Shoulder reconstruction - who's had one and rehab??

With the averge age of the kneeboarder these days this area should be used to post issues on health matters (surfer's ear, knee surgery, stretches, etc).

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Mike Fernandez
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Post by Mike Fernandez »

I like Terence's idea of sourcing another country. I got a dental bridge back in the 70's in Tijuana, and it's still in me, :lol: and I didn't even get HIV or Hepatitis. 8)
I am a traveller of both time and space, a weaver in and out of dreams, I see worlds seldom seen.

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Bumps
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Post by Bumps »

Red,

If you do the oversea's option, just investigate how long after surgery you can travel. Danger of additional bleeding, especially if you end up having an open reconstruction. There is a lot of debate on the issue of Open v Scope surgery. Some say an open provides a better result for more involved surgery and in some cases is the only way... like mine. I had an open due to the extent of the injury and would not have been allowed to fly for a while. Also I would not have been confortable sitting in a plane.

In your case, if the supraspinatus (and rotator cuff?) is the only problem they may just reccomend an arthroscopic technique. If the MRI shows more damage, then the experienced surgeon will decide.

I'm having physio in a public hospital.. saving me truckloads..but you do need to book in early. Let them know you are a surfer/swimmer. This becomes pertinent in the outome for the range of motion in your shoulder.

Regards

Garry
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red
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Post by red »

Hey guys,
I'm overwhelmed by the response. Thanks.
As I understand the tax situation, excess of $1500 gets to be a deduction which means a refund of 30 cents in the dollar.

Thanks for the stories about your experiences. They help.

Terence, I spent many an unhappy day at Addington hospital in Durban getting patched up for surfing injuries. Still got pins to remember them by. Medical tourism to Asia is big business here (I like my boobs, fine, thank you). But people in Asia who can afford it come to Australia for treatment.

I'm operating pretty normally in most respects and could probably get in the water if I wasn't worried about hurting myself again. I think I'll contact Rod Dalziel (thanks, Travis) for a second opinion about necessity for surgery.
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MJ
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Post by MJ »

Hi Red,

Doesn't sound too flash. My shoulders have been giving me the irrits for years and I wondered if I should get surgery. I have decided after reading all of this that they can't be too bad after all.

In regards to the tax offset have a look at the attached link this will provide you with a bit more in the way of detail in regards to the medical expense tax offset:

http://www.ato.gov.au/individuals/conte ... 2&st=&cy=1

It's not quite 30% I fear. Don't forget there is a big timing issue between incurring the costs prior to 30 June or post 1 July.
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Post by red »

I read all your submissons (thanks!), looked on the internet and then did what I do .. looked in the medical journals for the real "state of the art". Here is what I found*

Appropriate methods of treatment of rotator cuff tears have not been finalised. The current clinical approach does not mandate surgery for tears through less than 50% of the muscle. The dividing line of 50% between surgery and none is a "rule of thumb" and not based on any clinical research.

Where surgery is necessary the muscle is cut and cleaned up (i.e. shortened!) and then stretched and attached to the bone.
Even if a surgeon succeeds in reattaching the tendon to the insertion site (i.e. the bone), delay between injury and repair have a dramatic effect on success of the union.
The torn muscle retracts (shrinks) after injury The longer the delay between injury and surgery, the more tension that has to be put on the tendon to reattach it to the bone.

The more tension the less likely the success.
If you get to surgery within say a day or two, then the tension is minimal. If you wait 2 weeks then you need about 3x to 6x the tension force.
If you wait 9 weeks you need about 6x to 10xthe tension force.
Tension force increases only gradually after 9 weeks.

In my case I went undiagnosed for 3 months, so the chance of a successful operation was low.
The private consultant neglected to mention this in his consultation.

After I did the research I decided to let time do its work and not have a high risk surgery.
I had never stopped yoga but now I intensified the regime (under expert supervision) to keep fit and to get blood flow to the region.
I went to an osteopath and that seemed to help. Actually the remedial massage (pure pain!) was the most necessary thing to free up the muscles.
I started very light weights a few months later and continue them along with light exercise like half pushups.
I got in the water about 5 months after the incident.
I've surfed a few times now and fitness is coming back.

If things tear again then I'll get directly to surgery.

More stuff:
  • Some believe that severe acute tears are more likely to enlarge and extend over time than chronic tears, while others maintain that acute tears occur in an already diseased tendon and thus early repair may unnecessarily subject the patient to an invasive procedure.
    Radiography is used as a first attempt to diagnose. X-Ray images can show spurs on the bone, but their success in showing tendon tears is limited and depends heavily on the expertise of the operator.
    Arthography is a well established technique for diagnosing full thickness tears with great accuracy (but it is an invasive procedure).
    Ultrasound is a less costly diagnosis method but identifies only 70% of full-thickness tears - it should be used together with arthoscopy.
    MRI is more costly but able to be used to diagnose complete tears around 90% of the time. MRI is less successful in diagnosing partial tears.
NOTE: when you combine the lack of difinitive diagnosis with the "rule of thumb" 50% tear, you end up with a very hit and miss decision from the experts. I suspect it's mostly "cut and see". "Since we're here let's do it anyway" (how else do you get paid for the surgery?).


*From a Chapter "Mechanics and healing of Rotator Cuff Injury" by MH Zgonis, NA Andarawis and LJ Soslowsky in a book "Arthroscopic Rotator Cuff Surgery" published by Springer in 2008
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Another Shoulder recon

Post by Bumps »

looks like I've now done my left shoulder...off to the GP today and get a referral to a shoulder specialist and a MRI. Might fast track the MRI/US and visit some radiology contacts.

It's a different injury to my Rt shoulder. This one is Posterior and Superior, top and back of the shoulder. It occurred during a chest press, can't lift my arm above my head without pain, laterally without pain and crunching in the postero-superior aspect of the joint with load.

Oh well, I knew it was a matter to time before it went. I've been nursing it well before my Rt shoulder got recon'd.

See ya in the water later than sooner.



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