Questions re: pain mgmt. Day 6 post rotator cuff repair and open tenodesis

I needed a break today, I broke down and took some naproxen with my extra strength tylenol in spite of my doctors instructions not to take anti-inflammatories for six weeks. The research doesn't seem conclusive and I have to say that the pain is a lot better today. If people aren't recovering with anti-inflammatories maybe it's because they do too much with their shoulders because they are in less pain. 

Ice ice ice ice cool it off!

 I agree below.... ice and cold packs all

Day!

From

What  I have read.. the reason you don’t want to take anti inflammatory meds is because it hinders the healing. 

Imagine yh blood flow is thinner, the tissue wont be able to adhere to the bone. The healing will take longer. 

Stick to only Tylenol.

If you’re wanting to check yourself

Google it! Tons of info

Out there!

I have been using ice and sone heat on surrounding muscles. I spend the night with an ice machine which is a wonderful invention.  Not only does it ice and compress but adds padding around my shoulder making it easier to sleep in week 4. 

I am limiting the naproxen to times that I am in the kind of pain nothing else will help besides doubling oxycodone which I am not going to do. I am only taking it at night. I can't take a lot of inflammatory meds anyway because it aggravates my acid reflux.  Recently, my physical therapist had me doing active ROM exercises that I in no way should have been doing. So I switched to his wife who seems more reasonable and has been doing passive ROM with me. 

Although I am lucky enough to have a lot of financial support to fall back on, I am self employed and have to get back to work next week. These past three weeks have completely revolved around thinking about my shoulder,  my pain,  my ice machine, my tens unit and how much I hate physical therapy. 

 I am not sure your location. And if you have access to good medical facilities, but you should not even be beginning physical therapy until after six weeks postop. The tissue needs to heal to the bone a bit before you start moving yet. (Tissue heals  15% a month )

 I am 15 weeks post op.

Studies have shown the longer you let this heal the better the success  rate. I did not start any PT  until 7 weeks postop. I took the immobilizer off at 6 weeks, I see my surgeon  every three weeks. My physical therapist does stretching and massage only. She always supports my arm while doing it. There was absolutely  no ROM until after 8-10 weeks post op!

Fortunately for me I have one of the top rated orthopedic surgeons in the US. I am very lucky. He treats athletes from around the world for knees and shoulders. He gives seminars. He has been written up in medical journals. He is very good at what he does. And he is specific on what kind of physical therapy you should do because they have studied it. If I were you I would look for somebody that would understand the healing process of this very extensive surgery. Good luck with it all!!

We had different surgeries. I was never in an immobilizer, only a sling for 4 weeks which comes off today. He would have had me start immediately, I waited for a week and a half. My surgeon was very specific in his orders. I don't know what is right or wrong to do since I'm no expert but I am going to stick to his orders. Sometimes that means telling my p/t that I'm not going to do something. 

I totally get what you're saying. All surgeries are different, and seems you're lucky not having such an invasive one as I did. I too listen to my PT person, and was told by my Dr that PT shouldn't hurt to the point of taking the breathe away. So..he said it is interactive, so she's asking me the entire time how I am doing. Gone are the days where they would yank the arm into positions thinking it was needed to heal. Thank GOODNESS!!

I agree 100%. That's why I switched therapists. The first one was pushing me way too hard way too early. I freaked out and went in to give him what for and it turns out he's gone for the month anyway. I am working with another therapist who actually asks me to tell her when it hurts. I can see working with the other therapist next month once I'm further along with my passive ROM.  

Hi ARJ,

I’m not recalling exactly your sgy date, I am now 3wks post op today.  I’m on MD prescribed diclofenac (NSAID) 2x daily to decrease inflammation and relieve pain.  It is working fairly well. I’m still in the immobilizer sling for another 3 weeks, so PT is just passive ROM only.  Did have an issue with bicep suture site - angry, swollen and weeping...was placed on antibiotics and WOW...what a difference they have made only 36 hours into taking!  So glad I reached out to my surgeon’s office!  Swelling from the bicep sgy part is improved, but noticed that it increased on the day I was out/about for errands.  Will so appreciate being able to drive again...but that wont happen til immobilizer component of sling is d/c’d.

glad to hear you are getting better!  I don’t have any laser experience, sorry.

I'm a little over 4 weeks. Glad to hear that the antibiotics helped! 

I think that my recovery has gradually crept up on me and in the middle of week 4 I kept desperately pulling off my sling and putting it back on again, I am so relieved to have it off...and my range of motion seems to be getting a lot better very quickly but not without pain. 

I was feeling great until today. I think my p/t ramps up the exercises whenever I start feeling too good.

It's a different kind of pain than I was having after having laser. I've scoured the internet for any kind of information with  no luck so I'm just not having laser treatment any more.

Perhaps  I missed something... But did your surgeon not put you on anabiotic’s immediately after surgery? After any surgery like that you should be on anabiotic’s for 5 to 7 days.

Protocol here is IV antibiotics within 30 minutes of sgy and then usually nothing more.  For me, the oral antibiotics were Rx for a post op infection of the open bicep tenodesis site at 20 days post sgy.  They have really made a big difference.  The suture line had not looked as well aligned as I expected and one area was very puffy, not healing and still open and weeping.  Turns out it was an infection.

Diclofenac is good stuff.  I can't take the pills cause I have some kidney issues, so my doctor gave me the cream which I massage into my shoulder and bicep.  Helps a lot.  You may want to ask your doctor about that.  Seems like it helps to have the medicine go right to the problem area instead of throughout your body.   

 Pain relieving cream sounds wonderful. I would much rather have that than have to take ibuprofen. So may I ask where you and Ed are located? 

hi Mia....I'm in the Phoenix area....you?

My doctor and hospital were extremely careful about any infection pre and post surgery.  Pre-surgery I had to take a shower the night before with antibacterial soap and then another in the morning.  I had antibacterial wipes to use after each of my showers.  When I arrived at the hospital, I had more antibacterial wipes to use.  I also had to swab my nose and mouth with antibacterial stuff.  I'm guessing all that was MRSA prevention.  After surgery, I was placed on antibiotics.  

 I think what happens, and this is my personal opinion, is that surgeons that have seen things happen they take note and they do it differently the next time. That’s why the more experienced surgeon is usually the best. I’ve never heard of anybody having the surgery that we’re not on anabiotic’s after words. 

Santa Barbara Ca

 Just noticed some of the protocol is different from state to state. And from continent to continent. Britain has odd pain relievers that I’ve never heard of and different therapies. So I was just wondering? 

Yup that is true, even different within the state.  My first surgery was when I lived in a small mountain town where there is 1 orthopedic practice.  I'm sure that had a lot to do with my needing a revision less  than a year later.  That and the PT...he was horrible.  I literally would have tears running down my face.    When we moved to the Phoenix area, I did a lot of research and found an amazing ortho.  Before moving here he was the team doctor for a couple of pro teams in Florida and a few weeks ago was given an award for Physician of the Year.  His protocol is much more strict.  And the  PT I go to is excellent, keeps a very close eye on me.  I'm confident this procedure will work for me.  My PT is 6 months long!  Ugh.  I only just now, at 3 months post op, started on un-assisted range of motion.  Everything has been gentle PT assisted stretching.  Long road, but I'm in for the long haul.  

That sounds exactly like my doctor and protocol. I have an excellent physical therapist too that does the same thing. Today I am almost 4 months postop and doing so much better I can’t believe it. Because things that other people told me they were in pain for a year,  I worried.  I feel sorry for people that do not have access to a really good top surgeon. I would consider flying somewhere else and have it done by somebody that knows what they’re doing and that is very well experienced, then just go to anybody in my area because it’s convenient.  This is was a brutal surgery! 

Hi Mia,

I’m in central VA.

I agree with you and Grammie about a top surgeon!  Mine is highly awarded and serves several major universities as their top surgeon for athletic shoulder injuries.  I recognize the protocol Roberta shared...as a nurse I highly support it. I also agree this is an EXTENSIVE and highly complex recovery...brutal is aptly applied!  I still have 2+ weeks to go in this immobilizer sling and long for the day that I can function two handed again! This highly taxes my patience on some days.

One surgeon I went to in Phoenix told me he has never performed an arthroscopic procedure,  not just  on shoulders, but anywhere.  I couldn't get out of there  fast enough!   

Ha ha- Thanks for the laugh! 

ED- My surgeon has been written up in medical journals, goes to and teaches at seminars monthly. Works seven days a week. He does most athletes in local areas and has autographs of athletes from basketball, football players in his office etc. in California. If you question if he has the experience he will look you in the eye walk out of the room and bring back a medical journal where he is written up. Perhaps arrogant, I don’t care he is meticulous and he knows exactly what he is doing! That’s the surgeon  I want working on me!!

 On another note, that immobilizer Ugh. I got to the point where I hated that thing. I wore it 24 hours a day for six weeks. When I was finally able to take it off, I hurled it into the trash outside!! I know exactly how you feel. But it will be worth it to allow your shoulder to heal correctly....so hang in there you’re almost through the worst part.