Man down, shoulder overboard!

Let us review a few relevant pieces of information. It has got to be done before we can get down to the good bits that may be useful. Sad but true.

  "If you don't eat your meat, you can't have any pudding. How can you have any pudding if you don't eat your meat?" Pink Floyd

Requirement:

Shoulder Surgery to remove bone from the acromion and repair the rotator cuff.

About the patient:

Male, 61 years of age, physically demanding job with above shoulder height work. Physically active. Right hand dominant. Gorgeous ( not from the doctor's notes but implied).

Mechanism of injury:

"Whilst he was at work he was moving a patient off the operating table onto the  patient bed with all the necessary precautions, when he felt a twinge and pain over the anterior aspect of the right shoulder. He reported this to his employer but continued to work.On the same night and particularly the next morning, he developed significant and severe anterolateral shoulder pain associated with difficulty of elevation of the arm. Particularly troublesome at night."

Tests ordered:

X ray and ultrasound: Xray shows the bone with a bony irregularity on the underside of the acromion. The ultrasound clearly shows a full thickness, full width tear of the supraspinastus.
 As the diagnosis is quite clear no MRI was ordered. Range of motion tests were carried out in the doctors room. There was a full range of motion but with pain.

Other points of note:

Country where this is taking place. is Australia, in the small regional town of Coffs Harbour.
As the injury happened at work, the surgery will be covered by workers compensation.The significance of this last point will be covered in a future blog.

X ray of my right shoulder. The bone at the very top, bright white in the main is the clavicle. The gap is the acromioclavicular joint. Passing over the gap you come to the acromion which is the end of a long bony process that starts with the scapula or shoulder blade.. You can see a small bur of bone on the underside of the clavicle  and some extra bone in the acromion which rubs against the supraspinatus muscle that runs though that gap.

So let's just break this down a little. What does it all mean?

The shoulder is any amazing joint. Your hip joint is a ball and socket joint. There is a lot of stability in the ball and socket joint. Your knee joint is set up for the basic motion of walking. The shoulder joint is almost a flat joint with little intrinsic stability in the joint itself. But look at what you can do with your arms; up high, down low, rotate them, cross over your chest, scratch your back- a huge range of motion. What permits all this is a group of muscles that connect around the shoulder to the humerus. This group of muscles forms the rotator cuff. Over lying that is more muscle, predominantly the deltoid.

If you do too much, muscles fail. Things wear. If you do a lot with your arms through sport or your job it stands to reason you are going to wear out earlier. Age changes structures and in the body, not much gets better with age, let's be honest. 

So without going into a full on lesson into the intricacies and issues of the anatomy of the shoulder and all that can go wrong with it / them, there are failures in the structures. Hey life ain't perfect. Perfect in it's imperfection.

There are plenty of web sites that can cover anatomy and shoulder problems if these interest you. 

But here is the rub,  A study looking at the shoulders of a group of deceased males found 70% had rotator cuff tears. It is thought that tears are just a natural occurrence as a result of the aging process and are often asymptomatic or at least with few symptoms. Therefore unless the  patient is young, is working in a physically demanding occupation and is experiencing undue discomfort, surgery is not routinely required. There are conservative treatment options that can help instead.

At 61 years of age, I am considered young. Hey, that's a bonus. I have had pain and if I get back to it at some stage, my work is physically demanding. I am having surgery. That really is what the blog is about.

One final point I discovered in my search for answers, was the amount of pain a person suffered as a result of a failure in some way of the shoulder, had no correlation to the amount and nature of  the damage. In other words listen to your surgeon and let them tell you what is best for you.