Joe A Shaw PA-C - 1/13/2009

Question
QUESTION: How long after surgery should I start filling
better I.e. No pain at night, when working, and
relaxing?
Some history I am a 37 year old female who
had a fall in 7-06. This fall I stepped into a
hole and injured my right wrist, right ankle,
right shoulder.  After having x-rays done that
showed no fractures at the time. I started with
my right wrist because that was the most
painful. After seeing the Ortho he splinted my
wrist for 3 wks. I went back still having pain so
I started therapy.  Pt falled and then a MRI
was ordered and that showed I had a TFC
tear. So I had surgery 3months after the fall.
The was repair of the TFC tear and
arthroscopic partial synovectomy, and open 1st
dorsal compartment extensor
tenosynovectomy. So my wrist heal and is
doing great now. So the next thing I focased
on was my right shoulder.  I had an injection
for impingement of my rt shoulder and started
PT. At first I got releaf then the pain came
back so I contued Pt and had a MRI of my rt
shoulder. The MRI showed distal rotator cuff
tendinosis or partial tear.  After having another
injection and going through Pt for 4 months I
had arthroscope surgery. There was no tear
but the doctor did a subacromial
decompression. I have to say I had a great out
come. I was using my arm that week and
working with out pain. I thought arthroscopic
surgery was the greatist thing. So I then turned
to the pain I had in my ankle. My ankle was
still swollen after 6 months of Pt and was
causing me to walk with my foot out ward.  So
after MRI I had arthroscope surgery to clean
up the joint with debridement. I have had a
good result from that I no longer walk
incorrectly which has helped my my back. So
after that long history everything sounds great
but in 7-08 I was attacked by a rottie at work.
So in that attack I had my right arm (bicept)
bitten. In that attack the dog got his jaw stuck
in my sleeve and the owner was pulling him of
me and I was resisting him so I would not fall.
So in the struggle I was pulled so hard my
shoulder started to hurt 3 days later and was
very swollen. I could not use my arm and it
was in so much pain all I could do was cry. I
also had a puncture in the middle of my bicep.  
So having now dealing with workmens comp I
was told that would have to see a different
Ortho than the one who did the first surgery.  
So I went and a new MRI was ordered and it
showed osteoarthritis of the AC joint and
subacromial bursitis and minimal evidence of
partial bursal tearing no full thickness tear.  So
at that time the new Ortho gave me an
injection and 4 weeks of PT. After that I did not
improve so a artheogram was ordered. The
artheogram showed a full thickness tear of the
rotator cuff so surgery was scheduled. I had
surgery in October 2008 to repair the tear. So
when I woke up the surgen tells me that there
was no tear and he can't explain why. He did
remove more bone and cleaned up the bursa.
So hear is the problem I have not gotten any
releaf from the surgery I have taken the Motron
and pain meds like clock work and gone to PT
3 times a week for the last 10 weeks. I had an
injection 2 weeks ago to take down the
swelling.  So I am in pain 24/7 when I am
using it. it  swells and is having sharp pain.
When I am resting the pain is throbing and rule
ach. When I sleep the pain is sharp stabbing
and throbing. I can't lay on my shoulder and if
someone tuches it I have pain run up my neck
and down my arm. One last thing when I use
my arm my whole arm swells and gets week.
This happens after 30 min of work.  So I am
wondering is this something I will have forever
or should it get better with time.  Also is there
another problem that could be going on?  
Thank you for your time.

ANSWER: Janice..Wow that is a lot of stuff!!and a dog attack by a Rot!! You may need to ask for a 2nd opinion from a shoudler specialist...ie a ortho that does about 75% or > of just shoulders. There may not be anything at all that the first ortho did or didnt do and I would stay w him/her as long as you could.

Perhaps the attack caused a cervical disc injury..which can sometimes mimic shoulder injuries..esp if the whole arm aches..throbs etc..

There is also something called brachial plexus stretch syndrome (google) gymnast get this..where the arm is stretched..the brachial plexus is a bundle of nerves that pass through the shoulder jt area. Perhaps this happened during the attack..as you were pulling and yanking fighting for your arm /life. Unfortunatley there's not a lot to do for this other than PT,pain mgmnt,time...but it would be worth looking into?

---------- FOLLOW-UP ----------

QUESTION: Is there a test to check for this problem?  Also the surgen is a shoulder guy
that is why I went to him after the 2nd injury. I may have not stated that I had
a fusion of c-4,5,6 in 2005 after I was in an accentant.  So I asked if my neck
was involved and the Ortho and Pt said they don't think so.  So sense I wrote
to you my shoulder has become swollen and more painful. I am now having
trouble lifting things even at waist leavel. The pain is mainly at the front of my
shoulder and on top.  If I lift something the pain is going down the bicept
which is new for last two days. So I am going see if I can see the doc this
week.  Thanks

Answer
No specific tests really ..it is usually a diagnosis of exclusion and history. (ie exclude other things rotator tear, etc..)
You also may have a bicepital groove tendonitis or tear..this causes pain in front of shoulder and with lifting arm in front of body. I would Stick with your shoulder guy.