Post-op rotator repair problems

[slightlywarped1]

My problems started 8 months ago. I was injured at work when someone kicked a door open that I happened to be standing on the other side of. I blocked the door with my hand to prevent it from hitting me in the face. The force pushed my arm into my body and twisted me around. I immediately felt a sharp stabbing pain in my shoulder and was unable to lift my arm away from my body. I went to the occupational health unit at the local hospital. My symptoms continued even though I received 6 weeks of PT for a shoulder strain. An MRI was ordered which showed that I had a supraspinatus tear. I was referred to an orthopedic surgeon who did surgery to reattach the tendon to my bone. My post-op PT seemed to be going well although it was painful. I had good range of motion in all directions except forward elevation. I could raise my arm with assistance but was unable to bring it back down without bending it back into my body then lowering it. I would get such horrendous pains that I became physically ill on a couple of occasions. PT thought this was due to my muscles still being weak...nothing that therabands and weights wouldn't fix. That's when my real problems started. My pain level increased significantly. The area around my clavicle, which had never bothered me, became swollen and painful. My ortho reluctantly ordered an mra to check the integrity of the repair and said that the only thing they could tell was that I had a slight posterior subluxation which the ortho said was due to a weak rotator cuff and that the swelling was probably due to using other muscles to compensate so he had PT up my therapy a few notches. The swelling has now spread to my neck and above my scapula on the same side of my surgery. I sometimes get stabbing pain in the scapula. When I try to blow dry my hair, drive, type, etc... I get the sensation that I am being squeezed with pliers between my armpit and my shoulder joint. If I try to elevate my arm in front of me, the swelling in my clavicle area increases. I have pain that radiates down to my deltoid area and I sometimes have pain across my wrist on the palm side and have occiasional tingling in my fingers. My pain is not always intense but it is always uncomfortable. The pressure is the worst. That goes from my armpit up across my pectoral region. I have to recline often to relieve that heavy feeling. My husband claims that I cry and say ouch in my sleep. When the pain does wake me up, which is often, I need my husband's assistance to get up. I also have veins across my chest and shoulder that are becoming very prominent. I still do my PT twice a week and do my home exercies dilligently. The real pain comes after I stop exercising. I have sat in the parking lot of therapy crying for an hour before I could drive home. I have one more PT session scheduled and then a visit with my ortho this coming week. He told me on my last visit that I should have been ready to be released 8 weeks post-op and on my next visit he was going to release me to light duty. I left his office thinking OMG! He thinks I am a malingerer! I understand in his position as a Dr. working with a lot of worker's comp patients his duty to the insurance company is to get people back to work as soon as possible but his obligation to his patients should be to get them as healthy as possible first. I look forward to returning to work! I just know that something is very wrong! I guess my question is...Does this sound like the normal healing process? If my ortho minimizes my symptoms on my next visit, should I ask for a neuro consult. Would that be out of line? Should I trust my Dr. that this will all go away in time? Should I go to another Dr. and pay out-of-pocket and not tell him it is work related so I don't have that stigma attached. I just want to be better. I have had one pain free day in the last 8 months and that was the day of my surgery and only because I had a nerve block that numbed my arm for about 20 hours. Are there any particular muscles that I should be working on that could help with the swelling and pressure?

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[Judith Mollet]

Sounds like your post op rehabilitation wasn't optimal.
There are various programs here depending on the state of the supraspinatus tendon during repair but they usually involve passive abduction only and no anti gravity abduction for 6 weeks and other directions active-assisted for 3-4weeks at least after OP. The 8 weeks limit is not realistic here for ending treatment. Normally patients are on the way and doing active stuff but not there yet at 8 weeks. I don't have your OP notes or rehab program infront of me to study. It sounds as if physio could have been too agressive in light of the " slight posterior subluxation which the ortho said was due to a weak rotator cuff ". The weak rotator cuff muscles will possibly remain weak and not hold the head of the humerus in the right place if their proper training is neglected and one does too much heavy resisted exercise with weights etc. The underlying weakness remains. The humerus joint can remain "un-centered" (sorry, we say "Nicht zentriert" here) and the luxation could get worse not better and cause more problems and pain. Sounds like that has happened.
My rotatorcuff repair patients do have pain at the start but it should slowly improve, even if not always at the same rate.
I in your position would get access to my records, operation protocols etc and get a new second opinion. Can you find another surgeon that does lots of shoulder operations? I'm not sure about a change in physio but try talking to the physio first. Agressive rehab and weights is probably not the answer at the moment. If the physio can't explain why she thinks things aren't working convincingly find another one. If I am not getting anywhere with a patient i consult a fellow physio and give the client further. Your shoulder needs a new good assessment from a good physio and a new start.
Hope this has helped you a bit!
regards

[opihiman]

Question?

you probably have ambient pain (constant pain), but I am pretty sure that it increases as you go through the day. Do you find that the end of the day is worse than the say the mid morning?

OPI

[slightlywarped1]

My pain level increases as my activity level increases....by the end of the day it almost unbearable. Also the pressure and heavy feeling in my pectoral regeion increases as the day goes on.
thanks for you reply,

[opihiman]

My experience with pain pattern that present like this, is that it is genreally being over trained. Think about what things that you are doing through out the day and particular exercises that are causing you the most pain. If possible try to refrain from doing them for a couple of days and see what happens. Also the pectoral pain normally just under the collar bone is a muscle that is in spasm.

R you still in the sling? This will generally perpetuate the problem...Judging from your description of your post-op course, you have been probably keeping a pillow under you elbow or hugging a pillow to get comfortable. this will also perpetuate the pectoral pain.

Has the doc discussed any anti-inflam meds?

OPI

My pain level increases as my activity level increases....by the end of the day it almost unbearable. Also the pressure and heavy feeling in my pectoral regeion increases as the day goes on.
thanks for you reply,