Under the Knife Pre-Op

Posted by Allen Rucker in Life After Paralysis on April 05, 2022 # Lifestyle

Anatomy of the shoulderAfter 25 years in a wheelchair, and all the pushing, lifting, transferring, aging, advanced arthritis, and a partially torn rotator cuff or two, my left shoulder finally gave out.

The orthopedic surgeon was crystal clear. “Your shoulder is badly damaged. The tendons holding the ball to the socket are irreparable. They can’t be fixed. The only solution is shoulder replacement surgery.”

The MRI was even more specific: “Massive rotator cuff tear involving the subscapularis, supraspinatus, and infraspinatus tendons with…rotator arthropathy…”

Medicine is not as difficult as it seems if you learn the jargon or have someone you trust implicitly to explain it to you. I needed a second opinion. So I sent the MRI report to my nephew in Charlotte, NC, Dr. Patrick Connor, an orthopedic surgeon specializing in shoulder injuries and recently retired team physician for the Carolina Panthers NFL team for the last ten years.

His response: “You will rock your reverse shoulder replacement. As you know, shoulder surgery is my wheelhouse. I probably do 150+ reverse shoulder replacements a year. Definitely the right choice for you – no doubt…”

A “reverse shoulder replacement,” I quickly learned, is a relatively new procedure that was first developed in France in the early 1990’s and only got FDA approval in the US in 2004. It is also called a reverse arthroplasty. It is employed when there is a combination of severely damaged tendons and the destruction of bone cartilage via arthritis. To keep it short, the surgeon lopes off the ball on the end of your arm and the socket on your shoulder that holds it in place. He or she then reverses the position of both, mounting a steel ball on your shoulder and a plastic socket on your arm. Confused enough? Just know that these substitute cyborg parts will fit together nicely, bypass the now-useless tendons, and allow a big muscle in the area, the deltoid, to provide strength and stability.

I wade into this detail because many of you paras out there, whether you are 30 or 50, have a splendid chance of dealing with the same problem one day. You can partially or completely tear a rotator cuff tendon at any age by simply falling over and sticking your arm out to cushion the fall. I tore one of mine with just a sharp, jerky motion. As for the arthritis: 50% of Americans over 65 have it, and 70% of those over 70. Add it all up, and you got what I got: almost constant pain – dull when at rest, acute in all but about 30 degrees of movement – and an arm so weak I can’t lift a 2 lb. weight over my head.

I, of course, had the option of not having this surgery and trying to keep the arm functional with PT and strengthening exercises. If I went that route, nothing would improve much and maybe even things wouldn’t get much worse, barring the consequences of age, advancing arthritis, and accidents that could increase the pain or weakness. My choice is to do it now and get it over with. It’s like the pandemic or the war in Ukraine: who the hell knows what’s on the horizon? I’d like to face the future with two good arms. In your case: talk to your doctor.

I spoke with a patient of Dr. Connor in North Carolina, Greg Tipton, born with Spina Bifida, who had this procedure some time back. He gave me the hard reality: “Don’t expect your old arm back. It won’t be as good as it once was, but better than it is now.” No pain, still a residual weakness. I’ll take it.

My orthopedic surgeon at Cedars-Sinai Medical Center is a stone pro, vouched for by Dr. Connor. What keeps me up at night is not the operation – it’s the recovery. I’ll be down to one workable limb for three months or more. I know the heavy meds will mitigate the pain. I am still investigating the technology that is going to make my life livable. That might include a rental Hoyer lift to get me from bed to chair and chair to car; a trapeze-type bar over my bed or office desk to pull up with (Dr. Connor says pushing with my left arm is absolutely verboten); and perhaps a power assist for my manual chair for getting around. I’m still a few weeks out, so I plan to be as prepared as possible. I feel like I am about to go down some turbulent whitewater rapids with only one oar.

The post-op report is coming. Stay tuned.

Allen Rucker was born in Wichita Falls, Texas, raised in Bartlesville, Oklahoma, and has an MA in Communication from Stanford University, an MA in American Culture from the University of Michigan, and a BA in English from Washington University, St. Louis.

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