Has anyone had superior capsule reconstruction?

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Hi all!

Long time lurker, first time poster. I've had just about everything in my arms done at the point; right shoulder decompression (2006), bilateral carpal tunnel and ulnar nerve release (2016), and most recently left shoulder decompression, calcium removal, and rotator cuff repair (Jan 2019). 6 weeks after this last surgery the RC repair failed. Now I'm scheduled for superior capsule reconstruction in 2 weeks. For those who don't know that is where they go back in and do another full repair, then place a donor skin graft over the repair that will eventually fuse with the tendons to give the repair an added layer of protection and better chance at healing.

Everything I've read online says nothing but good things about this procedure. I'm just curious if anyone has experienced it personally. The recovery for my last repair was so easy. I had some improvement in pain almost immediately. ROM seemed to be getting better very quickly as well. But that was actually to my detriment. I was out of my sling too soon, and using that joint too much. That's how I ended up tearing the repair. All it took was the tiniest movement, then "POP!" excruciating pain and my shoulder was worse than it had been before surgery.

I have a lot of cervical issues, as well as chronic migraines. So the sling is not a friend of mine. My neck can't support the entire weight of my arm for long before I start getting spasms and severe pain in my neck and/or head. But I realize I HAVE to keep my shoulder immobile for 6 week, at the very least, if I want things to work this time around. So any tips on how to deal with sling pain is greatly appreciated as well. I've already ordered a sheepskin sleeve for the strap on my sling. But I think the only real answer to avoiding neck pain and migraines is to avoid letting that arm hang too long each day.

If you got this far, thanks for reading. And again, any stories, tips, or suggestions are welcomed!!

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  • Posted

    Hello

    well it was interesting to read about the RC tear

    I go in to have this op in MAY and I am worried about keeping the arm still and comfortable for 8 weeks

    i dont know why the arm is not put into a cast for the entire time of recovery

    as I have already had 8 ops on both shoulders its not the pain I am worried about it about preserving the graft

    Can you tell me if you live in the UK or not as I have been told that the chance of success from this op is low

    also you talk about the graft is there a reason it was not taken from you I have to contact my insurance as they will not cover me if its a human donation only if its man made or my own will need to check that out prior

    on my last MRI scan not only did it show the tear but also 2 cysts so hoping he will deal with those as well

    while having physio for my shoulders my lower disc has compressed onto a nerve in my leg I have had a decompression on my lower back so carrying the arm in a sling for me is not going to be that comfortable not looking forward to it at all

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    • Posted

      My graft was from a cadaver. It was about $30,000 just for that. Thank goodness my insurance paid for it.

      Also the reason they don't put your arm in a cast is your shoulder could never handle that weight. The worst part of the surgery is that stupid sling. There are days i thought I would never get through it.

      As far as living with the sling, see what I said to Blondi.

      I wish you lots of good luck and lots of patience. It is a slow recovery.

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    • Posted

      Thanks for your reply. I'm in the US. From what I gather they only go this route if the tear is so massive a simple repair would not be possible. In my case, since they've already done one repair in that joint, the chances of him having enough of the tendon left to do another complete repair is very slim. So they repair as best as they can with what's left of the tendon, then overlay the graft to reinforce it.

      They use donor tissue because it's more cost and time effective. Since time =money creating a graft from my own skin would cause my insurance to have to pay more. Not only because my surgeon would have to spend more time with me, when he could be doing surgery on another patient, but also because it's likely a different surgeon would have to be called in to assist and actually make the skin graft. So there are many reasons donor skin is used. I find it strange that your insurance will only cover this procedure using a synthetic or animal (assuming that's what they're calling man made?) graft, or if they use one from made from your own skin. The only reason I can come up with for these guidelines would be the risk of infection. But the risk of infection using donor skin is very low, that just doesn't seem logical.

      In general, repairing a failed repair doesn't have good odds of being successful. But from all the research I've done, that isn't the case with this procedure. Using a skin graft when doing a second repair seems to have better odds for success than even initial repairs do. It could be that you've already had so much done (you mentioned having 8 surgeries on your shoulders) your chances at achieving any improvement is slim.

      My biggest worry is about keeping my shoulder stable long enough to preserve the graft as well. They don't cast because the shoulder is a very awkward place to cast. But you also have to be careful not to make that joint so immobile that it atrophies; causing frozen shoulder, which can be just as painful as a torn RC tendon.

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  • Posted

    You found someone 😃 I had 2 cuff repairs within 2 years, both failed. The last one failed within weeks of the surgery. The tissue was just too shredded and could never hold the repair. So I had a superior capsular reconstruction just about 1 year ago. (3 surgeries in 2 1/2 years) It's been very successful. But I have to warn you, recovery is longer than a regular cuff repair. My physical therapy was a full 5 months. They took it slow and easy because this was my last chance. About 1/2 way through I got discouraged but then things seemed to turn around. At my last visit with the surgeon, he had another surgeon come in and look at me. He kept saying, that is really impressive and words like amazing. My doctor was beaming. haha It is not a real common procedure. All I can say is for the first time in 3 years I can use my shoulder and have full range of motion. Yes it is weaker and I will never lift more than 10 pounds overhead. I can live with that. Oh the other thing is with rotator cuff repair I was in physical therapy after 3 weeks, with this procedure it was 6 weeks before I could start.

    As for the sling, it is awful as you know. My doctor allowed me to unhook the sling and lay my arm on a pillow on my lap as long as I was sitting. I also put a pillow next to me so my arm didn't accidentally slide off my lap. But as soon as I got up, I hooked it back up. So...I spent a lot of time sitting. 😃 I know you probably don't want to just sit around, but it really did help. And ice packs....lots and lots of ice packs.

    Good luck to you. Hang in there and I think you will be happy you had it done.

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    • Posted

      Thanks for the reply! How long did you have to wear the sling after the repair with the graft? After my first surgery they said they only start PT as early as 3 weeks if you're showing signs of frozen shoulder, otherwise they have you wait till 6 weeks post-OP. That's right where I was, and I had my PT appointment on the books for the next week, when I re-torn my repair. I'm so thankful for my surgeon. He really lets me be a part of the decision making with all of this. I've done it enough times with all the other joints in my arms, so he knows I'm aware of what I'm getting into. When I tore the repair just 6 weeks after my initial surgery he said I could give it a year and go through PT, and there would be a SLIM chance I'd get some improvement. Or he said we could go back in immediately and do a second repair with the graft. I gladly took him up on another repair right away!! I just want to get this fixed once and for all. But I know the only way this is going to be successful is if I'm super dedicated to wearing that sling. So I know it will be like you said... lots of sitting. Ugh!

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  • Posted

    I had to wear it for 6 weeks. At that time I could take the bumper thing off so it was a little more comfortable. I wore the smaller sling for another month or so whenever I was out of the house, like the grocery store. I was always afraid of someone bumping into me.

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  • Posted

    After 2 failed rotator cuff repairs was recommended that reverse total shoulder was only option. Did research and got superior capsular reconstruction even though I was not an optimal case (high riding shoulder with deficient subscapularis). Now, 4 months post-surgery, forward flexion has increased from about 45 degrees to 80-90 degrees, have greater strength and stability, but still weakness when arm extends. Being 69 years old, main aim is for SCR to deter further arthritis due to the massive rotator cuff tear, hopefully for the duration.

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    • Posted

      Just out of curiosity, why were you against the reverse total shoulder? I know SCR is looking like it's a pretty reliable long term fix. I kind of feel like I got lucky my first repair failed and I'm getting a much better fix so soon after. But from what I have read the total replacements have really good success rates too, albeit only for the life of the device which I understand can be anywhere from 10-20 years.

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    • Posted

      1. Surgeon said I'd only get slightly above 90 degrees forward flexion WITH RTSA.
      2. Some loss with RTSA of behind-the-back range I now have.
      3. Risk of complications (including infection) substantially higher with RTSA. SCR has essentially no risk.
      4. I'm active and "young" for my 69 year age and RTSA would seem to restrictive, especially since it entails my dominant arm (right handed).
      5. Hopefully I'd outlive what would be the life of an RTSA device.
      6. I currently have no arthritic pain (pain sometimes only in arm muscles due to straining which supplant the loss of rotator cuff in raising my arm and stretching out front -- but have built muscles in that arm quite significantly in PT).
      7. I don't think I'd gain that much range with RTSA over what I now have with SCR since, as I said above, the surgeon said WITH RTSA forward flexion wouldn't be much over 90 degrees.
      8. Bottom line, even though SCR proved far less successful in my case than the normal SCR case (because of deficient/partially torn/irreparable subscapularis plus very high riding shoulder) it's still significantly better than before the SCR and the SCR can still retard development of arthritis which normally happens in case such as mine.
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    • Posted

      That is exactly what my surgeon told me. I am 70 years old and he said I was too young for replacement 😃 for all the reasons you stated. I also talked to my physical therapist and he said, in his experience, he has not seen anyone return to full range of motion or use of the shoulder/arm after replacement. I think for someone who has debilitating arthritis replacement is a Godsend as it will relieve the pain they have and the restrictions that go along with pain

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    • Posted

      You will be happy you had the SCR. When I went for my final follow up with the surgeon, at about 8 months post op, he was so thrilled with the outcome. He brought another surgeon in to look at it and brag a little bit. Interestingly it happened to be the first surgeon I saw. He told me he was very impressed with the outcome but said he would never have performed the procedure on me, he would have stuck with the replacement. I'm sure glad I sought out a second opinion and found the surgeon I did.

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  • Posted

    there are other types of slings. i bought a slingshot 3 . nothing over my neck!

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    • Posted

      By the way, in my case of SCR surgery the doc said move the arm pretty quickly and out of the sling pretty quickly. Basically he said move arm till it is a bit painful and you can't, but no strain or heavy lifting for a few months.

      My graft was 5mm (1/2cm) -- which I guess now is pretty standard, and doc said tear is very unlikely in his experience.

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    • Posted

      My doc sort of did that too. He had me doing pendulum swings and wall walks after a couple of weeks. But whenever I was walking around the sling was on. Everyone is different and every surgery is different. Plus my physical therapist was very conservative. He knew this was my last chance. The next surgery would be a replacement.

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    • Posted

      As I said above, mine was definitely not an optimal case for SCR and full favorable results were very questionable (in my case, there had been some arthritis albeit no pain, extremely high riding shoulder, partially torn irreparable subscapularis) and the surgeon and I knew that going in.

      Pre- SCR I had pseudoparalysis limiting forward flexion to about 45/50 degrees -- and now 4-1/2 months since surgery, I'm up to about 80/85 degrees plus added strength and stability in my movement.

      I'm not assuming pre-surgery you had pseudoparalysis (defined as anything below 90 degrees).

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