I'll first address a few smaller, but still important details. I'm currently through about 11.5 days following surgery. I have been mostly without any Percocet for the past 96 hours. Three of the last four nights I did use 1/2 a pill to help me sleep, as the discomfort is highest and most noticeable in the evenings, particularly when trying to sleep the whole night sitting upright. I've instead taken a few Tylenol during the day if needed, which don't make me drowsy, don't mess with my GI tract, and don't leave me dehydrated and tired. Also, when I came down from nine pills (day 1), to six (day 2), to four (day 3), I definitely felt what I would describe as withdrawal; even lying still in bed, I felt like I was on a boat, gently undulating on the waves.
Every day I also get a little more motion back with a little less pain. My pendulum exercises started at about Cheerios size and are now about 8-12 inches in diameter. In addition, getting in out of my sling, changing clothes, and taking a shower (without getting the stitches wet), have all become increasingly easier. The only crappy part is the sling continues to take a toll on my neck and shoulders, so I unclip every chance I am quietly sitting, and the therapist told be I could to scapular retractions as often as I wanted, which definitely helped the discomfort.
Pendulum
Scapular retraction
On Friday (Day 10+), I had my third PT appointment. For the first time I started with a heating pad, which felt awesome. This is OK now that the main inflammation from the surgery is gone. Fun fact, day 10-11 is when the movement of type III collagen into the site of the repair is highest, and it will slowly deposit and start to turn to type I collagen as scarring sets in. Additionally, my therapist, Lita, did an incredible job activating my shoulder and doing some shoulder decompressions. I also did a new movement, which I can continue as often as I would like at home, called table slides. These can also be done with the body at a 45 or even 90 degree angle to the table, but I'm not going much past 45, now.
Table slides
The crazy stuff happened after PT. I went across the hall to get my stitches out to find that the middle of the three incisions on my arm was significantly larger than I anticipated. Instead of the standard arthoroscopic shoulder repair, Dr. Berdia had decided to do the mini-open version of the procedure. This did *not* involve detachment of the deltoid, as full-open requires, but does require the central incision is 4-5cm to allow more viewing and a larger portal to work in. The reason for the decision shocked me. As I mentioned in earlier posts, it was thought my supraspinatus had a 6mm full-thickness tear, and my infraspinatus had some fraying. As it turns out, once Dr. Berdia inserted the scope through the posterior incision he saw a TON more damage than he anticipated. The supraspinatus muscle runs under the clavicle and the tendon attaches to the humerus at a site about 14mm across. Apparently, my tendon only had 1-2mm of attachment remaining. The infraspinatus was not much better. At this level of damage, the muscles are barely functional at all.
Two things surprised my surgeon. First, he has never seen so much damage on a shoulder of such a young person. Usually, this level of insult is seen with older patients with chronic degenerative tendon issues. Second, he was impressed that I was able to play (and play pretty well) during the end of the last Ultimate season. Each time I threw a deep huck or pulled the disc, I essentially was risking shoulder dislocation, because of the weakness of the two tendons in questions. Part of their job is to anchor the shoulder in the socket. However, the last 18 months of weightlifting, with specific attention given to strengthening my deltoid and the rest of my shoulder complex (subscapularis and teres muscles) was apparently sufficient to compensate for the underlying injury. So what I thought was a simple stitch up of the one tendon became an intense bit of work that required putting four dissolvable anchors in to reattach both the supra- and infraspinatus. Wow.
Details on anchor placement. Tendon is then sutured to bone via anchors.
Fortunately, the severity of the injury has no bearing on the recovery time. Currently, according to the therapist, my range of motion (ROM) and overall strength are very good. At the end of next week we will start assisted active ROM, and then shortly after that I will leave the sling behind and go to full active ROM, for weeks 4-8. I'll start a heavier strengthening program around weeks 8-12, at which point I'll also be able to return to Ultimate, climbing, and weightlifting. In the meantime I'm getting in some KILLER leg workouts. One-legged skater squats are awesome!
So there you have it. Getting stronger every day!
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