11-29 Less Courts, More Hospitals

I have some good news and some bad news.  The good news is that a) I will not be having shoulder surgery and b) I can train again.  The bad news is that I have a labral tear that will never heal.

I have a four week break from attending court, so instead I’m going to the doctor to try to figure out why parts of me still don’t work.  Not that I wasn’t going to the doctor while also going to court, but it was taking a back seat to the legal stuff.

In July, I started physical therapy on my knee and shoulder.  My knee responded well and started improving.  By mid-August I had clearance to go back to most activities.  The same is not true of my shoulder.

I did 4 months of PT with very little improvement.  Currently, I can raise my arm to about 45 degrees up from my shoulder without pain.  On good days, it goes a bit further.  I can force it all the way up, but it hurts.  The same thing happens when I reach across my body.  The PT helped me regain a bit of my range of motion and stabilized the whole thing some, but not enough.  So, my physical therapist sent me to a sports medicine doctor.  The sports medicine doctor wanted more information, which comes in the form of more tests.

Today I had an MRI with contrast dye.  I’ve had an MRI of my collar bone done in the past, but it didn’t have dye. (Did you know there is a joint where your clavicle and breast bone meet?  Neither did I, until I dislocated it.)  Turns out, dye is a whole different set of unpleasant sensations.  To get the dye into the joint, they do a really neat thing with x-ray where they take a series of pictures as they are inserting the needle to make sure the placement is right.  Once the needle is fully in the joint (about 2 inches), they squirt in some x-ray dye to make sure it is in the right place.  Assuming they hit the spot, they then use the needle to inject 20cc of saline solution on MRI contrast dye.  20cc is the equivalent of 20 ml, or a fifth of your Nalgene bottle.  They shoved all that liquid in the joint of my shoulder.  My shoulder is not happy about this situation.

From all of that, the sports medicine doctor learned that what should be a closed system inside my joint is no longer closed.  The dye was leaking out the back of my shoulder joint, which is a clear marker of a Superior Labral tear from Anterior to Posterior or a SLAP tear.  (The other major labral tear is a PASTA tear and these names crack me up.)  Here is what I understand about this.

The shoulder is a ball-and-socket joint, which means there is a cup part on the ribcage side and the head of the humerus is a half-sphere that fits into the cup.  The cup part is actually pretty shallow and covers only about a third of the head of the humerus.  Around the edge of the cup is a layer of cartilage which acts as a cushion to keep from bone-on-bone nastiness and to deepen the cup which stabilizes the joint and reduces the chances of dislocation.  This cartilage is the labrum.

The labrum in the back of my right shoulder is torn, which is why the dye was leaking out.  There isn’t a lot of great options to fix this.  The surgery statistics aren’t great.  I’ve read anywhere from 50-95% recovery rate, but I think that variety is based on the definition of recovery.  I’m using a definition that allows me to return to my normal activities, which involve hanging my body weight off that shoulder.  So, the surgery isn’t a great option.  That leaves strengthening the surrounding muscles until they sort of take over for the labrum.  This is also not a great option, because there aren’t muscles that are redundant to the labrum.

In short, I’m in a bit of an SOL place.  I have a shoulder that isn’t working right and won’t heal on its own.  It is badly enough injured that I will have to be careful and modify my activities for the rest of my life.  It isn’t badly enough, or correctly enough, injured to allow a surgical or other form of repair.  So, I’m just stuck with an effed up shoulder to go with my effed up life.

I’m going to have feelings about this.  Eventually.

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