Next steps? Shoulder not healing after spactacular fall.

My wife goes in for surgery tomorrow for a badly broken upper humerous and possible shoulder issues (pulled down by our Labradors out walking). We are using the Carrell Clinic at Walnut Hill and 75. They are full of rework patients because of botched operations. You might check them out as well.

http://wbcarrellclinic.com/about/
 
ClimbnSink said:
Quick to go for the knife imo. Your shoulder so your choice. To a surgeon everything is a nail. Not saying the homeopathic folks aren't nuts cause they are, but there are some exercise related cures that may work.
Click to expand...

Hopefully, he can look at the data and make a determination.
He is a surgeon but also runs his own PT clinic. I assume (hope) he will investigate and do what he thinks is needed.

I am not gonna lie, I way half-assed my PT when this happened.
That may be the solution after all.
 
Badger said:
get another cortisone shot.
Click to expand...

Multiple cortisone shots is not the answer....it weakens the bone structure, actually makes it "rubbery", as my doctor explained. I've had surgery on each hand for trigger thumb. Simple, in at 7 am, out by noon. Down side is the bandage on the hand for 4-6 weeks. Make sure PT is prescribed after the bandage comes off.
 
SixPapaCharlie said:
I am putting all the MRI pics on a CD and I am going to locate a specialist this morning.
I am at the point where I will do whatever is needed. I am at the point where I have pain at any range of motion where the arm is raised past 90 degrees.

I can lift a bowling ball off the ground no problem but if I raise my arm out laterally and rotate my arm as if I am going to say "How" like an Indian in a racially insensitive movie from the 1960's, there is this sweet spot on the top that hurts like hell.
Click to expand...

Find the orthopods that work on the sports teams. I forget if Corithn is closer to Dallas or Houston, but make an appt with those docs. I've had shoulder and both knees done by the docs that take care of the Avs hockey team and the Nuggets basketball teams, lots of the college kids, the US ski team, etc. Best bet are the sports specialists...they see lots and lots of shoulder injuries.
 
I've seen video, too, maybe that same PBS deal.

Seeing stuff like that does make you think more of your body as a piece of equipment and a surgeon as a mechanic (but without the cigarette hanging out of his mouth while he's working.) "Let's pull this thing out and set it over here for a while to keep it out of the way. Dang, this time I hope I remember to put it back in before I button up the cowling."
 
murphey said:
Find the orthopods that work on the sports teams. I forget if Corithn is closer to Dallas or Houston, but make an appt with those docs. I've had shoulder and both knees done by the docs that take care of the Avs hockey team and the Nuggets basketball teams, lots of the college kids, the US ski team, etc. Best bet are the sports specialists...they see lots and lots of shoulder injuries.
Click to expand...

I work in Las Colinas.
Going to see these guys in Irving: http://www.irvingortho.com/
 
murphey said:
Find the orthopods that work on the sports teams. I forget if Corithn is closer to Dallas or Houston, but make an appt with those docs. I've had shoulder and both knees done by the docs that take care of the Avs hockey team and the Nuggets basketball teams, lots of the college kids, the US ski team, etc. Best bet are the sports specialists...they see lots and lots of shoulder injuries.
Click to expand...

That's the same guy that did both my knees. They work perfectly. He's got an Avs jersey in his office on the wall. I think it's a Roy, but I could be wrong. Nice guy, but he is a stickler about PT. I did all mine, and more, and my knees are the bees knees(pun intended).

Still thinking this is nerve bundle related though.
 
Bryan: Good luck.

I'm dealing with shoulder pain right now, too. I have an appointment with my PC Wednesday morning. I have fairly mild pain and a feeling of weakness and burning across the top of my shoulder. Shoulder also seems to catch or pop at some points during its range of motion. I have a hunch that mine is repetitive-stress related, which I seem to be prone to. I sit in front of a computer all day and unlike some folks it is not treating my hands, arms, and shoulders kindly.

Let us know how yours works out.
 
Alexb2000 said:
My wife goes in for surgery tomorrow for a badly broken upper humerous and possible shoulder issues (pulled down by our Labradors out walking). We are using the Carrell Clinic at Walnut Hill and 75. They are full of rework patients because of botched operations. You might check them out as well.

http://wbcarrellclinic.com/about/
Click to expand...

My wife suffered a four part humeral fracture a couple of years ago. It is the worst arm/shoulder injury one can experience.

I hope your wife recovers fully.
 
Alexb2000 said:
My wife goes in for surgery tomorrow for a badly broken upper humerous and possible shoulder issues (pulled down by our Labradors out walking). We are using the Carrell Clinic at Walnut Hill and 75. They are full of rework patients because of botched operations. You might check them out as well.

http://wbcarrellclinic.com/about/
Click to expand...

Speedy recovery wishes to her!
 
As an academic orthopaedic surgeon and flight surgeon I feel compelled to address some of the misconceptions in this thread:

First, just because a doc takes care of XYZ team does not necessarily mean that they are knowledgeable or up to date, or are skilled surgeons.

Sports medicine docs are not necessarily good at performing joint replacement surgery, which has its own unique considerations, problems, and potential complications. Joint replacement surgery is a specialty unto itself.

Getting recommendations on choosing physicians from lay people simply because they got a good result is not optimal or accurate.

Perhaps the best way to get an honest opinion about choosing a doc is to find someone who works in the OR where you're considering going- a surgical tech or OR nurse, and the more opinions the better. These are the people who see and work with the surgeons on a daily basis, and are perhaps the best judge of surgical skills. Second would be to talk with hospital staff who provide direct care for orthopaedic patients- they can comment on how attentive and caring the surgeon is toward patients. Finally, speak with orthopaedic implant reps, as long as they are not promoting surgeons who use their products.

From what you're describing, either a shoulder and upper specialist or a sports medicine doc would be reasonable. Be sure to hand carry your CD with the images, so they can be uploaded on the day of your visit. Do not send them or assume that someone in the office received the disk- they invariably get lost.

Hopefully you also have plain films- we often see MRI's performed that cost thousands of dollars when a simple set of plain films would provide the answer.

Good luck.
 
AcroBoy said:
As an academic orthopaedic surgeon and flight surgeon I feel compelled to address some of the misconceptions in this thread:

First, just because a doc takes care of XYZ team does not necessarily mean that they are knowledgeable or up to date, or are skilled surgeons.

Sports medicine docs are not necessarily good at performing joint replacement surgery, which has its own unique considerations, problems, and potential complications. Joint replacement surgery is a specialty unto itself.

Getting recommendations on choosing physicians from lay people simply because they got a good result is not optimal or accurate.

Perhaps the best way to get an honest opinion about choosing a doc is to find someone who works in the OR where you're considering going- a surgical tech or OR nurse, and the more opinions the better. These are the people who see and work with the surgeons on a daily basis, and are perhaps the best judge of surgical skills. Second would be to talk with hospital staff who provide direct care for orthopaedic patients- they can comment on how attentive and caring the surgeon is toward patients. Finally, speak with orthopaedic implant reps, as long as they are not promoting surgeons who use their products.

From what you're describing, either a shoulder and upper specialist or a sports medicine doc would be reasonable. Be sure to hand carry your CD with the images, so they can be uploaded on the day of your visit. Do not send them or assume that someone in the office received the disk- they invariably get lost.

Hopefully you also have plain films- we often see MRI's performed that cost thousands of dollars when a simple set of plain films would provide the answer.

Good luck.
Click to expand...

I am bringing the disc to the doc. It has the Dicom images and reader on it that allows you to scroll through hundreds of the in succession basically going through the shoulder from front, back, and top in very thin slices.

I don't have any x-rays. probably going to need new ones.
 
docmirror said:
That's the same guy that did both my knees. They work perfectly. He's got an Avs jersey in his office on the wall. I think it's a Roy, but I could be wrong. Nice guy, but he is a stickler about PT. I did all mine, and more, and my knees are the bees knees(pun intended).

Still thinking this is nerve bundle related though.
Click to expand...

Andy or Joel? Joel did my knees (arthroscopic) - into PT 3 days after surgery. Just saw him last week about the right knee. Things are fine except I'm getting old - indications of arthritis in the knee. Diagnosis - no PT at this time but lots of walking. The retired senior parter did my shoulder back in the late 80s when he was the new guy. I think I'm on the third "generation" of physicians in the practice.
 
trepine said:
Cortisone is really a short term fix, it can cause long term problems like osteoporosis (weakening of the bone) and other problems if it's used too much.



Maybe an MR arthrogram might help, it's possible you have a small labral tear, which can be hard to see on a normal MRI.



Just shooting from the hip, so take with the appropriate grain of salt
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But from which shaker????

Oh, sorry, wrong thread. ;)
 
AcroBoy said:
As an academic orthopaedic surgeon and flight surgeon I feel compelled to address some of the misconceptions in this thread:

First, just because a doc takes care of XYZ team does not necessarily mean that they are knowledgeable or up to date, or are skilled surgeons.
Click to expand...
I agree about the surgical expertise, but to me, someone who sees sports injuries all the time has lots of exerience with a variety of problems.
Sports medicine docs are not necessarily good at performing joint replacement surgery, which has its own unique considerations, problems, and potential complications. Joint replacement surgery is a specialty unto itself.
Click to expand...
Agree again. But I wasn't advocating surgery at this time, just finding someone who's good at analysis & diagnosis. I'm lucky, the practice I work with are skilled at both. Best part - they consider surgery only when absolutely necessary and no other option makes sense.
Getting recommendations on choosing physicians from lay people simply because they got a good result is not optimal or accurate.

Perhaps the best way to get an honest opinion about choosing a doc is to find someone who works in the OR where you're considering going- a surgical tech or OR nurse, and the more opinions the better. These are the people who see and work with the surgeons on a daily basis, and are perhaps the best judge of surgical skills. Second would be to talk with hospital staff who provide direct care for orthopaedic patients- they can comment on how attentive and caring the surgeon is toward patients. Finally, speak with orthopaedic implant reps, as long as they are not promoting surgeons who use their products.
Click to expand...
Having worked in two academic & research medical centers (software side of the house but I work with the medical staff when designing the software for their research) I've never met anyone on the staff that would comment, even off the record, about a surgeon's ability or competency other than saying nice things or not saying anything. Gossip, ya know.
From what you're describing, either a shoulder and upper specialist or a sports medicine doc would be reasonable. Be sure to hand carry your CD with the images, so they can be uploaded on the day of your visit. Do not send them or assume that someone in the office received the disk- they invariably get lost.

Hopefully you also have plain films- we often see MRI's performed that cost thousands of dollars when a simple set of plain films would provide the answer.

Good luck.
Click to expand...
On the positive side, we now have another AME available to pester with questions!!!!
 
murphey said:
I agree about the surgical expertise, but to me, someone who sees sports injuries all the time has lots of exerience with a variety of problems.
Click to expand...
Of course a team docs expected outcome may be different from what us middle aged lameos need. Just make the pain go away and restore mobility for forty years is different then get it working again while he is still under contract, we don't care how it works or how much it hurts in 5 years.:dunno:
 
murphey said:
Having worked in two academic & research medical centers (software side of the house but I work with the medical staff when designing the software for their research) I've never met anyone on the staff that would comment, even off the record, about a surgeon's ability or competency other than saying nice things or not saying anything. Gossip, ya know.
Click to expand...

While you can't get them to comment directly, you can get them to comment indirectly. My method: go to that surgical wing of the best hospital in the area and ask the nurses, "If you had to send your family for 'x' surgery, who would you send them to?" Poll a dozen and 10 will give you the same answer, go see them.
 
Went to the doc.
He said it is one of 2 things. Tare in the rotator cuff or tare in the Labrum.

He said both would require laproscopic(sp) surgery but he is not willing to do it until I get an arthragram MRI. His clinic doesn't do those, only standard ones but he said if I get the arthragram MRI, they will inject Dye into the joint and then do the MRI and he will have a much better picture of what's going on.

He also took some Xrays and showed me a couple things bones that need to be reshaped as well as a bone spur that should be removed.

I like that he want's more information before just going in hoping to find something.
I may hold off 3 months just because if done in January, this will eliminate my deductible and then I get free healthcare for the rest of 2015.

They need to do groupons for MRIs
 
SixPapaCharlie said:
Went to the doc.
He said it is one of 2 things. Tare in the rotator cuff or tare in the Labrum.

He said both would require laproscopic(sp) surgery but he is not willing to do it until I get an arthragram MRI. His clinic doesn't do those, only standard ones but he said if I get the arthragram MRI, they will inject Dye into the joint and then do the MRI and he will have a much better picture of what's going on.

He also took some Xrays and showed me a couple things bones that need to be reshaped as well as a bone spur that should be removed.

I like that he want's more information before just going in hoping to find something.
I may hold off 3 months just because if done in January, this will eliminate my deductible and then I get free healthcare for the rest of 2015.

They need to do groupons for MRIs
Click to expand...

Well then it's simple, just pay the tare and be done with it.:D
 
Henning said:
Well then it's simple, just pay the tare and be done with it.:D
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Agh. wife woke up at 3 AM to be on TV for some awareness thing and I couldn't get back to sleep in my groggy state Tear looked funny to me.

I need coffee.
 
nddons said:
Welcome to middle age. Enjoy the ride. :D
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LOL. I was going to say that, too. Funny how stupid little injuries you got in your twenties that would disappear magically overnight, just don't anymore, starting around 35. Then after 40 they hang around long enough you wonder if your body's immune system and healing mechanisms have given up. Haha.

A couple years ago I started actually bothering to wear gloves when doing yard work, for example. Otherwise the stupid cuts and scrapes will be there for what seems an eternity.

kyleb said:
Time for a second opinion. You don't need to let this go.
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Late on the reply, but agreed. And he did. Cool.

SixPapaCharlie said:
Yeah but it is starting earlier than I imagined it would.
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LMAO... For you and everybody else. Wait until the mystery pains start. Those are interesting. You'll pull a muscle and have no idea when or how you did it, and it'll be one of them that about kills you if you move a certain way. Not knowing when you did it makes it a "mystery" and you wonder about it while it heals up. Haha.

Henning said:
:rofl::rofl::rofl: You're never watched an orthopod work have you? Hammers and chisels brother, hammers and chisels.:rofl:
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Big time, big tools.

murphey said:
I remember the PBS series on hip replacement...not for the squeamish!
Click to expand...



Matthew said:
I've seen video, too, maybe that same PBS deal.

Seeing stuff like that does make you think more of your body as a piece of equipment and a surgeon as a mechanic (but without the cigarette hanging out of his mouth while he's working.) "Let's pull this thing out and set it over here for a while to keep it out of the way. Dang, this time I hope I remember to put it back in before I button up the cowling."
Click to expand...


A buddy of mine makes the tools. He always has multiple surgery videos available for a moment's notice whenever teenagers need to be grossed out, or shown the cool stuff so they'll want to become Doctors. Heh.

SixPapaCharlie said:
Agh. wife woke up at 3 AM to be on TV for some awareness thing and I couldn't get back to sleep in my groggy state Tear looked funny to me.

I need coffee.
Click to expand...


Ahh yes, have we mentioned the sleep problems that arise as one gets older? :) Note how many retirees who have no particular reason to be awake or places to be, are out and about at 6AM. Yup. Might as well get up and get on with it. :)
 
Last year at my annual physical, I mentioned to my doc about some aches and pains that were getting progressively worse, mainly hips and knees. He poked, prodded, bent, and twisted different parts of me, then said, "Ahh, I know what it is." Me, "Yeah?". Him, "Yeah, we call it 'getting old'."
 
It is funny your perception of aging as a younger person.
I really believed grey hair would set in around 50.

Thirty fruckin three! was when people started saying.
"Oh I like that salt and pepper look you have going"

Get off my lawn!!!
 
Like with used cars: It's not the age, it's the mileage. :D

OK, some of it is the age. I'm now (just) old enough to qualify for the seniors menu at Denny's. I hardly ever eat at Denny's but somehow that hit me as a milestone. I have arthritic big toe joints, but otherwise going pretty good. I've lost ~55 pounds since last November and I'm exercising more and feeling very good. But I still can't remember names worth a darn. My beard is gray, but most of my hair is not. And I still have my hair. So does my Dad who is 82. I hope to go another 30 or so, but who knows? I will try to stay fit so as to enjoy whatever I've got left.

It occurs to me that my avatar pic is nearly 10 years old. There's considerably less of me, but considerably more gray than in that pic. Maybe it's time for a new one?

John
 
My avatar pic needs a little less Arnold and a little more Mrs. Garrett.
I don't even know what that means.
 
jsstevens said:
Like with used cars: It's not the age, it's the mileage. :D

OK, some of it is the age. I'm now (just) old enough to qualify for the seniors menu at Denny's. I hardly ever eat at Denny's but somehow that hit me as a milestone. I have arthritic big toe joints, but otherwise going pretty good. I've lost ~55 pounds since last November and I'm exercising more and feeling very good. But I still can't remember names worth a darn. My beard is gray, but most of my hair is not. And I still have my hair. So does my Dad who is 82. I hope to go another 30 or so, but who knows? I will try to stay fit so as to enjoy whatever I've got left.

It occurs to me that my avatar pic is nearly 10 years old. There's considerably less of me, but considerably more gray than in that pic. Maybe it's time for a new one?

John
Click to expand...

I've never been good at remembering names, so I don't let that bother me. But, I've come to the solid conclusion that the only thing good that can be said about getting older is that it beats the alternative.
 
Ghery said:
I've never been good at remembering names, so I don't let that bother me. But, I've come to the solid conclusion that the only thing good that can be said about getting older is that it beats the alternative.
Click to expand...

Yep. And my dad has been saying for years "Getting old is not for wimps."

John
 
NO NO NO to cortisone shots - its the hail mary the saw bones use when they run out of ideas. Plus, they weaken the tendons and ligaments and make reinjury not only more likely but a worse injury if it happens.

I got one in my life and it was a mistake - never again.

I fell also off my bike on a trail when the trail was blocked by some idiot around a blind curve puling their kid in one of those trail buggies. . . . there is a reason why you should be on the right side of the trail . . . . but I digress.

I hurt my shoulder and broke two ribs. A calcium nodule developed and wore at my tendons and ligaments inside the bursar for a while - hurt like the dickens for 2 weeks out of every month. Doc imaged it and sawbones wanted to cut with no more than a 50/50 shot a full recovery and range of motion - mind you - all I had was pain - had full range of motion. I know that 75% of the time these calcium nodules get reabsorbed - so I waited a year - and now its mostly gone. Except for some residual soreness in and around the joint - but the pain is resolved with Vitamin M. Surgery? No.

Back to OP - if you have something that should be straight and is not -you probably separated the shoulder and broke the collar bone - and did nothing about it for 2 years. Where's your sign. . . . seriously.

Fixing it will likely require rebreaking it and putting a pin in to keep it straight - and you will always know about the weather forecast from now on. Go see an orthopedic surgeon and at least get your options . . . .
 
No I had the MRI back then and it was inconclusive.
So I just lived with it. I have full range of motion just pain as well

So top pic he says my (some bone) bends downward which is not bad but it is somewhat rare and can cause pinching when the arm is raised out laterally
BONES63655536.jpg






In this one he says there is a bone spur that may also be causing some pinching when the arm is raised. He wants to cut off that point (spur) and is also concerned about the bones that meet in the circled section. I forget what the deal is there.

BONES6669838.jpg




Lastly where these two bones meet, one is going beneath the other and he thinks that could also be putting pressure on something. He is considering removing the portion below the red line

BONES942114.jpg



The good news is he isn't doing anything until he gets the Dye x-ray back.
I am also going for a 2nd opinion just to make sure. Cutting bones out seems pretty permanent. Want to make sure.

All in all it sounds like I fell, and mashed the bones into a position that makes them press on things easier than before the fall.
 
Henning said:
Cutting bones is also painful lol.
Click to expand...

And one of my worst fears is waking up during surgery being paralyzed but able to feel. I really hate surgery. I am going to request a nerve block if they have to cut me open.
 
I think what your doc was saying is that you had a type III acromion, which might be causing impingement. The circled area, your AC joint looks entirely normal- it is not subluxated or at all arthritic in appearance.

The physical exam is the key in making a diagnosis of shoulder pain, and imaging almost secondary.

Your description of the doc's plans is a little concerning- could be this, might be that, etc. A good physical exam should really help to pinpoint the nature of your problem, and then verify with appropriate imaging.

Was this a shoulder specialist you saw or a general orthopaedist? Plus, unless you reversed the images, you showed two different shoulders. Almost always, a course of non-operative treatment including physical therapy is the first thing to try. Cortisone injections in the right circumstances can be very helpful, despite some old wive's tales on this thread.

Unless this was from a shoulder specialist, it certainly sounds a bit vague and uncertain as to the cause of your pain- I'd think long and hard before having surgery of any kind, especially in the absence of PT.
 
The vagueness if it all is my fault because I don't speak the language. I am going to do my best here to recall what was said. It was a blur. He spoke very fast.
It is only my right shoulder.

Best I can recall from the physical exam he suspects I either have a tear in my roator cuff or a tear in my (Labrum?) I think that was the word. I recall right away my next blog post is going to be about the tear in my labia.

So he wants me to get the Arthragram(sp) so he can tell what is torn.

So after that exam he sent me in for the X Rays.
That is when he said he had concerns about the bone spur and I do think he said the way my shoulder is shaped, I am more susceptible to Impingement issues.

Then he showed me those parts of bone he wants to remove.

I am moving forward with the Arthragram but I am also going to Southwestern Med where my mother works to see some people she recommended for a 2nd opinion.

His title is orthopedic surgeon at a sports medicine / PT clinic

He did offer the cortizone shot but I declined. I had one when I first got the injury. It did not help and the pain was so bad I had to leave work and take some sleeping pills to get to the next day.

Sorry for confusion. I am really out of my element talking about med stuff.
 
You might very well have a rotator cuff tear, and there are some specific physcal exam findings that would help to support this- an MRI would show this.

On the other hand, a labral tear is entirely different, in which case an MRI arthrogram is the better test.

What is concerning is the conversation (as you relate it) in that "it could be this, could be that, could be your AC joint, could be your labrum", etc. Your symptoms and the physical exam should point to a specific entity- the imaging should be confirmatory. The thought process you relate is weak as to finding the correct diagnosis.

I would never let anyone operate on me based on conjecture- there should be a firm diagnosis in place before surgery, not "we'll look and see what we find".

Anyone can call themself a sports medicine specialist- I would certainly consider getting a second opinion. But, it's not my shoulder.
 
murphey said:
Andy or Joel? Joel did my knees (arthroscopic) - into PT 3 days after surgery. Just saw him last week about the right knee. Things are fine except I'm getting old - indications of arthritis in the knee. Diagnosis - no PT at this time but lots of walking. The retired senior parter did my shoulder back in the late 80s when he was the new guy. I think I'm on the third "generation" of physicians in the practice.
Click to expand...

It was Joel. I was sitting in his office once, and he opened the left drawer, and there's a couple of small Vice Grip pliers in there with custom teeth on them. I had a good laugh and he said he designed one of them for some kind of special work on a guys neck. I wasn't laughing after that. Gulp...
 
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