Massive RC tears with pseudoparalysis -- chances of riding again after surgery?

[draftxfan]

The condensed version of this story begins with my slamming into the wall of an indoor, at high speed, at the beginning of March (bolting horse got up a good head of steam and dropped me off on the short side). My left humerus snapped like a twig.

Fast forward from there to the end of May, when my local ortho finally, and grudgingly, agreed to send me for the shoulder MRI I’d been requesting for the previous two months. The scan showed full-width, full-thickness tears of the infraspinatus and supraspinatus tendons as well as a partial-width, partial-thickness tear of the teres minor tendon. The muscles associated with the complete tears were judged to be “markedly” atrophied. Arthritic changes were negligible.

Clinically, I’ve got a severely limited range of motion, with only about 15 degrees of forward flexion and negative 5 degrees or so of external rotation, even after three weeks of PT.

I’ve seen five different surgeons over the past few weeks. The first two wouldn’t even touch the shoulder, the third said I’d be lucky to get back to 50 percent of normal function with surgery, and the fourth and fifth – happily the most experienced and best regarded of the bunch – thought that at my age (fifty-five), we needed to at least give repairing it a shot.

So I’ll be going in for arthroscopic surgery during the first week of August. The plan is to try to reattach the tendons, do some other cleanup, and perhaps release the suprascapular nerve.

I know a few of you guys have come back from massive RC tears – did anyone else have pseudoparalysis? It’s a huge pain in the ass, to put it mildly. I have four horses, two of whom are now in full training; if it’s going to be a year till I can ride again, and/or if the strength of my left arm is likely to be permanently and seriously compromised, I’ve got to downsize pronto. I’d also love to hear specifically from a horseperson’s perspective what recovery from rotator cuff surgery is like. Did you stay away from the barn entirely when you were in the immobilizer? How fragile did you feel when you resumed riding?

TIA, fellow veterans of the RC wars!

[Bluey]

I had extensive repair for a RC tear and also the main bicep tendon was almost cut in two by a spur.
They repaired the RC and anchored some tendons and did sew back together that main tendon.

I had Zu-Zu’s list of what to do, get big panties that go on easy get a recliner and sheets to put on it, because you can’t lay down for a few days, the shoulder block drugs they use paralyze your lung on that side, ice, ice ICE is your friend, get those light pads you can freeze and USE them.

There is a thread about that somewhere here.

I didn’t need any pain killers at all, for a few days took Advil, but really didn’t need it.
Others have had pain with that surgery, you may or not.
I could feed horses one handed but yes, I was cautious not to get around a horse that may bump the very bulky sling.

Very important to do your therapy right off, as they tell you.

I am fine, don’t have any trouble at all, can do anything I want, but I am careful, now I know how easily we can tear something, so don’t overdo it.

I fell a week ago, right on THAT arm and shoulder and I am sore now, hoping it will be eventually ok, but that is because of the new injury, the previous repair was 99% effective.
Age should not matter, my surgery was at almost mid 60’s and no one questioned that being too old to repair a shoulder.

Of course, what is wrong and what they can fix will depend on what the surgeon finds when he gets in there, that is what they told me.

Here is one such thread:

http://www.chronofhorse.com/forum/showthread.php?257316-Shoulder-surgery

[summerhorse]

Ouch, I feel for you! The first time I tore one out like yours my arm fell to my side like it had been shot. After a few minutes I was able to raise my lower arm and hold it against me. Good thing because at the time I had a 50 lb. bag of feed on my shoulder and one arm working! I managed to get that to the shed and put up but it was about 3-4 weeks from then to when I was able to start using my upper arm. I could hold it against me and use the arm from elbow on down so I could write and such but it took several months of self therapy (after having therapist exercises ruin THREE surgeries I am not too keen on them) to get a mostly normal range of motion back. I was not able to hold anything out from my body or hold my arms over my head or bear any weight in those positions, still can’t do that much, after 4 surgeries and 4 tear outs to varying degrees I’m done, done, done with surgery.

Except for moderate pain (that can get severe if I misuse my shoulders, no vacuuming, raking, overhead painting, etc.) I’ve been able to regain most of my normal function even with the failed areas. But if this is your first and you do not plan to go back to heavy lifting (like 50 lb. feed bags, hay bales, etc.) then go for it. Do NOT let therapists force you into exercises that hurt too much. Esp. if you are 6 weeks or more out and it still hurts a lot. I found I did better when therapy was put off for 8 weeks and I gradually weaned off the pillow sling starting about 4-5 weeks and losing it at 6 weeks or so. I had to because I had developed tendonitis in that elbow which was more painful than the shoulder!

I have asthma and fibro so I did NOT have the nerve block after the first time. I could barely breathe and the nerve was horrified by the insult and hurt worse than the shoulder (again) for a few days and took a week to finally calm down. People without these things that I’ve known swear by them. But I kept smacking the poor dead thing against the walls.

[draftxfan]

So I had my surgery last week – a four-hour arthroscopic procedure – and the surgeon felt it went well. He succeeded in getting the severed tendons reattached and did a subacromial decompression but left the suprascapular nerve and the biceps tendon alone. Thanks to the nerve block, I didn’t feel a blessed thing till sometime the following day, and the pain overall has been astonishingly manageable. Now it’s a waiting game, with six weeks of immobility in the pillow sling before I can start any PT at all. (Summerhorse, recent research confirms your experience: early and aggressive PT seems significantly to increase the chances of a retear of RC tendons.)

I had a bit of a scare over the weekend when I began running a fever that ranged from a low of 100.4 to a high of 102.3 (and this despite plentiful amounts of painkillers with Tylenol). Since I felt otherwise okay, I figured one of my incisions must be infected, no doubt with some strain of staph. I called the hospital and the on-call doc covering for my GP and left a message for the surgeon. Took temp again yesterday morning: yep, still pretty elevated, at 101.6. Got to GP’s office and had temp taken again: 97. WTF? Turns out my digital thermometer had gone wonky and was reading consistently four degrees high. The staff at my GP’s office got a good chuckle out of that, since of course I’d invoked the dreaded specter of MERSA…

[charismaryllis]

oh dear! had to laugh, but glad you’re doing better.

[walktrot]

I’ve had a couple of misadventures with my shoulder, starting with a Bankhart repair as a result of numerous dislocations. I wasn’t riding at the time, just volunteering at the local therapy center. Once I was okay getting around I led the horses off the “wrong” side. Several years later a bizarre roll off when my horse fell down on his knees did major damage to the brachial plexus. I have permanent loss of use of one muscle (I think the infraspinatus) and major loss in the biceps and deltoid, right side of course. That was more than 10 years ago, and I still continue to see improvement in the function of what remains. I rode one handed with bridged reins for a while. Now I ride 2-handed but it is difficult to keep my right hand in the proper position. It keeps pronating.

So don’t give up hope if you don’t come back as far as you would like in a short (few months) period of time.

[draftxfan]

Walktrot, thanks so much for that advice. Having done some reading about BP injuries before the MRI definitively diagnosed my RC tears, I
can sympathize with how frustrating your deficits must be. Good for you to have persevered and found a way to ride – that can’t have been easy.

[draftxfan]

I’m five weeks out from surgery now, and while I’ve tested my range of motion only very surreptitiously – as I’m really not supposed to do anything for another three weeks or so – I THINK my RC repair actually worked! I can raise my outstretched arm to about chest height, actively and unassisted, for the first time in over half a year. That may sound like a pretty trivial achievement in the grand scheme of things, but it feels absolutely HUGE to me. I’m so glad I didn’t take the word of the first couple of surgeons I saw, who said I’d simply have to live with the pseudoparalysis: already, with no postop PT at all yet, my ROM is about twice what it was immediately before the surgery (when I’d just been through six weeks of PT). Yay for modern medicine, and thanks most of all to my incredibly gifted and caring surgeon!

[betsyk]

Just yesterday I watched the mom of one of the barn kids lift a water bucket with her right arm and carry it through the barn. Looked more closely and realized it was the shoulder she had had surgery on last summer - almost exactly a year ago - and if you didn’t know that, you’d never suspect she’d ever had a problem. Hope that’s you in a year!