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Shoulder Surgery – Biceps Tenodesis+ – Surgery Day

DISCLAIMER – Just to re-emphasize the point, this information is provided as a record of my particular experiences and should not be construed as medical advice. Each surgeon, patient, surgery, and recovery protocol is particular to that situation.

Instructions were pretty standard for surgery-nothing to eat or drink after midnight, stop all supplements and most medications two weeks prior, things like that. My surgery was kind of late in the day since we were arriving at 12:30 but I didn’t even get hungry until then.

They had suggested a cold therapy unit which unfortunately is not often covered by insurance. You can sometimes rent them as well. When I saw that the price was about $130 we went ahead and purchased one. I wasn’t sure at first but you’ll see plenty of people on forums suggesting them. I have to agree with what I read that it seemed to help me with the pain and recovery quite a bit. If you do get one, bring the pad with you to surgery as the nurses will put it on you before you are sent home.

We saw both my surgeon and the anesthesiologist before hand and found out that I was going to get something a little different for this one-a nerve block. I will talk more about that later but it was pretty amazing.

The Takeaways

  1. If possible get a cold therapy unit. It definitely helped especially in the first few days and I’m sure it will be helpful during physical therapy as well.
  2. If you do get a cold therapy unit, bring the cold pad with you so that the nurses can put it on for you.
  3. Have some individual socks and pads available. I sometimes had a sock in my armpit, other times used socks to pad my neck, elbow, and wrist. Early on before I readjusted it we even plugged socks in around the cold pad to make sure it wasn’t touching my skin.
  4. Remember that you will only have access to one arm for a while. I was able to open a lot of things with my right hand but was not able to get into my own pill bottles for the first few days. Try to prepare your house ahead of time and make sure you have somebody at least checking on you.
  5. On the note of having only one hand to use, have help available that you are comfortable with. You will find that bending over is very difficult at first. I needed help with my pants to go to the bathroom pulling them up and pulling them down for about two days.
  6. Make sure you have some Cottonelle fresh wipes or something similar in the bathroom. Just trust me.

Getting Prepped

Basically this was the standard undress, remove jewelry, etc. I also got into my compression socks and was fitted. with pneumatic cuffs on my legs. They got the IV in and we talked to the surgeon and anesthesiologist. *This is your main opportunity to ask questions with a clear mind so be ready!

They said that once you go in it takes about 10 minutes to set up the nerve block and that because of meds “no one cares”. Considering it is a needle in the neck I wasn’t so sure but it is true. Whatever they use before hand I wasn’t bothered by anything. The block left a bruise and an ache but I’m convinced it had a huge impact on how smoothly my wake up and recovery went.

After this I was out cold.

Recovery Room and Rest of the Day
I woke up and went from completely out of it to functional like I was pushed out a window and clarity was the ground. I’m not sure why I woke up so much more quickly but the nurses even commented on it, and it was a noticeable difference from previous surgeries. That didn’t help me to remember doctor Zooker when he checked on me afterwards but shortly after his visit I was relatively alert. I tend towards thinking that there is less anesthetic because of the block which lends towards waking up quicker and feeling normal more quickly.

I am convinced that the nerve block is as close as many of us will come to losing a limb. It certainly re-creates the feelings I have been told about at least when it comes to things like ghost senses. I was certain that my left arm was laying across my leg with my hand in my lap. When they pulled aside the sheet my arm was actually sprawled off to the side not in contact with me at all otherwise. What an odd sensation and a jarring moment mentally. This continued in various ways through the night and into the next day as the block wore off.

We went home and set me up in the recliner where I could sleep without rolling over onto my arm. I was able to eat regular food fairly quickly but I already knew that I don’t tend to get sick after anaesthetic so your mileage may vary. 

By the next day the nerve block was wearing off and I was feeling pins and needles. Other than that I had no significant pain and by the time it wore off I was already on my pain medicine. Just for the record they say that the nerve block can last anywhere between 12 and 20 hours. For me, they put it on somewhere around 2:30pm. By the end of surgery day I was able to flinch my finger closed a little bit. By the next morning at 11:22am, I could start to open my fingers some as well. It continue to wear off gradually through the day.

Last things for the first 24 hours

Remember that with the nerve block on you can’t feel anything in certain places. That means you have to be very careful with the cold unit to make sure that there are pads in between it in your skin and that it is set to the right level. Anything else that can cause issues you might not feel can also cause problems. The brace you get has a foam pad that goes in your hand to help keep it in place and partly open. For whatever reason my pad was always too tight. Even when we tried to adjust it I could not get comfortable and we ended up cutting it off. When the nerve block wore off I noticed that my phone was still very uncomfortable. I looked at it and there was a large blister that had formed from the pressure of the grip pad. Just have someone check your arm visually to see that nothing is causing problems you cannot feel.

The last thing I think is also from the brace but I’m not 100% certain. The brace has two metal pieces-one that wraps around your torso and the other that holds your arm at a distance from your body. I found that I had pain vertically and underneath the rib cage near my stomach area that felt very much like a runners stitch. I noticed it most as I breathed deeply and the stitch really hurt then but I feel like breathing deeply, adding socks for padding, and adjusting the brace some all helped it to feel better. By day two, the day after surgery, this pain seem to go away.

That’s it for the first 24 hours. I will update after my first postop, and once I start physical therapy which won’t be until after four weeks. If you are reading this, I wish you or your loved one well on their own surgery and recovery.

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Shoulder Surgery – Biceps Tenodesis+ – The Lead-Up

DISCLAIMER – Just to re-emphasize the point, this information is provided as a record of my particular experiences and should not be construed as medical advice. Each surgeon, patient, surgery, and recovery protocol is particular to that situation.

In December 2016 I injured my shoulder. When I finally got it checked out including an arthrogram MRI, it was classified as a type 3 SLAP tear, bordering on 4. (Update 4/26/2017: Once my surgeon got in and looked at it, he said that it was actually a grade four  tear, and the first one that he had ever seen. Go me for tearing my shoulder the best I could!) While the grading for these tears is not really “higher numbers are worse”, 2 and 4 do tend to require surgery more often and 4 is fairly rare. It’s really a classification of type more than severity, though a 4 is basically ‘grade 2 with some additional tearing to the bicep tendon’. Additionally, while the MRI is very helpful you never know for sure what the damage looks like and what needs to be done until the surgeon can go in and actually take a look. For me, it turned out to be somewhat worse than we thought. Based on that, I am already glad that I have the surgery even though it will likely be taking me longer to recover. More details and suggestions for surgery day are below.

While searching around for information on the surgery and recovery I came across Neely Quinn’s experiences at TrainingBeta.com. I thought I would go ahead and share mine as well because hers helped me so much to feel prepared and make a good decision. The link will take you to the first of her posts but take a look around the site and you will find several more including a 12 month report. As of this writing, I am still at the beginning of my journey but I do know that our experiences are already different.

How did it happen?
The injury occurred in a martial arts class during partner drills. This particular drill requires you to sit on the ground with your back against a wall, feet splayed out straight in front of you. Your partner meanwhile attacks you in this case just with punches. Your goal is to defend yourself and stand up as quickly as possible getting away from the attack. We did this a number of times and I decided to try something a little different on this particular round of the drill.

This time when my attacker came in, I trapped and straightened his arm then pulled towards me to set him off balance. Then I shifted towards him and got to my feet as I extended my arms away and out to my left pushing him with his straightened arm. This worked great except that as he fell back either he held on or I did.  I immediately heard and felt a loud pop in my shoulder along with sharp pain.

How did I respond? 

When it popped it definitely hurt and i knew something was wrong. I finished out the class, about 20 minutes, and I tried to stretch it during that time. I thought I could do the equivalent of “walking it off”. Punching the heavy bag felt awful and I had to limit the use of my left arm. I was convinced, however, that it was going to get better. It really did not feel terrible especially compared to some of the ankle injuries I had had in the past or even my AC joint separation.  

When did I get it looked at? 

It was clearly injured so I did take some time away. I ended up giving it about four weeks expecting it to get better the whole time. Unfortunately it never did and in fact got slowly worse and worse. I was able to do less and less as time went on so I decided I had better get it looked at. An urgent care visit led to a specialist. I had seen Dr. Chad Zooker for my AC joint problem previously and really liked him. As an active crossfitter, he knew the sort of lifestyle I wanted to get back to. I have to admit, in retrospect I wish I had gone to him sooner rather than just trying to let it rest but it’s one of those things you just don’t know until you have to do it. It really did not seem to be as bad of an injury as it turned out to be.

Physical therapy, arthrogram, surgery, oh my!

Dr. Zooker performed an O’Brien’s test on me (amongst others) and called me a “textbook case”. Basically, that identifies a near 100% chance for a SLAP (superior labral anterior posterior) tear. Basically it’s a tear of the labram on the top side (superior), running from front to back (anterior posterior).  The difficulty then becomes in determining what kind. In an effort to avoid surgery unless it was definitely necessary, he had me go through a process of physical therapy first. At the same time we decided to set up a specialized MRI called an arthrogram. 

Fluoroscopy and needle done as part of the arthrogram

Go here for more information on what the arthrogram was like.

My physical therapist was great and definitely got me rolling, but based on the injury, my level of strength in different areas, and the pain I was feeling in different positions, he felt we were likely to end up with surgery.

Thanks to various timing issues and some trips that we were going on (both work and pleasure), I ended up not getting in as many physical therapy sessions as I had hoped. When the arthrogram came back Dr. Z called me immediately because it was pretty definitive.

Could I have avoided surgery?

This is one of those cases where it depends. As I understand it a 30-year-old has good success with surgery, a 50-year-old not so much, and a 41-year-old is somewhere in the middle. With the specific surgery that was being done to me I had a good chance of positive results. That said, a torn biceps tendon does not exactly require repair; it really depends on what you want to do and your activity level.

For me personally I wanted to get back to back squats, fighting, ground combat, overhead pressing, etc. and this was the way to be able to do that safely and with strength. I really think that the decision to repair this or not depends on the individual and their goals. I plan to be highly active my entire life. If all you are worried about is jogging, shooting some light hoops, or things like that then it may not be necessary for you.

(Update 4/26/2017: OK so first thing-I kept second-guessing this over and over again. It wasn’t that it didn’t make sense for me, just for some reason I was really frustrated knowing how long it would take me to get back to doing things. However, with the pain I was feeling I was unable to do quite a bit of what I wanted to. When I stretched out my arm to catch a baseball a little outside my wing span, my shoulder lit up with pain. When I tried to jump and get a rebound playing basketball with coworkers, my shoulder lit up with pain again sometimes to the point that I had to stop for a minute and let it pass. I never tried tennis but even such simple moves as putting my hand behind me and pushing myself up out of bed give me intense pain. Long story short-it was definitely impacting my life and I still second-guessed doing the surgery. 

The second part of the update is this-after having had the surgery and finding out just how bad my shoulder was I am extremely happy that I went through with it. This isn’t something that was going to heal on its own and I would have been dealing with not just the pain but range of motion and movement restrictions for the rest of my life. This way I have a very good chance of doing all of the things I want to. And honestly, even if I continue to have pain but regain strength and range of motion enough that I can be active again then I will consider that a success.)

Going Forward

This Thursday the 20th is my surgery, set for the afternoon. We have my brace, compression socks, an ice machine, and a list of movies picked out. Here we go!

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Arthrogram MRI

Fluoroscopy of shoulder – needle injecting contrast

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SSPT

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