Do not be alarmed – I’m okay!

Deutsch: English: X-ray of a right shoulder wi...
Image via Wikipedia

I had surgery on my right shoulder today. Nothing serious, although it did turn out to have more things wrong in there than anticipated. At the last minute I had thoughts of putting it off for a better time. But there really is no good time when it comes to things like elective surgery. One can always think of some reason why now is a bad time to have it done. So I got up early, showered with pink antibacterial soap, had my husband write “yes” on my right shoulder, and “no !!!!” on my left shoulder, and off we went, where I was scrubbed some more, given an attractive “one size fits all large people” gown to wear, and bonked into oblivion with multiple kinds of modern-day anesthesia. All this, and back home in time for lunch. 

Surgery has certainly evolved from the good old days when I first studied nursing. Over  thirty years ago this surgery would have been done with a big open incision, and a several-day hospital stay. Or more likely it would not have been done at all, as a male surgeon would have said to me “you’re a middle-aged woman with ‘a little arthritis’ – just live with it.” Of course, it turned out be more than just ‘a little arthritis.’  It was arthritis, calcific tendonitis, a small rotator cuff tear, bursitis and a labral tear, in case you wanted to know.

But meanwhile I’m having a dickens of a time typing this, and just a tiny bit worried that I might be accidentally saying something goofy so soon out of anesthesia, so I’ll stop here. Maybe I’ll post some pictures later in the week, so I’ll warn the squeamish readers now, just in case. Meanwhile, I have even greater respect for blogger buddy Mark, of The Idiot Speaketh, who is bed-bound recovering from foot surgery. My gig sounds like a piece of cake in comparison. Good recovery Mark, and at least now you have someone with whom to commiserate.

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I’m being tortured. A strong man is pulling on my arm. Now he’s pushing on my shoulder. He’s leaning in, pushing down while holding my arm against him. I can’t get away. I can’t make him stop. In desperation, I try  to get off the table. Despite being inured to the pain he’s causing, he senses my struggle. “Where do you think you’re GOING?” he queries. “I’m trying to get away from you so you’ll stop hurting me,” I reply. He breaks into a grin and lets up for a nanosecond from reefing on my arm. Welcome to boot camp physical therapy.

Yes, I’m actually paying for this. My physical therapist, who studied at Mr. T’s school of physical therapy, has the hands of a mob boss. For the last few weeks, he’s been singularly determined to beat the tendonitis out of my shoulder if it’s the last thing he ever does. He’s exercised it, stretched it, iced it, heated it, ultrasounded it, taped it, and now he’s massaging it. Although it’s more like the kind of massage one might expect to get at Gitmo. In an earlier time, Mr. T. was a trainer for a Big Ten college football team. This explains a lot. A 300-pound linebacker probably would be saying right now “So when are you going to start?”

It’s not just physical therapy. In my efforts to keep biking despite the tendonitis, I’m accumulating a large collection of accoutrements. I have pages of exercise instructions scattered across my desk. The thought is that when I see these papers, it will remind me to do them. I have a foam roller for stretching the myofascia, leaned up against the piano. Yes, so I’ll remember to use it. I have a large red exercise ball in my living room, again, to remind me ….  I have a small exercise ball too, also red.  And a yellow stretching band. And a blue one. The Tony Horton “Ten minute trainer” series is sitting out on the table to remind me that if I give Tony ten minutes, he’ll give me the body I want, so I won’t have these problems in the first place. Right.

Then, there’s the Yoga stuff. I gave up Yoga when I started having trouble with my shoulder. But my massage therapist, the other torture guy, keeps giving me Yoga accessories to use for stretching. So, now I have a Yoga bolster, which is like a long narrow couch cushion, and a Yoga belt, which for the life of me, I can’t imagine, and really don’t want to know, what they do with this thing in Yoga class.

But back to Mr. T. He’s done “massaging” my shoulder and now he’s getting ready to tape it. The same man who minutes ago was pushing my arm in directions it doesn’t normally go, is stretching and smoothing out tape as gently as if he’s taping up a butterfly’s wing. He’s the same guy who softly wraps a wonderfully warm heating pad around my neck every time I arrive. He gives me all sorts of sage advice to help me balance my cycling habit with a shoulder that doesn’t want to behave, all the while making me laugh. When I’m not crying that is. He’s cajoled me into agreeing to have my bike refitted, and even recommended I hire a housecleaner, so I can give my arms a rest, and save them for biking. What’s not to like about a man like that? Turns out he’s more Mr. Rogers than Mr. T. And as I leave the office, I notice my shoulder feels, well if feels good. He’s managed to turn aiieeeeehhhhh into ah. Thanks Mr. T.

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 © Huffygirl

More on the #@%*$; rotator cuff: Part II

The human shoulder joint

Image via Wikipedia

The pesky rotator cuff (RTC) is the group of muscles and tendons that attach the arm to the shoulder joint and allow the arm to move in all directions. 

Four main muscle-tendon groups  make up the RTC.  

The supraspinatus runs across the top of shoulder and is the most used, abused and most commonly injured of the four muscles. The supraspinatus makes it possible to abduct or raise one’s arm.

Next are the infraspinatus and teres minor muscles. These make it possible for the arm to externally rotate, or move out away from the body.

The last muscle is the subscapularis, which controls internal rotation – turning the arm toward the body.

How does the pesky rotator cuff become injured? The most common cause is trauma as in sports injuries (think throwing a ball, swinging a club or bat,  being thrown forcefully to the ground) and falls. I’ve seen many RTC tears occur after a fall onto an outstreched hand (FOOSH), which is especially common in an icy slip and fall. Yup – this protective mechanism that we all instinctively use when we fall, to keep ourselves from hitting our face or head, is bad news for the rotator cuff, as the force of the fall is transmitted up the arm into the rotator cuff. 

Another way the rotator cuff is injured is through overuse and cumulative trauma. This is often seen in industrial workers, commercial drivers, orchestra conductors and the like: those  who perform the same arm motions day after day, year after year. Over time, this leads to RTC tendonitis, which may progress to becoming chronic, causing the RTC tendon to become calcified and brittle. A calcified tendon is more prone to tearing when an injury does occur, and also can develop microtears and erosions that can go on to become major tears over time.

A third cause of RTC tears is arthritis, such as spurs and other bony deformity and misalignment in the shoulder from previous trauma. Bony spurs or a misaligned joint can impinge upon, or wear away the RTC over time, eventually causing rupture. This is why it’s not surprising to see the stereotypical “little old lady” who despite having never been athletic ends up with an RTC tear.

How would you know if your rotator cuff is injured? Suspect a tear or strain any time there has been a fall or acute injury that is painful and limits your ability to move your arm, or any time recurrent shoulder pain becomes worse after overuse. Symptoms of RTC tear, tendonitis and strain are quite similar – inability to raise the arm from the side to shoulder level, weakness, pain that radiates down the arm into the upper arm muscle (deltoid) or under the arm, and inability to sleep on the affected side, so it’s important to seek health care to diagnose the problem. A thorough exam, plus a combination of diagnostic imaging such as MRI, CT and/or x-ray can determine the problem.

If a rotator cuff tear occurs, often surgery is needed to repair the tear. This will depend upon the health and age of the person and the size of the tear. Tears do not “heal up” on their own, but sometimes a small tear is not repaired. Instead, rehab (physical therapy) can improve the arm by strengthening the surrounding muscles, but does not “heal” the tear. In either case, it’s important to seek care promptly; delayed treatment can lead to atrophy (weakening) of the muscles and tendon, making a later repair difficult or impossible.

We use our arms every single day. A rotator cuff injury can keep you from doing the simplest things – from getting dressed to driving a car. Take care of your shoulder so you can keep doing the things you need and love to do – whether it’s climbing a wall, playing sports, or hugging the ones you love. 

Disclaimer: The information provided here is not intended to replace treatment and advice by one’s own health care provider.

References: American Academy of Family Physicians

© Huffygirl 2011

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The #@%*$; rotator cuff

The human shoulder joint

The amazing shoulder (Image courtesy of Wikipedia)

What is the rotator cuff anyway? We hear a lot about it these days, from injured quarterbacks  in the news, to your neighbor down the street who tore his falling on the ice. Prior to MRI being widely available, we heard very little about tears of this offending musculo-tendonous group, because there was no good way to image it, and no easy surgery to fix it. Most people did not even know they had a rotator cuff, and many still don’t, if the names I hear it called are any indication. People describe it to me as anything  from the “rotator cup” to “rotary cup”, to just plain “rotatory cut.”

So what is the rotator cuff? It’s the group of muscles and tendons that surround the shoulder joint, and make it possible for the shoulder to move in all the amazing directions that it does, otherwise known as flexion, extension, abduction, adduction, internal rotation and external rotation. Basically north, south, east, west and everything in between. When our rotator cuff is working properly, we don’t notice it at all. But should it become strained, pinched or torn, we’re acutely aware due to pain and/or loss of movement.  I recently strained my rotator cuff (it was a combination of Yoga class and weight lifting) and spent a miserable week or so nursing it back to health. I tried all the traditional and nontraditional methods I knew to put it right, because when you can’t lift your arm, can’t sleep and can’t get dressed without help, you’re ready to try just about anything. I did manage to get it better and have sworn off Yoga class for now, but am back to biking, weight lifting and climbing, but trying to be a little more reasonable about it.

In the next  few days I’ll explore the pesky rotator cuff a little more, hopefully to help us all understand it better, and know what to do if it’s injured.

Addendum: I just found out my problem is calcific tendonitis of the rotator cuff. So, I’m going to stop treating it myself and get some expert consultation, hopefully nipping it in the bud before any more chronic problems develop.  (Don’t want anything to keep me from climbing or biking now do I?)

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