Shoulder Surgery 2009

[Tommy T]

In my Taos reports this year, I was not entirely candid with respect to certain physical problems.  In fact, in a spooky replay of 2008, I tore the rotator cuff in my left shoulder in early January (in fact, my first visit to my Texas orthopedic surgeon was exactly one year after the first visit in 2008.

This time it was caused by a snowboard wipe-out followed by a violent self-arrest.  On my fifth day at Taos, I dropped in on a steep alternative entrance to Stauffenberg on a modest wind-packed surface.  I was cautious and attentive on the entrance which was 50 degree steep and pretty technical with a fair amount of exposed rock.  Upon joining the main line of chute (which I had done as my first Taos run on the first day), I probably relaxed my concentration a bit, caught the down-hill, heel-side edge and ended up head-down, on my back, moving rapidly down a 40 degree slope toward a rock butress.  An ice climber in this circumstance could back-flip to a belly-down/head-up position and virtually simultaneously apply ax pressure to stabilize and then stop.  I was afraid that a back-flip would cause the board to bite in and start a tumble.  (In fact, during the two weeks of snowboarding allowed at Taos in March of '08, a snowboarder was killed in Stauffenberg as a result of uncontrolled tumbling most of the way down the chute.)  So I rolled first to a belly-down/head-down position and spread-eagled my arms to slow my descent rate.  That worked a bit and I continued by leaving my left arm spread out but tucking my right arm in so I would rotate counter-clockwise, as seem from above, which, even if the rotation wasn't completed and/or I still couldn't stop in time, would place my board, rather than my head or kidneys, toward the butress.

The manuever worked.  The process of turning itself cause a significant drop in my slide rate and I used the (now dowh-hill) board to complete the stop.  However, my left shoulder disapated a lot of the inertia and was seriously tweaked by the action.  Reminded too clearly of the year before, I stopped at the Whistlestop Cafe and evaluated my situation.  I had full range of motion with the left arm, just a lot of pain.  I seemed to have full strength in my grip and in tricep tension but increased pain in bicep tension.  That was quite unlike last year when there were some motions I just couldn't do and whole arm/hand combo felt very weak.

I continued to ride that day and all days thereafter.  I protected the arm a bit, but used it as needed.  It hurt me some but not the way the one at Sun Valley did.  Finally, in March after a fairly strenuous week with my Son and his family, it was really aching at night and I went to a Taos orthopod.  He diagnosed tendenitis and brusitis, scheduled some P.T. and said it might be a small tear but probably not.  P.T. hurt and didn't help.  In fact, it made the ache at night worse and seemed to be inducing a little stiffness (swelling?).  The season was over and we left Taos, went through big Bend and then my Daughter and I went to South Africa.  There we did little tandem ocean kayaking and a bit of surfing.  The kayaking was OK because all the action was at or below shoulder level and involved movement through pretty small angles.  Surfing was bad news and I stopped after just a couple of waves.  Problem was with the swimming motion.  It killed me to do a crawl stroke.  Even breast stroke involved full extension and a pull down and out.  Side stroke really doesn't cut it in even small surf.

So I went to the surgeon here in Texas, got an MRI and got the news.  Two tears.  Good news is that both are pretty small; bad news is that one is a rather rare tear in the sub-scapularis muscle (most rotator cuff tears are in the super-spinatus and I have one there too).  Last year I had super-spinatus completely severed from the bone and have stuture anchors to hold the repairs in place.  That won't be needed this year.  Unfortunately, the sub-scapularis is difficult to get to and the incision will be longer and down the front of the shoulder, sort of heading toward the left pectoral.

Surgery is tomorrow at 10:30.  P.T. will be long because the therapists will have to be careful to use exercises that work each of the injured muscles without doing damage to the other one.  "Long" probably means the end of September which is about when temps down here get back into a reasonable range for motorcycling.  I can live with that.

I can hold and play my trumpets and cornets with just my right hand.  Flugel can wait a month until the left arm can take a static weight.

I probably won't get a lot pressure from my wife to weed the driveway in the hot Texas Sun and that sort of thing.  Silver linings.

Tommy T.

Edited to corrrect the anatomy.

[atruss]

Sorry to hear you are going in for another procedure, but I'm glad to hear it won't interfere with your Jackson Hole trip.

Not weeding the driveway in Texas heat is definitely a silver lining; possibly gold.

Good luck tomorrow Tommy.

[surf88]

Good luck with the procedure and recovery.

That self arrest sounded exciting.  Thankfully the consequences were'nt bigger.

Just curious if you would recomend the technique?  Why I ask is: I took a class on snowboarding steeps in JH about 14 years ago and they actually taught us that you wanted to be head first on your belly and dig your board in with your toe edge to arrest and to avoid going into a ragdoll tumble.  The instructor said he had used it in Corbetts.  Nothing about the practice feels comfortable or safe if your sliding towards rocks, but I have used it when not around rocks and it works.

[Tommy T]

I practice self arrest at least a few times annually and I arrest in the real world pretty frequently.  I have practiced the manuever as described and did it pretty much automatically without a lot of thought.  I was on wind-pack on a steep slope and headed for rock and didn't do a lot of analysis.  Mainly, I wanted to save my head if I couldn't stop.

I agree with your instructor that all else being equal, you should brake with the highest part and the board is your usually your best tool.  But, going down head-first seems inherently dangerous and I would almost never manover from a head-up to a head-down position.  On your back, head up-hill, knees bent 90 degrees and feathering the heel edge into the surface is my preferred position.  Even in a full skid, you can actually move left or right across the slope while still sliding to avoid exposed rock or whatever.  And, if you hit something, the board takes it first.

Sounds like a good subject for a Master's Thesis in winter sports.

Tommy T.

[Dsmith3232]

Good luck Tommy

[Tommy T]

Good luck Tommy

??

With the surgery, with the Master's Thesis or with my next self-arrest?   

I've finished my first week of PT.  Surgery went pretty much as expected.  Three more screws (for a total of nine -- pretty soon I won't be able to get through the metal detectors at the airports) and an incision which actually is almost a mirror image of the one from last year. 

From my point of view, some good news is that the orthopedic surgeon thinks that the tears probably started on a bone spur and he has smoothed up the edges on the shoulder socket as part of the surgery.  He thought the same with the really uncaused tear last year.  This is good news because it means that the tear is not due to age related stiffness or deterioration of the tendons nor is it a sign that I am losing flexibility due to neglect of stretching.  It also relieves me of some unarticulated guilt that my reflex self-arrest wasn't good judgment or properly executed. 

For the time being, the PTs and I have some explicitly prohibited movements because the complexity of repairs to the tear, across two tendons, has caused some serious tightness that is aggravated by anterior rotation.  That's the movement you make when you reach out to close the driver's side door on your car.     The orthopod said working it now might rip out some of his nice neddle work and admitted that not working it now could mean reduced movement in the future.   I'm in the process of doing thought experiments with all my canoe and kayak paddle strokes, telemark pole plants, hand checks on steep walls or waves and the variety of rock climbing holds and pulls that I need for my usual range of activities.  It turns out that a fairly serious list of movements are put in jeapordy, including high and low paddle braces and the hand checks. Those two directly affect the most important of my sporting activities. 

My therapist knows me, my body's response to pt  and my rehab work ethic from last year.  I am going to specifically discuss this with her on Monday and see if she can give me some comfort that the ultimate restriction will be only a few degrees of motion -- not any restrictions on activities.

I practiced trumpet for the first week with my feet up on a stool and resting the bell on the horn on my knees.  I am free of the sling now and as long as I keep my elbow in, I can hold all the horns properly.  Keeping the elbow in isn't perfect posture for breathing and chop to mouthpiece alignment and it restricts my movements a bit, but I can practice to my heart's content and that is keeping my mood up pretty well.

Tommy T.