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Thread: bone spur fraying rotator cuff

  1. #11
    No word on my shoulders yet, but the MRI was nothing like I expected. I've had them before, but the doc wanted me to go to a facility with better magnets. You go inside the tube. Forget it if you're claustrophobic. Start searching for an open MRI if you are. My knee is contracted so it was constantly against the side of the tube. You cannot move or you'll create shadows on the films. Since I needed MRI's on both shoulders, I figured I'd get them out of the way at the same time. Big mistake. I spent an hour in the tube with a couple 1 minute breaks. You have to use ear plugs to minimize the constant noise. Here's the worst part. The room is cold and they offer you a blanket. However, the MRI tube is HOT. Good thing I didn't accept the blanket. The heat comes up from the bottom of the tube and you sweat and it drips and you can't move. It's not waterboarding, but it feels like torture in the name of medicine. I'm going on vacation. I'll worry about the MRI's when I get back.

    One more thing: Make sure you inform the staff if you will need assistance with transfers. Your w/c is made of metal, so you can't take it in to the MRI room. They transfer you to a gurney outside the room, and then you have to transfer again from the gurney to the tube.

  2. #12
    Senior Member zagam's Avatar
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    The RF is not free radio waves, but induction from lower f pulsed gradient coils may stimulate giving warm sensation. I keep getting woken up as I find the mad daemon hypnotic. The contrast is relaxation time quantum weirdness. Read up first and enjoy the adventure.

    Put me in dark drain pipe or hood on my head and I nod off.

    The gurney must be made of special materials. Hear of botched MRI where oxygen cylinder ended up where kid's head was?
    Last edited by zagam; 12-08-2014 at 06:49 AM. Reason: caution magnet

  3. #13
    I am 48 yrs post injury, t-12, had L rotator repair done in '97 and R on 2002. I am 63. Unless I abuse my shoulders by doing things I shouldn't do (washing windows, carrying something heavy without my elbow tucked into my waist) my shoulders are doing pretty good after the surgeries. I will share some experiences and opinions and hope they help you make your decision.

    I also had cortisone shots but my surgeon warned against them as they will inhibit healing after surgery, and he refused to give me a shot on my R side as he knew surgery was imminent and we were discussing having it done five months down the road. Other doctors (physiatrists) were more than willing to give them to me. Your right, the shots will only buy you time, they will not fix the damage. And if you feel no pain you may continue to do things that may cause more damage which may eventually be harder to repair. I do know some para's who waited too long and could not have surgery due to too much damage.

    As far as laproscopic surgery, some surgeons do a repair via this method. My surgeon likes to have more space to see and work so he does not do laproscopic. My incision was only about an inch long. I don't think it matters how they go in as much as what they have to do once inside.

    After surgery expect to not use your arm for "anything" except physical therapy exercises which are pretty limited the initial few weeks. I guarantee that you will not be doing any transfers, or putting any significant weight on the shoulder for up to 6-8 weeks depending on what repair they have to do. I rented a motorized wheelchair for that period of time and maybe a couple of weeks longer. That was a godsend for mobility but I don't own a van so going anywhere was limited. Initially your arm will be in a sling, then you can have it out of the sling but only resting at your side or in your lap. No weight bearing on it at all and very limited movement. So you will need assistance for all of your transfers.

    The first time my insurance company negotiated an agreement with the hospital to allow me to stay in the rehab unit for 8 weeks instead of a nursing home. I think they took sympathy on me due to my age and as I understood at the time, the hospital agreed to accept a lower rate of pay from the ins co as they had many empty beds and so my taking a bed meant some income to them vs none. I think the rate of pay was at nursing home rate. There was a clause in my insurance policy that allows for special negotiations. I utilized that time in Rehab by seriously using the PT room to strengthen my other shoulder and for PT for the repaired one. It was hard not being home but as with most rehab units, you make relationships with other patients, and the staff and the time actually passed quickly (that is?.looking back, it didn't feel that way at the time). I was also able to get passes to leave for a few hours to out to dinner etc. so that helped.

    The second time, the ins co agreed to allow me in home care to get me out of bed in the AM, showered and dressed, etc and for a Physical therapist to come in to teach me the exercises I needed to be doing from week to week. Although it was great being home, living in the country i was quite isolated from people and my personal care assistant lived quite a distance so if I needed her unexpectedly it wasn't guaranteed that she'd be here for me. Both situations has its plus and minus's. If I had to do it over again I think I would opt to go to a nursing home vs being home as I was socially isolated, did not have family or friends around, husband was working long days, and there was the added stress of worrying about needing to get on the toilet and not being able to due to no attendant being immediately available. My husband assisted me getting to bed at night, but during the day if I wanted to lie down I couldn't as I had no assistance to get into bed. That at times was very uncomfortable and exhausting. You will also need to figure out how to sit up and roll over in bed using one arm in order to avoid pressure sores. After the first few days, i generally did not have a lot of pain, but when I did it was usually at night and one has to find a way to support your arm shoulder with pillows etc. One other important factor is weight gain. If you are pretty active now, you won't be after the surgery. I had to really watch my diet. When I was in the hospital they put me on a 1200 calorie diet as I had gained six pounds after two weeks (just sitting in a motorized chair) , and there was no way I could continue to gain that weight and go home on a weak shoulder and do transfers. So watch what you eat.

    Maybe a consideration would be to go to a nursing home for the first two/three weeks until you see how it all comes together, and then go home for the rest of the time. Good luck, feel free to ask any questions, more than willing to share my experiences.

  4. #14
    Thanks, Blue Dog. You summed up my concerns accurately. I will be in touch with the shoulder doc this AM to schedule an appt. to review the MRI's. As I stated, I'll keep everyone posted.

  5. #15
    Met with the doc to review MRI's yesterday. More good news than bad. Bad is that there are several small tears in both shoulders. Good is that surgery is not recommended now and won't be considered unless I initiate it. I have no plans to get surgery. There is a 30% chance that surgery will not be successful and may make condition worse. As KLD indicated, even successful surgery would require 2-3 months of rehab with no transfers. PT to strengthen rotator cuff and topical NSAID gel were prescribed. Given my age there is the chance that my shoulders will outlive me, if you know what I mean. That's a good thing.

  6. #16
    Quote Originally Posted by tasty View Post
    Met with the doc to review MRI's yesterday. More good news than bad. Bad is that there are several small tears in both shoulders. Good is that surgery is not recommended now and won't be considered unless I initiate it. I have no plans to get surgery. There is a 30% chance that surgery will not be successful and may make condition worse. As KLD indicated, even successful surgery would require 2-3 months of rehab with no transfers. PT to strengthen rotator cuff and topical NSAID gel were prescribed. Given my age there is the chance that my shoulders will outlive me, if you know what I mean. That's a good thing.
    They can last if you take care of them.
    You will find a guide to preserving shoulder function @
    http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

    See my personal webpage @
    http://cccforum55.freehostia.com/

  7. #17
    They can last if you take care of them.

    I plan to take excellent care of my shoulders. When you're younger you have to build a life; work, family, exercising to stay in shape. Now it's a matter of holding on to what you have and not living a totally sedentary lifestyle. Unfortunately, life for paras and some lower quads is a series of transfers. You have to do them. BTW, Merry Christmas to all.

  8. #18
    Tasty, I have lots of questions for you.

    May I ask how old R U that you think your shoulders will outlive you, how many years with SCI, and what level of SCI do you have?

    What is your plan for taking "excellent care" of your shoulders?

    Why is surgery not recommended now? If the tears are small, why would surgery make the condition worse and not be successful? And final question, what kind of doctor are you seeing who is giving you this advice? Is this a General Practitioner, or a Bone and Joint Doctor? It is pretty common to recommend PT before advancing to surgery (often an Inusurance and W/C requirement)

  9. #19
    Hello, Blue Dog. The answers to your questions: I am 63 yrs. old; 43 yrs. post. My injury is T11 incomplete.

    Because my father had coronary artery disease, concerns about heart attack or stroke have motivated me to stay super-active in order to maintain cardio-vascular health. Besides 40 yrs. of wheelchair sports, 27 yrs of FT employment, and multiple recreational activities, I have always pushed myself to live vigorously and pushed my body to its physical limits. I cannot do that anymore. The risk to my shoulder is too great. For people with SCI, life is measured in transfers. You only get so many. I have to save myself for transfers mandatory for daily living. Therefore, I have to restrict the optional activities. Without going into detail I recently fell while participating in one of these optional activities. I put out my arm to break the fall and drove the spur further into my rotator cuff. The pain has greatly increased and my ROM greatly decreased since then.

    I am working with the foremost orthopedic group in my area. They serve as team doctors for all the professional sports teams. My doctor and his PA specialize in shoulders. That's all they do. Given my age, he believes that I can get by with injections every 3 or 4 months for an indefinite period of time for the rest of my life. The alternative of surgery, even if it's performed laproscopically, would prohibit doing any transfers or self-care for 2-3 months. This would be intolerable to me as I have had no assistance with ADL's since leaving rehab 42 yrs. ago. Even my wife has never assisted me. According to the dr., there is a 30% chance that there would be no improvement. The surgical incisions might even make the injury worse. Of course, there is a 70% chance that I could get better.

    BTW, I have found that Voltaren Gel provides significant relief, if you can tolerate NSAIDS. Think of it as ibuprofen in gel form. It can be applied up to 4X per day as directed, and does not cause any gastro-intestinal distress. Hope this helps.

  10. #20
    Tasty, Your history and mine are very similar?age (by the way if your Birthday is in fact tomorrow, so is mine?.Happy Birthday!), length and level of incomplete injury, no ADL assistance, FT employment, family medical history (I have early familial deaths by heart attacks), high value of being independent, etc?

    When we rehabbed forty plus years ago we were taught that "if you didn't use it, you would lose it'. I was never taught anything about aging and overuse. Only until I developed shoulder pain and the internet became available did I learn anything about aging with a SCI. And of course when your young you never relate to seeing your self as getting old and having other issues. I was sent home from rehab in 1968 without a bathtub bench and I transferred into the bottom of a bathtub everyday since my injury until Jan of 1997. It just never occurred to me to get a bathtub bench to make bathing easier, and no one ever suggested it, until after my rotator cuff repair. Now I wish i had one forty+ years ago! It was nothing for me to lower myself to the floor and crawl or scoot into an inaccessible bathroom or to play with my dog, and then get back into the chair from the floor. I used to hike myself up on my kitchen counters so I could clean the inside of my upper cabinets. Why? Because I could. My poor shoulders, what abuse!!

    So I thoroughly appreciate and have lived with the same values that you have regarding being independent. Like you, no one had ever assisted me with personal cares or getting groceries etc. However I am wiser now, and have adjusted and re-organized my priorities which include asking for and accepting assistance in order to save my energy and shoulders for future transfers that are critical to maintaining and extending my independence. I have made an active decision to sacrifice some of my pride and to ask for help so that I can extend the longevity and quality of being independent. And having done so I don't feel less of a person, and my ego hasn't been injured.

    I would urge you to get that second opinion that SCI Nurse recommended, and hopefully one of the opinions is from a surgeon, and one who fully understands the kind of lifestyle that you personally desire to live as a SCI person and the day to day demands upon your shoulders.

    Sorry, but I am skeptical about doing cortisone shots every three to four months for several years in the future. I guess doctors vary on that opinion cuz mine would not approve of that. Or perhaps your injuries are much different which allows for it.

    My reasons for being skeptical are:
    One, the shots will reduce your pain which is great but that will also give you a false sense that your shoulders are doing ok. Given your pride and need to be in control and independent I suspect that you will push your limits due to no pain thus potentially causing more injury.

    Two, the shots are not going to heal the damage already done, and if the cortisone ever stops working you will be faced with surgery anyhow, that is if there isn't too much damage at the time to do surgery.

    Three, you have a better chance at recovery as a younger person than an older person due to a better blood supply for healing the area operated on.

    Four, you have no guarantees that you will die before your shoulders give out on you. I call that wishful thinking.

    Five, In our area nursing homes have a rehab unit for people who need recovery time and physical therapy/rehab for that recovery, and the unit is separate from those patients who will never go home again. So the atmosphere is not as depressing as one may think. As I stated in an earlier post, you could possibly consider going there initially for a short time and then continue receiving care at home with someone coming in to assist you as needed.

    Yes, I have used Voltaren, mostly for arthritis in my hands. The last time I read the insert no studies have been done on the use of the med on shoulders. I am sure you have read the side affects and warnings, one of which by the way addresses heart disease etc. The drug is not something that I personally would want to apply several times a day on a daily basis.

    For me, without a doubt the surgeries were worth the humiliation of temporarily loosing my independence. None of my family or friends think less of me due to my temporary loss of independence. The people caring for me at the time did not think less of me. At the time, my ego was knocked down a notch or two which was totally humiliating as it took me back to the early days of my injury and feeling like a child all over again being so dependent on others...?quite difficult to endure at the time. BUT I was able to re-gain strength and full use of my shoulders. So a few weeks of being dependent was totally worth the years of pain free independence that I gained.

    Tasty, I really wish you luck in your choice, and hope you keep us appraised of how things work out for you.

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