Serious shoulder questions for BC skiers, and my own labrum WTF thread

[SchralphMacchio]

Chainsaw, I hope you get yourself a job with good insurance. I hope this situation works out for you - the dislocation in your sleep sounds like a red flag to me.

I'm still nowhere near being able to ski. Too much chance of quick/extreme external rotation that would cause sudden pain & inflammation and then result in a setback. My muscles are just re-learning how to fire correctly right now. The good news is that I snowboard better than I ski, and that the likelihood of falling with external rotation on my leading shoulder on a snowboard is way less than on skis, so I might be able to start doing that in March.

This brace is pricey but my doctor recommended it for me because it limits ROM. I have a Flexible Spending Account that I might use to purchase it, so that at least it's paid for with pre-tax money.
http://www.dme-direct.com/sawa-shoulder-brace

[SchralphMacchio]

hmm I bet I could strap a radio harness to that front buckle, then I'd be able to act like a real asshole to ropeducking snowboarders about to poach my line!

[Chainsaw_Willie]

I've seen a couple braces like that. Not sure how the strap that goes from chest to arm under the armpit would work under my ski jacket though.

My insurance is through my union. While the coverage isn't the best for some things (dental is really good and coverage for surgery is decent) the good thing about it is that when you're working it gets paid ahead. I got laid off last May and I'm covered through June '12, so basically your insurance is paid up a year in advance if you work steadily for a couple years.

[SchralphMacchio]

I've seen a couple braces like that. Not sure how the strap that goes from chest to arm under the armpit would work under my ski jacket though.

It certainly depends on the cut of your jacket. My touring jackets are cut a lot more slim and might not allow the straps that limit abducting and rotational motion. I wonder if there is enough adjustment in the brace to work outside of a shell - which is why I was saying to double it up as a radio harness and look like a 'troller or SAR member

[crackboy]

EVS sells a couple different shoulder braces with various levels of support. works really well. I use mine to boat with. really only had it in teh pool but it has kept my one shoulder in joint

[SchralphMacchio]

Those EVS braces don't appear to have any hard limit to abduction or external rotation. However, they do fit under ski shells. I'm just wondering how much they are really going to help.

[crackboy]

it actually has a bit built in to the design, granted its not a firm strap like the brace you linked but the cut of it prevents a lot. i i thought they offered one with a strap like that though, but could be wrong.

[SchralphMacchio]

So just bumping this because I had an unhappy day today.

Last night I subluxed the shoulder while rock (gym) climbing on an overhanging bouldering problem and doing a strong move. I heard/felt a pop/crunch sound and felt the joint moving, instantly let go and as I was falling I could feel the joint move/pop/crunch back into place. It was all very bang-bang-bang so the humeral head was never quite out of the joint, but that movement felt to me very much like a subluxation. A little sore today but full ROM and popping IBU's.


To rewind a bit, since I haven't updated this thread since January:
-I elected to skip the surgery and try PT
-I did PT from February into May, at which point I had 99% ROM
-I got back into activities slowly, based on intensiveness - BC snowboarding (i.e., using a pole to skin) in March, skiing in May, mountaineering in June (i.e. using an ice axe as an ascending aid) and rock climbing (2-3x/wk) in June
-I had soreness issues when the shoulder was cold, weakness issues, felt funny sleeping on my side, going into the heart of summer it felt really good overall
-I felt good gym climbing and worked my way back up over the last 3 months from 5.8/V0 to 5.11a/V3 - no signs of instability during the last 4 months of climbing
-Since late June I tapered down rehab exercises (incorrectly) figuring that I was recovered and doing enough activities to stay strong
-I started having some minor impingement issues the last few weeks
-last night was the first sure sign of a compromised/unstable joint I've had since originally dislocating the shoulder


I guess at this point my plan is to go back into PT next week, take a few weeks off of climbing, and think about maybe looking into PRP/Stem Cell as a pre-emptive treatment. I am not considering surgery at this point unless it dislocates under a regular activity (excluding falls or strenuous pulls basically) ... then I am concerned about it being a safety issue in the BC for multipitch trad or multi-day ski touring.



Willie, how is your shoulder doing?

[MJbumper1121]

Sucks to hear I really think the real solution is surgery, mainly because I had a successful surgery and have been pushing my shoulder harder than I did before my injury with 0 issues (knock on wood). Obviously, everyones body is different, but I just hope either way, your shoulder gets to a point where you don't have to worry about it dislocating/sublux...

[neufox47]

When you finish PT this time transition into a shoulder strength program.

Remember it typically takes one to two years to make a physiological change through exercise. PT gets your ROM back and does some basic strengthening. You need to do more than that.

Your best bet would be to find a facility that deals with strength and conditioning for athletes, with a specialty towards baseball and swimmers, ie athletes with shoulder problems. See if they offer group training to make it affordable. If you are doing it yourself Eric Cressey has a program you can order Optimal Shoulder Performance that is probably the next best thing.

[~mikey b]

I spent 1 year trying to recover w/o surgery. Had arthroscopic surgery. Did not work. Spent 5 years doing PT, subluxing, etc. Had proper surgery. Shoulder is WAY better now.

Some things need proper surgery. Even if you do all the right things, you still might end up looking like this...





8 weeks in that fucking sling.

[SchralphMacchio]

When you finish PT this time transition into a shoulder strength program.

Remember it typically takes one to two years to make a physiological change through exercise. PT gets your ROM back and does some basic strengthening. You need to do more than that.

Your best bet would be to find a facility that deals with strength and conditioning for athletes, with a specialty towards baseball and swimmers, ie athletes with shoulder problems. See if they offer group training to make it affordable. If you are doing it yourself Eric Cressey has a program you can order Optimal Shoulder Performance that is probably the next best thing.

Thanks for these comments. Thoughtful and useful.


I think for me the biggest challenges without surgery would be withholding my climbing and not allowing myself to get close to pushing 100% (a hard thing to do for people like us) and the mental roadblock of not having any trust in the joint and wondering if the arm is going to be dangling by my side the next time I pick up my mountain bike to put it on the roof rack, etc.

But shit man, ski season is coming up, and I'm planning on being too funemployed to afford a big surgery and PT recovery in June once the season winds down.

[~mikey b]

when yours blows out in bed like mine did, you'll be calling the surgeon

I was done fucking around wondering when it was going to happen again

[MJbumper1121]

Ha! This happened to me as well. Attempting to push myself out of bed and dislocation on the way up, was a nice way to start the day.

when yours blows out in bed like mine did, you'll be calling the surgeon

I was done fucking around wondering when it was going to happen again

[RegCT]

I know this is old but...

Circa 2006 I busted my ass on rail resulting in a posterior dislocation of my right shoulder and f**ked it all up. Many docs recommended PT until an MRI showed a labrum tear of like 80 percent.

That spring/summer it would sublux constantly or totally dislocate, even while sleeping. I had a technique down where I would step on my fingers and pull the shoulder back into place. It was awful. After 25 or 30 dislocations I finally had the surgery.

Doc performed real surgery and used 7 or 8 anchors to re-attach the labrum. I spent an entire semester of college throwing a tennis ball up against my apartment wall. PT was long and it was painful but SOOOOO worth it.

Range of motion is 100% 6 years later. The only time I feel pain (zero to hero, lots of pain) is if I am making movements like reaching back behind the seat of my vehicle. Tennis, climbing, bikes, skiing, all good to go. No persistent clicking or soreness and no signs of any chronic inflammation yet.

[SchralphMacchio]

thanks for that - my PT's main concern with surgery is not being able to guarantee 100% ROM. In his opinion, it's climbing where I have a problem, and yet my climbing would be affected if I had limited ROM after surgery.

That said, I have yet to take a gnarly enough fall while skiing to blow it out.

I feel like I will probably need to have the surgery at some point, but not in the next 7 months ... ideally I do it right at the end of ski season, but I'm planning on being unemployed at that time and my health insurance will be very minimal at that point - not a great time to throw down on a surgery and months of PT - so it might have to wait until the end of the 2014 ski season, unless it gets dramatically worse between now and then.

[wendigo]

ummm stop climbing?

best thing i ever did for my shoulders was stop climbing - nerve damage in my elbow was what really ended my climbing though.
had MRI - SLAP lesion, doc who really wanted to cut. mostly solved all of it by no longer climbing.
i was a 5.12 trad climber, so i know what it means to give it up - but skiing has filled the void.
YMMV

[crackboy]

honeslty climbing was the best thing for my shoulders. just lay off those weird overhanging moves that stress the joint at weird angles. it will help strengthen the muscles around the joint which is what you want

[RegCT]

^^I agree that the motions involved with climbing are healthy for recovery, and strength is key. I would be concerned though, having to rely on a shoulder that is in rehab. Shit can be sketchy.

To clarify my PT experience, its been 6 years since the surgery. It probably took a very solid two years to get to a confident 100% and then another year to where I don't even think about it.

[SchralphMacchio]

honeslty climbing will help strengthen the muscles around the joint which is what you want

^^I agree that the motions involved with climbing are healthy for recovery, and strength is key. I would be concerned though, having to rely on a shoulder that is in rehab. Shit can be sketchy.

Well neufox's comment that it takes a solid year plus of work to effect lasting changes is probably key here. Climbing does very little to strengthen supraspinatus or whatever ... my arms are strong for pulling moves, but my shoulder is less strong for external rotation, and actually very weak for that motion when you open up your arms from having them intially placed hands at your hips (I don't know what kind of motion that is).

You guys are right though, if it starts subluxing in my sleep, I'll be calling the cutter. I'm kind of glad I didn't do surgery to at least give myself a chance to evaluate the situation, but know I'm thinking, this past January would have been THE perfect time for me to have had surgery. Oh well, hindsight's a bitch.

[telek]

Ha... I've only come here when I'm a gimp myself... but gotta comment as I just had my left shoulder done 2 weeks ago. I've had 3 operations on my right... 1st - ortho, 2nd - open bankart, 3rd - some name I forget... but I've got pins in there now and hasn't come out since. Did the right one climbing... can't say that climbing is the best thing for a unstable shoulder.

My left shoulder started popping out 2 years ago (kayaking)... both shoulders were anterior... then it got bad enough this summer that it was popping out pretty easily. When it popped out climbing at Lover's, I decided to go under the knife.

I know a lot of folks that have had one or two dislocations and no more... but if it pops out more than 2x a year, it's probably time to get it done. At that point there's probably enough damage to your labrum, some hill-sachs... and you can't repair that without surgery. PT isn't going to repair your labrum.

But as far as surgeries go, it's pretty mellow. In and out... on a bed for a day, then in a sling for 5-6 weeks. It's pretty boring but I can still get a workout on the bike trainer, and unicycle...

[SchralphMacchio]

Thanks Yu.

I'm pretty sure I'm going to do the arthroscopic repair once the ski season is done. My capsule is just so loose that the muscles are misfiring and compensating in stupid ways, even with my ongoing PT. Plus I do have a Hill Sachs, so it's pretty much an open liability.

I did a week of climbing in J-tree over Thanksgiving and there was zero pain during the trip, but when I got back I noticed a completely messed up muscle directly opposite from where I think my labral tear is.

Good luck with your recovery dude!

[baron]

Peronally people I know ,who had shoulder surgery ,did Not like the results in the long term.Maybee pushing re-hab to fast is the prob? I had a doc diagnose me as grade 2 shoulder separation.Healed better than new. I hear the rubber band exerciser works wonders(when your ready)

[baron]

Carefull there Chainsaw......;my knee dislocated(doing reg work) a week before the mcl went 2 yrs ago.

[kingofpuck12]

Might be a little late but I had the exact same injury and complications. Spent 8 months rehabbing myself but I never got better. Finally went to the ortho and had an MRI, torn labrum in two spots plus a lot of other technical stuff I can't remember, rotator cuff was fine.

Ortho didn't want to do surgery due to my young age (24 years old) but said I could get better with extensive rehab. Went to a great sports PT who mentioned with labrum tears they won't heal themselves. After 8 weeks of 2x a week PT my shoulder is back to 95%. Just don't like heavy benching and military press anymore.

My advice go to a solid sports PT and do rehab