Sunday, October 9, 2011

Shoulder Problems

Sophomore year of high school I went up to block next to our middle hitter (I was a setter for my high school team) and I came down from the block and as the middle hitter came down her elbow landed hard right on the end of my left collar bone.  I immediately crumpled to the ground.  I didn't cry, it stung more than hurt, but I did sort of curl up in a ball for a second.  Play stopped and my mom and the other coaches came over to see what they could do.  I waved them off and said that I just needed to step out and get some ice.

My injury was fairly early in the practice so I iced 20 minutes and felt good enough to go back in and play more. I went home that day and my shoulder felt mostly fine, but I still iced every hour for twenty minutes like our high school trainer had told me to.  I woke up the next day and my arm was on fire.  I threw on a sweatshirt and for the majority of the had my arm slung through the pocket on it, like a make shift sling.  If I kept my shoulder and arm still it didn't hurt that bad and I stuck with the icing regiment as much as I could between classes.

After school I went back to the trainer who had been very busy with football players the day before and asked her to take a look at my shoulder.  She had correctly diagnosed the second degree tear of my MCL (medial collateral ligament: the one on the inside of your knee) the freshman year, so I trusted her pretty implicitly.  She looked at my shoulder for about ten minutes and ran the range of motion tests and pain tests that trainers do and told me that I might have impingement (the rotator cuff muscles interfering with part of the collar bone) in my shoulder because she suspected that my middle hitter's elbow had hit a nerve.  She told me to go see a doctor if it didn't start getting better.

And, for awhile it did feel a bit better.  I'm not really sure why, but about a month later, right as we were going   into districts my shoulder started killing me again.  I had to stop jump serving because it just put too much stress on my shoulder.  I bore through the pain, knowing a doctor would say I couldn't play and the pain wasn't getting any worse, it was fairly constant.

After districts (we were literally two points away from making it to state) but before the club volleyball season started I went to see my general practitioner and requested a referral to an orthopedist.  I saw the orthopedist who had operated on my mom's knee (and thus was a knee specialist).  By this point my scapular muscles (the ones around your shoulder blade) had begun to compensate to allow my shoulder to have semi-normal motion, so most of my pain was in fact in my shoulder blade.  He took one look at where most of my pain was and decided that I just had chronic inflammation of my scapular muscles and told me to take Advil (to be slightly more fair, they did X-Ray my clavicle to see if there were any bone chips).  I tried to explain that there was also an awful popping that happened frequently within my shoulder capsule itself, but he told me that was fairly normal.

Three months later, right as the club volleyball season was starting, I went to pick up my cat with my bad arm and my shoulder popped and I dropped my cat and couldn't move my shoulder afterwards for several minutes.  Needless to say, I went back to the orthopedist and explained what had happened and he prescribed physical therapy (in order to help strengthen my scapular muscles).

I went to physical therapy and the physical therapists of course focused on what the doctors had ordered: muscle strengthening.  They particularly focused on improving my core muscles.  It did seem to stabilize my shoulder enough that I could jump serve again, but my shoulder still tired more quickly and the pain level stayed mostly the same.

I went on like this through the club season and into the next high school volleyball season (I transferred schools in between my sophomore and junior years, so I was starting on a brand new team).  About a month into the high school season my pain got so bad that I could barely move my shoulder again (used my sweatshirt as a makeshift sling again). I went back to my general practitioner who referred me to another orthopedist at a different, but affiliated, clinic.  This doctor looked at the previous doctor's notes, prescribed physical therapy and recommended more Advil.  I pointed out that I had been taking Advil (and other painkillers) for over a year now and asked if it could be dangerous.  I was told that it wouldn't be dangerous unless I did it for years, so I said okay, despite my doubts.  This orthopedist did suggest that I might have a torn labrum (the cartilage of the shoulder) but labrums are almost never operated on or repaired, so I went back to physical therapy.

The physical therapy this time around did pretty much nothing since they were still focusing on the muscles around my shoulder blade.  However, at least my shoulder pain didn't get worse.  It stayed at a mostly steady level throughout the rest of my junior and all of my senior year.  At one point I was walking to physics senior year though and my shoulder popped and I literally no longer could move my shoulder.  It really didn't hurt that much but I could not move my shoulder at all so my physics teacher sent me to the nurse's office where I iced and laid down, which popped my shoulder fully back into its socket (which is when the pain really kicked in).  Also during Prom senior year poor Boyfriend went to sit down during karaoke after the dance and managed to sit on my bad shoulder (I was sitting on a very low bench), which created an experience similar to above but with a lot more pain.  But other than those two very minor, clearly, episodes my shoulder wasn't that much of a problem (part of my problem is I am fucking stubborn and I knew the orthopedists would just send me back to physical therapy)

After I graduated I helped my mom (who had gotten the varsity coaching job at my new high school because of a vacancy) with her C team because her actual coach was completely new to volleyball.  That's when my shoulder pretty much got to the level of barely able to move without pain.  I went back to my general practitioner and got yet another referral, though at least this doctor suggested it might be  impingement and made note of it in my charts, so I went to yet another orthopedist, same clinic as the first time (our insurance only covered certain places).  I walked in and explained my problems and the doctor first recommended physical therapy which I declined immediately.  I then talked to him further and explained they had done an X-Ray when I first came in and that when I saw the second guy he had told me that the X-Ray would be good for 10 years so there was no point doing another X-Ray (I didn't actually agree with that dumbass but arguing with doctors is often futile).  My new doctor seemed slightly shocked at that and asked if they had done an MRI.  I shook my head and my doctor seemed shocked and promptly scheduled me for an MRI with contrast.

I went to my MRI about the week later and Boyfriend came with (it was a damn good thing too as you'll see shortly).  I went into the MRI appointment and they prepped me and explained the process and then promptly stuck a giant-ass needle right in the capsule of my shoulder.  I think I actually screamed, at the very least I blacked out for a few seconds.  I have never felt that much pain in my entire life and I have an extremely high pain tolerance, I played through my shoulder problems, cracked ribs, and a 2nd degree MCL tear.  I then went in to the test my shoulder mostly stopped hurting and they took the images they wanted and I left.  By the time I got out to the car I felt like I was staggering, though Boyfriend can probably confirm I wasn't.  My shoulder hurt so much and after jumping my car (whose battery had died) Boyfriend drove back because there was no way I could manage it with the pain I was in.

I woke up the next day and it felt like my shoulder was out of its socket.  I couldn't move my arm and actually went and bought a sling (it was summer and a sweatshirt wouldn't have been sufficient anyway).  Another week later and my shoulder was mostly back to it's normal state and I went in to have the doctor explain my MRI images to me.  They had already called me to confirm I had a minor labrum tear, but my doctor said it was fairly ambiguous and surgery was not really worth it.  I said that I really wanted surgery I was so tired of my shoulder hurting but my doctor recommended a cortisone shot first to see if it would help me any.  Miraculously it did actually and I went to practice after my appointment and was actually able to hit balls for drills (although my arm felt oddly heavy there for awhile).

A year later and the cortisone was wearing off.  I had gone through my entire first year of college and was able to the physically demanding tasks of loading in and loading out shows at the local theatre and anything else my job demanded of me.  It was great but then the pain returned full force almost exactly a year later.  So, I went into to see my doctor and he said that the cortisone shouldn't have worn off so quickly and that he'd give me another shot but if it wore off in less than two years that I would have to have surgery.  I didn't really care either way, so I went back to college and then only a month later the pain was back worse than it had ever been.

I made a special trip back to see my doctor and he sat me down and ran me through (finally) the exercises the trainer had run me through three years before.  He told me that the tendons in my shoulder were loose, but it was very odd that someone as young as I was would need surgery, but that was how genetics worked sometime.  I tried explaining that it wasn't genetic, there was in fact an inciting incident, and he himself had not noticed any problems whatsoever with my right shoulder.  He said this was just how things worked sometimes and I didn't argue because at least this doctor was taking my pain seriously.  He said that in addition to the loose tendons and torn labrum, I had impingement (you know, like the trainer said in the first place) which had caused bursitis (swelling of the bursa (a cushioning pad)).  So, he scheduled me for surgery in December (it was October, but that was the first time that I could afford to have surgery).

I did my preop visit in late November and then on December 15th I finally had my surgery.  It took a little over an hour (longer than they expected).  The first thing I remember coming out of the anesthesia (which hit me hard) was my doctor saying: "You had a lot more damage in there than we expected".  I think if I had not been anesthetized and with my dominant arm in a sling from being freshly operated on, I honestly would have hit him.  I am not a wimp.  I have an extremely high threshold and it's not like I was making this up for attention!  In my surgery they had tightened the tendons of my shoulder capsule (the process is about as gruesome as it sounds), fixed the bursitis, stopped the impingement, smoothed out my torn labrum, and fixed my surprise rotator cuff tear (30% torn) which is why my surgery had taken extra time.

I took a long time to come out of the anesthesia, nearly two hours, but I went home in a sling and slept (with ice on).  And then woke up and had my parents get me more ice and give me my pain pills and then slept.  I have never been more nauseous in my life either.  The combination of anesthesia and pain pills really took it's toll on my.

All told, my dominant arm was in that sling for two full months.  It was torture in a lot of ways and I still, thinking back, am extremely grateful for Boyfriend's help (especially since I couldn't drive).  I started physical therapy after about a month.  I would go into the physical therapist and he would take my arm out of the sling and slowly, centimeter by centimeter (yes the progress was actually that slow), we began to restore the range of motion in my shoulder.  It hurt a lot, but it was a good hurt.  The physical therapist also noticed something that no one else, myself included, had.  My scapular muscles are trained in a funny way and were extremely overdeveloped.  They had been compensating for my rotator cuff and thus were in near constant pain.

The only scary part of my recovery was when my incision popped open.  I bought steri strips and closed it back up and then at my postop check up two days later had my doctor look it over and he said it was fine.  It took a full two months in a sling but (after four postop visits) I finally was allowed to take it off and then with physical therapy I got the majority of my range of motion back.  I hadn't had that amount of range of motion for years.  Now my shoulder only occasionally twinges and it doesn't pop at all, I have to say it is a truly wonderful thing.  If something is going to be achy in cold weather, it is most likely going to be my shoulder, but at least it's finally better.

Fun Fact #1: I did my first stage management job while I was in a sling.  It was a fun balancing act.
Fun Fact #2: I was pronounced fully recovered the day before I had to start the light hang I was master electrician for.

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