PART I: Injury
Partly for my own recollection and partly to answer the FAQs from my friends, I figured it would be smart to write down a timeline of my shoulder issues to date. With this baseline established, I can provide periodic updates and track my progress going forward. I've spent a few hours this week trying to find similar rehab stories (Bankart Repair) on the Web, and there aren't many out there. Maybe this will help someone a year or two down the line as they Google search for first-hand info like I have.
I had no history of shoulder problems. In fact, I've always considered my right shoulder to be particularly strong. I was an above-average thrower with many years of baseball (3B), football (QB) and more recently kickball (3B/Pitcher) under my belt.
My shoulder experienced an anterior dislocation for the first time on Saturday, Sept. 28, 2013, at the age of 27. I was playing in a charity kickball tournament. Diving back toward first base after a caught fly-ball, my hand got stuck on the grass and forced my shoulder back and up. I knew immediately what had happened. I could only move my arm at the elbow and the pain was excruciating. The trainer on the field decided not to reduce the dislocation on-site, so after he applied a masterful splint I was on my way to the University of Colorado Hospital in Aurora. My girlfriend, Kate, managed to hit every pothole in her path. I think she was doing it as revenge for some unspoken wrong I'd caused her.
The ER doctor popped my shoulder back into place without pain killers or sedation roughly 1-1.5 hours after it dislocated. This part was much easier than I was anticipating. He positioned my arm by my side like an "L," with my fist extended in front of my ribcage. Then he slowly rotated externally while a nurse applied pressure to my chest to hold me in place. A few seconds of intense pain later, there was a gentle click and all was well.
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| Ouch |
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| All patched up |
I wore a sling for about a week. My range of motion returned and the pain faded. I knew I was now prone to subsequent dislocations, but I figured I'd never had issues before and physical therapy would have me as good as new.
Well, almost exactly two months later, I was watching the Panthers vs. Patriots game on Monday Night Football. I felt like my shoulder was back close to 100 percent. When Ted Ginn caught the go-ahead touchdown for my beloved Carolina Panthers, I pumped my fist. Nothing dramatic, not a full blown punch or anything, just a subdued little fist pump. There wasn't much pain, but I recognized the sensation and the tingling right away. My shoulder had slipped out again. I asked my buddy Ryan sitting next to me to repeat the motion the ER doc had performed, and sure enough it clicked right back into place. The next morning my range of motion and pain level returned to what it had been about a week after the initial dislocation.
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| Ryan, the hero of the second dislocation, with some poop on his shirt |
Surgery now became a serious option. I throw, I climb, I'm active. Recurring shoulder instability would completely change my lifestyle. I met with a surgeon who explained that I'd experienced something called a Bankart Tear (or Bankart Lesion).
As I understand it, whenever anyone dislocates a shoulder, part of the labrum rips away from the bone. All of the correlating muscles, tendons and ligaments thus become looser than they were before, resulting in instability of the shoulder socket. A Bankart repair procedure reattaches the labrum to the bone using dissolving sutures as anchors.
PART II: Surgery
I scheduled my surgery for Wednesday, January 29, 2014. I spent the interim two months of purgatory enjoying myself as best I could, even squeezing in a few 14er hikes and an ice climbing trip to Ouray. I didn't have much pain, but the best way to describe it was my shoulder just felt unstable. Loose. I couldn't trust it, and that's not a good feeling when you're hanging by an ice tool 60 feet above Uncompahgre Creek.
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| Ice climbing in Ouray over New Year's |
My only prior experience with surgery was a knee scope in high school (Lateral/Collateral Release), and by comparison this one was a breeze. The anesthesiologist stirred up a cocktail of drugs that kept the nausea at bay, the pain upon waking was minimal and I avoided the need for a nerve block. I hardly even felt any discomfort and stopped taking the pain medications after only four days. I returned to work seven days later and wore the sling continuously, except for typing and bathing, as directed for the better part of three weeks.
Even out of the sling, the only physical therapy I was allowed to do were pendulum swings. Recovery progressed rapidly. Unfortunately, during my first checkup with my surgeon's PA, I was informed not to start setting real PT appointments until the six-week mark. That wasn't what I wanted to hear. I felt good and was eager to take a more proactive stance toward recovery. Mostly abiding by his rule, I set my first PT session for five weeks post-op.
It went better than I could have imagined. I could do all of the exercises the therapist assigned without pain, so much so that he gave me extras usually reserved for later weeks. I skipped right over the entry-level yellow rubberband and onto the intermediate orange. The therapist said I was way ahead of most people, and I left energized and grinning from ear-to-ear.
PART III: Peaks and Valleys
I climb peaks as a hobby, and six weeks after surgery I felt like I was on top of one. My range of motion was still severely limited, but I couldn't remember the last time I'd felt much pain. I was doing PT for an hour a day, went on a couple hikes, and enjoyed the company of friends for my girlfriend's birthday and St. Patrick's Day. No pain. I was even starting to feel strong.
Then I woke up Monday, March 17. The pain had returned with a vengeance. I could hardly drive my stick shift, something I'd been doing since about 2.5 weeks post-op. Panic set in. What if I'd done something to tear the sutures, or if those had dissolved already, the labrum back away from the bone? I went over everything I'd done the previous day. Nothing stood out as dangerous. I'd spent most of it on the couch.
So I went back to the weekend. I'd gone for a short hike/run Thursday, also the last time I'd done my PT exercises. As part of a WFA class, I'd helped drag a person about three feet in a mock scenario. That night I'd gone out to celebrate St. Patrick's Day. I got a few hugs, shook a few hands, supported a friend's legs (with help, using mostly my good shoulder) during a keg stand. Sunday I threw a frisbee -- once, about 15 feet, using mostly my wrist -- for my dog. I definitely hadn't fallen, which my surgeon said was the most dangerous threat.
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| Hike of Bear Peak, early March |
Yet, my shoulder felt back to where it was two or three weeks after surgery. There was a deep, burning, throbbing ache right over the largest incision. Monday night I even had to sleep in my sling again for comfort. What gives? Everyone told me I was being paranoid, or exaggerating. To be honest, I was terrified. What if I'd somehow damaged the repaired area? I kicked myself for not babying it more, for doing all of those activities listed above.
It's gotten better throughout this week, but even sitting here Friday morning, some pain remains. More than there was last Sunday, for sure. I'm optimistic I'm fine, telling myself I just slept on it wrong, or that all of my activity last weekend had a cumulative effect. But a lot of lingering doubt remains. If I did somehow manage to re-tear my labrum, the result would be five months and thousands of dollars down the drain.
For half a year, this shoulder issue has prevented me from doing the activities that sustain me. I might be paranoid or exaggerating, but not exactly without cause. I'm in the prime of my climbing life, and instead of accomplishing all of the dreams and goals I'd concocted for this winter, I've spent most of it in a sling. I'm ready to be healthy. Considering the possibility of a failed surgery and continued instability makes me break out into a cold sweat.
PART IV: Climbing Out
I've leaned exclusively on my girlfriend during my recovery, and my recent week of nagging worry has been especially draining on her. I can't say enough how thankful I am for all of her love and support. She's imploring me to be more positive, and she has a point.
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| San Francisco with Kate, during the sling's final days |
There's always someone that has it worse. In my case, lots of someones. My surgery was unbelievably minor in the grand scheme of things. I can still walk, I can take care of myself, I can work. I have my mental health. I'm not dying. I met with my doctor Monday for my six-week follow-up, and he seemed very unconcerned about my newfound pain. I'm not entirely sure I voiced correctly what I was trying to convey (I left out the keg stand part), but still, he kept on coming back to falls being the big danger. I hadn't fallen.
The doctor said there would be no way to tell if the surgery failed, unless another dislocation occurs. Re-tear or not, the next step is the same: total dedication to physical therapy. That's all that's in my control, so I might as well stay positive.
I was told five months for a full recovery, meaning if I played contact sports or pitched baseballs for a living, that's when I'd be cleared. For more normal stuff, I should have full range of motion and limited pain by the three-month mark -- the end of April. That's the next goal to work toward. If I clear that hurdle, maybe I'll even be able to squeeze in some snow climbs by mid-May. A boy can dream.
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| Did someone say snow climb? |
Whatever happens, I'm going to try to be more upbeat and keep everything in better perspective. If I don't and the surgery did in fact fail, the next time Kate is driving me to the hospital after a dislocation, she might hit even more potholes.
-Jeff
