Post shoulder Labral repair and decompression

Hi guys i would appreciate any comments/advice. I am 16 week post shoulder Labral repair and decompression. All was going well until 2 weeks ago when i got the all clear to go surfing and swimming. After going swimming and surfing(around 30 mins) for to days in a row i felt fine in the afternoon although i woke up the next day extremely stiff and sore. I still have full range of motion but i have lost strength still 2 weeks later it is aching and have trigger points through all my muscles in the shoulder.
My physio seems to think that i have just inflammed the scar tissue in area from my operation. I am hoping this although my shoulder is extremely sore and achey and catches in areas where it didnt before i have lost a lot of confidence with the shoulder and am a bit wary of using it to much.

Has anyone had any experience with this sort of thing and come good. Im a bit worried i have re torn the labrum

Hello Overit,
I agree that some concern may be relevant following your increased post exercise symptoms. Shoulder reconstructions are potentially at risk of injury at the four month point as symptoms tend to be minimal however tissues are still healing. It is difficult to make accurate comment as I do not know the progressions undertaken during your rehabilitation. In general terms, progressions of time, weight, repetitions etc should not exceed !5% of the current level until you feel that the exercise is atv a comfortable level then increase again.
If your rehab only included very controlled gym type exercises, it can be risky progressing to go surfing and swimming in an uncontrolled manner. Pool swimming at a low initial level would be safe, building strength, endurance and control, then progress to surf swimming then a further progression to board paddling then surfing. Exercise one day on one day off rather than two days in a row allows recovery.
It is possible that your physio is correct regarding inflamed scar tissue, although I prefer that my patients try to avoid any activity that causes discomfort to last longer than 2 hours. Two weeks of irritation is excessive. Inflammatory change post exercise then excessive rest can cause tissue tethering, although loss of movement range usually occurs at the same time.

To allay your concerns and ensure correct diagnosis then permitting the right rehabilitation advice you would be best advised tom see the specialist again for a reassessment. If the labral repair has partially failed, it is better to find out earlier rather than later.
Dependent upon the reconstruction undertaken, the specialist may advise an ulktrasound scan, cortisone injection, non steroidal anti inflammatory medications or perhaps MRI if the anchors are non metallic. The ideas mentioned are only suggestions based upon limited information. Other options are possible.

Hopefully the above info is of some help. I do not want to give actual exercise advice as incorrect suggestions may worsen your condition. If you have further info to add please let me know.
Good luck.
Cheers,
MrPhysio+

Hello Mr Physio

Thank you for your reply the information is very appreciated.
Over the last few days i have improved my strength is coming back and the shoulder isnt aching now. The muscles still have a few trigger points causing me grief although the physio is working through them. The shoulder still catches/pinches with some quick movements above my shoulder that shoots a pain down my upper arm tat wasnt there before although is decreasing from 1 week ago.
the shoulder isnt as strong as it was before the reinjury but it is improving again?
Would it improve if i had reinjured the labrum or would it continue to worsen or plateau.
I understand it is difficult to make comment on some things not knowing my ful situ ut any comments would be appreciated.
Before reinjuring the shoulder i was doing execises like Push ups with a plus x10 twice/3 times daily, mowing the lawn and using a whipper snipper quite comfortably(being careful though) i had also been swimming laps for 2 times a week for 3 weeks. quite comfortably other weights and stretching exercises.
My physio was very impressed with my recovery rate before rehurting the shoulder, DAMMIT










in.
If your rehab only included very controlled gym type exercises, it can be risky progressing to go surfing and swimming in an uncontrolled manner. Pool swimming at a low initial level would be safe, building strength, endurance and control, then progress to surf swimming then a further progression to board paddling then surfing. Exercise one day on one day off rather than two days in a row allows recovery.
It is possible that your physio is correct regarding inflamed scar tissue, although I prefer that my patients try to avoid any activity that causes discomfort to last longer than 2 hours. Two weeks of irritation is excessive. Inflammatory change post exercise then excessive rest can cause tissue tethering, although loss of movement range usually occurs at the same time.

To allay your concerns and ensure correct diagnosis then permitting the right rehabilitation advice you would be best advised tom see the specialist again for a reassessment. If the labral repair has partially failed, it is better to find out earlier rather than later.
Dependent upon the reconstruction undertaken, the specialist may advise an ulktrasound scan, cortisone injection, non steroidal anti inflammatory medications or perhaps MRI if the anchors are non metallic. The ideas mentioned are only suggestions based upon limited information. Other options are possible.

Hopefully the above info is of some help. I do not want to give actual exercise advice as incorrect suggestions may worsen your condition. If you have further info to add please let me know.
Good luck.
Cheers,
MrPhysio+[/QUOTE]

Hello Overit,
It is a good sign that the pain is decreasing. There is much less liklihood that the labral tear repair has been damaged, although specific testing movements by your Physio can shed more light on this aspect.
If the pain down your arm is on the outside of te uper arm and occurs as you move your arm sideways and upwards, (abduction) then it is possible that you have an inflamed bursa (fluid filled sac) undr the deltoid muscle / AC joint.
It can also indicate a tear in the supraspinatus muscle or tendon. General inflammation in the area can give a painful arc of movement. If this does not settle soon specific treatment will be required. Such treatment needs to be discussed with your physio / doctor so as not to interfere with the repair (non steroidal anti inflammatories tablets / topical gel or high dose fish oil, steroid injection). Sometimes deep massage over the point of the shoulder with AC joint mobilisation can assist.
Strength will be down due to pain. Once the pain and underlying swelling decreases your strength should continue to increase.

You may well have created a new injury to the shoulder that is now on its way to healing. Hopefully that is the case. As things are improving each week there does not seem to have been a recent plateau. Enjoy the graduated exercise program, going slowly and consolidate the healing process.
Cheers.
MrPhysio+

Thanks again for your help mrphysio, i went to my physio yesterday who also though i may have tendonitis in the tendon over the front of my shoulder running down the outside of my arm, he worked on it extremely hard massage/rubbing which was extremely painful(he told me it would be) he said that if it was tendonitis this should clear it up pretty quickly.
I pulled up pretty sore today but hopefully will improve over the next couple days.
The feeling i have is similar to how the shoulder felt when i rehurt it so im thinking that maybe it was something to do with the tendon and not the repair(hopfully)

I think i will try to get an appoint with my specialist as it might be a while till i can get an appoint, if it comes good in that time then i can always cancel it.
I will also try the fish oil like you suggested.
Its very annoying as you could imagine that a month ago i was well ahead in my rehab of what i am now.

Thanks again for you comments and info

Hello Overit,
Sounds to me as if you are heading in the correct direction despite the frustration. I also do deep tissue work as despite the discomfort results are generally faster. Progress at the previously mentioned 10 - 15 % rate and all shoukld be well. The idea of making an appointment with the specialist just in case is a good move. You probably won't need it.
All the best,
MrPhysio+