What to do for a torn rotator cuff shoulder injury?

[sailgersor]

Finally got to see an orthopedic surgeon upon approval of health insurance company that takes 25% of my husband's gross pay to provide. The injury occurred from a slip on the ice on my own property in January. Xrays showed no fracture other than a dislocated shoulder which was relocated. The MRI finally taken two weeks ago showed what is called Torn rotator cuff injury of my right shoulder. The surgeon says it is inoperable. Being right handed, I am left with minimal arm motion. I can barely sign my name or feed myself, now needing assistance with bathing, dressing, meal prep, housework, yard and house maintenance, etc. I have been using a cane for stabilization on uneven ground when walking and was told to use it with my right arm for the bad left knee. Also have 50% tear of crucxate? ligament of my left knee needing a knee replacement not arthroscopic surgery.
I have been given no recommendation for PT, surgical or medical treatment other than stomach stapling to loose weight. There is a thing called a diet and excercise, but rest and decreased activity was recomended for the 6 herniated discs in my back. I was handed a prescription for a manual w/c and narcotic pain killers from the orthopedic surgeon who did not do a hands on manual exam to see what range of motion, strength, and usage still might exist.
So where do I go from here. Some interesting observation u all might want to know. For ease of grooming, I had my hair cut very short and did not color it since November of last year. I cannot wear my normal clothes and or shoes/boots so had to start dressing like an old lady now--velcro tennis shoes, pull on sweat pants, no income from work, so no manicure or pedicure. I cannot cut my own toenails because the right hand does not work. I can barely feed myself left handed. In these last few months, I have been treated like I am grey-brained instead of grey haired. Have been targeted as a potential victim of violence when walking to my car. Cannot drive my pickup truck or motorcycle or ride my bicycle.
I will take any suggestions short of using my firearm on myself.
I have already been turned down on round one for SSI or SDI. Now am looking for a lawyer. Had to sell my van just to pay short falls on bills this month. My husband is working 1 fulltime job and almost a 2nd full shift. I am trying to coordinate my errrands with possible free meals at friends homes or soup kitchens. Have hit as many food banks as possible to stock up. Have no children or family on my side to help except for one 70+ cousin who can handle car maintenance but will not move out of his assisted living facility to help me. My hubby's siblings are all to busy taking care of his mom, and their grandchildren because of babymommadaddy drama. I have hit all my friends up for favors, rides, and cash and now the well is running dry. I can still drive because I can now walk to my car about 20 feet from the door so I can get to places I need to get to.
Basically, the docs have all told me I will never work again and can look foward to a w/c existence. So where do I go from here.
Lisa from NJ

 

[CVORNurse]

Lisa, is there any way you can get a second opinion? At least maybe a different doctor can recommend exercises or PT to help with the ADLs(activities of daily living to non medical like hair brushing, feeding and stuff like that). Some doctors just do not exhibit compassion or caring, it seems to be a class many skip nowadays.

 

[summerthyme]

ABSOLUTELY a second opinion! And while this is going to probably sound racist to some, try to find a doctor who isn't Muslim or MidEastern. Their ingrained prejudices against women tend to make them pretty bad when a woman needs help. I was very nearly crippled by an Iranian neurosurgeon- not because of anything he did, but because his first surgery failed and he COULD NOT admit he wasn't God. Add that to his certainty that ALL American women were bored housewives who simply needed to find a hobby (I was a full time dairy farmer and mother of four at that time), and he was dangerous.

He finally grudgingly agreed to do another myelogram, saying snidely "if it's normal, it's normal. You're just going to have to go home and find something to keep you busy" (like 4 kids, 50 cows, a few horses, dogs, cats and chickens weren't!) And then, when the tests showed a 75% compression of my spinal cord, he scheduled emergency Saturday morning surgery, but never apologized. He DID say I had about a 50-50 chance of ever walking again.

Three years later, hubby was his patient, with severe sciatic pain. HIS myleogram was normal. The SAME doctor said "well, just because it didn't show something doesn't mean you don't have a serious problem". Hmmm... something REALLY wrong there.

Anyway, while you're trying to find another doctor, start writing down what you're thinking, and what you need to ask. NUMBER ONE: WHY is it "inoperable"? You mention weight loss... if you are so heavy that surgery under a general anesthesia is highly dangerous, well... rotator cuff surgery is considered "elective". That means it's not life or death... and the doctor may feel the risks of operating are much too high for the potential benefits.

I can't say I've heard of doing a knee replacement for JUST a cruciate ligament tear... if there are other serious issues with the knee joint, yes. But one ligament? Something odd there...

So, you need to ask WHY they won't operate. What sort of PT could help. What weight you need to reach before they consider surgery safe enough to do.

And, seriously, you need to at least consider the stomach stapling, if you are truly obese. Because while it won't help the shoulder, it may well help the knee and spine... it's rather amazing how many people find they no longer need "necessary" surgery when they lose a lot of weight. If you truly haven't been able to lose weight while carefully following a GOOD diet, surgery might be an option.

But it sounds like first you need to find a good doctor. A doc who doesn't even check range of motion, etc is NOT doing his job.

Summerthyme

 

[Oldironboy]

I have rotator cuff problems as well that I need to deal with sooner or later. I have found many youtube videos on the subject including many PT videos. You may find something to help.

 

[tiger13]

I would definitely get a second opinion on the rotator cuff surgery. I have had both shoulders done, the left shoulder. the right done twice although not successfully, but in it's case only because workers comp waited too long to do the first surgery, and the second was a failed attempt was to try to fix it. The left was a tear that was fixed, then I fell and caught myself while falling and re tore the repair, I never had it fixed as I did not have insurance to get it done. The all can be fixed IF you get to them before the tendons and muscles have a chance to shrink down too far. Then they cannot stretch they back far enough to do the repair, or if the shoulder joint is deteriorated from age and there is not enough good material for them to sew to when they make the repair. It can be done.

 

[KMR58]

I tore mine 18 months ago. I put off going to the doc for about 4 months thinking it would get better but it just got worse and worse. Finally went because I couldn't sleep it hurt so bad and almost zero range of motion left. Very stubborn I am. Anyway ended up with 4 months of physical therapy, 1 hour, 3 times a week. I still get a twinge now and then but no other problems. I'm a chef so it gets a daily work out. I don't know where I'd be without the PT. certainly wouldn't be cooking like I do.

 

[sailgersor]

Finding an excellent surgical team in an excellent medical center with minimal infection rates and other factors that promote negative healing factors was a full time job for the last few days having to work within the confines of participating doctors within my lousy insurance. I talked with friends, friends of friends, relatives of friends, friends of all my relatives on both my and my husband's side. I spent at least 12 hours burning up cell fone minutes but had over 5k in rollover minutes on my monthly plan. I decided to go for the best of the best in NYC. Their chief of knee surgery operated on a friend of my husband's first wife. After lengthy conference calls with me, my family doctor, and them, I was finally referred to the team of the best NJ hospital in Newark. Their head guy has a very nice resume and is known to some doctors and other medical professionals that I know. I am an RN altho I have not worked in institutional nursing for 15 years. I have cared for my aged parents, my inlaws, and other relatives to keep them out of nursing home warehouses. Basically, I coordinate the homecare of various relatives and friends.
I can still drive, walk on flat level surfaces with a cane and my custom prescribed shoes, and deal with all the cr*p that comes with managing rental property which is my only income other than my husband's jobs. I try to keep track of all the stuff that needs to be dealt with because my hubby doesn't open mail or charge his cellfone. We fell from a 6 figure income from 9/11 to a base salary of 1/4 of that. The property tax is supposed to be funded by the rental income assuming the tenant paid it. He still expected heat and hot water this past winter. Yeah, right!!!! And I allow pets. Every week in the local weekly paper, the classified rental adds of which there are 200 to 300 mostly all are no pets. One apartment is occupied by a girl who has not been here in more than 5 years--best tenant a person could have. The other guy will be put out by the sheriff on the last day of the month if he does not come up with all of the rent owed me. And I am following all the rules of eviction in the state of NJ, the judge said so two weeks ago when we went to court for the final time. I did all the legal work myself.
The particular medical diagnosis is "R shoulder--with large full thickness tears involving the supraspinatus and infraspinatus tendons both of which exceed 3 cm in length and are associated with medial retraction of the musculotendinous junction to the level of the AC joint......" as it reads from the MRI report which is something. The Left knee is "Chronic complete tear of the posterior cruciate ligament....chronic ACL tear and undisplaced oblique tears of the medial and lateral meniscus..... " with something about "SUBCHONDRAL sclerosis and 8mm lateral subluxation of the patella indicative of past traumatic injury..."
Basically, the R arm and L knee along with 2 broken ankles and 8 herniated discs. And there is no one to sue to get lots of money. The final straw was falling on the ice on property I own. Throw into the mix, getting hit by a car when I was 11, bicycle/car collisions, motorcycle/car collisions, me vs the stairs/bathtub in my house. I also fell off a cliff when 19 rocking climbing in Wyoming, fell off horsey in 1995 in Montana, and ground vs me when trying to land successfully when parachuting and hangliding. I have also done alot of other stupid stuff involving trees, rocks, and porch roof at various times when I was a kid. When the railroad police bring you home because you were riding on the roof of a commuter train at the age of 14, you know I was not the type to play quietly in my room. And I was an only child who graduated high school in the top 5%, went to a state university nursing school, got my EMT training, lots of other college in things I was interested in, earned a MS in geriatric nursing, and held the night shift head nurse position at a maximum security state prison until injured in a riot. I was a part time civilian records clerk in the town police dept while in college. I worked many different part time student employment positions with my hometown government.
And thrown into all this mixture is recent event memory loss from accumulated concussions/head injuries. I would not consider myself safe to be employed and/or responsible for someone else other than my cats or dog at the present time. Having enuf trouble taking care of myself.
I am trying to build up a large stock in the pantry/food stores over and above what we have on hand from foodstamps, couponing, trading and accepting what other people don't want as long as it is not trash. We have a 50 X 50 area of yard that is usable for gardening. The house and car parking take up the rest of our not so suburban city lot. We live in what is called a trolley car subdivision of Newark, NJ. This house was purchased by the maternal grandparents on a factory worker's salary. It is pre WW I construction and not attached to anything else. We lived without a car all my young growing up life until I was 18 and got a car and motorcycle. Everything one needed was walking or bus/rail commutable and within reach. My dad and mom met in childhood growing up, went to highschool together, then Dad went off to the military WW II, Mom did wartime industrial work and suprise, I came along by accident in '59.
So there is my life story.
I am still investigating the rehab possibilities with no answers or recommendations yet. I have many appointments in the next 2 weeks. My arm hurts and am loosing functioning and range of motion. Am doing passive ROM. I am not diabetic as of 2 weeks ago. I have more blood work scheduled for Friday. I am taking every single xray and mri along with medical reports/summaries with me whenever I leave the house just in case.
For info I am about 300 lbs with most of the excess gained in the last 5 years. While the temptation of junk/convenience foods is there, my problems is steady decreasing ability to do the physical activity I have done in the past. The dog is the only reason I am doing any walking of any distance. She needs to go to the park everyday the weather is dry. There is no fence around the yard. Doggy is a westie, she looks like the little white dog on the can of Kalcan dog food. And my alarm clocks are my 5 cats who think that when the birds start chirping around 440am that it is time to get me up. The cats do not know how to use a can opener, and they have dry food.
The reason for this lengthy post is that there are some injuries that cannot be solved with the book "where there is no doctor" and my dental problems are solved with barter. My dentist is semi retired with an apartment bldg that needs managing, painting, garbage collection, etc. He only does fillings, dentures, and extractions. Has no full time employees. Works when he wants to or when someone calls in pain and needs him. If anyone in Northern NJ needs budget oriented dental care and doesnot mind antique dental equipment circa 1950's, email me. He will work with you on the fee and has given credit also. I have never seen what I would call malpractice on his part. He does not do anything fancy or take insurance. No anesthesia other than novocaine.
Lisa R from NJ

 

[summerthyme]

Sailgersor... I'm not quite sure where you're coming from... I sure didn't see anyone here suggesting that you find your answers in "where there is no doctor"!!

And absolutely, when TSHTF, there WILL be people who are permanently crippled/severely disabled who can NOW find answers and solutions through the miracles of modern medicine.

I do have to say that given what you've posted, bariatric surgery MIGHT well be a potential lifesaver for you. Spinal problems especially do very poorly (and get increasingly more painful and debilitating) with extra weight... as little as FIVE POUNDS extra in your belly puts a TON of strain on the lower spine.

Certainly, you need to make your own choices, but if I personally was in your position and had health insurance, I'd probably seriously consider a bariatric procedure, and then look at whatever could be done to "fix" the knee as much as possible.

Being able to walk better without pain (and when you limp from problems with your legs, it throws your spine out of alignment and causes more problems... both hubby and I are all too familiar with this type of domino effect) will let you be more active, which can improve your mental outlook as well as making you feel better physically. And if your shoulder seriously can't be repaired (I suspect it CAN be, but that the chance for a "perfect" outcome isn't good, and some doctors don't want to take that chance, because they know too many people will sue them), you're going have a real problem handling a wheelchair.

I hope none of this comes off as cold... it's not meant that way, but more as a dispassionate assessment of your best chance to regain some control over your health and not end up unable to even care for your own physical needs. I think you CAN get some real improvement, especially if you can lose some of the weight which is both making physical therapy difficult but which is almost certainly actively damaging your spine, knees, hips, etc...

It won't be fun or easy. BTDT, too... But in the long run, it should be worth it. You'll be in my prayers.

Summerthyme

 

[sailgersor]

"Where There is No Doctor" and "Where There is No Dentist" are good books along with EMT and Paramedic training that can keep most physical problems at arm's length along with preventative medicine, lifestyle changes, and a really good first aid kit. But when you have had as many injuries as I have thru the years along with conflicting medical advice from different "Specialists," one tends to get somewhat pissed off at the whole medical establishment. Proper blood work and tests along with nutritional/diet analysis will determine whether Bariatric surgery will even work. Those results are not in yet. I have seen a less than 50% permanent weight loss among the people I know who have had it done over the last 20 years. And who knows what is will do to one's ability to consume enuf protein and vitamins from the food they eat to encourage healing if I even have surgery. I see the orthopedic team this weekend, Physiatrist and rehab team on Friday, and get the stitches out of my gums from teeth extraction a week from today. I managed to avoid spinal fusion surgery 3 years ago with pain management center and much PT 3X weekly for a year for the 6 herniated discs in my back. Throw arthritis into the mix also. I originally wrote to this section of TB2k to share how demoralizing and depressing physical ailments can be. I also suffer from a thing called life, and sometimes it throws crap into the mixture of my life and can be very depressing which can be crippling itself. BTW my name is Lisa Rogers, female, 52, no kids, one husband, one mom-in-law, one west highlander terrier 9, 2 male and 3 female cats in a 3 family house over 100 yrs old. I voted for Ron Paul in the last primary. We have not had this years yet. And we want to move to New Hampshire but will take North Dakota, Wyoming or Montana if my hubby can find a better job.
Lisa from NJ

 

[colonel holman]

I am a Dr of PT specializing in musculoskeletal problems like yours. Everything Summerthyme has told you is right on. I could not add to or correct anything she said.

 

[Grammytomany]

Good Luck. Summer has given wonderful advice to all of us. I had a broken shoulder in two places with a chunk of bone out of the rotator area. They told me surgery wasn't a good idea as so many do not work well. BUT...I had PT and I faithfully did all of the exercises they gave me to do and within 5 months can almost do everything as I was before. Not all. But most. So, good luck and know that you CAN do what you need to do.