Shoulder surgeries (right shoulder,
Surgeon: Dr. William B. Wolf, III of The
Orthopaedic Center in
I had loose shoulders for
a long time. No, scratch that, I have
loose joints, period. I’ve always had
the problem: hyperflexibility in my joints.
Generally, it isn’t a problem, unless I somehow manage to further injure
the joint or otherwise exacerbate/overstretch the tissue in the joint.
As far as my shoulders
go, the “further injury” probably had something to do with years of climbing
and catching myself awkwardly, karate, and swimming. Between those activities, I had repeated
dislocations and subluxations (where the joint would pop out and then pop back
in on its own), and it got to a point where my shoulder could pop out in my
sleep and it wouldn’t bother me, or where it’d pop out while I was doing
something completely normal and then I could pop it back in on my own.
While I was at W-EMT
school after finishing up my undergraduate career, I really started noticing
how loose my shoulders were, that they were popping out more often than they
used to, at really bad times (think: Conway, NH--awesome climbing, shoulders
not staying in are bad). One drunken night out with coworkers, they
convinced me to get my shoulders looked at. Dr. Wolf came highly
recommended, so I first saw him on
Both of my shoulders were
very loose, though we decided to focus on my right shoulder first since I'm a
dominant right-y. Through a series of tests, Dr. Wolf determined that I
had multidirectional instability (MDI), caused by the overstretching and
possible tearing of the inferior glenohumeral ligament (IGHL), i.e. a major
ligament supporting the shoulder joint. The first course of action would
be to try to strengthen the rotator cuff muscles to see if the shoulder would
tighten up. The exact quote from him,
which at the time was pretty disheartening, was, “Well, we’ll try some physical
therapy and when that doesn’t work, we’ll discuss surgical options.” Apparently people with MDI rarely respond
well to conservative treatment. He gave me a Theraband and
exercises for flexion, extension, internal & external rotation to do. I did 50 reps of each exercise every day,
plus some other stretches.
On 16 July, I went back
to his office and my shoulder was still wicked loose, so we decided to do
surgery. Apparently they don't always
operate on people with MDI, unless strengthening fails and some other criteria are
met. I had all the criteria (to this date I still have no idea what the
mysterious criteria are). 10 days later on
I was awake during the
surgery haven been given an interscalene
block. My anesthesiologist left
a lot to be desired, but I have no memory of the procedure and don’t think I
was in pain during it, so I guess she didn’t screw the pooch completely. For the surgery, I was given "relaxing
medications" (conscious sedation/MAC anesthesia) that left me with no
memory of the surgery nor the events just after surgery. The surgery
starts with an arthroscopic evaluation, and then, if certain
"criteria" are there, then they do an open
inferior capsule shift/open anterior shoulder reconstruction (again, I
have no idea what these “criteria” are).
So that's the inside of
my right shoulder. I had the mysterious "criteria" for open surgery
based on the arthroscopic evaluation.
The main things they look for in the evaluation are extra space between
the shoulder socket and head of the humerus and evidence of damage from the
repeated dislocations. For those so
curious, the pictures are:
- Upper left:
The
little white strip at the right is the head of my humerus (the top bone in
the arm). Note the large gap between the top of my arm and the
inside of my shoulder. That gap was what needed to be
minimized. Apparently, that shot is done with minimum
traction being pulled on my arm...
- Upper right:
A
very pretty bicep tendon.
- Lower left: My rotator cuff, still in tact.
- Lower right:
Another
view of the top of my humerus. The bone should all be smooth and
white like you see on most of that shot. The red and rough
stuff is where my shoulder rubbed every time it popped out. Guess
that explains why it hurt.
The open surgery left me
with a 3” scar on the front of my shoulder, along the bathing suit- or
bra-strap line. As with most orthopaedic
surgeries, I had physical therapy to do after the surgery. I started
physical therapy at 2 weeks post-op, and at that point was allowed to take off
my sling to sleep. I went to PT three times per week to Sports and
Orthopaedic Therapy Services (S.P.OR.T.S), in
My timeline for returning
to “normal” activities was pretty standard as far as ligament surgeries go:
- six weeks in a sling/immobilized
- @ 6 weeks: run, practice
soccer (not compete--it's a contact sport)
- @ 12 weeks: play
soccer, do karate forms
- @ 4 months: karate sparring, search and rescue ground
work, road cycling
- @ 6 months: karate jujitsu, climb, cave, technical
SAR, mountain bike
I was very stupid and at
11 weeks post-op went to karate and ended up getting kicked in my shoulder
(what my surgeon calls a "forceful partial abduction"). He said
I didn't hurt it too much, but that I was definitely stupid. Well....yeah...I
admit that. But after that, every time I went into his office, he’d
somehow remind me of that little incident.
After the success of my
right shoulder surgery, I decided to get my left shoulder fixed, too. I
had MDI in it and rehab didn't work, just as the case had been with my right
shoulder. My surgery was on
Inside of my left
shoulder:
- Upper left:
The white
strip at the left is the head of my humerus. The other white stuff
on most of that shot is the IGHL, the ligament that was completely abused
during my subluxations and dislocations. The fuzzy white crap is
debris from the repeated dislocations and subluxations.
- Upper right:
Bicep
tendon and rotator cuff, looking pretty. Note the fuzzy stuff not
looking as pretty.
- Lower left:
The
head of my humerus. It's hard to see the red and rough stuff, but
it's where my shoulder rubbed every time it popped...and more fuzzy
stuff :(
- Lower right:
The
head of my humerus and the glenoid (inside of shoulder socket). Note
the huge gap...
Surprisingly (to
me), my doc said that it was worse than my right was. I guess
because I'm right handed, I noticed my right one more, but I definitely went
into this surgery wondering if he'd find the "criteria" and actually
be able to do the surgery. As a result, rehab this time around was even
slower than it was the first time. Dr. Wolf wouldn't even let the PT
start moving it until 3 weeks post-op and he wanted me in the sling 100% of the
time until then. Then it was another 3 weeks of wearing the sling during
the day (but sleeping without it). I finally got out of the sling on
A lot of people have
asked for pictures of the operation, but I don't have any from mine--this guy
does, from a very similar surgery (not exactly the same, but same type).
It’s now been more than 2
years since my left shoulder surgery. My
right shoulder is still doing great...my left gets sore still and still doesn’t
feel quite “right,” but I was admittedly not as diligent with its rehab as I
was with the right shoulder. My left
shoulder still makes noises at me, though it’s nowhere near as bad as it was
prior to my surgery. My focus on my left
shoulder was hampered by my ankle surgeries and the long recovery I’ve had with
them, but in the grand scheme, I’m glad I had both shoulders fixed. Unfortunately, because of my ankle, and to a
lesser extent my shoulders, I will never be able to play soccer, do karate, or
run or jump again. This also rules out
climbing. I hope this page has been
helpful for anybody out there who needs shoulder surgery and needs some
reassurance about the procedure. Feel
free to drop
me an email if you have any questions.
Or, go back to my blog
or to my main index.