Wednesday, October 29, 2014

Confirming diagnosis & reluctantly leaning towards surgery

I was kind of devastated when I found out about the lack of a labral tear and in its place discovered the tendon tear, simply because of how much more complicated the procedure and recovery will be. In fact, the emotions I was dealing with were probably the main reason for starting the detailed log of my process, because I realized other athletes will go through this and hopefully benefit from my research and experience.

Ok, so the doctor at the imaging facility wrote the report I quoted from in an earlier post, diagnosing the anatomical problem. I also requested to have digital copies of the report and the images, which I showed to a friend who is a hand and shoulder surgeon. It’s always good to get an extra set of eyeballs on your images, no matter what your situation. Sometimes a doctor is looking so hard for one thing he expects he may miss another, I’ve done the same thing as a scientist in the lab with my data. It’s not a disrespect to the orthopedist to ask another one what he thinks, too.

On Oct. 29th, I received an email back from our friend, a hand and arm specialist who trained at the Mayo clinic. He is excellent, but back in Philly/Lehigh Valley and thus too far to be my surgeon on this one. Here is his email reply:
***
Peter.

I reviewed your MRI scan and the report.  I agree that you have a small full thickness tear of the supraspinatous tendon of your shoulder.  I do not see a SLAP tear (labral tear) and agree with the radiologist as well with that account.  The fact is, with these tears, we know that they tend to enlarge with time.  As a younger guy, if the tear is causing pain and discomfort, not allowing you to do what you want or need to do, there is a good reason to fix it and get it over and done with.  The surgery is done arthroscopically, but takes a good amount of time to heal (6 weeks in a sling and then rehab - 3-4 months average).  The other option is to try therapy to make it better.  Therapy will not fix the tear, only surgery can do that, but it may make it asymptomatic.  The tear, while it may become asymptomatic, may enlarge with time becoming more problematic to fix in the future.  

My take on it to patients - partial tear or tendonitis - rehab +/- injection.
Full thickness tear in a younger, active individual - fix it if it is painful.
Full thickness tear in an elderly person - rehab.

I hope this helps.  If you want a second opinion or another guy, I have one in Bethlehem, he’s very good.  Let me know if you need anything else.  

Kris
***
I feel utterly deflated hearing this. I spent a good portion of today not working, but instead obsessing over my diagnosis, hoping I’d find something on the web telling me about some crazy bovine-sperm-derived-growth-hormone method of speeding up recovery. Of course, I didn’t find any such thing, in fact a study shows that HGH doesn’t do anything to help rats over placebo, and can also negatively impact tendon repair at the point of bone attachment. And now, Kris’s email confirms what my research shows. Six agonizing weeks in a sling, 3-4 months of hard rehab afterwards. 

I did find one person who logged some of her experiences with recovery from rotator cuff repair, although she *also* had a SLAP tear and some other minor issues discovered once the surgeon got inside. Essentially the extra problems made the recovery significantly longer. She is an amateur volleyball player and fellow climber.


I am remaining optimistic that my high baseline strength, youth, dedication, and stubbornness will lead to a rapid recovery, although I’m not sure there is much I can do to speed up the original 6 weeks in the sling. We’ll see how well my body handles this. Still have to meet with the actual surgeon.

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