Which shoulder should I get fixed on Wednesday? You are not my doctor...

February 25, 2021 11:02 AM

I've been in physical therapy for pain in both shoulders for about seven months after talking to my Primary Care about persistent issues. Both shoulders were making great improvements until two months ago my right shoulder totally freaked out and I started getting more pain than I've had in over a decade. PT suggested I check in with an orthopedist who ordered MRIs on both shoulders and found issues in both. I have surgery scheduled on Wednesday, which should I get fixed? Lots of details inside.

Here are the details of the MRIs:

Left - Moderate grade partial thickness (5mm) tear of the rotator cuff (supraspinatus). This is likely due to overuse, followed by underuse and bad posture. Surgeon wants to fix this and says it could progress with time and be harder to fix. In talking to my primary care and my physical therapist we decided to avoid surgery and just work on stabilizing the joint, and up until now it seemed to be working rather well.

Right - Torn labrum, labral cyst, and a moderate grade longitudinal bicep tear (which may or may not need fixing, he won't know until he's in there). This all due to a bicycle accident about 15 years ago. Surgeon says that the labral tear and cyst will never heal itself and needs surgery, but they won't progress into anything worse and that the pain I have might flare up occasionally but generally won't progress over time.

I was all set up to get the right shoulder (labrum issues) fixed on Wednesday because the 7 months of PT had been working really well on my left shoulder and I felt confident with it being my only arm for a couple months...then cut to four nights ago: I'm sleeping on my left side, I move slightly and there is a SNAP that is loud enough to fully wake me up. It doesn't hurt at first, but the next day my arm can't be lifted much past my shoulder without sharp pain, and a general ache that occurred without movement. Over the past few days it's gotten a bit better, but still getting some pain when lifting past my shoulder and I'm nervous about it being my only arm for several weeks. Saw my PT yesterday and she recommended that I check back in with the orthopedist who again said that both shoulders need surgery, and that it sounds like the left is getting worse, but it's up to me which I do first.

At this point I'm getting almost equal pain and weakness in each shoulder, but with different motions/activities - reaching up high with the left shoulder, and external rotation and some lifting with the right shoulder. I'm torn (pun intended) as to how to proceed. I'm now hedging towards the left shoulder because the tear can progress, unlike the right shoulder, but I'm dealing with the "I didn't try hard enough in PT or give it enough time" guilt (the PT said that I did try hard enough and she was proud of my progress...but you know...guilt) and the thought that maybe the left will continue to get better over the next couple days and I should do the right.

I guess what I'm asking is - has any one had either and/or both of these injuries/surgeries and have any thoughts? I feel like I'm balancing tons of thoughts, the opinion of an orthopedic surgeon who wants to do surgery on both, a primary care who grudgingly agrees that surgery is needed on the right but dubious of the need for it on the left, a physical therapist who was hedging a little more towards conservative treatment for the left but admitted yesterday that the surgeon is the specialist and should have the final word, and then finally my own indecision.

Oh, it bears saying that I'm right-handed.

Jeez, if you've read this far I really appreciate it.

posted by aloiv2 to Health & Fitness (11 answers total)

In your shoes I would go left - the problem seem more likely to progress if not treated and you have use of the right and it's not likely to worsen. Presumably there will be a period of recovery after surgery so if you're going to have one arm temporarily out of commission its probably better for that to be your non-dominant hand.
If you can get the left to a better place then you can have surgery on the right with a lot more confidence.
posted by crocomancer at 11:28 AM on February 25, 2021 [4 favorites]

I have had many an operation with an orthopedic surgeon. Not on my shoulders though. I would either take the advice of my surgeon or do the right first. You're right handed. Fix that first or not second (both). I will say that I am of the school that try rehab, but if that is not successful in a reasonable amount of time (7 months seems long), then do the surgery.

Or, on preview, what crocomancer said. It depends on your risk tolerance. Do you want to risk your dominant side first or second? To me, another reason to do both.
posted by AugustWest at 11:31 AM on February 25, 2021

I think I would choose to do the less-functional arm first. (So generally I'd pick non-dominant first, unless the injury is such that your dominant arm is the one rendered less-functional).

That way if healing takes longer or you decide to put off the second surgery, at least your more functional arm is still with you. And with that arm you'll get more used to one-arm coping strategies so when you eventually do your more-functional arm, you'll be more used to one-armed life.

Maybe also worth considering- there any way you could line up extra help, do both, and just get it over with?
posted by nouvelle-personne at 12:27 PM on February 25, 2021 [2 favorites]

My dad has had surgery on both his shoulders, consecutively (I think he had one done and then the other like six months later - like he missed a hockey season and a golf season?). It's a very similar story to yours where he initially had problems with one shoulder but the surgeon identified his "good" shoulder as having even more serious problems and so it was decided that he would get them both done. The recovery time was significant and he had to wear a shoulder-immobilizing splint/brace thing, even to sleep. Both times. It was a pretty shitty year for him.

So I think maybe those suggesting "just get them both done!" are underestimating what recovery from shoulder surgery is generally like - I'm sure it depends on the exact surgery but you can't really get two shoulders operated on at once because you wouldn't be able to feed yourself or wipe your own butt for weeks. It would even be hard to do things like standing up and balancing with both shoulders immobilized. So I would be surprised if your surgeon would consider doing them simultaneously regardless.

I agree with nouvelle-personne that you should fix the less-functional arm first. And definitely talk with the surgeon about what recovery will look like in both your best- and worst-case scenarios, and how much use/mobility you can realistically expect to have when you've recovered from the surgery - that might help inform your decision. (Like, if the surgeon thinks there's a high probability that post-surgery you'll have full use of your left arm, again I think that's an argument in favor of doing ol' lefty first, since if you're going to have to rely on your non-dominant arm for a while it would be better to have it in the best possible shape before you have to do that.)
posted by mskyle at 12:59 PM on February 25, 2021 [2 favorites]

Not a shoulder surgery survivor here, but I agree with the primary care person -- the issue on the right is well-characterized, and not improving, and is known that only surgery will fix it. The issue on the left is not well characterized (or at least you haven't made what "needs surgery" means clear -- has new imaging been done?), so I'd see what can be gained with non-surgical intervention there first. Even if only your left shoulder was wonky, a new injury wouldn't send it straight to a surgical solution, correct?
posted by Dashy at 1:14 PM on February 25, 2021

I would do the right shoulder first for the reasons people have mentioned - it's your dominant side, won't improve without surgery. It sounds like you'll need to do the left side sooner than later but better to have the dominant arm functioning better at that point.

I had surgery to repair an injury similar to your left shoulder - tear in supraspinatus plus a bone spur. It was a hard recover - lot of scar tissue, muscle spasms afterwards that required massage therapy and that still cause me problems most of a decade later and are not fixable with surgery so be aware that you may not end up with a total fix. I have a lot less pain and more functionality but wasn't a total fix despite loads of PT before and after.

Also if you don't already have both a bunch of pillows to sleep wedged in a comfortable position (such as that might be) and a shoulder specific ice pack with straps look into it. I was sent home with one post surgery - sounds like you really could use one for each side about now. I'm sorry - shoulder stuff is the pits.
posted by leslies at 1:35 PM on February 25, 2021

Response by poster: Ahh, Dashy, I do see a hole in my data.
When I said he wanted to do surgery on the left shoulder I meant that he wanted to do it after the first MRI, and this latest flareup, whatever it may be, supported his opinion of wanting to do the surgery. The way he's been speaking about it implies that getting it done is not an option, it's a foregone conclusion that at some point he will have to fix this, the question is just when. I think he didn't order more imagery because he's already convinced I need the surgery and doesn't want to make me pay for another MRI. I don't know if he's hedging his bets on which shoulder would be better to do first for liability's sake, or he doesn't want my ire if he makes the wrong choice, or he just thinks that they are equal risk.

As for the non-surgical option my insurance won't approve any more physical therapy (I've been at it for 7 months), though I guess after either surgery I would be back there.
I hope that clarifies.

Thanks everyone for your responses. Though they don't all agree it's just good to have deeper analysis of the situation from folx who have been there.
posted by aloiv2 at 2:10 PM on February 25, 2021

The other thing about this is that they don’t actually know for sure what you need until they get in there. I went in for one thing and came out with a repair for something else. Based on my experience, I think these are the factors to weigh: 1) Are you losing more range of motion on one side? The longer that goes on the harder it is to get back. If it’s your right side then that’s an even stronger argument for doing it first. 2) Is one side interfering with your sleep more than the other? Pain during the day is one thing but pain that keeps you from sleeping has huge health consequences. I would give zero weight to the PCP’s opinion and not very much to the PT’s. It’s been 7 months. Time to let a surgeon look inside.

Get yourself an ice therapy machine and a foam wedge to sleep on. I’m actually a huge fan of orthopedic surgery—they have made huge advances and every time I have something fixed I wish I had done it sooner. Good luck!
posted by HotToddy at 4:15 PM on February 25, 2021 [1 favorite]

The surgeon doesn't know exactly what happened 4 nights ago with your left shoulder, since there isn't any new imaging. If it were me, I would give it a few more days and stick to the right shoulder unless the left gets significantly worse. A lot of weird aches and pains resolve themselves in a week or so, and it's a good sign that it's been slowly improving. It's not a foregone conclusion that the supraspinatus tear needs to be treated surgically.
posted by autolykos at 6:21 PM on February 25, 2021

If this will help you, I had both shoulders destroyed at different times. Rt, three rotators completely torn off, and fully retracted, with the bicep torn off the head. The left shoulder two rotators with massive tears, and the third torn in half, the bicep torn off in a couple of places. The second surgery was more comprehensive, but I started PT one month later, and I PT'd from mid November until Mid February when the pandemic broke out. I am completely as good as new in both shoulders, I healed well, I rake leaves and cook with cast iron, hang my clothes on the line. Surgery works, and rapid start of PT works too, they call it The Moon Protocol. It is not a pleasant recovery, but you do recover and the residual pain is gone. Let the orthopedic surgeon decide how far to go, and you insist you want a full repair. It is worth it.
posted by Oyéah at 8:18 PM on February 25, 2021

Just want to emphasize getting the ice machine: it’s a velcro pad with straps to fit on your shoulder connected to a small device that circulates ice water around the body part. Instead of filling the reservoir with ice cubes, freeze small bottles of water to submerge in the reservoir. You get two sets of bottles and keep one set in the freezer and swap them out when they thaw. Even if your insurance doesn’t cover it, please rent one; it will speed your recovery by as much as 1/3 amount of time. Between us Mr. Serendipity and I have had 5 shoulder surgeries. And please do the left shoulder first.
posted by serendipityrules at 4:57 AM on February 26, 2021