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Scott Kustes
05-17-2007, 10:54 AM
As in arthroscopic surgery. I dislocated my left shoulder on Sept 14th, 2005 and had returned it to about 98% of pre-injury health. Last night, I was playing in my volleyball league and dove for a ball. Landed funny and out it came. So I spent my night in the ER getting my shoulder put back in socket. And now I'm ready to have surgery so I don't have to worry about this damn thing anymore. Anybody had shoulder surgery? What's the recovery time like? This really puts a damper on my training...back squats are out, pullups are out, pressing is out, pushups are out. Looks like lots of bodyweight squats, 1-leg squats, and sprinting (when I can swing my arm that hard). Any other exercises I missed?

On the other hand, Percosets are fun.

Dave Van Skike
05-17-2007, 11:12 AM
As in arthroscopic surgery. I dislocated my left shoulder on Sept 14th, 2005 and had returned it to about 98% of pre-injury health. Last night, I was playing in my volleyball league and dove for a ball. Landed funny and out it came. So I spent my night in the ER getting my shoulder put back in socket. And now I'm ready to have surgery so I don't have to worry about this damn thing anymore. Anybody had shoulder surgery? What's the recovery time like? This really puts a damper on my training...back squats are out, pullups are out, pressing is out, pushups are out. Looks like lots of bodyweight squats, 1-leg squats, and sprinting (when I can swing my arm that hard). Any other exercises I missed?

On the other hand, Percosets are fun.

No words of wisdom on the scope. Have a close friend who had terrible luck with his but he doesn't take the rehab seriously enough, it randomly pops out while mountain biking, motorcyling and swimming. Pretty gross.

Percocet on the other hand, I have great expertise.

Try this. I call it the Irish Budda.

Guinness, Percocet and a shot of Jameson's....

.....sit back and be one with everything.....

Garrett Smith
05-17-2007, 01:37 PM
I'd look into Prolotherapy (aka Regenerative Injection Therapy) before the scope, and maybe still after the scope.

Cold laser therapy will help minimize scar tissue and recovery time.

Let me know if you need help finding any of the folks who do this stuff...

Allen Yeh
05-18-2007, 04:56 AM
Scott,

I have never had surgery but a friend that did (warming up with 135 on BS's with his arm draped over the bar, bar started to go back...etc) He didn't take his rehab seriously enough like Dave's friend and it still pops out when just doing random things.

While it's not helpful right now I've been following Mike Robertson's/Bill Hartman's/Eric Cressey's stuff on rotator problems and how they can stem from a dysfunctional scapula and not necessarily just a rotator problem.
When you are in your "rehab" phase, I'd seriously look into that and their articles/work.
If you want links to their articles let me know and I'll link them all up here.

List of exercises:
-bodyweight squats
-1-leg squats
-1-leg straight leg deadlifts
-step ups/lunge variations
-Possibly bounding/jumping stuff? i.e. lateral bounds, squat jumps...etc
-scapular strenghthening exercises
-glute activation exercises
-front squats (if you utilize the arms crossed method)
-lumberjack squats (iffy?)
-sprints on a road bike or stationary? (unsure how hard that would be on your shoulder but just a guess that a stationary bike would be easier).

Hope these help, and let me know if you want me to dig up those articles.

Garrett Smith
05-18-2007, 05:31 AM
Allen's suggestion on the scapular work is a great one, try to find that article on T-Nation...

Allen Yeh
05-18-2007, 06:16 AM
Excellent article:

Push-Ups, Face Pulls, and Shrugs
...for Strong and Healthy Shoulders!
by Bill Hartman and Mike Robertson

http://www.t-nation.com/readTopic.do?id=1426252

Robb Wolf
05-20-2007, 12:03 PM
Scott-
If you do end up having surgery find the BEST person you can for the job. Not a generalist...this person should do nothing but shoulders morning, noon and night.

Avoid surgery if you can.

Valium scratches my itch better than percoset...but, hey! Each to thier own.

Rick Deckart
05-20-2007, 12:16 PM
In my humble opinion surgery should always be plan B, after plan A failed. Plan A is conservative therapy, strength exercises, stretching, stuff like that. The better docs will ask before surgery how long plan A was followed, a month, two month, half a year or even a year? Remember after plan B you will still need to follow plan A, so I would seriously ask myself: Did I really play low with exercises which aggravate the problem for at least half a year, doing rehab exercises religiously and did I see no improvement... In other words, was there a serious no nonsense plan A you followed or was it just so so (no offense here...)

Scott Kustes
05-21-2007, 07:24 AM
Robb, the Dr. I'm seeing is the head of orthopedic surgery for the largest hospital group in the region. From the PTs I'm working with, he's pretty awesome, so I feel in good hands there. And I've never had Valium, so I can't comment. Only had 1 Percoset in my life and that was last Thursday. Too bad I didn't do this a month or so ago...we could've had a "one-arm showdown"...a Royal Rumble of geezers with 1 bad stick.

Garrett, I found a couple website on prolotherapy but couldn't find anyone closer than Indianapolis. Any help? I'm in Louisville, KY by the way.

Peter, I also view surgery as a last resort. After the first dislocation in Sept 2005, I did serious rehab work. Until last Wednesday, around 6:45pm, I considered my shoulder to be nearly 100%. I could do all exercises without any pain....clapping pushups/pullups, bench press, overhead press, C&J, overhead squat, back squat, etc. I've been putting in some hardcore PT since last Wed and the pain is nearly gone and my ROM in the front and to the side is 95-100%. Pain/pressure only occurs when I'm behind my back as it forces the ball of the humerus forward (so like a smart guy, I avoid that position). I've had problems with this shoulder since sophomore year of high school (1995) when I took a helmet under the shoulder pads...over the years it's been pinched nerves and strained muscles and who knows what else. I know when I saw my family doctor after the first dislo, he said something to the effect of (while flipping through my file) "left shoulder, left shoulder, left shoulder...you're never sick, but I've seen you for this left shoulder about 5 times over the last 10 years." Since the pain is going away so quickly (perhaps because everything was so torn up the first time, there was less to tear this time) and ROM and strength are returning, I may see if we can make this a "if it happens one more time" thing. We shall see what the good doctor says.

I'm apparently one of those marvel patients who heal quickly. I think there are several contributing factors, including top-notch diet and loads of fish oil, less tissue to tear the second time, and more prompt, better medical care this time (as opposed to Acapulco, Mexico).

Garrett Smith
05-21-2007, 06:19 PM
Scott,
Here's a good start. A review on prolotherapy (aka Regenerative Injection Therapy) (http://painandspinecare.com/images/RIT%20for%20Axial%20Pain%20-%20in%20print.pdf) that has some sort of link to the University of Louisville. I'd try that route first.

Here are some other things to search under:
Prolotherapy
Proliferative Injection Therapy
Regenerative Injection Therapy
RIT

That may help. Some anesthesiologists are getting into it, however, I don't believe they truly understand the mechanisms, compound formulations, or intention behind this modality. Basically, if the doctor thinks of this modality as only being for pain relief (and not for repairing tissues), then find someone else--they don't understand what it is meant to do...

Scott Kustes
05-23-2007, 12:54 PM
Walking down the steps this morning, missed one (haven't done that in ages), grabbed the banister, and out it came again. So I suppose that pretty well seals the deal on having surgery. Pain level is significantly higher than it was after last week's dislocation.

Dr. G., still searching for local prolotherapy.

kevin mckay
05-23-2007, 01:09 PM
Thats sucks! get better fast

BTW I am on my second treatment of prolo in my SI and l5-s1 fisets (spelling?) man does that shit hurt I screamed like a little girl felt like I had a fork in my back and 220~ running down my legs.

Garrett Smith
05-23-2007, 05:52 PM
Scott,
I can't find anyone there either.

Either no one in KY is doing it, or they're really bad at optimizing their websites (maybe both).

Considering how lax your shoulder has become, surgery may be the best option at this point.

Scott Kustes
05-23-2007, 06:50 PM
I may call the place in Indy. It's only an hour and a half to two hours away. May be worth it for a once a week treatment or something for a few weeks. My wife is out of town next week, but I hope they can get me in quickly so I can get the rehab process underway. Unfortunately, I think surgery is the best option...I imagine double dislocation in a week has wrecked everything in there.

David Wood
05-23-2007, 08:53 PM
Scott: not to hijack, but I'm about to do this myself for rotator cuff issues. (Next week.) Yes, it's plan B (or more like D or E) . . . I've been on Plan A (rest, careful rehab, heavy-duty NSAIDS, ART, ice, stretching, and God knows what else) for over a year now. I can get substantial relief . . . as long as I don't actually, you know, *use* it. Any form of pullup, pushup, dip . . . pain. I can front squat, or even back squat a light weight. But no pullups and/or dips pretty much means I can't do CrossFit, and that's damn near killing me.

So I'll do the scope. The doc comes highly recommeded and (apparently well respected . . . does about 8 shoulders a week (although he also does other joints (makes me nervous))). I know people who have had complete and successsful recoveries after his work. He claims it's about 1/3 how bad the damage is, 1/3 his skill, and 1/3 whether I do the recovery right. He's seen me work out and pretty much threatened NOT to do the surgery if I wouldn't play by his rules post-surgery.

Garret, can you recommend someone in Central NJ practicing the cold laser you recommend. My relevant ZIP code is 08807 (Bridgewater). I know you've mentioned (on the CF board) one particular company/technique; they don't seem to have anyone close by. Anybody else you're comfortable recommending? (Sorry, if you want to tell me to do my own damn research, that's fair . . . I'm just being a leech here.)

Thanks,
Dave

Garrett Smith
05-24-2007, 07:34 AM
Dave,
I don't know anyone in that area.

Look around on your own, then post/send me the websites and I'll check them out to make a recommendation. That should work for both of us...

David Wood
05-27-2007, 06:43 AM
Still looking. Thanks Garrett, I'll post or PM what I find.

Scott Kustes
05-29-2007, 11:37 AM
June 13th is D-Day. I suppose I should hit some rehab between now and then to try to go in with as much strength as possible in the joint.

Scott Kustes
06-04-2007, 10:04 AM
Okay, so I'm thinking through this surgery next week, trying to get my ducks in a row to prepare for a great recovery. The area I'm really examining is nutrition and thought I'd throw a few questions y'all's way.

First, I will be getting antibiotics since there will be wounds. I currently take probiotics. Should I double or triple them afterwards to repair the gut flora? If so, how long? Second, I already eat a solid Paleo diet with a few beers a week and a cheat or two on the weekends...I'm probably 95%, but plan to be even stricter for the two months after surgery. I also include only a little bit of nightshades with no ill effects - some salsa or hot sauce on chicken. I will probably ditch these as well for a month or so to make sure there is no undue inflammation. There will be lots of salads and vegetables.

So with nutrition in order, is there anything else I should look at? I take Glucosamine already...should I increase this or just stick with a regular dose? Beyond that I'll be sticking with my ZMA and doubling up on the fish oil for awhile to help cut inflammation.

Anybody have any other thoughts?

Dave Van Skike
06-04-2007, 11:05 AM
Don't know about all that macrobiotical stuff but I've done some scope time and long rehab. Here's the basics of post surgery fun.

clean your house before surgery.
reduce your stress level, take more time than you need for everything.
get new sheets and pillows so you are comfortable when you sleep.
take walks amongst green stuff (you know trees and shit) as soon as you can.

anticipate that you will get euphoric that it is over, then a little depressed from at lack of mobility and pain meds..if you take them.
schedule some time with friends and family
Read good shit, avoid the blue light, tv and internet are inflamamtory

Oh yeah. do your f'ing PT. even if you need to take pain meds to do it..do your PT.

Scott Kustes
06-04-2007, 11:15 AM
Good stuff Dave. The house is clean (wife is a neat freak) and I'm finishing up the repainting of the bathroom this week, so that'll be one less concern. I have 2 or 3 books that I've been needing to get into, so a few days off of work will allow me to get into them.

I also plan to sleep as much as possible. I usually get 8-8.5 as it is, but pain meds will probably help me catch a few extra winks during the day. I won't be taking them unless they are needed however as I'm not big on medication. I'll probably get the dog out once I can get the sling off (which he said will only be on for a few days and as needed to get movement going again) and take some walks.

And I will be PTing like mad, following it to the letter.

Garrett Smith
06-04-2007, 04:28 PM
Scott,
I always suggest a loading dose of probiotics after antibiotics of nearly any sort. Contact me if you want more info.

Definitely no nightshades. Definitely yes Paleo.

Possibly some liver supps to help clean out the pain meds.

Systemic enzymes will likely help the healing go faster. Wobenzym seems to be one of the better ones. I must say I've been personally disappointed by Vitalzym.

Yuen Sohn
06-11-2007, 07:44 AM
Scott,
Good luck with everything on the 13th. I wish you a smooth and successful recovery.

Scott Kustes
06-13-2007, 06:49 PM
Thanks Yoon. The surgery went well. Dr. repaired the labrum, said the rotator cuff and biceps are in fine shape. Last dislocation caused some unrepairable cartilage damge, which could manifest some arthritis later in life. No pain yet as the nerve block is just now wearing off. Took my first of 6 Oxycontins (3 days worth) and then I back off to Percs. I have a cool device that pumps ice water out of a cooler, through a pad and back to keep icy cold water on it. Also have a bag with a tiny tube delivering numbing meds into the shoulder.

So many meds...I'm sure those liver boosters are going to help. Also picked up some dandelion root tea and 200 count wobenzym. Oh yeah, and an 87% chocolate bar. :D

Typing with one hand sucks BTW.

Allen Yeh
06-14-2007, 03:31 AM
Glad the surgery went well.

Garrett Smith
06-14-2007, 08:00 AM
Scott,
Just heard about some research that showed playing music in the background (during recovery) helped lower the dosages of painkillers needed post-surgery.

Do your best to avoid any movement that causes pain, as pain increases protective reflexes and inhibits healing. Do what you need to in order to keep your bowels moving d/t the painkillers.

Basically, get off the meds as soon as you are able/comfortable.

Traumeel may be helpful as well.

Scott Kustes
06-14-2007, 09:47 AM
I have pretty poor ROM right now. I can move it maybe 6" front and side and nothing to speak of to the rear. But I am able to get it out of the sling, which feels good. The wife and I just took the dog for a short walk...it was nice to get out in the sunshine and fresh air. I will probably lobby for some more walking later as it's nice to get out of the house.

I thoroughly enjoyed the dandelion root tea. That is probably something that I will keep up often now. The one I have is roasted dandelion root...it has a very nice roasted bitter taste.

What is Traumeel for? I am going to finish the course of oxycontin, which is 4 more pills, last one is 8am Saturday. From there, I'll see what I need in terms of painkillers. I plan to go back to work Monday, so my painkiller usage will have to tail off. I may shift to ibuprofen or aspirin (recommendations?) so that I can drive and work while still having some pain relief.

Garrett Smith
06-14-2007, 10:46 AM
Traumeel is a combination homeopathic specifically for "trauma" to the musculoskeletal system.

It works great when used for this indication. Problem is, people start using it for every single ache or pain (obviously not all of them are trauma) and then they might only notice it helping 30% of the time, so they stop using it.

Using it post-surgery or injury, it works awesome. Some on this board who have tried it may wish to chime in...

Easy to get at nearly any supplement/health food store.

David Wood
06-15-2007, 03:20 PM
Garrett: How long post-trauma (post-surgery) is Traumeel good for? (i.e., how long after can it still provide value?) I'm about 2 weeks post now, coming along nicely (I think), but interested in anything that will futher the recovery.

Garrett Smith
06-15-2007, 05:11 PM
Dave,
I'd definitely think it still has some use in the situation you describe.

If it doesn't work, just save it for the next traumatic event...such a small investment for such a miracle remedy (when it works).

Scotty Hagnas
06-16-2007, 11:07 AM
Hi Scott-

Best of luck with your recovery. With careful dedication to your recovery, you should be able to recover fully. Once you are done with the PT, check out all of the info you can on joint mobility and scapular stabilization.

I have dislocated my right shoulder a minimum of 40 times, and finally went under the knife in 1999. I found that the PT will take you back to a basic minimum function, but beyond that you will have a long way to go to get it back to full athletic function. I have been pretty adventurous in taking my shoulder back to full ROM, while being careful to train for stability of the scapula. The serratus anterior muscle usually tends to shut down with shoulder trauma, leading to poor scapular control and increased likelihood of impingement issues. This caused trouble for a few years until I realized how bad the motor patterns in my right shoulder had become.

I've suffered no further dislocations, and am far stronger after the surgery than I ever was before it. So much for my PT's advice that since I was over 30, I should never lift more than 30 lbs overhead.

Work hard on your recovery, and you'll be fine.

Scotty Hagnas
CrossFit Portland

Jared Buffie
06-16-2007, 05:49 PM
Scott,

Glad to hear you're recovering well. I suffered from chronic anterior dislocations of my right shoulder (it would be out so far I'd have to go to the emergency room so they could sedate me to reduce the dislocation). It got so bad that it would pop out if I rolled over in bed funny.

I had a modified Bristow procedure done in 1998 (turns out they don't really do them anymore except for offensive linemen in the NFL and stuff, but I'm Canadian and that's probably all the local surgeon knows how to do - no incentive up here to learn new things because of the socialized health care, but I'll save that rant for later).

I managed the pain with Tylenol 3's (which I though were a big deal because I never take anything - my wife, who was my girlfriend at the time would wait 15 minutes until they kicked in to challenge me to a game of Scrabble and then kick my ass), and I was back on the ice playing hockey 6 weeks after the surgery and competing 8 weeks after.

I guess what I'm trying to say is be patient, rehab hard, and your prognosis should be favorable. As much as it sucked (every try wiping your ass with your left hand?), I'm actually glad I did it. My range of motion, while reduced, is a good trade off for my shoulder not popping out anymore.

Best of luck.

David Wood
06-17-2007, 03:46 PM
Thanks, Garrett. Will pick some up.

Scott Kustes
06-18-2007, 05:39 AM
Jared and Scotty,
Thanks for your stories. Scotty especially, I know you do some good stuff with gymnastics and all, so knowing that you've had your shoulder operated on makes me feel good. My ROM is returning steadily and I'm already off of pain meds. I haven't had anything since Saturday night. Lots of icing and I have some Aleve in case it starts acting up while I'm at work (where I can't exactly pop Percosets). Friday night seemed to be the turning point. I went to sleep with very limited mobility and woke up able to fully contract my trap to pull the shoulder up to my ear and I can also bring my shoulderblades all the way back together painlessly. ROM pretty much doubled overnight and it has steadily improved since. Keeping the arm straight, I can get it up to a 45 degree angle or so without pain.

My first PT session is tomorrow at 8:15. I have a 6 week course of rehab, which I don't expect to gain me alot in terms of strength. I'm most concerned with ROM...strength will come back over time.

Thankfully I'm off of the pain meds, which require eating, so I can get back to IFing....I don't enjoy eating in the morning anymore.

Scotty Hagnas
06-18-2007, 04:59 PM
Scott-

Glad to hear it's progressing well. Best of luck for a quick recovery!

Scotty Hagnas
CrossFit Portland

Scott Kustes
06-19-2007, 08:33 AM
Holy moly! I had my first rehab session today. That was not a painless experience. But I did manage to get my hand overhead with ~2lbs of weight. Bow to my superior strength!

There was an out of shape lady in there who said she had her shoulder operated on in August and it took till January to get full range of motion. I'm sure functional fitness beforehand and a very diligent diet and supplement routine is helping.

Scott Kustes
06-28-2007, 11:23 AM
2 week update:
ROM is 80-90% (depending on the movement), strength is pretty pathetic. Pain level is nil unless I get a bit overzealous or get to the end of ROM. I saw the surgeon yesterday and the only thing he said to stay away from is external rotation. All seems to be repairing well, but the dr. warned me to give the labrum a full two months to repair before I start getting crazy with it.

Dave Van Skike
06-28-2007, 11:39 AM
Nice work.
strenght will come back slowlyslowlyslowlyslowly and then exponentially faster each week.....hang in there, that's great ROM for two weeks out.

Scott Kustes
07-03-2007, 01:05 PM
3 week update:
Tomorrow is 3 weeks since the surgery. The shoulder is doing well. The PT and surgeon are discussing my rehab protocol as the surgeon doesn't want to move me to weights yet, but the PT thinks I'm ready to progress ("above average progress" was the term he used in his note to the surgeon). ROM is progressing slightly....moving towards the 90% range everywhere but external rotation and abduction. We're laying off of the external rotation/abduction for now per the surgeon's advice, so the ROM of those moves is decreasing (PT said it'll decrease until the labrum is healed enough for us to go back to working it, then it'll come back), but everywhere else is improving.

I did my first real workout in about 4 weeks today. I'm obviously severely limited by not being able to put weight on my left arm. After doing my rehab work, I did some right handed DB presses, 1-leg squats, and followed that up with Tabata squats and Tabata situps. Both of those started off very strong and then reality reared its ugly head and fatigue set in on the 3rd set of each. My legs are destroyed. I thought I'd be able to jump rope since that's mostly wrists and elbows, but after 10-15 seconds, my shoulder showed me how much it appreciated that. So that's still out. I know that I can't sprint yet. I may give some jogging ("or yogging. It might be a soft j. I'm not sure but apparently you just run for an extended period of time. It's supposed to be wild.") a shot just to keep some blood flowing. Although I hate jogging, so I might not be able to motivate myself to do that.

In other news, the last 6 weeks has seen a drop from 193lbs to 183, not all of which was fat (although I am at least as lean as I was, so a good portion was fat). So the good news there is that my lack of exercise isn't contributing to fat accumulation. Low-carb Paleo FTW.

Robb Wolf
07-04-2007, 09:32 AM
Dude...I'm going to find a promoter to enter you in some one handed boxing matches...will check in later.

Scott Kustes
08-04-2007, 04:08 AM
This coming Wednesday will mark 8 weeks since surgery. I was discharged from PT yesterday, so I'm now on my own. ROM is within 2 degrees of 180 on both flexion and abduction, past 90 on external rotation, whatever is normal on internal rotation, and just all around "great". My left arm ROM is nearly 100% of my right arm ROM, so that's all good. My focus now is on scapular stabilization and rebuilding strength. I hit the Gravitron (why does that sound dirty?) this week, cranking the assist up to 170 for a set and 155 for a set (at a BW of 185) of pullups and dips with no problems. I just wanted to see how the shoulder would react to some weight. I'm able to bench press.....the bar for reps with no pain/instability. I have done some light deadlifts and Romanian deadlifts, so it looks like the groundwork is laid for starting to rebuild. I can front squat lightly, but still can't rack a back squat comfortably, so that'll have to wait probably another month or so. So I'll be working alot of assisted pullups/dips, stretching to keep my ROM, and other scap. stabilization exercises.

All in all, I'm very pleased with the results of the surgery. Prior to surgery, my arm felt like it was kind of floating within the socket, almost like it was just barely attached. I could tell when benching previously that, while it didn't hurt or feel like it was going to pop out, it certainly felt different than my right arm. And after the two recent dislocations, it would sound like Rice Krispies when I moved it. Now it feels solid, although the muscles are a bit weak. But when the PTs would get in there really moving it around and working it through the joint, it just felt solid. I think a few more months and I'm going to be able to start really getting back to heavy lifting and maybe rise above the status of "chump".

Mark Brinton
08-10-2007, 12:08 PM
Scott,

Glad to hear of your positive experiences thus far. I had surgery for both my shoulders; bristow & bankart. On balance the surgery has resulted in a substantial, long-term improvement in my quality of life.

Mark