Surgery Is Set

Well, I met with Dr. Forsyth tonight to discuss the pros and cons of surgery and I have decided to go ahead with it on December 8th pending the results of a physical.  The decison wasn't made easily but it is just the right time to do it.  My boys are still young to the point that they aren't wanting to play catch with me, wrestle and all the other things boys do when they get to be 3, 4 and 5 and it is the beginning of winter so there is no yard work to take care of.   So the timing is just right.  That plus I am still young in terms of a quick rehabilitation.

I am now off to FL for the weekend with the guys so no more posts until next week.

Therapy Tonight

Almost forgot about PT tonight.  Thank god for my Outlook alarm on my phone!  My shoulder was really sore all day today and I think it is because we did not do an ultrasound last night. Struggled doing the first several exercise because of the tightness but felt better as the session went on.  The shoulder is actually feeling better now than it has all day and it is now over an hour since therpay ended.  I guess the ultrasound really helps.

Tomorrow I meet with the surgeon to discuss surgery options so I should have a pretty well informed decision by Monday when I get back from FLA.

Mulling Over Options

After discussing options and situations with Courtney (my wife) last night and doing research online I am leaning towards the surgery.  Physical Therapy will only do so much and the tear will still be there which means I would probably have to have surgery in the future.  The timing is good in the aspect that the surgery and recovery will take place during the winter and spring so I will be good for all of the outside chores of summer once it comes around.  The down side is that with our sons, Nathan and Alex, being 1 and 2 it puts a huge burden on Courtney.  I will not be able to do any lifting of any sort for several weeks and after that it is limited lifting for several more weeks.  They say no driving for the first 6 weeks but we will see about that :-).  I still have time to think about it and will get more information tomorrow night after meeting with Dr. Forsyth.

WHAT IS A SLAP Tear?

Thanks to http://www.orthspec.com for the info below.  

What is a SLAP tear?

A SLAP tear is a cause of shoulder pain. The labrum is a

cartilage ring which surround the shoulder socket (Figure 1).

The biceps tendon, which come from the muscle on your arm,

goes through the shoulder joint and attaches to the top of the

labrum. A SLAP (Superior Labrum Anterior Posterior) tear

occurs when there is damage to the labrum where the biceps

tendon attaches  

How does a SLAP tear occur?

Many times, a SLAP tear occurs from repetitive trauma in

overhead throwers, such as baseball or volleyball players. It

can also occur from a traction injury to the arm, such as lifting a

heavy object off of the ground.

How do I know I have a SLAP tear?

Many patients with a SLAP tear have pain in the front of the

shoulder or deep inside the joint. There also may be a feeling

of catching or grinding in the joint. The examination in the

office usually confirms the presence of a SLAP tear.

Do I need x-rays, MRI’s or any other test?

A set of x-rays is usually ordered to make sure there are no

fractures (broken bone) in the shoulder. An MRI can

sometimes be helpful to confirm the tear of the labrum or

biceps tendon, and evaluate for other shoulder problems. In

some cases, a special MRI called a MRI arthrogram is

performed. This requires an injection into the shoulder joint,

and can be better to evaluate a tear of the cartilage ring, the

labrum, in the shoulder. An MRI is not necessary in all cases.

Is there other damage to the shoulder in cases of SLAP

tears?

There can be other damage to the labrum (where the shoulder

ligaments attach) seen with SLAP tears, usually in cases of

shoulder instability. The biceps tendon itself can also be frayed

or torn. Rarely, there is also a rotator cuff tear.

What are the treatment options for SLAP tears?

The treatment primarily depends on your activity level and

symptoms. Since SLAP tears can be difficult to diagnose, they

are often first treated with physical therapy. The therapy is

designed to restore range of motion and strength to the

shoulder.  In cases of persistent pain and disability, surgery is

recommended.

How are SLAP tears treated with surgery?

SLAP tears are repaired with arthroscopic techniques

(Figure 2). The arthroscope is a small fiber optic instrument

that is placed into the joint through a small incision. A camera

is attached to the arthroscope and the image is viewed on a TV

monitor. The arthroscope allows a complete evaluation the

entire shoulder joint, including the ligaments, the rotator cuff,

and the cartilage surface. Small instruments ranging from 3-5

millimeters in size are inserted through additional small

incisions so that any injury can be diagnosed, and damaged

tissue can be repaired reconstructed or removed.

In SLAP tears, the damaged labrum and biceps tendon are

identified and then repaired back to the socket. This is

usually performed by using suture anchors (a small rivet with

sutures attached) to sew the labrum back in place (Figure 3).

The anchor is usually bioabsorbable, meaning the body

absorbs the anchor over time.  Sometimes a metal anchor is

used, which does not need to be removed. Occasionally, the

biceps tendon is too damaged to repair. In this case, the tendon

is cut and reattached in the upper arm (biceps tenodesis). This

requires a small incision. If the tendon needs to be cut, there is

no loss of strength that occurs.

What are some of the possible complications?

Possible complications include stiffness of the shoulder after

surgery or continued or recurrent pain. The use of arthroscopic

techniques attempts to limit these complications. Other

complications include an infection, bleeding, nerve damage, or

problems with the anesthesia.

What kind of anesthesia is used?

A combination of general anesthesia and regional anesthesia

is used for most surgeries. Before the surgery, the

anesthesiologist will inject numbing medicine around the

nerves of the shoulder. This numbs the arm and helps to control

your pain after surgery. In addition, you go to sleep (general

anesthesia) to help keep you comfortable during surgery.

What do I need to do to prepare for surgery?

Our staff will help to set up the surgery through your

insurance company and will instruct you on any paperwork

that may be necessary.  Prior to your surgery, you may be asked to get several

medical tests, done on an outpatient basis. Some patients need

some minor blood tests and a urinalysis. If you are over age

50, you may require an EKG and chest x-ray. Some

patients may also need to see an internist or their family doctor

to obtain clearance for surgery.

The night before the surgery, a member of our staff will

contact you about what time to arrive for surgery. You may

not eat or drink anything after midnight the night before your

surgery.

How long will I be in the hospital?

Almost all patients are able to have surgery and go home the

same day. Occasionally, patients will be admitted for an

overnight stay.

What happens the day of surgery?

The day before surgery you will be told what time to report

to the hospital. You will be admitted and taken to a preoperative

holding are where you are prepared for surgery.

You will be asked several times which shoulder is being

operated on, and the surgical site will be initialed. Please

note that you are asked this question many times on

purpose.

After the operation, you will be taken to the recovery room

to be monitored. Once the effects of anesthesia have worn off

and your pain is under good control, you will be taken to

another area where you can see your family and finish

recovering. You will be given all of your post-operative

instructions and pain medication before leaving.

Please be aware that the process of getting checked in,

prepared for surgery, undergoing the operation, and recovering

from anesthesia takes the majority of the day. We would

recommend that you and your family members bring along

some reading material to make the process easier for you.

How should I care for my shoulder after surgery?

Prior to your discharge, you will be given specific instructions

on how to care for your shoulder. In general, you can expect

the following:

Diet:

Resume your regular diet as soon as tolerated. It is best to

start with clear liquids before advancing to solid food.

Medication:

You will be given a prescription for pain medication.

Bandage:

You will have a thick dressing on the shoulder. You will be

instructed on when it can be removed, usually in 3 days.

Showering:

You may shower after your dressing is removed, after 2 –3

days. You cannot take a bath until the wounds are completely

sealed, usually 2 –3 weeks after surgery.

Sling:

You will have a sling, which you will use for 4 weeks. You

can remove it for grooming and physical therapy.

Ice: You may receive an ice machine that continually surrounds

your shoulder with cold water. If not, you may apply ice over

the dressings for 30 minutes every hour for several days. Do

not use heat.

Suture removal:

Your stitches will be removed at your office visit 7-10 days

after surgery. Ocassionally, sutures are used which absorb and

do not need to be removed.

Follow-up office visit:

You will be instructed on when to follow-up in the office.

This is usually 7-10 days after surgery.

Exercise:

You will be instructed on exercises you can do immediately

after surgery. You will start physical therapy within 1 to 2

weeks after surgery.

Return to work or school:

You can return to school or work within 3 –5 days without

using the affected arm. If you need the use of the arm to return,

you may be out of work or school for a longer period of time.

What will rehabilitation involve?

The rehabilitation is based on several goals: 1) allowing the

tissue to heal; 2) regaining motion; 3) regaining strength; and

4) return to sports. The rehabilitation protocol for the physical

therapist is attached for you to review.

When can I return to sports?

In general, you will be allowed to return to sports in 6

months after surgery. You must have good motion, strength,

and control of your shoulder and arm. How quickly you return

to sports depends on several factors, including: 1) your own

rate of healing; 2) the damage found at surgery; 3) if you have

any complications; 4) how well you follow the post-operative

instructions; 5) how hard you work in rehabilitation.

What is the success rate?

Overall, the success rate for SLAP repair ranges from 85 to

95%. The goal is to achieve a shoulder with no pain for

throwing or overhead activity.

Why Am I Doing This Blog / Received The Bad News Last Night

First a little reasoning as to why I am doing this blog.  When getting ready for SLAP Tear surgery I tried to find a first person account of the days leading up to the surgery and the long painful road to recovery after the surgery.  Much to my surprise I could not find anything that detailed.  I found some blogs here and there that mentioned this and that about the surgery but nothing as comprehensive as a beginning to end 1^st person account.  So I decided to document the process the best that I could and if someone out there finds if helpful then I have accomplished my job.

(Added 1/24/11) – Looking back at this blog so far, I notice that in the beginning I didn’t go in to a lot of detail about the pre-surgery days and the surgery itself.  Most of that can be found anywhere on the internet and from my experience it was pretty spot on.  I get in to the details following the surgery because everyone’s experience can differ greatly.  I am not writing this blog to say “hey…this is how everything is going to go” because no one will have the same recovery as me.  My intent is to give people a look in to the recovery process and help future patients asks questions of their own doctor before they have surgery.  There is a lot of stuff that I didn’t ask of my doctor before surgery just because it never entered my mind.  Hopefully you enjoy this blog and it helps you come to an informed decision on your SLAP Tear surgery.

A little background on how this all happened.  About 1 ½ months ago as I was going to bed I laid down on my left should and had a sharp shooting pain so intense I almost cried.  I was unable to sleep at all that night and when morning came I was still in pain.  I am not one to go to the doctor’s office but after researching my symptoms on the internet and coming to the conclusion that I had either a rotator cuff injury or a torn labrum I decided to get it checked out. 

I went to Athletico in Tinley Park for a free diagnosis and met with Brian over there who did a complete check up and gave me some exercises to do at home for a week to see if the symptoms improved.  If they did not he recommended I make an appointment with Dr. Lee with Oak Orthopedics in Frankfort. 

Needless to say after a week there was no improvement so I made an appointment with Dr. Lee.  After doing some tests on me he feared that I may have a labrum tear but suggested trying physical therapy first to see if there was any improvement.  If there was no improvement after 3 weeks we would get a MRI done.  Dr. Lee told me I had my choice of places for PT.  I could go back to Athletico where I went in the first place or I could go to ATI which was connected to the OAK Orthopedic office in Frankfort and 2 minutes from home so I chose ATI and I am glad I did.  The staff  there (Beth, Kevin and Emily (Beth’s student) has been great even if Butch (another shoulder injury vicitim) “jokes” about Beth and her “Devil Horns” coming out when she works his shoulder.

Started PT on November 18^th and met with Beth who did a complete checkup and created a workout for me to start strengthening my shoulder.   After the first week I was sore but feeling a little better.  I suffered a setback the second week when I started getting really sore in my bicep and bicep tendon area.  Beth started to do ultrasounds on the area after I started to get the pain but was concerned that I was not getting better by Thursday so had me move my check up with Dr. Lee by a week at which time he ordered an MRI for me and that was done this past Friday.  That brings us to where we are now.

I met with Dr. Lee last night and he informed that I have a SLAP tear of the labrum and my bicep tendon is frayed along with bursitis and tendisosis of the shoulder muscles.  Not what I was hoping for but it was what I expected.  So I set up a meeting with the surgeon Dr. Forsyth for 11/10/2010 to discuss surgical options vs. physical therapy options.


I went to physical therapy right after my appointment with Dr. Lee and informed the folks at ATI of the bad news.  Beth, Emily, Butch and Darlene (my PT workout buddies) seemed genuinely upset with the news which made me feel a little bit better about the entire situation.  But Beth seemed a little too happy that I had the frayed bicep tendon. (Actually she wasn't....she was just happy she diagnosed it and the doctor never did).