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Bruce Morris
Social climber
Belmont, California
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Typical RC symptoms. Did all the PT exercises for 2 years. Slow improvement. Now, 5-years later as good as new without undergoing an operation. People want a quick fix and there is no such thing. Patience and chilling out are the keys. Time is the healer but climbers and athletes are by their very nature impatient and keep re-reinjuring themselves.
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Bad Climber
climber
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Topic Author's Reply - Dec 8, 2015 - 02:34pm PT
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So, Bruce: Did you climb during treatment? Or was this a 2-year-layoff thing!
BAd
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LOWERme
Trad climber
NM
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Thanks, Lowerme. It's good to hear about time frames. It's much better to hear that the VA in NM is treating you well. That scandal has me screamin' mad.
Any climbing yet?
Kool.
Not actively climbing at the moment, but I'm probably capable of doing some moderate routes (which is pretty much all I test myself on at this stage of life anyway). Its just that I'm totally committed to accomplishing a few goals as a powerlifter. I'm able to train Skwaatz & Deads without aggravating the shoulder. I'm keeing the assistance work to a minimum, and naturally I've had to back off on the bench.
I actually busted a bench press PR right before the MRI. A few days post-MRI I competed, then I began therapy about 3 weeks after that.
The recovery process has been anything but linear. A good day here and there, followed by a couple days of retrograde. By "good day" I mean relatively mobile & pain free. At times I began questioning my PT's competence. Then I realized yesterday that I've been pain free for several days back to back.
Like someone else mentioned, I wall-roll the bastard with a lacrosse ball in between PT sessions, and I also do band work...pull-aparts, tractioning etc, with mini bands.
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Bad Climber
Trad climber
The Lawless Border Regions
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Topic Author's Reply - Jan 14, 2016 - 08:10pm PT
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Just feelin' down about the bum wing. Seems like nothing has changed. In fact, sometimes seems like the PT is making it worse. Grrrrr.
Took years, huh, Bruce? Well, at least I like cycling and hiking, too.
Reading a great book now as well--Crazy River--by Richard Grant. It's a fascinating tale of travel in east Africa--Tanzania, Barundi. Pretty sad, too, about the loss of wildlife.
I'll go do some massages now.
Wishing everyone an injury-free 2016!
BAd
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phylp
Trad climber
Upland, CA
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Jan 14, 2016 - 08:28pm PT
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I'm not sure why you are so reluctant to have surgery. With my left shoulder I did PT for 4 months and when it wasn't any better after that had the surgery. When I came out of surgery he said It had a full thickness tear, which does not heal on its own. Cleaned out all the junk, created more space etc. it's been good now for almost 20 years.
Anyway good luck whatever your decision.
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looks easy from here
climber
Ben Lomond, CA
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Jan 14, 2016 - 11:10pm PT
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I hear ya about feeling like PT sometimes makes it worse. I was definitely frustrated about that at times, especially at the beginning.
But hope abounds! Just over the last month the improvement has been exponential. I'm up to carrying 30+ lbs with my bad side, and have started very gently pulling plastic (paying a lot of attention to what my body tells me).
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Ken M
Mountain climber
Los Angeles, Ca
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Jan 14, 2016 - 11:26pm PT
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IMO, surgery of a joint, any joint, is to be avoided unless there is no other option. Yes you can have a good outcome, but the potential downsides for an athletic person are substantial.
Here is how I would approach it as a doctor whose treated a lot of shoulders:
First, I would tend to take a conservative approach, as you are doing, due to the lack of disability caused by this. It is not entirely clear what the exact diagnosis is without an exam, although your physical therapist should be able to indicate whether this is muscular, tendon, or joint.
Inevitably, there is a lot of irritation/inflammation involved in such things, and this can impede the healing process. I would (and have) taken a month course of INFLAMMATION STRENGTH anti-inflammatory medication. My drug of choice is one Diclofenac 75 mg twice a day. Cost, $4 at Walmart/Ralphs/Costco.
Massage twice daily with a corded massage wand, digging to get to where it hurts. (cordless not strong enough) Maneuver the shoulder and wand to get some significant ache, if you don't, it's a waste of time.
If doing these things for a month don't work, you won't have caused any harm, and will not have lost anything by the wait.
But the next step involves getting a precise diagnosis without doubt. A cortizone shot will totally clear some things up, not others. MRI's enter the picture when surgery is seriously being considered.
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TLP
climber
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Jan 14, 2016 - 11:29pm PT
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Phylp is right, if you have a full tear of any of the bits, it will never just heal on its own. Period. In such a case, surgery is not a "quick fix", it is the only fix. Close friend of mine tore the supraspinatus tendon and muddled on along for months, did all kinds of really rigorous PT and other stuff, laid off climbing, no real progress. Finally got an MRI, which showed tear and separation of about 1.5 cm - no possibility of rehabbing that in 100 years. Surgery, then a couple months of miserable uncomfortable PT, and back to climbing stronger than ever.
You really should probably spring for the MRI and see what is really going on, then choose accordingly. If it's not a full tear (or mostly), you can perhaps strengthen it and rehab. But your succession of posts are exactly like others I've known who wasted half a year hoping for rehab and not getting there. But take heart, after you shell out the money and work to rehab, it'll be solid. Best climbing partner I ever had was a pitcher and ripped the RC, got it fixed, and took up climbing as rehab, pulled down hard burly stuff in the Valley and everywhere for decades. So surgery works when it's needed.
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Bruce Morris
Social climber
Belmont, California
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Jan 15, 2016 - 12:06am PT
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Partial tear of the supraspinatus tendon, it'll heal. Catastrophic total tear of the supraspinatus tendon requires surgery to fix. Big problem is who's interpreting what the MRI shows. Fanciful? Monetarily self-interested? However, prior to doing an MRI, you should do an old fashioned range of motion study, like the kind old docs used to give routinely. I don't know much, but I do know that if you can hold your arm in a Nazi-lite salute out in front of you, the tear is partial. If you can't, it's probably total and catastrophic. Therefore, old fashioned range of motion study of the joint first, then on to MRI. Not a really good idea to diagnose with an MRI alone until you've established the basic situation with a full range of motion study of the joint in question.
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Ken M
Mountain climber
Los Angeles, Ca
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Jan 15, 2016 - 12:09am PT
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If you decide to go the MRI way, be sure you understand that for the exact same study, you may spend as much as $5,0000 MORE or LESS, depending upon where you get it.
Be sure you shop first. (Hospitals are almost always the most expensive in a community)
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the Fet
climber
Tu-Tok-A-Nu-La
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Jan 15, 2016 - 01:35am PT
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I have shoulder impingement. I went to a physical therapist that I thought was good. Did elctro stim stuff and he gave me abut a dozen stretches and exercises to do. It would take about 20 miutes or so to do all of them. Didn't help much. A couple years later I saw an orthopedic surgeon who specializes in shoulders. He said 90% of what I was doing was a waste of time. He showed me the 3 excercises with bands that would really help. He said ill need to do them twice a day for a few months to get it back to being okay, and once a day for the rest of my life. If that didnt work then come back for more testing and thinking about surgery. He was right and the excercises improved my shoulders dramatically. But the 3 excercises only take 5 minutes so I religiously do them. I do them once a day now but if I aggravate them I go back to twice a day.
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phylp
Trad climber
Upland, CA
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Jan 15, 2016 - 09:35am PT
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For what it's worth, I did have the MRI with the first shoulder and my doc said it was inconclusive whether it was a full or partial tear. He told me I had two options: have surgery immediately and it would be fixed. Or go to PT for 3-4 months and if there was no improvement, have the surgery then. He said the time would not have been wasted because I would come back from the surgery that much more quickly. And he was right.
Also I did go thru a month of diclofenac after seeing him the first time. And for the first couple weeks after my surgery. That's my favorite nsaid. Not available otc but at least for me, I cannot tolerate high dose of the otc nsaids.
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overwatch
climber
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Jan 15, 2016 - 09:42am PT
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What are you teasing us , Fet? Spill!
Edit;
There’s no point in talking exercises since each person’s needs will vary. But the Doc was right and my shoulder is doing well.
disagree about 'talking' about exercises. There is value in knowing the approach of others
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Ksolem
Trad climber
Monrovia, California
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Jan 15, 2016 - 11:09am PT
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I think I related my shoulder stories on a similar thread, but whatever...
In 2004 I tore up my right shoulder. Ruptured long head bicep tendon, ruptured subscap, full thickness tear supraspinatus… Mandatory surgery. Excellent recovery, 1 year.
About three years ago I was feeling weakness and instability + occasional pain in my other shoulder. I went back to the same Doctor (El’Attrache at Kerlan-Jobe.) His gatekeeper did the standard assessments and ordered up an MRI. The MRI tech gave me a copy of the imaging and the report on disc, and I had an apt. to see Dr. El’Attrache in a couple weeks. Of course I read the MRI report compiled by the radiologist, and it was beyond depressing. Based on the report I was surprised that I could still move my arm.
It was with some trepidation that I showed up for my appointment. I was sitting in the room with a copy of the report in my hand when Dr. El’Attrache and his “fellow” entered. “Hi Kristian, this is Dr. Bernard. Oh, did you read that report?” “Yeah…” “I’m sorry, you shouldn’t have wasted your time.” He took the paper from my hand, wadded it up and threw it in the trash. He opened up his laptop and turned to Dr. Bernard. “This is why you have to be able to read your own MRI’s.” He flipped through several images and stopped. “Do you see that?” Again, “Do you see that?” After a few minutes he asked Dr. Bernard “So, What are we seeing?” A bit like a deer in the headlights, “Um… scar tissue?” “Exactly!”
Dr. El’Attrache explained that the litany of problems described by the radiologist were old injuries and insults which had healed in their own way. “What we have here is what we call a well balanced torn cuff. I could go in and try to clean things up and see what else I find, but it will only make things worse. Kristian has a good chance of saving this thing if he gets on the right therapy program and does it with 100% commitment.”
There’s no point in talking exercises since each person’s needs will vary. But the Doc was right and my shoulder is doing well.
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Bad Climber
Trad climber
The Lawless Border Regions
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Topic Author's Reply - Jan 15, 2016 - 11:21am PT
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Thanks for the additions folks.
@Bruce: Yeah, I can hold the Nazi, but it is painful. Palm up? NO pain.
@Fet: What ARE the exercises, dood? Folks want to know.
This is all especially depressing since we just got our place in Bishop in last Aug. Oh, well.
BAd
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LOWERme
Trad climber
NM
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Jan 15, 2016 - 11:38am PT
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My MRI report from this past September:
Report: Technique: Coronal proton-density, coronal fat-suppressed proton-density, axial fat-suppressed proton-density, oblique axial T1, and sagittal fat-suppressed proton-density MR images of the left shoulder were obtained at Albuquerque VA Hospital using 1.5 Tesla MR magnet.
Findings: Acromioclavicular joint demonstrates mild hypertrophic degenerative change. There are are several small superiorly projecting pericapsular ganglia. There are small downward projecting acromioclavicular osteophytes. The rotator cuff demonstrates a distal tendinopathy near the insertion on the greater tuberosity, mostly in the supraspinatus component . No tear is observed. There are are subenthesial cystic changes in the greater tuberosity. Muscle bulk appears preserved. Long head of the biceps tendon demonstrates some thickening and increased signal indicative of tendinopathy in the intra-articular segment. Subscapularis biceps pulley complex intact. Biceps anchor is intact. No obvious labral abnormalities are identified. No significant joint effusion identified.
Impression: AC joint hypertrophic degenerative change which can contribute to symptoms of impingement in the appropriate clinical setting. Supraspinatus tendinopathy without tear.
Report: Exam: Left shoulder series. Comparison: None. Findings: AP views in internal and external rotation, transscapular Y, and axillary views are submitted. A.c. and glenohumeral joints show no significant degenerative changes. Borderline widening of AC joint is present. There is deformity of the anterolateral second rib probably from old fracture. Otherwise no posttraumatic deformities are seen. No aggressive bone lesions.
Impression: Borderline widening of AC joint may be from previous low grade separation. Old healed left second rib fracture.
***
I recently completed two months of PT and my symptoms, now random and intermittent, have improved substantially. After 2 months of rehab work with nothing but light dumbells, cables, and bands, I'm bench pressing in preparation for my next meet in March.
I just received VA approval for two more months of PT which began yesterday. My PT works on me in the gym. This round of therapy will be comprised of trigger point therapy, ultrasound, and electric stimulation, 3 times a week (immediately following my training sessions).
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ron gomez
Trad climber
fallbrook,ca
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Jan 15, 2016 - 11:44am PT
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Bad, never got a message from you, did you try through Supertopo? If ya wanna talk let me know I'll figure some way of getting our numbers hooked up. You say yer in Bishop? I come up that way to work on a few climbers/friends in that area. You should be better by now, something is up with either the condition of your shoulder or the exercise/physio routine.
Peace
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Bad Climber
Trad climber
The Lawless Border Regions
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Topic Author's Reply - Jan 15, 2016 - 12:30pm PT
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Hey, Ron:
Yeah, I tried through ST.
Email me at: roknutzus at yahoo dot com
Thanks!
BAd
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Ken M
Mountain climber
Los Angeles, Ca
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Jan 15, 2016 - 01:11pm PT
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It should not go unsaid, that being seen by an ortho who has vast experience, not only with shoulder problems, but with athletes, is important for a climber.
In SoCal, Kerlan-Jobe is a good choice.
Another choice, in Burbank, is Stetson-Powell, and their newer associate, Lee. All three are team physicians for Olympic teams that particularly have shoulder problems (Soccer, Vollyball). I know all three, and they are all decent guys.
Powell is also an authentic Rock and Roll star, performing at Woodstock!
http://www.stetsonpowell.com/
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ron gomez
Trad climber
fallbrook,ca
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Jan 15, 2016 - 01:27pm PT
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Sent
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SuperTopo on the Web
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Let us know!