Anudder shoulder

[Don P]

About 3 weeks ago they went into my right shoulder again. I had felt something tear and the MRI showed 3 tears in the rotator, something going on with the bicep but the radiologist noted there was a motion artifact, I had moved while it took that particular shot.

When the doc got in there the rotators were not torn but are stretched very thin, apparently they are flying under MRI in places. The doc is good, he's put me back together multiple times in the past 20 years, he suspected the MRI wasn't really telling us everything about the rotators and the bicep was not acting right. We had agreed beforehand if it didn't stand a good chance of improving things not to mess with it, so the rotators are on their last hurrah, the 5 places they pinned last time were holding and he didn't do anything to them.

He shaved the bicep a little last time and it was the real problem. He showed me pics last week. That tendon should be nice and round, mine is drawn out flat and the end was just individual separate fibers, kind of a pile of hair connecting at the shoulder. He shortened it about 1/2" back to better connected tendon, drilled a 1/4" hole in the bone, stuffed the tendon in the bone and pinned it there. Should be a good solid repair since he could stuff it into the bone rather than just tagging it onto the bone the way rotators are done. He removed some bone spurs, then ported and polished a little while he was in there.

He said this was a powerlifters injury caused by many reps at overload. He's repaired it in a number of men and one woman, this is from repeated heavy lifting.  So, I'm trying to use more hydraulics, lesson here young man is you'll end up needing hydraulics sooner or later, save your muscles and get them sooner. I've bought the doc a boat instead of me owning a good loader.

Stuff I think I've learned, feel free to correct me here;
Tendonitis is an acute inflamed injury, specific in occurance and of relatively short duration, cortisone works here. However, a raincoat ain't gonna help in the deep end of the pool. The real solution is figure it out or cut it out before it becomes...
Tendonosis, that's us, chronic abuse of the tendon, inflammation is long over with, rode hard and put up wet repeatedly. Cortisone simply steals collagen from what is there and makes it fail sooner in that case.
Watch antibiotics, if the side effects say anything about spontaneous tendon rupture, like Cipro or any of its cousins, you might want to rethink that. I suspect a number of us are quite literally hanging by a thread, don't abuse cortisone or antibiotics.

[yukon cornelius]

Prayers for recovery! It is tough on a person to not be 100%.

[thecfarm]

Good luck on the healing and may you have no more troubles with that shoulder.

[Brucer]

... Watch antibiotics, if the side effects say anything about spontaneous tendon rupture, like Cipro or any of its cousins, you might want to rethink that. I suspect a number of us are quite literally hanging by a thread, don't abuse cortisone or antibiotics.

I happened to my brother. He was rescuing a kitten in their house and it bit him -- hard -- on the finger. Pain got worse and doctor diagnosed a bone infection. It required surgery to remove dead and infected tissue in the bone, followed by antibiotics. The doctor said not to do anything requiring "a lot of force" for the next six months. Apparently there was a misunderstanding about what constitutes "a lot of force". My brother subsequently pulled a tendon off one of the bones in his finger.

[samandothers]

Take it easy and be the brains of the organization!

[doctorb]

Regarding antibiotics, I know of no other family of antibiotics, besides the quinolones, that lead to tendon failure.  Ciprofloxacin, or Cipro, is by far the most commonly used antibiotic of this group.  All the other antibiotics known to most patients, like the penicillins or the "mycins", do not lead to tendon problems and should not be avoided for such reasons.  This is a complication of a very specific group of antibiotics and not something that can be ascribed to the general wide world of these drugs.

[Don P]

Good deal, thanks Doc, I wasn't sure how widespread the issue was.
I was a month or two out of the first shoulder surgery when a walk in clinic doc prescribed cipro. Luckily the couple I was working for at the time were drug scientists. They saw what he prescribed, clued me in on the tendon issue and it went in the trash. I did learn to pay attention to the side effects in fine print. Which is really part of being your own advocate, especially when bouncing from one doc to another.

[Brucer]

Thanks for the reminder, doctorb.

I should have mentioned that in my brother's case, the problem was the specific antibiotic, not antibiotics in general. My brother is seriously allergic to the penicillin family and will often be prescribed other antibiotics where a "--cillin" would normally do the job.

[Pulphook]

Rotator cuff tears from too many falls and lifts over years of fun. The last was a hard fall on frozen ground last winter while clearing a blowdown.
Had to throw the running saw, land on the shoulder rather than face planting.
The Orthopod said because of age he couldn't sew it back without the sure possibility of it not holding. Couldn't raise my arm over my head.
He shot me with cortisone ( how do you spell this Doc ? ). It's been 6 months and it worked, and is working.
BTW: why do you Docs always tell us that "..it'll feel like a bee sting" ? Hurt like hell; kept the needle moving around in the joint, and telling me to "relax" :'( .

[Southside]

Pulphook, all depends on the size of the bee I suppose.  Maybe the doc was thinking of the Asian Giant Hornet when he said that.  

[Don P]

What I can look back on mine and see what happened in hindsight, but everyone is unique and creative. I injured it and couldn't raise it, got a cortisone shot. I turned to the doc scowled and growled at him  :D.

10 years later it was getting bad, I fell and couldn't raise it again. I got another shot and an MRI.  That original problem tendon was torn out, retracted, old and atrophied. probably about 10 years old. the other was fully torn and fresh. After that shot the shoulder went down completely, it fell apart. That's when I decided to stay away from cortisone. He did surgery and with 5 anchors got it all stuck back together.

 When he was in there this time, the repaired tendons are stretched quite thin but it is holding. He removed a pretty large piece of torn scar tissue from that repair area. I think that is the tear I felt that sent me in this time. Also while he was in there this time he did the bicep tendon repair. He had commented on it being chafed and he shaved it when he was in there before, it wasn't as bad 6 years ago and he was busy pulling that tiny retracted tendon and muscle over and pinning both rotator tendons back down. That recovery hurt but has held, I do look at hydraulic equipment sales more than tool sales now. I'm not sure I wouldn't shop another opinion Pulphook but we all do tear in our own unique way.

And yup I'm trying to keep my tail in a chair today, been havin too much fun for 6 weeks out from this surgery, they're both all jacked up but this one isn't nearly as bad as that original one. Patience is a virtue .

[Magicman]

  I wish you the best with your recovery. 

[Pulphook]

Hey Don, best success with the recovery.
The shoulder is one complicated joint especially for us older species (you never said how old the shoulder is ???  ).
My Orthopedic Surgeon was a rare bird for a surgeon not recommending surgery.
But boy that cortisone shot was a trip to H; worth it tho. "Relax" he said as the foot long rod is probing around the joint.
He did show me a rotator joint repair rig ( like a knee prosthesis ) he had invented that could be implanted if needed much later. Hope not.

[Don P]

Thanks guys, recovery is going well... but all the other kids want to go out and play

My Mom has had that reverse shoulder replacement done, then this past Christmas she fell and split the arm bone lengthwise where they had grafted the titanium in. The first docs wanted to leave her broken, not an option. It took months but they got it all wired and pinned back together at Duke, she is playing piano for the "old folks" again.

Now for horse needles, holy cow, the anesthesiologist came in to give me the nerve block this time. They had a drip going but I was still 100%. He had 2 syringes in his hand about the size of caulking tubes, he couldn't wrap his hand around them, there's an 80 penny pole barn nail sticking out of each one and he proceeds to stick one my neck and go hunting. I had forgotten apparently to tell anyone that I had some pinched nerve trouble in that particular vertebrae and that needle lit me up. The bee was in my neck but the fire was running down my arm and growing fast. He seemed unfazed and slipped the second tall boy in. All I could think as I came down from the fun was that poor old lady in the next bed ain't gonna put up with that nonsense, and then boop, I was out. I personally hope she decked him :D

The nerve block is weird. You wake up and the arm is totally out. You can see it but have no control or feeling of it, its just swinging by gravity in the sling. It lasts about a day. When they did the rotator on the left shoulder last summer that arm was still out and I was standing down in the kitchen and looked down. I had one finger bent just about backwards against a countertop but was getting no feedback from it. I could just look down and think, that's gonna hurt. Sure enough that was the first thing to wake up. Takes your mind off the other problem  :D.

[bwstout]

I had the reverse shoulder done a couple of years ago and I have been pain free and it works as good as it did 40 years ago. Going to have the other one done this winter. But could only image what your mom went through. I never thought about breaking it. Dr. said don't lift more than 100Lb over your head just laugh at that I do go to get 50lb above my head. :D

[Pulphook]

Some off the topic, but much of what we get for med care now originated in combat situations.
Because many of us work solo in woodlands, it's worthwhile to take a local Wilderness Medicine class.
The instructor had just rotated from a tour in Iraq as a Corpsman.
Learned much that could easily save me or a partner when far from an ER facility. Bleeding out, shock, CPR stopped heart.
Had some very basic mandated emergency care in my mil trainings, but it was nothing like this recent Wilderness Medicine program.
She made us do IM injections as prep for diabetics or anaphalactics. Great program.

[Ron Scott]

Had a x-ray of my left shoulder this morning to determine cause of pain. Doctor has me scheduled for a shot Monday morning to help relieve the pain. 

[petefrom bearswamp]

I feel everyone's pain having blown both rotator cuffs, both repaired years ago and are gone again.
Also got an antibiotic about 10 years ago for a bladder infection while elk hunting in Jackson Hole.
When I got home and was cutting up my cow elk, I got a piece of tissue stuck on my left fingers and violently shook it off.
Immediate pain and this resulted in detachment of my left longer bicep tendon.
I later read that that particular med can cause weakening of tendon attachments.
May have been one of the meds doc mentioned above