Fucked up shoulder

[Bunion 2020]

Big decision.

And IMO no shoulder repair will get you 100% pain free and good as new.

Good luck.

[Dantheman]

Spur of the moment called up "THE shoulder ortho" for my major metro area to get an appt scheduled to see what my options were as im sick of dealing with 50% function of my dominant arm at 36yrs old. He randomly had a cancelation opening for 8am this morning. Perfect. I go in, they take a few more xrays of the shoulder as a follow up to 2022's xrays and MRI which had revealed multiple labrum tears and significant arthritis. Doctor comes in, takes one look at the xrays and says "if you were 20 yrs older this is a perfect case study for full shoulder arthroplasty, but, since youre young lets look at some other options." Perfect, thats exactly what im looking for. His ultimate recommendation, which he seemed very confident about is an "Interpositional arthroplasty using dermal allograft"... basically slap some cadaver tissue around the ball of the humerous to act as short term cartilage (my body would also build tissue onto the cadaver tissue). Recovery would be ~3months and the time to it wearing out would be entirely dependent on use/abuse, but he thinks i could easily get 5-10 years of basically full function back. The Cherry on top is that he thinks he could probably get me in w/in 2 weeks. My wife did just throw a damper on things when she told me she is planning a surprise trip at the end of september and wants me to wait until afterwards... but refuses to tell me what the trip is because it will ruin the surprise. id rather not push recovery into January, so thinking about just rolling the dice and getting it done before that trip.

X-ray Findings: The glenohumeral joint show severe significant chonromalacia. Narrowing of the joint space. Inferior osteophytes. No fractures or dislocations of the glenohumeral joint. AC joint shows mild to moderate arthrosis.

Nice, good luck. Curious to see how this goes since apparently my Hill Sachs lesion tore a chunk of humeral cartilage off that I'll never get back. It's asymptomatic for now but could cause problems in the future, so nice to know there's a possible alternative to arthoplasty.

[californiagrown]

no shoulder repair will get you 100% pain free and good as new.

Totally. But, i am at the point where my shoulder/arm is borderline non functional and im in pain from the moment i wake up (somedays worse than others), and im also 100% going to get a full replacement in the future as im already an ideal candidate- just trying to put that off as long as possble. So the risks i would typically associate with surgical repair (scar tissue, nerve damage, mobility issues, etc) just arent really there for me because the symptoms cant really get much worse before full replacement is necessary. Also, its been so long since i've had full function of my shoulder that i honestly dont really remember what that is like, so ill take any improvement i can get (probably 5 years since ive actually thrown a ball over 50 ft). Id just like to be able to play catch with my kid in the backyard without having to do a jim abbott impression.

[Bunion 2020]

Sounds like a go. Chronic pain at your age blows.

I'm about to turn 67, my surgery was pretty major but I am hoping to keep all the OEM eqpt.

I'm around 95% ROM and usage, not 100% pain free but manageable. Heading out in a bit to play 18 holes and I can bike and ski so I am happy.

[old goat]

It's widely regarded now that the WHI data was misinterpreted. At most, it caused a statistically significant but clinically meaningless increase in the rate of breast cancer with no corresponding increase in cancer deaths. Meanwhile, untold numbers of women avoid or are denied HRT to treat their menopause symptoms and suffer needlessly.

It's part of the universal ebb and flow of medical fashion. HRT becomes standard of care. No journal will publish and article supporting it--it's not news--but they will eagerly publish articles that debunk it. Until HRT becomes taboo. Until someone publishes an article saying, no it's ok. And on and on it goes.

AAS hasn't gotten nearly the attention HRT has--mainly because men don't go to the doctor. And we're all convinced we're more manly than we are--we just need to get back in shape but you know too busy, but after the new year.

[californiagrown]

"This was one worst shoulders I've ever seen."

I didn't ask how many he's seen, but it's a lot. Passive ROM for now, real PT starts in a month. He got caught in traffic so was behind and in a hurry, so I didn't get to ask about recovery enhancers, but I'm pretty sure I know the answer.

Dan- what are you doing to keep in shape?

Ive got a belt squat jerryrigged up in my garage which i am training on now so i can get used to it and work out all the kinks before im one armed and stuck with it. Planning on landmine belt squats, single leg RDLs, body weight sissy squats, and just riding the assault bike. Im trying to figure out how to best train posterior core and am a little bit at a loss other than some modified supermans. thoughts?

[californiagrown]

Well shit. Had my preop today and the PA is going through the normal stuff and then mentions that on top of the dermal allograft that was what i thought this surgery would be, the ortho was planning to look at fixing my shoulder capsule, SLAP, and biceps tendon. My stomach just sank. Really mixed emotions. On the one hand, i do need all that stuff fixed (i was stretching overhead in my office chair yesterday and my shoulder just straight up fell out of joint to the side and backwards flopping behind me. It was gross) and if it does get fixed i might get a fully functioning shoulder back again... but on the otherhand, if all that stuff does get fixed im looking at 6-9 months of really hard recovery and PT instead of the easy 3month recovery for the dermal allograft. And the ortho doesnt know what is fixable till he gets in there as all that stuff was torn 20 years ago, fixed, and then promptly retorn and left that way for more than a decade so some or all might just be unfixable shredded pastrami.

So, basically, i go under and what i wake up with could just be a minor surgery and ill be skiing by New Years... or i wake up with a fully reconstructed shoulder, no skiing or MTB though the long dark PNW winter, and 6-9month recovery time. Really fucking bittersweet/anxiety inducing. Ugh.

I already rely on mountain activity as my only stress coping mechanism, and with that taken away, dealing with recovery, and managing a tactical retreat at work (a whole nother story) my wife is really concerned about my mental health and not having any real hobbies or outlets if they do the BIG surgery. gonna need to find something. And then she is also worried about how much ill be able to help with a feisty 3yr old if i cant use my dominant arm to hold/grab/play with him.

Fuck. This went from perfect timing, hardly disruptive, free 1 week break from life while i recover, and then a short PT... to a real big wrench thrown in to things (even if it is a much better long term, big picture strategy).

[mcski]

What does the dermal allograft fix? I feel ya on the timing. It’s never perfect tho

[californiagrown]

What does the dermal allograft fix? I feel ya on the timing. It’s never perfect tho

I have little/no cartilage left, so im dealing with pretty sever arthritis. Im really young for a replacement, so the allograft was meant as a last ditch effort to slap some cadaver cartilage around the head of the humerus to mitigate some arthritis pain and buy myself 5-10years before i do the full replacement. I had previously been told (2 years ago) that they didnt want to fix the labrum/capsule because that would tighten the joint up and exacerbate the arthritis... but i guess now that they are putting in some cadaver cushion, tightening the joint back up to prevent it knocking around so much would help the cushioning last longer.

[Dantheman]

Dan- what are you doing to keep in shape?

Ive got a belt squat jerryrigged up in my garage which i am training on now so i can get used to it and work out all the kinks before im one armed and stuck with it. Planning on landmine belt squats, single leg RDLs, body weight sissy squats, and just riding the assault bike. Im trying to figure out how to best train posterior core and am a little bit at a loss other than some modified supermans. thoughts?

Leg press, DB reverse lunges, one-arm DB bench press, one-arm pushups, one-arm DB rows, curls, biped planks, airdyne, hiking. Was downloading the tram but last weekend graduated to wogging down the service roads (w/ sling).

[rideit]

So, this year I have been suffering through all day pain, but still riding/working/working out etc. through the pain. I am getting a total replacement mid-November, but I have two big bike trips coming up that are worth roughing out the end of the season.
I am actually looking forward to it, I haven’t been able to lift anything over my head that is over about 15 pounds since 2022.
Good luck, everyone!

[Dantheman]

Well shit. Had my preop today and the PA is going through the normal stuff and then mentions that on top of the dermal allograft that was what i thought this surgery would be, the ortho was planning to look at fixing my shoulder capsule, SLAP, and biceps tendon. My stomach just sank. Really mixed emotions. On the one hand, i do need all that stuff fixed (i was stretching overhead in my office chair yesterday and my shoulder just straight up fell out of joint to the side and backwards flopping behind me. It was gross) and if it does get fixed i might get a fully functioning shoulder back again... but on the otherhand, if all that stuff does get fixed im looking at 6-9 months of really hard recovery and PT instead of the easy 3month recovery for the dermal allograft. And the ortho doesnt know what is fixable till he gets in there as all that stuff was torn 20 years ago, fixed, and then promptly retorn and left that way for more than a decade so some or all might just be unfixable shredded pastrami.

So, basically, i go under and what i wake up with could just be a minor surgery and ill be skiing by New Years... or i wake up with a fully reconstructed shoulder, no skiing or MTB though the long dark PNW winter, and 6-9month recovery time. Really fucking bittersweet/anxiety inducing. Ugh.

I already rely on mountain activity as my only stress coping mechanism, and with that taken away, dealing with recovery, and managing a tactical retreat at work (a whole nother story) my wife is really concerned about my mental health and not having any real hobbies or outlets if they do the BIG surgery. gonna need to find something. And then she is also worried about how much ill be able to help with a feisty 3yr old if i cant use my dominant arm to hold/grab/play with him.

Fuck. This went from perfect timing, hardly disruptive, free 1 week break from life while i recover, and then a short PT... to a real big wrench thrown in to things (even if it is a much better long term, big picture strategy).

I guess this really comes down to how long does the big surgery delay your eventual arthoplasty. 10+ years of a functional and relatively pain free shoulder seems worth a 6-9 month recovery. If it's 5 years or maybe less, not so much.

Also, mountain activity can't be your only coping mechanism. Relying entirely on a single coping mechanism is unhealthy in general, but as awesome as mountain sports are they're guaranteed to be unavailable at times.

[VTskibum]

I give up

[Dantheman]

Take it to the broken clavicle thread, this is a soft tissue safe space

I feel you on getting hurt doing something lame. I slipped and fell hustling through the tram line.


edit: Whoa, you deleted the post? I didn't mean it like that, was just giving you shit.

[californiagrown]

Take it to the broken clavicle thread, this is a soft tissue safe space

I feel you on getting hurt doing something lame. I slipped and fell hustling through the tram line.


edit: Whoa, you deleted the post? I didn't mean it like that, was just giving you shit.

IDK if you or others are interested, but i found a really good youtube channel that discusses the physical therapy aspect for athletes (including various shoulder repairs, knee repairs, etc). I feel like PT is kind of a dark-magic that i dont really understand fully all the nuances... and i think it is REALLY important to get a PT who is athlete focused for your particular sports... But the patient is going to be the one doing 90% of the PT on their own so the patient really needs to understand how hard to push, when to back off, when ROM vs strength is important, and all the other things that go into successful repair and return to sports/activities. Its waaaay more complicated for an athlete (especially a throwing athlete like myself) than it is for the average joe just looking to address pain and do everyday tasks. Anyways, i found this youtube channel and really like the roundtable discussions from the POV of athlete-focused PT's.

https://www.youtube.com/@Mikereinold


On a personal note, headed in for surgery in a week. Have BPC/TB/MK on hand and planned out. Didnt totally think about how to do it all one handed, so will probably have to get the wife to atleast load the stuff for me for the first few weeks. Very nervous and anxious to know the extent of the surgery that actually gets done, and nervous/anxious about it being as debilitating and painful as it was the first time around 18 years ago. Ugh.

[Dantheman]

I'll check that out. Good luck, that's tough not knowing what you're really in for until you wake up. I'd be curious to hear about the regimen. Did you find a surgeon that believes it's the future? Going through a separate doc? Self coaching, so to speak?

I'm doing pretty well. Cleared to ditch the sling, do full ROM without load, and run on the road which is awesome. 2 miles on pavement tonight never felt so good.

[californiagrown]

I'll check that out. Good luck, that's tough not knowing what you're really in for until you wake up. I'd be curious to hear about the regimen. Did you find a surgeon that believes it's the future? Going through a separate doc? Self coaching, so to speak?

I'm doing pretty well. Cleared to ditch the sling, do full ROM without load, and run on the road which is awesome. 2 miles on pavement tonight never felt so good.

Damn, you're progressing quick. 4 weeks out? The jostling from running sounds scary/painful, but sounds like its not too much trouble for you... thats awesome!

Everything im preparing is assuming that all procedures will get done, and im in for the long haul. I figure if the full gammut isnt needed i can save the stuff for 2 years in the freezer and use it to address niggling injuries and tendonitis that pops up throughout the year like normal. I havent talked to my surgeon about my recovery strategies, but when i was interviewing PTs the one i ended up going with is a big huberman fan and basically said he has seen good results from TB/BPC in recovery, and that his main concern was contamination/infection from bad stuff or bad application. he didnt know about MK. I actually got really lucky with finding him as he had recently quit being the head of the PT clinic associated with my surgeons larger practice to open his own smaller practice to spend more time with his kids and their sports teams (and his listed focus was on throwing athletes)- he was very sympathetic to me being a former baseball player/ Quarterback who is currently unable to throw at all with his 3yr old son.

I did a whole bunch of googling and youtubing and feel that i have a good program scheduled out that walks a fine line between conservative and aggressive (id be happy to share the excel file by IM). TB/BPC appear to be just really safe if used short term (assuming you don't already have cancer), and MK is the only one with legit concerns and i have some good strategies to address that. At the end of the day these arent AASs, they are far, far safer with far less side effect concerns. I looked at also using a low dose test/deca cycle but the length of cycle/pct and cost/logistics of consistent bloodwork vs the benefit to mostly just address muscle atrophy wasnt worth it to me (when i turn 40 im gonna push hard to get on TRT, so ill wait till then). Ideally i would be on HGH instead of MK, but thats super expensive and presents the same possible issues that MK does but in a much more serious/acute manner so i didnt want to go that route. There are other (possibly better) options besides MK, but MK is the only oral and i didnt want to become a pin cushion especially because subq will be hard for me. There are a number of online sources (I read about recent issues getting TB from compounding pharmacies ) and after redditing and foruming around it appeared that the same 4 or 5 names kept popping up with generally consistent positive reviews. Once i sourced everything needed the cost was about $600 for everything needed for a 12 week program. Im gonna preload the first 2 weeks of syringes (because theres no way i can do that immediately post surgery) and keep them in the fridge... i am a little worried about the subq shots in my stomach as ive always been a single digit BF person, and stomach is the only place on my body with enough fat/flesh where there is even a chance to do subq.

Supplements i usually take and will continue to take:
Whey Protein
Vitamin D3
Fish Oil/Omega3
The Ol' Costo brand Multivitamin

Supplements i will be adding:
L-citrulline
Collagen peptides
ZMA (will add in if the MK doesnt help my sleep as much as expected)


My shoulder was actually feeling really good the past couple days and i was starting to have second thoughts about this surgery. Rode bikes to the park with my kid on the shotgun yesterday, and tossed around a kickball for a couple minutes with him while we watched the local pop warner team practice. This morning im sore AF with 20% use of my arm. In a dark way, its kind of nice to get that reassurance that im doing the right thing with this surgery.

[Dantheman]

I'll be 7 weeks out on Wednesday.

I'll certainly be following your experiment with interest. I wish there was more real research happening in this area. Perhaps we should start a separate thread. A guy I know through work was telling me last week about some crazy stem cell treatments and other stuff he gets done in Mexico that are equal parts amazing and terrifying.

That's pretty much my "stack" as well, though I also highly encourage basically everyone to take creatine. I am also a beta alanine fan. Been on the collagen program for a few years. Another thing I also take is glycine. Very little in the way human RCTs on this, but I'll tell you why I do:

1) It's the most abundant amino acid in connective tissue by far.

2) While non-essential, there's a rate limiting step in glycine synthesis. We can make enough of it to avoid deficiency but not enough for optimum health, and modern diets don't contain much.

3) There's some evidence (albeit non-human in vitro) suggesting it stimulates collagen synthesis similar to how leucine stimulates muscle protein synthesis in skeletal muscle.

4) It's the only non-Rx compound to ever show efficacy in the ITP, so it's exceedingly unlikely to be unhealthy.

5) It's very sweet, almost as sweet as sugar, so I use it as a healthy sweetener in certain applications. It's particularly good for beverages.

[Dantheman]

(when i turn 40 im gonna push hard to get on TRT, so ill wait till then)

Care to explain here? If you're T is low now then it's silly to wait to correct it (either through direct replacement or other means). If it's not low at 40 then there's no reason to get on TRT, unless you want to dose up to supraphysiological levels which I would strongly recommend against.

[californiagrown]

Care to explain here? If you're T is low now then it's silly to wait to correct it (either through direct replacement or other means). If it's not low at 40 then there's no reason to get on TRT, unless you want to dose up to supraphysiological levels which I would strongly recommend against.

I dont want to permanently go to supraphysiological levels (im not necessarily against it either for a cycle or two). What i meant is that at age 40 i will hit up an endocrinologist and talk about options to bump my T levels up to the higher end of the normal scale. If i am already at the high end, great...but I would like to ensure i stay there, and ive already dialed in as many lifestyle factors as i find reasonable, so ill be exploring additional options to keep me there.

[Dantheman]

I feel you on the one cycle idea. The literature seems pretty clear that even one has benefits that last many years if not forever.

Beyond that, you need to consider more than just your T level. Androgen receptor sensitivity varies, there's free T to consider, it's complicated. Low T is a symptom based diagnosis, it's not "if your T is below X you have low T". If you aren't having overt symptoms (low energy, low libido, etc.) then it gets harder justify the associated issues.

[californiagrown]

Well, my 72 hr nerve block is gone after 22. I'm actually thankful because having the use of my fingers back is invaluable, and the pain is manageable at this point. Was under for a little more than 2 hours and have zero recollection of talking to the surgeon afterwards so I'm not entirely sure what all was done beyond getting some dead guy cartilage sewn in. Was nervous for the BPC/TB shots this morning, but they were stupid easy and unnoticeable. On the road to recovery!

[californiagrown]

Verdict is in, and they went to town on my shoulder.

[rideit]

Just scheduled my shoulder replacement for November 14fh. Yay!

[californiagrown]

Welp, 8 days after surgery and feeling shockingly good. Like dangerously good. I am, no joke, probably 75% back to where i was pre-surgery (which may just be an indictment of how bad it was to begin with). I really think the TB/BPC have helped with a quick recovery from the "trauma of surgery", we'll see how it affects recovery over the next 2-3 months. Compared to 17 years ago when i got a very similar surgery i am basically at week 7/8 right now. I am doing concerningly good.

The big downer is that at my postop appt today the PA made it VERY clear that i cannot be active overhead, or hold/curl anything heavy for 3 months- this is due to the bicep tenodesis. They really need that to heal fully before i start loading it in any capacity or i am at a really high risk for ripping it out of the anchor. Thats gonna be hard to keep in mind, but im gonna do my damndest to not push that.

Got in a good leg workout yesterday with a rigged-up belt squat, Sing leg RDLs, sissy wall sits, 10mins on the assault bike, and some abs. Felt great to get a sweat going based on exercise.