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View Full Version : SLAP and Supraspinatus


Justin Ludwig
04-17-2012, 03:28 PM
I finally had an MRI taken on my left shoulder. Initial injury in 1996 (fell rounding first base), re-injured in 1998 (drunk knee-boarding and dislocated), subluxation of the adjoining clavicle in 2008 from lowering a 200# 8x8 log into a hole. I didn't go to the doctor for any of those injuries. Young and dumb...

Started CF last Sept/Oct time frame and KStarr's Mobilitywod in November. All the while, knowing my shoulder is doing Rice Krispies when I work out. I think finding mobilitywod and this forum is the only thing that saved me from truly jacking up my shoulder.

I'm going to give the doctor's write up of my injury and then ask my question.

FINDINGS: There is mild edema in the anterior deltoid muscle from the injection procedure with a small amount of extravasated contrast in the subscapularis muscle. The subscapularis tendon is intact. the anterior and posterior labrum is intact. There is a prominent sublabral foramen in the upper aspect of the anterior labrum. The biceps tendon courses normally in the bicipital groove. The infraspinatus and teres tendons are intact. There is subacromial/subdeltoid fluid and contrast. This extends under the lateral aspect of the supraspinatus tendon. There is dense heterogeneous signal seen throughout the full thickness of the distal supraspinatus tendon near its insertion. There is large marginal inferior osteophyte at the tip of the acromion process. The contacts the superior surface of the supraspinatus tendon, although i see no discrete abnormal signal at this level. The acromioclavicular joint is essentially unremarkable. There is hyperintense signal in the inferior half of the superior labrum with partial separation from the glenoid anteriorly.

IMPRESSION: 1. Heterogeneous signal in the distal fibers of the supraspinatus tendon consistent with sever partial yet near full-thickness tear of the distal fibers of the majority of the supraspinatus. There is additional evidence of rotator cuff instability and discontinuity with subacromial/subdeltoid contrast.
2. Tear of the superior labrum, particularly anteriorly. Large marginal osteophytes from the tip of the acromion process inferiorly that contacts the superior surface of the supraspinatus tendon.

Question - I have my choice of any doctor that accepts TriCare (I'm Army). Am I looking at full blown "lay me open" or orthoscopic surgery? I'm extremely active and want full mobility of my shoulder back with no loss of strength. Might be asking too much, but with my shoulder as is I can: Push Press 185#, do 30+ kipping pull ups, Snatch 145# (technique still sucks), HSPU, Clean and Jerk 185# (form lacks), etc.

Also, how can I make sure I'm getting a surgeon that excels at shoulders?

Daniel Pope
04-17-2012, 06:50 PM
Looks like you've got some shoulders issues my man!

It seems that you aren't too bad though. If you can still do all of those exercises I'd think there's still hope for you, maybe even without surgery. Did your surgeon refer out for physical therapy? Would be a smart idea to link up your therapy from mobility wod with advice from a professional. Maybe cut out any exercises that give you pain for a while to let things heal and pain subside. Address any flexibility limitations before going back to previous offending exercises, promote lots of scapular stability. Let that poor supraspinatus heal and normalize motion within the shoulder joint!

Let me know how it goes brother,
Dan Pope

Justin Ludwig
04-18-2012, 08:02 AM
Advise from the ortho was to have surgery if I want full strength and to stop the cracks and pops, fix the clavicle, and reduce inflammation. They said my supraspinatus has 80% full tear through.

As for mobility, the only thing I'm lacking is "biceps behind the ears" on OH lockout. I can be biceps even with my ears, but not behind. That tightness is predominately in my lats and pecs. Oddly, I can do anything with my shoulder as long I start in a good position (externally rotated and locked). Whereas, something as simple as swatting at a fly randomly can bring me to my knees.

Because of the age of the injuries, it's probably too late for PT until post-surgery.

Daniel Pope
04-18-2012, 01:40 PM
PT before surgery can be one of the best things you could possibly do. It'll help speed recovery after surgery. Never too late for physical therapy. Physical therapy isn't just for immediately after an injury. most people don't see a therapist until they're had an injury for so long that they can no longer deal with it on a daily basis.

Let me know how the surgery goes. Interesting injury.

Dan

Steven Low
04-18-2012, 07:57 PM
It's never too late for "PT" (e.g. strengthening and stability work) before surgery.

Significantly speeds up recovery

Justin Ludwig
04-18-2012, 08:35 PM
It's never too late for "PT" (e.g. strengthening and stability work) before surgery.

Significantly speeds up recovery

Well, I follow mainsite coupled with Wendler 5/3/1 and I do KStarr's mobility work everyday I workout; in warm up and cool down. I don't take NSAIDs and only use ice when it hurts. I hope that's what you both have in mind for PT. Since getting the MRI, I turned off my firebreathing during workouts because I'm now skiddish.

Gravel Brown
04-18-2012, 11:26 PM
The surgery is worth it mate. I'm 10 months post SLAP surgery with 4 anchors. My ROM is near 100%, slightly stiff reaching behind my back but everything else is very much as normal.

I'm avoiding any loaded overhead movements still but exercises like deadlifts, bench press etc are back to pre op standards... so in short 10 months post op I'm pretty much back to normal.

It's amazing how quick your strength returns once you start lifting again.

Graeme Beath
04-19-2012, 12:30 AM
Go with gravel's advice. I've a had a SLAP repair & a spur shaved from acromion. A little different to Gravel I've had the bicep tendon relocated & only 7 weeks out so still quite stiff etc but hopeful.
It seems to me you may also have some spurs there & my Ortho told me that is where most the pain is coming from, also what is most likely rubbing on & causing the supraspinatus problem.3
Different guys do the proceedure differently but most these days use keyhole method so you'd have 3-5 small incisions. It's a little rough the first week or so & very restricted on what you can do for a while. Rehab process is long but if you want a reasonably permanent fix it's a must.

Justin Ludwig
04-19-2012, 05:51 AM
No spurs and no osteo problems, thankfully. I don't get pain from movement, just inflammation from overuse. Overuse is 220 pullups in one week (found out the hard way). My shoulder felt shattered for days during sleep.

Daniel Pope
04-19-2012, 11:52 AM
Well, I follow mainsite coupled with Wendler 5/3/1 and I do KStarr's mobility work everyday I workout; in warm up and cool down. I don't take NSAIDs and only use ice when it hurts. I hope that's what you both have in mind for PT. Since getting the MRI, I turned off my firebreathing during workouts because I'm now skiddish.

Ya, was meaning more along the lines of finding a therapist and listening to their advice. Continuing training full bore along with the advanced intense stretching from MWOD that is meant for healthy shoulders is probably doing more harm then good.

Steven Low
04-19-2012, 03:02 PM
I would tend to agree with this Dan

You don't know if he's reinforcing good or bad motor patterns

Justin Ludwig
04-19-2012, 08:24 PM
Well shoot, that is very disheartening. I guess I falsely assumed doing mob work was good for injured joints (case by case - and in my case). I'll ask my ortho.

Steven Low
04-19-2012, 09:08 PM
Well shoot, that is very disheartening. I guess I falsely assumed doing mob work was good for injured joints (case by case - and in my case). I'll ask my ortho.

Don't get us wrong -- it's for the most part a good thing.

BUt depending on your particular issue(s) and musculoskeletal problems we can't examine with there may be some particular movement or postural functions that you may need to be corrected.

There's nothing worse than doing a lot of something only to find out that you may be doing it wrong because then you have ingrained improper neural patterns into your body.

For a normal healthy person I would say MWOD is a great resource, but I would hesistate to refer someone to it that has acute/chronic injury issues that generally won't resolve by themselves. After all, we don't know if you have any technique/posture/movement issues that contributed to your injury in the first place -- and thus if you are reinforcing poor mobility patterns when doing that it's actually a very bad thing.

Make sense?

Sean Rockett
04-19-2012, 09:14 PM
I finally had an MRI taken on my left shoulder. Initial injury in 1996 (fell rounding first base), re-injured in 1998 (drunk knee-boarding and dislocated), subluxation of the adjoining clavicle in 2008 from lowering a 200# 8x8 log into a hole. I didn't go to the doctor for any of those injuries. Young and dumb...

Started CF last Sept/Oct time frame and KStarr's Mobilitywod in November. All the while, knowing my shoulder is doing Rice Krispies when I work out. I think finding mobilitywod and this forum is the only thing that saved me from truly jacking up my shoulder.

I'm going to give the doctor's write up of my injury and then ask my question.

FINDINGS: There is mild edema in the anterior deltoid muscle from the injection procedure with a small amount of extravasated contrast in the subscapularis muscle. The subscapularis tendon is intact. the anterior and posterior labrum is intact. There is a prominent sublabral foramen in the upper aspect of the anterior labrum. The biceps tendon courses normally in the bicipital groove. The infraspinatus and teres tendons are intact. There is subacromial/subdeltoid fluid and contrast. This extends under the lateral aspect of the supraspinatus tendon. There is dense heterogeneous signal seen throughout the full thickness of the distal supraspinatus tendon near its insertion. There is large marginal inferior osteophyte at the tip of the acromion process. The contacts the superior surface of the supraspinatus tendon, although i see no discrete abnormal signal at this level. The acromioclavicular joint is essentially unremarkable. There is hyperintense signal in the inferior half of the superior labrum with partial separation from the glenoid anteriorly.

IMPRESSION: 1. Heterogeneous signal in the distal fibers of the supraspinatus tendon consistent with sever partial yet near full-thickness tear of the distal fibers of the majority of the supraspinatus. There is additional evidence of rotator cuff instability and discontinuity with subacromial/subdeltoid contrast.
2. Tear of the superior labrum, particularly anteriorly. Large marginal osteophytes from the tip of the acromion process inferiorly that contacts the superior surface of the supraspinatus tendon.

Question - I have my choice of any doctor that accepts TriCare (I'm Army). Am I looking at full blown "lay me open" or orthoscopic surgery? I'm extremely active and want full mobility of my shoulder back with no loss of strength. Might be asking too much, but with my shoulder as is I can: Push Press 185#, do 30+ kipping pull ups, Snatch 145# (technique still sucks), HSPU, Clean and Jerk 185# (form lacks), etc.

Also, how can I make sure I'm getting a surgeon that excels at shoulders?

Justin this should be an arthroscopic surgery. As far as who to go to, you want someone who does about 100 per year or more. It is fair game to ask someone how many they have done. Your primary care doctor will have a good sense of who are the go to guys for this.

Justin Ludwig
04-22-2012, 07:14 AM
@ Steven - Yes, understood. Thank you.

@ Sean - Thanks for the advice.

Justin Ludwig
08-31-2012, 05:02 AM
It's been a long journey and the Army sure knows how to drag it's feet, but I am finally having surgery this morning.

I'll probably be on the forums a lot more over the next couple weeks... ;)

Justin Ludwig
09-07-2012, 05:17 PM
It's been 7 days since my surgery. I quit the Percocet Tuesday morning at 0200. I stopped ibuprofen yesterday and haven't used my sling since Wednesday morning. Today was my first workout; a modified one armed version of Lumberjack 20. Felt great to sweat again.

I don't see my surgeon again until Tuesday and have not been assigned any PT yet. But so far I can reach forward about 8 inches, backwards about 6 inches (pronated and supinated.) Trying to raise my arm laterally pronated I can manage about 12 inches, but with palm forward I get about 4 inches before I really feel some pull on the RC and at the anterior portion of the deltoid (maybe where he repaired the labrum?)

Surgery included: shave spur on head of humerus, bottom side of the acromion, reattach supraspinatus and stitch or screw up the SLAP tear (not sure which method he used, my wife didn't ask while I was still passed out.)

Overall, I'm very surprised to be pain free (except when sleeping) just 7 days out without medication. Now I just have to force myself to not push it. Tortoise wins the race, correct?

Selina McFall
09-07-2012, 09:02 PM
Good to hear the surgery went well. I had hardly any pain either, and my SLAP repair was quite extensive.

Were you told you don't need to use the sling anymore? And the movements you're doing - was that as prescribed by a physio before you were dicharged? If not I'd be careful until you see your surgeon for the follow up and get more instructions. I had to wear the sling for 6 weeks except when washing or exercising, and all movements were passive.

Justin Ludwig
09-08-2012, 04:26 AM
I didn't get to speak to the ortho post-op, but what he told my wife: get my arm extending and out of the sling a couple times a day the first day to assist circulation. (This was a must multiple times the first couple days because my elbow was going crazy) Also, to let my arm dead hang, lean forward and do small circles both directions and to gently swing my arm forward and back. (the first 2 days I wasn't able to swing more than a couple inches, I was just moving it and pumping my fist) That's all I know until Tuesday for my follow-up. My wife said he didn't explicitly state to keep it in the swing.

I've been told by everyone to take it easy and not rush it, especially my wife. I'm not trying to rush my arm or use it (I can't, honestly.) I'm just trying to improve circulation and reduce inflammation naturally using KStarr's newly mentioned MCE method minus the MarcPro (I'm not dropping 600+ when I can stimulate my own muscles).

I'm listening to my shoulder. Who's speaking quite loudly this morning due to sleep inflammation (up at 0530 on a Saturday!)