Subacromial Decompression

[Szyslak]

Any one have Subacromial Decompression surgery? I have been dealing with shoulder impingement for the past three months with no success treating it with physical therapy and such. Doctor is recommending continuing with the therapy with the surgery as a final option. My insurance changes on July 1 that will make my out of pocket cost much greater, so I am considering just going ahead with the surgery. Any thoughts?

[telepariah]

I had labrum repair (actually just removed), bicep tendon tenodesis, and subacromial decompression on April 2. My shoulder is still frozen but I think I was in the situation where I had to have it done because I couldn't ski, run, or do a lot of other normal activities and I wasn't sleeping much at all. That is still my situation 7 weeks out but I do know that it will get better eventually. As much as it hurt, it was worse before. There is another thread here where I have been posting about my recovery, which is generally slow and frustrating. I had hoped to be cleared to ski at Independence Pass next weekend but that idea was nixed by my surgeon, who said the worst thing I could do at this point would be to carry a heavy pack.

I guess all I can say based on my experience is that I was broken and had to do something or else give up all my passions. My shoulder is still fucked but if I am patient, I will be skiing again next season.

[TBS]

Of course surgery is the final option, but I don't see how PT is going to make a bone spur go away or make the supraspinatus any smaller so it won't get shredded. I had a subacromial decompression as part of a rotator cuff and labrum repair. My rehab was tough, but I had fucked up my shoulder good.

I would get the surgery done, but be prepared for an intense 3 month rehab and at least 3 more months before you're back to full strength. It's a lot better than not being able to raise your arm without pain, not to mention trying to grab a beer from the back of the fridge

Good luck

[Szyslak]

Luckily, everything is still intact. The tendon is starting to break down and shows up abnormal on the MRI. There wasn’t a specific incident that I can remember that caused this. It just started hurting in the middle of the night and has not let up. It could have been a bad pole plant, a fall in the terrain park, or maybe just age? But like has been said, it is affecting my life. I can’t play ball with my kids, run, sleep… So it is looking like surgery is where I am heading.

[MMP]

i had rotator cuff surgery including a repair, anchoring of thetendon and sub decom. it hurt like a motherfucker and i have had many injuries. this was among the worst to rehab. it was 2 years ago and feels awesome now, but the PT was a bitch. If you are an athlete and need teh shoulder, you gotta do it. its worth it, but no picnic for sure.

[splat]

Luckily, everything is still intact. The tendon is starting to break down and shows up abnormal on the MRI. There wasn’t a specific incident that I can remember that caused this. It just started hurting in the middle of the night and has not let up. It could have been a bad pole plant, a fall in the terrain park, or maybe just age? But like has been said, it is affecting my life. I can’t play ball with my kids, run, sleep… So it is looking like surgery is where I am heading.

i had rotator cuff surgery including a repair, anchoring of thetendon and sub decom. it hurt like a motherfucker and i have had many injuries. this was among the worst to rehab. it was 2 years ago and feels awesome now, but the PT was a bitch. If you are an athlete and need teh shoulder, you gotta do it. its worth it, but no picnic for sure.

I have an impending surgery coming up to anchor my ruptured and detached bicep tendon and to make muscle out of the hamburger that is my r/c. Killed me daily with pain until I spent a couple months flat on my back after knee surgery. I feel it when I lift things, but the pain greatly subsided with the kneehab time down.

[stridertg]

Of course surgery is the final option, but I don't see how PT is going to make a bone spur go away or make the supraspinatus any smaller so it won't get shredded. I had a subacromial decompression as part of a rotator cuff and labrum repair. My rehab was tough, but I had fucked up my shoulder good.

I would get the surgery done, but be prepared for an intense 3 month rehab and at least 3 more months before you're back to full strength. It's a lot better than not being able to raise your arm without pain, not to mention trying to grab a beer from the back of the fridge

Good luck

Begin hanging from an overhead bar and lifting small weights. The bone spur will remodel and the RC tendon will become stronger and healthier. Order and read the very short booklet "Shoulder Pain? The Solution and Prevention." (Amazon.com)
Surgery is always and option, but does not always work. The exercises do almost always work and are free.

stridertg

[Speedfreak]

Just found out that Im dealing with impingement (just thankful it's just that and not RC or Labral tear). I've got most of my ROM back since I ate shit the first week of March, but I still can't do real pullups or hold a bar overhead (I'm a crossfitter and O-Lift addict, so that last 5 degrees is pretty important) and sometimes pushups are an issue.

Anyone have a good result from just PT -- will the acromion eventually go back to where it's supposed to be?


Stridertg: I've tried the bar hang thing and it's pretty brutal...

[haydukelives]

I had a lot of pain in this area with very little motion in any plane from a mtb fall.

It took 8 months of slow work and "tincture of time" before I could do much of anything,or even sleep in any position for more than 2 hours. But I finally had 100% function with no pain.

[crackboy]

i had it done as part of my labrum repair. i am glad i did it, rehab is actually going better than i expected. i think the recovery is easier the stronger teh joint and surrounding muscle is.

[stridertg]

Speedfreak: Yes, the hanging exercise is painful during the first attempts. With each
repetition, you should find that this pain gradually lessens. When you finally achieve full acromial remodelling, that will happen with patience and persistence, you will find that hanging from the overhead support bar feels good. When you hang, you are bending the acromion and stretching the coracoacromial ligament (CA arch). Then, when you do the full side lift weight lifting, the RC tendon will become thicker, more robust and healthier. Most hardly ever use their rotator cuff muscles and the tendons become thin and fragile.
After remodelling your own CA arch, there will be more room beneath the arch for the rotator cuff, bursa, etc.


If you think the hanging exercise is painful, try having shoulder surgery. I know, as I performed this surgery both open and arthroscopically for 33 years. When I discovered that people can remodel their own CA arches by hanging, I almost completely quit doing the surgery.

You are the only one who can remodel your own CA arch. Nearly all therapy exercises avoid arm elevation above the level of pain and will never reverse the destructive changes that develop from contracture of the CA arch.

For more info, I have set up an educational website with videos from CT scans and still images showing the anatomy of the shoulder in the hanging posture to demonstrate how the CA arch may remodel: kirschshoulder.com

[kingdom-tele]

strider, sounds interesting - does this work for all types of AC spurs, class III an IV hooks, what are your parameters?

[stridertg]

The hanging and weight lifting exercises are normal human activities. Hanging from an overhead support is technically named "brachiating." Wiki has a note on it. There is nothing really new about the hanging exercise, although perhaps I have stumbled on it's significance for the health of the shoulder.

Acromial hook deformities have been usually divided into 3 degrees of "hooking." The cause is still debated; congenital versus acquired. From my review of the literature, most believe that symptomatic contracture of the CA arch (spurs and CAL thickening, shortening) is acquired by time (aging), and "degenerative" changes. Interestingly, Rockwood's shoulder surgery book does not list disuse as a cause, even as the authors do recommend exercise as a remedy.

With regard to acromial deformity, I believe there is a continuum of degree, and splitting the types may be an artificial construct. Where does one draw the line, when many with no deformity develop impingement problems and many with severe hooking have no problems.

No, I have no idea what various degrees of deformity respond to brachiating and weight lifting. Most of those that I have helped with the exercise program have never had acromial imaging studies nor any other radiologic studies. Nearly all have been recommended the exercises after simple H&P of the shoulder with a diagnosis of SIS or small RC tears or adhesive capsulitis.

Those who can, do. Those who cannot, cannot. I have spent many years investigating this issue but have no large controlled double blind cohort studies but can only say that for those who have persisted with the simple exercise program, nearly all have been rewarded with asymptomatic shoulders.

I don't ask for more. But, I have asked for help from some PhD PT program directors to run studies; given lectures to large PT and MD groups but have had no serious response other than "That's interesting."

As I am sure you know, but I will remind here; science does not ask for proof.
Proof is not the currency of science. Science is about defining truths about nature. Science asks for evidence; the more evidence, the better the theory.
So far, from my limited series, the evidence is that the exercise works for nearly all those who are willing.

It seems that the most difficult aspect of acceptance of brachiating as a prevention and remedy for shoulder pain is that there is nothing in it for those who treat. A hanging bar can be made from a simple tree limb or pipe, and 5# wgts cost about 10 bucks. Other than for patience and persistence, that's all one needs for the entire program.

Weighing the prospect of long term therapy or surgical solutions vs the simple hanging and weight lifting exercises seems to me to be no contest. What has one lost if it doesn't work? The cost of a piece of pipe. With a diagnosis of SIS, partial RC tears or "frozen shoulder," there is no urgency for therapy or surgery and time to at least give nature a chance by attempting to stretch the CA arch and strengthening the RC by these simple normal exercises. Gravity is free.

[starity]

Any one have Subacromial Decompression surgery? I have been dealing with shoulder impingement for the past three months with no success treating it with physical therapy and such. Doctor is recommending continuing with the therapy with the surgery as a final option. My insurance changes on July 1 that will make my out of pocket cost much greater, so I am considering just going ahead with the surgery. Any thoughts?

Your surgeon will only suggest having subacromial decompression if other treatments haven't been successful. These treatments can include physiotherapy, non-steroidal anti-inflammatory drugs and steroid injections. I suggest you to go for a surgery itself.

[Zalg8]

I've been hanging from a support beam in my garage the past week or so to try and help my shoulder. It is helping a lot. I've tried a lot of stuff for my old shoulder injury - it started as an impingement about 11 years ago, but I think I have a loose labrum and/or some tearing, as well as some rotator cuff tearing, probably some calcium deposits, and a lot of tightness in certain muscles. I do a lot of stuff for it, including a variety of internal/external rotation movements at various weights, some supraspinatus work, scapular work, and general weightlifting (including a large variety of rowing movements). Pretty much the works as far as stuff I can do on my own (no money for massage or anything like that). The hanging is definitely helping me. I will pick up that book when I get some money...

[splat]

It's now been a year and a half since I messed my shoulder up. AIG insurance hosed me on the surgery, so it never happened. As I mentioned above, I detached my bicep tendon and the r/c muscles 'looks like hamburger' according to Dr. Orr. The r/c pain went away while I was laying in bed for two months healing an acl and meniscus. Now,the bicep tendon is where the pain resides. I haven't lost all that much bicep muscle, but for lack of use due to the pain. Usually a shortened bicep muscle is an obvious sign of a detached bicep tendon, from what I've heard and seen.

I'm just wondering if 1) there is still some tendon attached and that's why it hurts when lifting? and 2) would anyone know if hanging on it would help that shoulder and not tweak the remainder of that tendon, if it is still attached?

[stridertg]

The Second Edition Revised and Expanded version of the book "Shoulder Pain? The Solution and Prevention" will be available at Amazon in a few weeks, or late Feb. 2011. This edition is in full color and has considerably more information than the first edition.
The Kirsch Institute for Shoulder Research, publisher of this book is calling for an international multicenter study of the Institute's exercise program in the recovery and maintenance of the healthy shoulder. To receive the Institute's protocols, results documents and to enter your results, request "Protocols" at:

kirschinstitute@gmail.com

The documents are free and contain a lot of info that is in the Second Edition of the book, "Shoulder Pain? The Solution and Prevention." Gravity is Free!

[splat]

I'm going to get into hanging, stridertg. It sounds like what I need to be doing, having not done the surgery and feeling like I can do my own healing. I still feel the bicep tweaking when I lift things and, though I have healed considerably, I still feel weak from the tendon rupture and rotator cuff tear. I'm going to dig into your references when I get some time. Thanks.

[stridertg]

Stoke,
It is the hanging exercise that stretches the CA arch. The CA arch is responsible for most of our shoulder troubles. It presses on the subacromial structures (rotator cuff, bursa, biceps tendon) and when contracted due to time and disuse, produces degenerative damage in these structures. Yes, you can do it. By hanging from an overhead bar or similar support; and then doing forward, side and extension dumbbell weight lifting (palms forward or down) you can restore the health of the rotator cuff tendon and muscles. Each time you stretch the CA arch by hanging, you are making more room for the RC. Over time, the deformity of the acromion will remodel (Wolff's law), and the coracoacromial ligament will stretch becoming more compliant.

If you can manage it, the 2nd Edition of the book will be at Amazon in a few weeks. Although it's 18.95 there, I think it's a lot better deal that several trips to therapy or the doc's office.

Best,
Stridertg

[stridertg]

Stoke,
Don't worry about the biceps tendon. What's left of it will remodel along with the other structures beneath the CA arch when you hang. Hanging restores the compliance of the CA arch. Small RC tears can heal. Work on two things: stretching the CA arch by hanging and restoring the health of the remaining RC tendons and muscles by the weight lifting. Things will sort themselves out once you remodel the CA arch.

Stridertg

[stridertg]

Stoke,
One more detail: do take a look at www.kirschshoulder.com There you will find still and video CT scan images in the hanging position. I think you will find the anatomy revealed in these studies self-explanatory. You will see why the hanging position allows the humerus to bend and remodel the acromion. Again, "Gravity is free."
Stridertg

[Orthoski]

Stoke,
Small RC tears can heal. Stridertg

While rotator cuff tears are a common problem and get increasingly prevalent with age, rotator cuff tears do not heal on their own. That does not mean that all need surgery, however, because there are many people who function fine w/ rotator cuff tears, esp small ones. The difficult caveat is that RTC tears tend to increase in size with time (like a rip in a pair of jeans) and it's hard to say who will and who won't become symptomatic down the road. With time, the muscle can retract and atrophy, and it becomes harder to repair a chronic tear than an acute one (and at some point becomes impossible). Point of the story is that whoever has a diagnosed rotator cuff tear would likely benefit from a sit down conversation with an orthopedic surgeon. That being said, would be hard to recommend surgery if you have no pain and great function - as they say, there is no problem that a well-intentioned surgeon can't make worse.

[stridertg]

The best remedy for rotator cuff tears is prevention. Tears of the RC are a result of gravity, time and disuse. Our Primate shoulder requires that we maintain the compliance of the CA arch by brachiating, and maintain the integrity of the RC tendons and muscles by simple weight lifting exercises. Maintaining the compliance of the CA arch is best accomplished by hanging from an overhead support (a bar) as a life habit. Small tears of the RC may be asymptomatic; incomplete partial thickness tears may heal with expansion of the subacromial space and reversal of the degenerative changes that are the result of tendon compression, atrophy and disuse.

Subacromial impingement is the first sign that the RC is in trouble, and that it is time to begin reversing the CA arch contracture: the result of gravity, time and disuse. Take a look at the CT scan studies and the DMX video of the shoulder in the hanging position available free at kirschshoulder.com, an educational website.

When you hang from an overhead bar, you engage the acromiohumeral joint. Use of this joint maintains the integrity of the subacromial space providing more room for the RC and other subacromial structures. During a hanging exercise, the upper humerus bends and remodels the acromion and stretches the CA ligament.

The hanging exercise is counter-intuitive: paradoxically, the pain that occurs while first attempting to hang from a bar is the first sign of contracture of the CA arch and if endured, will cure the contracture. Gravity is free!

[stridertg]

Orthoski,
I used to use the same double-speak during my practice. The patient leaves the office wondering what to do. You say that rotator cuff tears to not heal. But you have not discussed what might happen to partial thickness tears with proper rehab. Then you say that tears will extend and extend like a rip in a pair of pants. If you have a tear, "sit down with and orthopedic surgon." Then you say it is hard to tell someone with an asymptomatic tear to undergo surgery. But, the patient is subtlely led down the "primrose path" and that leads to an operation.

I have noticed in the literature that many ortho docs are recommending RC repair as soon as they are diagnosed for your reasons above. How can a patient deal rationally with this confusion?

[stridertg]

Orthoski,
I didn't finish the last post, hit the enter key inadvertantly. So here is a bit more
of this thread.
Given the tool of human effort using the hanging exercise with the gift of gravity, the compliance of the CA arch may be restored, the compression of the RC lessened and some small or partial thickness RC tears may be given a chance to heal. The key to all of this is the necessity of time. In this world of quick fixes, sound bites and photo ops, time has taken a back seat in our culture. Given the luxury of time, many patients may, if adequately motivated and properly taught, may regain a healthy shoulder.

"So many cracks, so little putty"