surgery or not?

Hi Michaela,

I work in Orthopaedics and upper and lower limb joint surgery with really good Consultant surgeons. If your surgeon said there was a tear on your "tendon" and suggested surgery, I think the advise was just right. When tendons are not repaired they will gradually wear off like an old elastic band and it may cause another problem in the future. I hope you can find a real good at that specialty if you decide to do so.

Ugh...it is a difficult decision but having gone through the surgery twice in four and a half months on the same shoulder, I find re-repairing (revision) surgery of one of the original two surgical repairs to be somewhat uneventful (so far).  I don't know if it because only one muscle/tendon had to be re-reattached with a double row of anchors this time or if my pain threshold has increased.  I was off of work 13 weeks originally.  I returned to work full time with overhead, lifting, carrying, pulling/pushing temporary restrictions.  After the PT's tear, I had to go off work for another 2 weeks, and now I am on summer break (which has helped) allowing the shoulder to heal.  I will return to work next month with the same temporary restrictions.  You will need to evaluate the whole scenario of your life at home and work as you make your decision.Originally, I had an accident and ripped three of the four r c muscle/tendons.  Two of the tears ripped completely off the humeral head requiring surgical intervention.  The third tendon is healing by itself.  Yes, they do heal without surgical intervention as evidenced by my last MRI and as stated by my orthopaedic surgeon and his surgical team.  The entire team did both of my surgeries.  Yes, they do heal, in my case, I have been on restricted movement for six months, and the partial tear has benefitted from the surgical repair of the other two, PT and rest.

Why a revision surgery?  My PT had a moment of temporary insanity after 13 weeks of PT 3 times per week and decided to have me do something that I should not have been doing.  My tears were not far enough along i.e. regenerating to the humeral head to be doing what my well-experienced (25 years) PT decided to have me do.  I don't know temporary insanity, or he was totally distracted working with two other patients.  One of the issues of that particular PT organization is that each PT must see 2.6 patients every hour.  UGH...gut wrenching experience to hear the loud pop (suture exploding inside) and feel the tendon tearing off the head and then to feel the tendon finish ripping off the anchors a few hours later.  OUCH!  Sobbing pain!  Nausea and then the emotional upheaval of what indeed happened and the digestion of here we go again i.e. re-repair and start all over.  Needless to say, I am not under that PT organization's care for the revision recovery.  I am with a PT group that only sees one patient at a time.  I am doing very well at the moment with the new PT - slow and steady.  Gentle, no jerking, no tears, no pain, lots of passive ROM and success.Back to your dilemma.  Do your research.  If it is only one suture and one anchor the recovery will probably be less eventful than those involving multiple surgical interventions.  

Evaluate how your lifestyle will be in the next 6-9 months at home and work.  Are you able to handle healing without surgery?  Will you be able to rest the shoulder daily while following a PT routine?  If you cannot the tendon may not heal.  You'll have to decide.  If you go the surgery route remember to get organized at home and work.  You will be sidelined for 6-12 weeks minimum.  Try to remember it's only temporary, and you will get better but remember the total healing processes for RC surgeries can take up to 12-16 months!  A year. Do you want to be functional or do you want/expect a full range of motion and recovery to your normal self?  Can you tolerate non-surgical means of treatment and managing the pain with OTC?  Think about it. How will you manage the post-surgical pain?  You will have pain, unlike anything you have ever experienced in your life.  My re-repair was pretty good thanks to the 22-hour nerve block.  At 22 hours and 3 minutes, the pain was so intense that I sobbed (again).  I started the Oxy with 325 mg every 4 hours, but the pain pill was not touching the pain.  I upped it 2 pills i.e. 650 mg every 4 hours. Pain pills help, but personal testimony-I wondered if I was breathing while using the narcotics.   After 36 hours or so, I had to go back to 325 mg.  The breathing concern freaked me out.  I added Ibrophen which helped and ICE.  Cold is good!After two weeks (60 pills used) I moved back to Ibrophen (800 mg each dose).  Aleve bothered my stomach after 3 or so months of use following the original repairs.  ES Tylenol helped for awhile then I stopped using it and rely now on the Ibrophen 400-800 mg each dose based on pain level 4-6 hours.  I am 5.5 weeks out of the re-repair surgery, and I rarely use the Ibrophen on a daily basis.  ICE, cold is good.Pillows four to five of them to prop yourself up while cradling yet supporting the shoulder.  I do two or three stacked in front of the headboard, another (45 degrees) angle in front of the stack and another pillow running the length of my torso under the injured shoulder. ICE ICE ICE whether or not you have the surgery, you should be icing the shoulder 2-3 times per day.  Some people use heat too.  Ask your surgeon how to use ice and heat.  I have found the ice to be helpful.  As the ice melts, I leave it on my shoulder 45-60 minutes at a time.  The cold and then cool practice feels good.  It does work.  You can use frozen water bottles (12-16 oz) they fit nicely into the spots you need them.  Frozen or very cold 12 oz unopened soda cans.  Frozen washcloths or the reusable gel compresses.  Just make sure to use COLD to help manage the pain.Think it through.  Do some research.  Evaluate your needs.  Good luck to you!!!  

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