Another Shoulder Dilemma Thread

[SheFly]

I didn't want to hijack ehirsh's thread regarding her shoulder bone spur, so decided to start a different thread (although I think this makes at least 4 of us currently with shoulder issues).

My official diagnosis is sever tendonitis in my rotator cuff, and a laberal SLAP tear (this is the cartilege that runs front to back, and where the bicep inserts in the shoulder). Right now, I have had 2 PT's look at the MRI readings and talk to me about my diagnosis and prognosis. Both are friends of mine, and both are cyclists (and they've been treating DH for about a year).

I am faced with some uncertainty. We currently don't know how much of the pain and ROM issues are a result of the tendonitis vs. the laberal tear. The only way to repair the tear is through arthroscopic surgery, and full recovery is SIX MONTHS :eek:. If I don't decide to have this surgery SOON, I likely won't have it at all this year - it will mean losing the race season if I do.

I am concerned about losing the race season, and not being able to compete this year. Some of you have watched my progress last season, and I am doing [fairly] well both on the road and in 'cross. I am not a spring chicken anymore, and feel that if I lose this season, I won't be able to come back and compete at the same level the next year... And not knowing for sure if the surgery will be the right answer is making the decision extremely difficult.

While I know none of you can counsel me in one direction over another, I would appreciate any insights or thoughts you may have.

Thanks for "listening".

SheFly

[rocknrollgirl]

Shefly,
I have a SLAP tear from climbing. I opted not to have the surgery. My doc told me a year for full recovery. I rehabed it so that I did not have pain on a daily basis. I do not climb any more for other reasons, but it does not bother me to swim or to mt bike. So mine did get better.

Keep in mind that I did not have the tendonitis on top of it.

[maillotpois]

I have nothing constructive to add, but as one of the Shoulder Club, I figured I should at least weigh in and say BUMMER!!!

I'm so sorry the prognosis for surgical recovery is so long. Sounds like you're putting up with a lot of pain and I really empathize.

[Wahine]

The tendonitis is often more painful than the SLAP lesion. What's tough is figuring out if it's possible to improve your tendonitis with the SLAP present. There are different degrees of SLAP lesions and how well you can rehab one without surgery is heavily dependent on how structurally stable the glenohumeral joint is. The less stable the joint is the more the rotator cuff has to work and the harder it is tho give the tendonitis the rest it needs to recover. One of your PT friends might be able to do some stability testing on you to help figure out how stable the joint is. That would give you a better idea of what to expect.

So I'd look at the pros and cons.

If you have surgery now, you'll recover faster overall but you're not likely to have a full race season and might have trouble training to prepare for this season.

If you don't have surgery now and you currently have a raging tendonitis, it's likely you'll need at leats 6 weeks to recover from that, you'll lose training in the meantime but may be able to salvage part or all the season.

Let's say you decide not to have surgery, continue to train and end up either blowing out the shoulder further or not being able to finish your season due to pain... you will have gained part of the season that you could early on, then you'll end up with surgery and out for the rest of the season.

Or, you might make it through the whole season, if you can get the rotator cuff under control and you can get it repaired at the end of the season or not at all depending on what happens.

Something else to keep in mind:

This type of shoulder surgery carries more than just a slight risk and you need to discuss this fully with the surgeon. I do see a proportion of shoulders that don't do well after surgery and end up with very little gain or sometimes worse. These are a small minority but speak frankly with the surgeon about it if you're going ahead.

[rocknrollgirl]

Another added thought after reading Wahine's post...mine was a small tear.

[SheFly]

Thanks for the feedback!

MP - I do hope that scapula is healing. Just thinking of being in a sling for 4 weeks (what would be required for me) is frightening. I hope you are managing ok.

Rocknrollgirl - thanks for understanding about the racing (and sorry to hear about your Xterra season this year). I think when we have the "competitive gene" it really pushes us, and in some ways, makes some of these decisions for us.

Wahine - I really appreciate your comments. I think that I am going to try to get the tendonitis under control (there is also some bursitis, apparently) and see where things go from there. As you so aptly pointed out, I may be able to salvage my season this way, and see what happens later this year. Any idea what a cortisone treatment might do (also suggested by doc and PTs)?

I did go out and ride the MTB this past weekend (in the snow and ice). While painful, I was able to ride in what were pretty miserable conditions. Given some rest and more PT, I think I should be able to get past the current condition.

Thanks all, for the support! I'll keep you posted on the progress.

SheFly

[Wahine]

Wahine - I really appreciate your comments. I think that I am going to try to get the tendonitis under control (there is also some bursitis, apparently) and see where things go from there. As you so aptly pointed out, I may be able to salvage my season this way, and see what happens later this year. Any idea what a cortisone treatment might do (also suggested by doc and PTs)?

Cortisone is a very powerful anti-inflammatory. It has side effects that are significant if not used appropriately and you will hear horror stories. But, and this is a big but, it will get the inflammation down which is the first step in the right direction, if not overused and performed correctly the side effects are minimal. If it was me, I'd do it.

[Crankin]

Cathy, I am sorry to hear about your shoulder. Can't say I have any experience with that part of the body, but I would try the PT rehab route and see if you can salvage part of next season. Sometimes, as others have said, these decisions are made for you, by your body. It su*ks, especailly when you have racing goals. My friends don't even understand why I was upset about not making my 3 000 mile goal last fall and that is just a personal goal, not racing.
Try to avoid surgery...

Robyn

[koala]

Keep in mind that the time frame given for complete recovery from tendonitis might be optimistic. I injured my shoulder in December 2006, and am still dealing with it! I had severe tendonitis & lost a significant range of motion (had difficulty getting dressed even). It took about 2-1/2 months of PT to restore some range of motion, but pain was an ongoing problem for a lot longer. The problem is that we continue to do things in our everyday lives that aggravate the condition. I still have serious pain days, where I pop anti-inflammatories & grit my teeth to get through. Yesterday was one of them. So I know I'm not past it yet, and I still do daily exercises & stretches. My PT-person had the same condition in both shoulders some years ago. She said it took her 2 years to get past it, & she does daily exercises to keep it at bay.

The upshot of all that is, that even if you do the PT, you still might be left with serious pain issues that will keep you from fully concentrating & doing your best at your racing. Not sure I would recommend surgery either, because recovery always seems to go slower than the "advertised" time (in other words, write off the entire season). But if you go with surgery to fix the tear, I would get a 2nd opinion from the best ortho doc you can find, and maybe even travel to get to one who practices at a sports med facility.

Best of luck on this one.

[RoadRaven]

I am faced with some uncertainty.
<Snip>
I am concerned about losing the race season, and not being able to compete this year. Some of you have watched my progress last season, and I am doing [fairly] well both on the road and in 'cross. I am not a spring chicken anymore, and feel that if I lose this season, I won't be able to come back and compete at the same level the next year... And not knowing for sure if the surgery will be the right answer is making the decision extremely difficult.

Oh SheFly, you are one of my race inspirations here on TE and to hear that this injury has progressed to this level with such a potential interruption to your fitness and racing opportunities is gutting. I imagine how I would feel if someone said "right, no racing this year" and I would be incredibly upset about it. And I am not achieving at your level.

I have no experience of this injury - its symptoms or its treatment so in that regard my comments may be unhelpful.

But I guess I think of all those who have overcome injury and got back to their prior race fitness. High profilers of course like Lance (in the extreme), or more recently our (NZ) own Julian Dean who had knee surgery in November and won the NZ Road championship a couple of weeks ago. I think of people in my club who have had forced time off the bike - people your age and older (like me) who have been able to regain race fitness.

Right know things might seem at times different shades of hopeless or pointless in regards to you and bicycles, but keep faith, and if forced time off the bike eventuates than stay involved in supporting other cyclists, get on a trainer, ride at less intensity when you can. Your time will come again and your body remembers what you have once asked of it, and getting fit again will not be so difficult as when you first asked your body to get as fit as you are now.

This all said, I wish you the best possible prognosis, the best possible surgical recovery, and time on the bike again with no pain and no complications.

You've inspired me in my TTs so often by reading about yours, solo and tandem... believe this is only a hiccup. You've still got alot to do on bicycles.

AwhiAwhi
Rave

[RoadRaven]

Wahine - I really appreciate your comments. I think that I am going to try to get the tendonitis under control (there is also some bursitis, apparently) and see where things go from there. As you so aptly pointed out, I may be able to salvage my season this way, and see what happens later this year. Any idea what a cortisone treatment might do (also suggested by doc and PTs)?
SheFly

Oh... and my partner had bursitis in his elbow. He wore a support bandage on it and we put alternately arnica and anti-flam creams on it. He rode through it and after a couple of months it went away - but it was very painful while he had it. It looked like someone had popped a tennis ball under his skin!

I have had a cortisol injection in my shoulder... for me it was almost instant relief.
However, a couple of friends have had cortisol injections (knee and shoulder) and for them the receiving of the injection was uncomfortable and it was mildly painful for a couple of days before the cortisol did its magic.

[RoadRaven]

OK... another post...
I just read the article Indysteel posted here
http://forums.teamestrogen.com/showthread.php?p=283064&posted=1#post283064

Check it out for some inspiration, SheFly :)

[SheFly]

I have been faithfully going to my PT appointments twice a week, and doing the various excercises they have been presecribing. Last week, the PT was pleased that there was an improvement in ROM, and the pain was much less - three steps forward.

This week, two steps back. I think I was a little tough on the shoulder this past weekend, and now everything is re-inflamed. The good news - I'm no longer "allowed" to shovel. We think that's what did me in last weekend (went to our house in Maine where there was 22" of new snowfall since last shoveling, and lifting the snow over my head and onto the banks wasn't a good idea). Of course, the 7 hours of snowmobiling and 2 hours of MTB probably didn't help matters...

I need to be nicer to it this weekend or I will be back where I started. My dad suggested I take up knitting :D - HA!

So, how do I "rest"?????

SheFly

p.s.
During my "recovery", I have also had a cold for two weeks, and sprained two fingers on my hand (opposite to my shoulder injury) while riding my MTB...

[bmccasland]

So, how do I "rest"?????

A good book? Or two or three? I find the avoidance of things that cause a pain response a good start. Then again, my shoulder is still complaining after pulling the cord to mow the grass this past weekend.

I can be a lump on the couch and just pet the various furry heads. Although I'm starting to go stir crazy and want to get back on my bike. But fear of pain is a factor.

sign me - one of the shoulders :cool:

[SheFly]

Ha! That sounds divine. I need to read youre suggestions to DH. My major issue is that he doesn't know how to rest, and therefore, I usually end up sucked into whatever activity he is doing... I think I just have to put my foot down on this one.

And no lawn mowing (or at least lawn mower starting)! If I can't shovel, I'm pretty sure you shouldn't be trying to pull that mower over either.

SheFly

[rocknrollgirl]

Just say NO!!! I will send you my DH for a week or two. He sits on me big time. I try to bargin with him, but NO GO!!!

All kidding aside, I finally had to just suck it up and rest as hard as I train. I have read lots of good books, watched movies, etc. Icing, icing body parts can be tons of fun, and an activity in and of itself.

Oh and don't forget the wine...wine really helps heal body parts....