Shoulder Surgery for Rotator Cuff Tear and Calcific Tendonitis – My Story

This is the story of my journey through shoulder surgery.  I’ve been helped by many such stories, so I thought I’d try to give back by sharing my own story with some tips and recommendations.

Background

In early 2010 I yanked a bag out of the overhead compartment of a plane and felt a sharp pain in my shoulder.  I didn’t do anything about it thinking the pain would go away, which it did over the next couple weeks.

A little over a year later I realized that the range of motion of my right shoulder and arm was much less than my left.  There wasn’t any pain, I simply couldn’t move my arm behind my back like I should be able to.  I went to the doctor and after an MRI with contrast I was diagnosed with frozen shoulder.  Basically since I didn’t do anything for the original pain a year earlier, I subconsciously didn’t move my arm through the full range of motion to avoid pain, so it “froze” in the injured configuration.  A cortisone shot and three months of physical therapy restored near full range of motion.

Six years after that I began to notice increasing pain and limited range of motion (limited more by pain than a physical stop) in that same shoulder.  After another MRI with contrast and an ultrasound I was diagnosed with calcium deposits.  Apparently when a tendon is injured the body will sometimes replace the tendon tissue with calcium.  It usually realizes the mistake and reabsorbs the calcium (which is actually a painful process).  In my case that wasn’t happening – the calcium was increasing.  I’ve always known I had issues with extra calcium, be it from needing to have my teeth cleaned every three months to issues with my eyes to even the multiple very strong baby teeth I still have.  It’s one reason I stay away from dairy when possible.

I lived with the pain for a couple years but it has had an increasing effect on my workouts and general living.  Anything that puts strain on the shoulder, be it pull ups, push ups, planks, even downward dog in yoga, has become very painful.  In mid-2018 I saw the orthopedic surgeon and we agreed it was time to remove the calcium deposits.

Preparing for Surgery

I knew that the surgery itself was arthroscopic and wouldn’t be too bad, but that the recovery would be tedious – though with a high probability of success.  My wife had had a much more difficult shoulder surgery less than a year ago to fix a very rare condition where the rhomboid muscles detach from the scapula.  In fact, there are only a couple surgeons in the country that perform that surgery.  So I knew from helping her what life would be like with a sling, how difficult sleeping and daily activities would be, and how long physical therapy would take.  Her surgery was successful, by the way.

Since I was over 50, a battery of lab work was required to ensure I could safely undergo surgery.  I had had surgery before – strabismus surgery to correct an eye alignment issue – so I knew I tolerated full anesthesia well.  I had an EKG, chest x-ray, and blood work done at a local medical center, which was then reviewed and signed off on by my primary care doctor.  All looked good.

I spent the next couple weeks working on tasks and projects around the house that required two good arms since I knew it would be several months before I’d be able to do them after surgery.  Cleaning up the garage, doing some gardening, and so forth.

A week before surgery I had my pre-op with the surgeon where he verified that my lab worked good, fitted me for a sling (one of the large ones with a pillow to keep the arm several inches away from the chest), went over the details of the surgery, and gave me a couple prescriptions for pain meds (Oxycontin and Naproxen).

A couple days before the surgery I picked up the two prescribed pain meds.  I also set up the bed for sleeping upright.  Many people choose to sleep in a recliner, but I thought a bed with a tall wedge pillow and a “pillow fort” around me would be better.   I also plugged in an iPhone/iPad charger with a long enough cord so I could use it in bed, cleared off the night stand, and so forth.

Surgery

My surgery was scheduled for 1pm, with arrival at the surgery center at 11:30am.  They expected that I’d be released around 3:30pm.  No eating OR drinking after midnight, so we had a nice big dinner out the night before.

The surgery center is about a half hour drive from my house so my wife drove me and planned on running errands while I was being worked on.  I wore elastic-waist shorts, which I’d end up wearing for a long time since buttoning/snapping/etc would be nearly impossible.  I also wore a button-front shirt to make it easy to get dressed after surgery.

I was checked in, taken back to the prep area, changed into a gown, and an IV was started in my left hand.  I’m fortunate that I have huge veins with very little fat on my hands so that was a piece of cake.  The nurses each verified that I was having my right shoulder worked on.  The surgeon came in and also re-verified this, signing his initials on that shoulder.

We went over the surgery plans again, and he mentioned the anesthesiologist would give me a choice of full heavy anesthesia, or lighter (but still full) anesthesia but with a nerve block on my right shoulder and arm.  The advantage of the nerve block is that anesthesia could be lighter which could lessen nausea, and it would also keep the surgical area completely numb for 12-18 hours which is the most painful period.  Seems like a no-brainer so when the anesthesiologist stopped by I opted for that.  He did say I’d already be sedated before he used a needle to deliver the nerve block, so I wasn’t concerned.  I’ll tell you more about the nerve block experience in the next section.

I was wheeled into the OR at 1pm sharp.  The cuffs around my ankles were connected to a machine to apply pressure so I wouldn’t get blood clots.  The sedative was added to the IV, and that’s the last thing I remember before surgery.

I woke up pretty groggy with the nurse and my wife trying to get me to sip some apple juice.  I did, and remember that there was very little pain – just a lot of pressure on my right shoulder.  I was already dressed with my sling on.  They helped me go to the bathroom (apparently a full two liters of fluid was pumped into me!).  By 4pm we were on our way home, and I crawled into bed (upright!) by 5pm.

The surgery took a bit longer than expected because, in addition to the expected calcium removal, they found and removed a bone spur, cleaned the labrum, and repaired a partially-torn rotator cuff.  So much for a quick recovery – rotator cuff repairs apparently take a lot more PT.

Since I hadn’t eaten since midnight I was pretty hungry, but the effects of the anesthesia caused anything in my mouth to dry out.  It seemed like I couldn’t drink enough to keep crackers from creating a cement-like mixture in my mouth.  But I got a few down.

Week 1 After Surgery

The first night was rough, very rough.  Not because of the pain, but almost because of the lack of it!  The nerve block, which sounded great initially, started to freak me out.  Imagine your entire shoulder and arm feeling like your mouth does when it’s numbed for a tooth to be pulled, but for 12+ hours.  I’m somewhat claustrophobic, so having no feeling in such a large part of my body was disturbing – especially in a very tired state.   Next time I may opt for regular anesthesia instead.

The nerve block wore off somewhat suddenly around 5am, and I downed a couple oxycontins and a naproxen.  It took about an hour for those to kick in, and they made me pretty drowsy so I actually dozed off for a couple hours.

I spent most of the first day wondering if I had done the right thing.  30 days in a sling sleeping upright felt like it was going to be a nightmare.  Did I really have sufficient pain to warrant surgery?  Yes I did, and it was only going to get worse, but at the time I was second-guessing myself.

The pain meds were very effective – I never felt much pain.  I did feel like there was a heavy brick on my shoulder though!  That was from the big compression bandage, as well as the large amount of fluid pumped into the shoulder to open it up to make surgery easier.

The second night was better.  I took the pain meds right before I crawled into bed for the last time, and they made me drowsy enough that I fell asleep for a couple hours.  I made sure to have pillows and a yoga bolster on both sides so I wouldn’t slump or roll either off the bed or onto my bad shoulder.  “Better” still meant being up most of the night though.

The second day was fairly productive, and I even got in a short walk.  I was eating normally, but noticed that, as I was warned, the pain meds were slowing down “the pipes.”  A little Dulcolax resolved that.

I tried typing and doing some small movements with my right hand, but after a few minutes my arm and shoulder would start hurting, so I decided that was a bad idea.

The third night was easier, thanks to a tiny sliver of Xanax, maybe 0.1 mg.  Just that small amount relaxed me enough to sleep almost through the night.  That morning I took the last dose of pain meds and have had very little pain since.  Being on pain meds for just over two days feels pretty good to me.

I was also able to take off the heavy compression bandage on the third day, which was a huge relief.  I could then finally see the four sutured cuts for the arthroscope instruments – two more than they expected thanks to finding the bone spur and rotator cuff tear.  All looked good so I put simple bandages on them for a few more days.

What was a bit more freaky was the bruising down my arm and especially bicep.  This continued to get worse for a few days, but I had read online that it was normal.

The next few days became increasingly easier.  I was able to type and do office work by the end of the third day, do some small house projects, and by the sixth day I even took a shower instead of a sponge bath – though I did cover the stitches.  I am allowed to have my arm hanging at my side for brief periods.  Showering with one arm takes some creativity, but isn’t too hard.

The sling is a bit of a pain, but I was getting used to it.  As requested on the post-op instructions, I took my arm out three times a day to do “pendulums” – just leaning over and swinging my arm in circles with no active muscle movement.  This is important to avoid scar tissue buildup, which will limit range of motion.  I did notice that the range of motion was pretty limited, especially in the upward direction, but I had been told to expect that.  After I started walking longer distances I found my arm would sweat quite a bit in the sling, but it can be easily washed.

I started driving short distances a day after I took my last pain pill.  Some docs will say to wait until the sling is off, but others say it’s ok to drive short distances with an automatic transmission as long as you’re not on narcotics.  Since it’s my right shoulder, fastening the seat belt is a bit of a chore and the twisting hurts a bit.  I also find that using just one arm can be fatiguing, so it will be short distances for quite a while.  I’m in a small coastal fishing village of just 10,000 people, so driving isn’t exactly difficult.

Holding any kind of weight your surgical side hand is difficult and not a good idea, even with the arm in the sling.  Even a coffee will cause some pain the first few days.  This became easier toward the end of the week, perhaps too easy as it’s still not a good idea since you need to protect the arm and shoulder.

I also started walking a lot to get back up to my 10,000 steps a day.  I had spent the last several years getting into pretty good shape and I was worried that the surgery would kick me off track.  I knew my upper body strength was going to suffer from several months of recovery, but I want to stay in as good of shape as possible.

One key event of note was bumping into (thankfully not literally) someone on the street who said he had had the same surgery just two months ago.  He was out of his sling and moving his arm, though he was still working on raising it higher than his shoulder.  Talking to someone who was on his way back to normal was a big motivator.

My first followup appointment was on the seventh day after surgery and went well.  The stitches were easily removed and I was reassured that the bruising was typical – and actually less than normal.  Apparently sometimes it spreads across the chest as well.  A prescription for physical therapy was also called in, to start in a couple days.  I was told to expect 3 months of range of motion therapy followed by 3 months of strengthening therapy.

Ending my first week I’m not excited about three more weeks in a sling, sleeping upright, and months of PT.  But since I am sleeping better I feel I can get through it (like I have a choice…).  The pain has been minimal and I’ve been able to return to my work – though I’m lucky to work from a home office.

Week 2 After Surgery

PT started on Monday, which was the 10th day after surgery.  I had a couple places to choose from, both with great reputations, but one was known for having the same person working with you the entire time, each time while the other moved you between stations with different therapists.  I chose the one with the same therapist as I figured the relationship and continuity could be important.  So far I think that was the correct decision.

The first session was primarily an assessment.  Filling out forms, the PT person reviewing my situation and analyzing my pain and range of motion, and then assigning some initial exercises.  The initial exercises were (twice per day):

• continue the pendulums
• curls to move the elbow, taking care to keep the bicep close and in line with the side of the body
• wrist movements – up/down, left/right, rotating clockwise/counterclockwise (forearm twists)
• hand grip and splay (spreading the hand as wide as possible – just as important as grip!)
• neck movements – up/down, laterals, rotating

She then explained that my good shoulder (and back, and pec) has probably been compensating for my bad shoulder, even if I didn’t realize it.  I also explained that I have always had very tight hamstrings and would like to continue stretching those while avoiding any stress on the shoulder.  The same with core strength, which I had worked hard at building up over the last few years.  So she added the following that are somewhat unrelated to direct PT on the shoulder:

• left (good) shoulder doorway pec stretch
• bending hamstring stretch with the leg on a stool, using the good arm to hold onto something for balance
• crunch with no upper body movement
• body weight squats, taking care not to tense the upper body

This particular PT place is affiliated and actually inside a large gym, so we added a couple items to keep my strength up where possible:

• Calf raise machine
• Leg curl machine (appropriate weight to avoid having to grip the machine or tense the upper body)
• Leg extension machine
• Leg press machine

I discontinued the leg press as I immediately realized that I tensed my upper body and shoulders.  Squats will have to do for now.

I am also using the recumbent stationary bike to get in some cardio, being careful with the tension to avoid having to flex and tense the upper body.  A regular stationary bike usually requires gripping the handles so that’s probably not appropriate at this time.  I find stationary cardio machines immensely boring, even with music or TV, so this is a tough one for me.  I still prefer long walks, trying to keep over 10,000 steps each day.  I did 16,000 steps on day 10 after surgery and that was a bit much – even in the sling my shoulder was jostled a bit too much and ached.  Icing fixed it fast, but I dialed back the walking a bit for now.

PT sessions were scheduled for 3x/week – Monday, Tuesday, Thursday.  The above exercises are on my own, so in the PT sessions she works on moving some of the smaller muscles around the shoulder, back (both sides), and arm.  Then she pushes the range of motion of the arm and shoulder, taking note of how many degrees of movement I can get – and then pushing ever so slightly more.  This is uncomfortable but not painful.  The last 10-15 minutes of each session are for an electric stimulation (electrodes placed around the shoulder, current applied, feels like a very light electric shock pulsing the muscles) combined with ice.  Very relaxing, and I usually nod off a bit.

Week 3 After Surgery

What has amazed me is how long the bruising has lasted.  At 16 days after surgery my arm bruise is slightly better, but still very dark.  I’ve asked about this and done my own research and it is apparently normal, and I won’t have a long-term discoloration that I’ll have to pass off as some kind of botched “wave tattoo.”

The incision wounds have healed very nicely and, in fact, are barely visible.  This photo is right after I got out of the hot shower, so they are more pronounced.  So I probably won’t have any nice big “shark bite” type marks on my shoulder – so much for a great surfing story!

PT continues, with no new exercises added.  I’ve started to take a shower almost every day so I do my first round of exercises in the shower first thing, then I do the second round in the evening when we’re watching some [usually mindnumbing – I’m not a TV person] TV.  Icing is always a good relief, especially in the evening when it relaxes me prior to going to bed.

Sleeping has become easier – perhaps too much so.  I’ve tried just using a couple thick pillows instead of the wedge but have found the angle doesn’t allow my arm/sling to hang right, so I wake up with some aching.  I’ve skipped the sliver of xanax several nights and will probably discontinue that completely in the next day or two.  I still haven’t taken any pain meds since the third day or so after surgery.  Amazing.

Probably the biggest thing I’m noticing is that even with the walking and handful of gym exercises, I’m just not active enough to balance out even the reduced calorie intake, so I’ve put on a couple pounds.  I’m looking at taking some more carbs out of the diet, more straight protein, and starting to up the walking a bit more.  Yes, the recumbent bike is probably the best solution, but I get bored out of my mind after just five minutes.  It’s actually the only place I get bored – I can be happy in a white (padded?) room with just my thoughts.  But put me on a recumbent bike and I go insane.  I did start back up on the handful of supplements I take.  Some of them, like fish oil, can thin the blood so I was told to stop them prior to surgery and for a couple weeks after.  I definitely noticed the difference not taking my tumeric supplement.

I’ve also loosened the sling a bit, especially around the waist.  It’s starting to look a little frayed on the sides, and the fuzzy material (to allow velcro to attach) does a great job of catching crumbs, hairs, and dirt.

I need to fly to Dallas (two flights, longest is 3.5 hours) at the beginning of week 4, so I’m starting to think about that.  I’m traveling with a couple coworkers, so they can help with my bag (which will be small anyway – just a 3 day trip).  I’ve reserved seat locations so that my sling is not on the aisle side, and is between me and my smallest coworker to avoid annoying others.  If I’m lucky my/our upgrades will come through and it will be a non-issue.

Week 4 After Surgery

The bruise is still there, but finally starting to fade.  The incision points are nearly invisible, which is almost disappointing.

PT has been going very well, though it does create some pain.  The sessions usually begin with a review of the exercises I do on my own, my pain level, and so forth.  Then she does some work on my back while I’m sitting up, then I take the sling off and lie down and she pushes the range of motion.  External rotation is definitely the most constrained (about 25 degrees now) and also the most painful as she pushes it.  Internal rotation is near normal, and up/down is at about 90 degrees which isn’t too bad.  This is all passive – I go limp and she moves my arm.  The last 15 minutes of each session is spent connected to a STEM machine with a cold ice pack, which does a great job on the pain.  I’ll usually ice at least once more a couple hours later.

What has been interesting is what she says about my “good half” – nonsurgical shoulder/back/arm/neck.  They have been compensating for my painful side for years, and are also being stressed by the sling creating asymmetrical forces.  So she spends a lot of time on that side loosening muscles and removing knots.  I definitely notice it in the neck exercises (rotation, left/right, up/down) she has me do on my own.  Lots of crackling and popping, which is a bit disturbing.  This should go away, especially after I stop using the sling.

The sling came with a ball to work on grip strength.  Something my PT mentioned is that everyone works on grip strength, but you also need to work on “splay” strength – spreading the fingers.  So I bought a finger extension exercise band and it’s working well.

I have a three-day business trip this week so that will test flying.  A TSA friend said that I’ll be able to go through the normal scanner if the Pre-Check lane is open, but if it’s not I’ll have to go through the full body scanner that requires everything to be removed and my arms over my head – so I’d have to be manually wand checked.  Shouldn’t be a big deal.

The sling comes off in a week.  Just in the past week, perhaps from basic healing or the PT or probably a combination, I’ve felt a lot more comfortable and confident when the sling is off in the shower.  I guess that confirms it’s about time.  I’ll probably keep the sling (or sling without the abduction pillow) on while sleeping, although I’ve found I move very little.  I’ll also use it while traveling to help people avoid bumping me.  Getting dresses is easy, even with zipping/buttoning jeans which was impossible a couple weeks ago.  Tying shoes is still nearly impossible, but I’ve long been a fan of Olukai slip-ons.

At the gym I’ve added the leg press back in, so getting some good lower body strength work in.    I can do crunches with a slight shoulder raise without any pain or stress so that’s helping the core.  Hoping to start doing back extensions soon, then maybe side crunches in another couple weeks.

Month 2

You’d think I would be excited about removing the sling, which the doctor confirmed I could do 4 weeks after surgery.  Up until two or three days before that date I was excited.  Then I rapidly became apprehensive, and from my reading this is apparently common.  The sling was protective.

So when that day came, I kept it on until my PT appointment later in the day.  She gave me some pointers on what to do and not do, which amounted to “protect it in crowds and from rolling on it at night, but everything else is ok as long as it doesn’t cause sharp pain.”  Pretty simple.  Also – don’t lift anything heavier than a cup of coffee for the next few weeks.

The sling came off at PT, and for the next several days at least I’ll wear it at night (not a chore, since sleeping had become fairly regular and comfortable).  I also put it on if I’m going to be in a crowded area and might get bumped.   But I do go to the store and out for walks with it off.

My shoulder ached quite a bit the first few days with the sling off.  It just wasn’t used to the movement.  But this became easier and easier.  I ice more with the sling off than with the sling on, and it helps.  I also notice that the arm is extremely weak.  In fact, for some of the exercises I need to use my good arm to hold and move my right arm because it can’t even support itself!  After three days I already notice a LOT more movement.

PT is rough.  In addition to the inactive movements the PT now has me help a bit – semi-active.  Pushing those few extra degrees is painful – but not sharp pain.  Just a stretch pain.  It is rewarding to see the movement increase ever so slightly each time.  More home exercises have been added, like sliding the arm along a table both in front and to the side, using a light stick for the good arm to move the right arm up and over.

Range of motion is returning quickly in various directions, with the exception of external rotation.  That will be the slowest recovery.

The bruise is also clearing up rapidly, perhaps because moving the arm is getting blood flowing better?

By the end of month 2, 8 weeks after surgery, I basically have full range of motion in all directions!  There’s perhaps a bit more that can be done when rotating the arm behind the back, but other than that I’m very happy.  The pain is also completely gone, as is the bruise.  I had a followup visit to the surgeon during week 7 and he thought I was about two weeks ahead of where most people are at this stage.  I’d like to chalk it up to great PT, but the mechanics of what was done in my shoulder, as well as the surgeon’s technique, is probably more important.

Strength is a different matter.  I’ve followed my PT’s instructions to not add any weight to my exercises, and I notice that my bicep is fatigued after only a few reps of light curls.  But I’m confident that will come back.

I was struggling a bit to do all of the PT exercises every day.  As I started to feel more back to normal it became harder to remember to do them.  So I’ve gotten in the habit of going to the nearby gym first thing each morning and getting the PT exercises out of the way, as well as doing some strength work on other parts of the body.  This new habit has accelerated my recovery.

Month 3

Going to the gym every morning has made all the difference.  During month 3 I did not focus on real strength, but just flexibility and movement.  I did several exercises with the cable machines, such as inner and external rotation, then up/down, side, and front.  This seemed to both strengthen and add range of motion to the shoulder in all directions.  I did it for both shoulders just to stay consistent.

I also added quite a bit of core work – abs and back especially – to get those moving again.

By the end of month 3 I really didn’t have any signs that I had a significant surgery.  There is no pain, and range of motion is probably 95% or so.  The only time I can still feel a little stiffness is when I lie on a roller (along the spine) and spread my arms out and down to the floor.  This has become a really good stretching exercise, doing several sets with the hands coming together in four different configurations – palm/palm, back/back, side/side, etc.

Month 4

This will be the last entry unless something significant occurs as I basically don’t know what else to write.

In Month 4 I began to add weights to strengthen the arms, and that strength came back very fast.  By the end of month 4 I was very close to the strength for biceps, triceps, shoulder press, bench press, and so forth that I had been at before the surgery.

I’m trying to remember how limiting the pain was before surgery, but really can’t.  There is no limiting pain now.  Range of motion is at least as good as it was before the surgery.  Strength is back.

Onward.