feeling where I might have overdone things and setting me back - fairly sure that was from a hilly bike ride - been cycling for a bit before that although fairly carefully, possibly due to it feeling better. I think I was pulling up on the handlebars a bit more. The soreness came good in just a couple of days - that was last week, so I'm still vulnerable. Shoulder feeling good during a vigorous swim and moderate boog paddle this morning.
 

Autoprax

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Jan 24, 2011
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How is your external rotation?

I went to my PT and she said I didn't have internal rotation.

But I also didn't have external.

The external shoulder rotation exercises really help

They felt awful at first.
 

Mr J

Michael Peterson status
Aug 18, 2003
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Regional Vic, Australia
How is your external rotation?

I went to my PT and she said I didn't have internal rotation.

But I also didn't have external.

The external shoulder rotation exercises really help

They felt awful at first.
Internal ROM not affected, which makes sense because my external rotators which gets extended during internal rotation did not get any surgery, External ROM a little less than my non-operative side - as would be expected from the internal rotator subscapularis partial tear repair, but plenty for every day life. Same with holding arms overhead - slightly reduced, enough for every day life. Surgeon says I am well ahead of schedule with recovering ROM - partly because I am hyperflexible, partly because the repair only involved one small/medium tear and the bicep long head relocation.

I have just started elastic internal external and 1.5kg dumbell external strengthening. I am meant to take it real easy at this stage as I am still quite delicate. I went for another half hour bike ride on hilly/bumpy gravel road (that's all there is near where I live) and I could feel it afterwards. Swimming and paddling the boog, even catching small waves on the boog don't seem to make it sore in comparison.

Prior to surgery all the rehab/prehab had built both sides up strong - stronger than most people my age I was told. I will always be vulnerable and have to be careful and the reverse hills sachs divot is not going to go away.
 

Mr J

Michael Peterson status
Aug 18, 2003
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Regional Vic, Australia
Probably the smartest dude I ever met.

GMB = always legit. Jarlo is a former gymnast turned MPT
Those stretches look good for getting overhead range of motion back. The bodyweight exercises look good for strength stabilising my shoulders - I will do some of them when I am ready. It will add a bit of variety and new angles to the one I used to do pre-surgery - one arm exercise ball planking. Cheers.
 
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slipped_disc

Billy Hamilton status
Jun 27, 2019
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Prior to surgery all the rehab/prehab had built both sides up strong - stronger than most people my age I was told. I will always be vulnerable and have to be careful and the reverse hills sachs divot is not going to go away.
What exercises were you doing for prehab?
 

Mr J

Michael Peterson status
Aug 18, 2003
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Regional Vic, Australia
What exercises were you doing for prehab?
The rehab became prehab. When it became clear about the extent of the damage to my right shoulder overhead exercises were stopped. The following exercises were kept and for both sides were:
  • - 4kg dumbbell in each hand - move shoulders upwards and back while simultaneously flattening scapula against body - when learning to flatten the scapula just simply pinch the shoulder blades together with shoulders back. Hold the shoulder in this position, then walk 10 steps, relax and repeat 19 more times.

  • - 4kg dumbbell bent rows - 15 to 20 reps.
  • - internal elastic rotation - 20 reps
  • - external elastic rotation - 20 reps
  • - lying on side with rolled up towel under elbow, 2.5kg external dumbbell rotation 15-20 reps.
All of the above repeated as 2 sets twice a day every day. For this volume to be maintained it means that it was lowish resistance/high rep training. I would imagine most people being bigger than me would want to go heavier than 4kg dumbbell for the shrug/flatten and rows - I was told to aim for 5kg, but my shoulder position form slipped on the dumbbell walk around routine. The 4kg rows felt enough considering that I was surfing a lot prior to surgery - something my physio wasn't happy with me doing, not so much from a make things worse point of view because the surgery was not considered urgent, more from a safety point of view that with a dislocated bicep tendon if I was to get another instability accident then it would damage my subscapularis. So every surf I went for was an exercise in popup form concentration to minimise the chances of another accident.

2.5kg lying dumbbell external rotation is a fairly decent weight I was told and my physio didn't expect me to achieve that. I had modified it on my injured side to limit the amount of external rotation. When my physio said I was stronger than most my age he would have been talking about external rotation only (which he measured with some sort of gauge), I am not strong by the usual standards!

At the moment I'm doing that shoulder shrug walkaround with a 2L laundry detergent bottle filled with water (because I don't have a 2kg dumbbell which is the prescribed amount).
 
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slipped_disc

Billy Hamilton status
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The rehab became prehab. When it became clear about the extent of the damage to my right shoulder overhead exercises were stopped. The following exercises were kept and for both sides were:
  • - 4kg dumbbell in each hand - move shoulders upwards and back while simultaneously flattening scapula against body - when learning to flatten the scapula just simply pinch the shoulder blades together with shoulders back. Hold the shoulder in this position, then walk 10 steps, relax and repeat 19 more times.

  • - 4kg dumbbell bent rows - 15 to 20 reps.
  • - internal elastic rotation - 20 reps
  • - external elastic rotation - 20 reps
  • - lying on side with rolled up towel under elbow, 2.5kg external dumbbell rotation 15-20 reps.
All of the above repeated as 2 sets twice a day every day. For this volume to be maintained it means that it was lowish resistance/high rep training. I would imagine most people being bigger than me would want to go heavier than 4kg dumbbell for the shrug/flatten and rows - I was told to aim for 5kg, but my shoulder position form slipped on the dumbbell walk around routine. The 4kg rows felt enough considering that I was surfing a lot prior to surgery - something my physio wasn't happy with me doing, not so much from a make things worse point of view because the surgery was not considered urgent, more from a safety point of view that with a dislocated bicep tendon if I was to get another instability accident then it would damage my subscapularis. So every surf I went for was an exercise in popup form concentration to minimise the chances of another accident.

2.5kg lying dumbbell external rotation is a fairly decent weight I was told and my physio didn't expect me to achieve that. I had modified it on my injured side to limit the amount of external rotation. When my physio said I was stronger than most my age he would have been talking about external rotation only (which he measured with some sort of gauge), I am not strong by the usual standards!

At the moment I'm doing that shoulder shrug walkaround with a 2L laundry detergent bottle filled with water (because I don't have a 2kg dumbbell which is the prescribed amount).
Thanks for sharing! Rooting for a fast recovery for you. Sounds like everything is moving in the right direction.
 
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