Wednesday, December 9, 2009

Shoulder Update

So I had my consult with Dr. Kwan, the orthopedic surgeon I'm seeing about my shoulder.  For those that don't know the full story, I'll give a bit of a recap:
  • I started having nagging shoulder pain in Jan of 2009; at this time, I was working on my clean + jerk a fair amount, and also working on my handstand pushups, and muscleups.  
  • From memory, there's no specific acute incident that I can recall that triggered anything; I roughly remember bailing on a few muscleups, but that's it.
  • I had been doing Crossfit since Nov 2007, pain free.
  • A potential subluxation/dislocation to my left shoulder happened around Sept of 2007 during Tae Kwon Do, resulting in pain overhead for about two weeks.
  • Since Jan, I have had: Chiropractic adjustments, physio, massage, and ART with no relief.  I adhere to an anti-inflammtory diet, threw copious amounts of NSAIDs at it around April/May, take fish oil religiously, and putting ice directly on my skin no longer bothers me.
  • I have had an ultrasound, multiple xrays, and a contrast MRI.

  • Anything overhead, where the angle of my acromion and clavicle (AC joint) is "closed" (arm straight up) causes pain.  Pushing movements away from me cause pain in the anterior delt region.  Pain during a WOD is tolerable, next day pain blows chucks, and is cumulative.
So what's the scoop now, you ask?

Official Diagnosis (80% official, but I'll get to that in a sec): Bursitis secondary to glenohumeral ligament laxity causing shoulder instability. 

English:  The ligaments holding my shoulder in place are loose, and the "bursa", or fluid filled sac that cushions the joint, is irritated.  Pissed. Steaming mad at Mike for letting it get all inflamed and shit.


So, everything as far as diagnostic imaging has been clear, with the exception of my xrays.  They showed osteolysis of my distal clavical---damage to the end of my collarbone where it had been bashing into my acromion during overhead movements.  Ultrasound of my rotator cuffs was fine, MRI was "clear"---but Kwan stated that even a contrast MRI is only 80% accurate, and I could still have a labral tear or bicep tendon issue.  Bah, wtf.

The Plan

So, the plan is this:  He wants me diligently working on strengthening my rotator cuffs with various mobility drills using light weight.  Like, 5 lbs weight.  Everyday, for the next 30 days.  Supposedly, this will "tighten" up the joint and stabilize it.   I didn't bother explaining that I have a mile long list of rotator cuff exercises that Cory gave me, mobility and thera-band drills that Brian gave me, and specific stretches, both static and dynamic, that Chad gave me, and that I do this at home, while reading, while at work, during warmup, during cooldown, etc etc etc. Nor did I explain I can still do over 40 kiping pullups, bust out 3 strict chins with 90#, and put 185# over my head.  I'm pretty fucking sure my rotator cuffs are fine.  Nor did I point out the ultrasound was clear on those, also.  I just asked "ok, and after that?"  

After 30 days, if there's still pain, he wants to inject cortisone, an anti-inflammatory drug, into the bursa.  My displeasure must have been obvious, because he explained that this would be more diagnostic than anything.  I'm not worried about the procedure, but it's a band-aid solution versus treating the cause, even if it is diagnostic.  All it'll do is remove the inflammation, I'll feel better, I'll start hitting WODs, and shit will get inflamed again.  Not to mention the increasing the risks of actual tendon rupture with cortisone.  But he's the surgeon.  Not me.

AFTER that, he would do an arthroscope to take a look inside the actual joint itself.  At this point, if I could do that myself, I would.  In the year I've had to dwell on my ongoing injury, I've had a fair amount of time to investigate various cases of acute and non-acute shoulder injuries; needless to say, I think the 80% rate of MRI success is bullshit, and going by how "smoothly" my contrast went, I'd say there's more going on than what the picture shows.

I understand why he's being methodical, and I understand I still have a very high degree of function compared to other injured folks, but christ, I just want this damn shoulder fixed.  A resection of the ligaments is a major, MAJOR deal, and I honestly DON'T know if I want to go there.  But a scope would be SO damn definitive for imaging, even if it is invasive---but it could find a spur, a tendon tear, a torn labrum instantly.  Before a ligament resection, though, there's other fixes---like clavicular resection, where they make more space for the bursa and tendons to move so they don't get pinched.  But he's the surgeon.  Not me.

For now, I'll comply with the Doc's orders, 100%.  I start physio again, based on the tentative diagnosis, and aim treatments around that. I'll throw the fucking kitchen sink at it, and I'll keep doing what I'm doing.