At a crossroad- arthroscopy or more physical therapy??

Posted , 3 users are following.

Hi, I'm a fifteen year old softball player fairly well acquainted with medicine and the procedures done for shoulder pain. I have had shoulder pain for about 2 years, due to improper throwing mechanics. I think a possible cause of this pain is due to altered throwing mechanics from elbow physical therapy 6 months before the onset of my shoulder symptoms. 

My shoulder pain began around two years ago, gradually increasing in intensity and frequency. Initially, the pain was upon throwing, and lasted about five minutes after stopping the throwing motion. It has progressed to the point where I have pain/ stiffness/ clicking at rest and doing normal everyday activities, and I have not thrown for a month and a half. 

About 4 months after the pain started, I was put on a vigorous (and painful) physical therapy regimen, which I did not do as much as advised because it seemed to make the pain worse.

My high school ball season started in October with twice-weekly weightlifting sessions. The bar weighs 45 pounds, and I weigh 100. Needless to say, I tried to do the squats "through the pain" to avoid being looked down upon by the coach (it was my freshman year). I quickly got a doctor's note after about two weeks of workouts, but the damage was (further) done. 

The season officially started in late January, with 2 1/2 hour practices every day, and the pain got much worse, to the point where sleeping was difficult and writing (the pain is my dominant arm) was a chore. I went to see an orthopedic surgeon who suggested that I get cortisone injection, along with an MRI. This was in the middle of the season, so I rested it for a week afterwards and the shot had little effect (worked for about 3 weeks). 

The MRI was done and revealed no major defects (full thickness rotator cuff tears, large SLAP lesions, etc.) of my shoulder. The surgeon recommended rest, but I played through the end of the season (early June). 

I had little improvement in the five weeks that followed, restricted to no throwing. I went to see the orthopedic surgeon about three weeks ago and he said that we are basically at a crossroads. He gave me my second cortisone injection at that appointment and instructed me to begin physical therapy in two weeks, which I did. I have various periscapular strengthening exercises, using the red theraband and one lb weights. I have been doing them every day since I saw the therapist (four days). The decision that I have run into is- do I a) continue with the physical therapy and see if improvement happens or b) have an exploratory shoulder scope with a removal of the bursa sac (subacromial decompression)? The doctor said to go ahead and schedule the surgery, and we could cancel if we felt the therapy is helping enough, so it is currently scheduled for July 28th.

There are a few complicating factors to the decision:

1. I have Driver's Ed scheduled for three weeks from now (two weeks form the surgery date). Will the surgery affect this at all? The doctor was very optimistic that I could be driving by this point.

2. I am registered to play field hockey this fall. The doctor said that this was okay because field hockey is played below the waist, but I still have some doubts.

3. School starts August 25th, and I am taking writing-intensive courses. Would a month be enough time for me to write? The doctor said that the recovery was about two weeks, but some of the literature I've read online says otherwise.

4. Finally, my most important concern is is it realistic to expect my shoulder to be 100% if I do the surgery with all the necessary physical therapy and post-operative care afterwards? 

Bottom line: I want to play, and play PAIN-FREE.

Also: We asked my pediatrician what she would recommend, and she said that surgery would probably be best because throwing at the intensity that I do would just require cortisone shot after cortisone shot. The surgeon, however, said he tries not to operate unless he feels that it is necessary.

Any help/ advice to making a decision would be GREATLY appreciated.

1 like, 5 replies

5 Replies

  • Posted

    I have the sme issues in both shoulders. Let UR shoulders heal. Slow down . Take a break. Or u will have issues u don't want the rest of UR life.mur too young to have pain issues. This can develop into serious loss of mobility down the road. Listen to UR doc he treats many with the same issues. Be patient. 

    Wishing u well on the road to permant recovery thru rehab and PT.


    • Posted

      You are way too young to have your shoulder "violated". I am a physician and can say almost all surgeons claim they only operate when there is no alternative so I would always take this statment with a big " grain of salt"! I would ask your surgeon what he/she thinks they will find at laproscopy that the MRI did not show. Many recent studies have concluded that "exploratory" laporascopy of joints ( shoulder, knee, hip) are not worthwhile and often harmful. The use of cortisone shots only gives temporary relief, as you have experienced. They also have less effect with repeated doses, can increase the incidence of tendon rupture and in rear instances result in injury to other joints. ( Steroids can cause, among other things, aseptic necrosis of head on the femur which usually requires a replacement of hip joint.) At 15 your shoulder is still developing and overuse is a big problem. Coches tend to use their good players over and over without adequate rest. I sugest you google pitcher shoulder injury. Pay particular coments by Tommy John, who has a typeof surgery named after him-he was a major league pitcher. He did well after his surgery-I am definately NOT recommending this surgery for you. Tommy John says that his injury and that of many pitchers is due to over use as young players and is a very strong advocate of more rest between pitching assignments especially for the developing teen age player. Some times too much exertion is worse than no exertion. Be patient, get good physical therapy, see a sports doctor. Never have surgery if there are not clear indications and a clear goal (repair a known problem - not just a let's look around and see if we can make things better). Good Luck 
    • Posted

      Great advice and support for cup duke.

      i have RA and osteo PSA in all my joints . Talk bout a itis antibodies in full hear hitting all my poor joints. I was diagnosed at 39 three hip implants and on mom recalled with complications.

      i know UR  comment was for duke I just wanted to support UR reply.


    • Posted

      Please can you read my earlier reply to Cpduke88 and respond soon. Thanks. Sue confused
  • Posted

    Hi I have similar shoulder problems and I am 55. I tripped on a kerb and fell forward on my right arm and I fractured my right upper humerus. An op led to a plate nails and a pin put in. I still get pain when I over excert myself. Would removal of the pin help as my tendons muscles and ligaments may also be affected by this. I also do phsio and I am joining a hospital day shoulder physio clinic soon. I still take occasiona pain relief tablets eg codeine ibuprufen with stomach aid tablets and paracetomal.

    I hope you also recover soon. It takes time to heal. God bless. Sue

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