Saturday, December 10, 2011

Ream and run diary - a one year perspective

The 50 year old gentleman who was featured in the November 17 post, generously offered a bit more detail his rehabilitation after his ream and run procedure. His shoulder x-rays looked like this before the operation:

And like this three months later

Here's the story the way he tells it:

One year ago I had surgery on my left shoulder, and today my shoulder is doing great.  At 1 year, I am playing basketball, flag football, tennis, golf, and ping-pong.  I have also resumed regular gym activity, swimming and just about anything else that I want to do.  Some of these may not sound like much, however my left shoulder (I am left handed) had very limited range of motion for the past 10 – 15 years with the last couple of years being so bad that I could not even play darts left handed.  I was unable to comb my hair left-handed without the assistance of my right hand.  I also could not raise my hand more than 1 foot above my head.  Needless to say, I could not participate in any of the sports listed above.  I even found that I could no longer bowl left-handed, and golf had become too painful to play in the last couple of years.

For months 0-3, I performed the exercises you gave me religiously.  I would do the shoulder stretch using a table and then the rope and pulley stretches 6 times per day.  Sleeping was a little rough.  There were times where I would wake up with pain and just go do my stretches.  I will say that every time I did the stretches, it felt like I had never done them before.  It sometimes seemed like my shoulder would never get any better and that the painful stretches that I had performed 2 – 3 hours earlier had no benefit.  However, day by day, things slowly got better.  On the exact 3 month anniversary of my shoulder, I was able to lift my shoulder completely vertical over my head for the first time in a long time.

Months 3-6 were also pretty difficult, but I think that I was pushing my shoulder too hard.  My goal was to have my shoulder back to 90% by 6 months, however, since my range of motion had been so limited for so long, I think I should have been more patient.  As a result, I had a couple of set-backs with rotator cuff muscle strains; the joint on the other hand, has never had an issue.  At that point, I had a couple of appointments with different physical therapists near my home in Southern California.  The concern I had (and still have) about PT is that sometimes the therapist just wants you to keep coming back to them.  I made it clear that I was no stranger to the gym and was just looking for guidance.  I learned from both of them to be more patient with my progress.  The soft tissue in my shoulder had atrophied significantly over the past 15 years and even though some of the stronger muscles of the shoulder were ready to go, I really had to focus on performing the rotator cuff muscle exercises (using the colored rubber bands) and stretches.

I have continued to see improvement in my shoulder beyond 6 months post op.  At 6 months I was not quite able to throw a softball 60 feet (I really wanted to be there for my 6 month survey), but today I can throw over 90 feet!  My arm still feels pretty weak in terms of soft tissue when I throw (there is no joint pain) so I am taking it very easy.  Eventually I want to play in a softball league, but I want to be able to throw hard without issue before that happens.  At 6 months I was still playing tennis right-handed but by month 10 I could play left handed including serving left-handed.  My most visible improvement is in basketball.  I gave that up 14 years ago because I could no longer shoot left handed or rebound with two hands.  Today, I am playing without pain and can extend my left arm without pain or resistance.  Please not that my skill level is pretty bad, but I can no longer blame it on my shoulder.

The interesting thing is that some of the planes of motion are completely better, while others have come around much more slowly.  For instance, I can do 12 pull-ups easily and am back to full strength for many exercises in the gym (curls, rows, tricep extensions, etc) but I am still weak when benching or doing flies (while lying on my back).  Don’t worry; I am not doing military presses or any exercises involving lifting weights repetitiously over-head.  One motion that I have not seen much improvement on is raising my left hand behind my back.  It just does not go, although I haven’t really worked on that motion too extensively.

As a bit of advice to prospective patients, they have to commit 100% to rehab.  You actually have to like it.  I found it interesting that many of the survey questions touch on depression as I have found personally that going through rehab does have its ups and downs.  However, if you keep focused on the long term goal, the progress you make can definitely put a bounce in your step.  Rehab can actually give one a purpose and a break from the ordinary.  I think goal setting is important (3, 6 and 12 month goals) and have a final picture of how you want things to be.  For me, my goal is to still be able to play in two on two volleyball tournaments with my son.  I still cannot swing hard left-handed to hit the volleyball (I am not sure that that is a motion that Dr. Matsen would recommend), but I want to be able to do that.  The only other difficult part of this goal is getting my 19 year old son to agree to it.

In closing, I just wanted to thank you and your team again for giving me back my shoulder and increasing the quality of my life.  It has really allowed me to get back into many things that I had long ago given up.  


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