Bankart repair

The Christmas after Ellie was born, we traveled to my parent's cabin for Christmas.  Since it is only about a half hour away from Brianhead, UT and their ski resort, Joe decided to take me skiing one night.  I had never gone skiing before.  We went and got our skis and started on the bunny hill.  I did not do well.  I fell a lot.  I didn't want to go fast and I was scared of falling.  When I would fall (keep in mind I am 29 at this point, so no longer a spring chicken), I would put my arm out to catch my fall- my left arm, the dominant arm.  That is not the proper way to fall.  Anyway, the first time I fell like that it hurt, and I complained, but Joe was sure it wasn't a big deal and I got up and skied some more.  I fell a few more times.  Another time I fell and it hurt pretty bad on my shoulder, but I was trying not to be a baby and nothing was broken so we kept skiing.  I never got very good and I never enjoyed myself.  My shoulder hurt after that for several months, but not sharp or unbearable pain, just a dull ache. 

Fast forward a year or two, and just doing daily things in our house, and my arm dislocated.  It hurt SOOO bad, and I was immediately able to lift it and it popped back in.  That was scary.  Then over the course of the next few years, it would randomly dislocate periodically- about every 6 months.  I can remember 9 times that it dislocated- a couple times folding blankets, once reaching in the back seat of a car, once driving, once in my sleep, another time while riding a tube on the lake, even once while putting on a sports bra.  Every time it was extreme pain- pain like you wanted to scream out loud and you can't think of anything else and all you can think of is getting it back NOW!.  Most of the time I could just move my arm the right way and it would pop back in.  When I was on the lake, I couldn't, Joe had to pull me into the boat with my arm dislocated and pop it back in.  The last time I dislocated it (last August) I was folding a blanket and it went out.  I started screaming really loud and the kids came running.  I told them to call their dad to tell them what to do.  He told Adam to pull really hard on my arm.  Adam approached me slowly and I said, "no" get back.  It hurt so bad I didn't want him to touch it.  The muscle in my arm was spasming and it seemed more painful than usual.  I suddenly remembered that someone was on their way over to borrow something I had left on the front porch, so I sent Ellie out to intercept her when she came.  A few minutes passed and she didn't come.  Apparently, she had come and gone.  I got the kids to call her and she came back.  It was our old relief society president, so I felt more comfortable being vulnerable around her.  I asked her to help, and she said she thought we should just call the ambulance.  I didn't want to do that.  I told her what to do, and she did it, and it went back in.  Right before it went in, I almost passed out from the pain.  After it went in, it still hurt like it was out for a while, and then was sore for several weeks.  After that, I decided that it was time to get something done about it.

I have a friend who is a PA for an orthopedic practice and she referred me to Dr. Michael George.  He said what I already knew, that I probably had ripped something and that I would probably need surgery.  (Shoulder surgery is scary so I had been putting it off until Nate was bigger and in school).  I had an x-ray done which didn't really show anything.  Then I had an contrast MRI done.  They injected dye into the capsule of my shoulder and then did the MRI to see if there were leaks of the dye.  There were leaks, so they could see that there was a rip.  They then scheduled me for surgery.

I was super nervous about surgery because everyone said that shoulder surgery is the most painful surgery and the recovery was supposed to be just awful.  They went in and saw that I had a rip from 12 o'clock to 6 o'clock on my labrum.  Here are pictures they took.  The first one shows that my joint is normal.  The second one shows my subscapular is normal.  The third that my biceps is normal.  Then in the 4th, 5th and 6th, you can see that the labrum is not normal.  There are spaces (shown by darker areas in the picture), where there should not be spaces.  They told me before surgery that I would have 3 screws put in my bone with wires attached that would secure the labrum to the bone.  After surgery, they said they ended up putting in 4 screws, and that my shoulder was really loose.  You can see the wires in pictures 7 and 8.  The screws and wire are plastic and will dissolve over time.

 

It was an outpatient surgery, I went home shortly after surgery.  One of my big concerns about surgery was feeling nauseous, so I made a big deal to the anesthesiologist before going into surgery.  They gave me an ear patch that mostly helped, but when I woke up I did dry heave for a minute.  I was in pain, but it wasn't unbearable.  That night I took my medications as required and even was pretty pain free when I went to sleep.  I did have to wear the massive sling all the time and especially to bed (see below).  That was a big adjustment, I brought a big mat and several pillows into bed so that I could sleep propped up.  The next day was good, pain was manageable, but I had a hard time reading things, I was seeing spots in my eyes.  We looked that up and found it was from the patch for nausea, so I took that off.  I was still taking my vicodin and nerve pain medicines, but that night I didn't sleep as well because I started to get nauseous.  I had my follow up appointment with the orthopedic surgeon that morning, and totally threw up on the way to the drs.  The pain was manageable at that point, so the Dr said I could stop taking the heavy medication that was making me nauseous.  They also said I couldn't take ibuprofen because it was supposed to hinder healing in the shoulder, so if I didn't want to be nauseous, I was stuck with Tylenol for pain.  They took the bandages off and put on steristrips and that was about it. I made a 6 week follow up appointment.

 

Immediately after my follow up doctor's appointment, I had my first physical therapy appointment.  I still hadn't showered and I had vomited on the way to the appt, so I wasn't in very good shape.  The therapist asked me a few questions, and then had me do some exercises where I leaned over and swung my arm  (think of the action you do when you impersonate an elephant).  I wasn't excited about doing these.  Then she pulled out a special angle measuring tool, and proceeded to move my arm to the limits I would allow and then measure the angle.  That was very painful and unpleasant.  She showed me some exercises that I could do at home, using a cane and my other arm to increase my range of motion, then thankfully let me go. 

 

 After the pain medication cleared out of my system, I felt a lot better.  There was pain most days and usually it was a little worse at night, but usually it was on the level of 2 or 3.  I was supposed to go to physically therapy for an hour 3 times a week, and I usually got in 2 or 3 times.  I also was supposed to practice my exercises at home every day, which I am happy to say I have done. Every.  Single.  Day.   I couldn't do anything with my arm.  The first week, I left it in the sling most of the time, and some of the pain was just discomfort from having it at that angle all of the time.  After the first week, I was allowed to take the sling off if I was at home, but I had to wear it to bed and in public.  After that, I slowly had it off more and more often.  I still didn't use my arm for much of anything, but after a couple of weeks, I started to do a few things like typing and writing and eating.  Simple things would make it hurt, but the pain was never really bad unless I was at PT and the therapist was pushing and pulling on it to stretch it.  That made it up to a 7 or 8 and maybe as much as a 9 for a few seconds at a time.  The pain never came close to the pain that I had when I would dislocate it.  At about 4 weeks, I started using it for a lot of things, but nothing that required lifting.  At 6 weeks, I was allowed to take the sling off all the time.  I slept much better that night.  I started adding in weights to my exercises then too. 
The first few weeks were rough because I couldn't do the things I normally do- or really anything.  I was really fortunate that my parents came to help me out.  They drove me around, cooked dinner, did dishes and helped roust the kids out of bed.  I don't know that I would have been able to do it, if they weren't here to help, that was a big deal for me.  I tried to do things, but every time I did, it would hurt and I would feel bad that I was overdoing it.

Now it has been 11 weeks.  I can do everything that I did before, although I don't quite have all my strength back.  My range of motion is pretty good, I cannot lift my arm straight above my head yet, and that may take many more months of working on it to get it to come back because they tightened the tissue down tight, and I have to restretch it out to get it to move that way.  Normally this is not a big deal, but doing my hair is still a little tricky.  I still have PT, but I am hoping next week I will be discharged from it too.  I think Dr. George did a great job.  His PA is in my ward, and he was helpful all along the way answering questions and making sure that I was doing ok. His wife even brought me dinner shortly after I had surgery. 

The scars from surgery are very minimal.  They did the surgery laparoscopically, and so there are only 3 small incisions in my shoulder.  There were no stitches outside of my body, and so the scars are tiny, just 3 little red lines.  This is them this morning (and I did have a swim suit on, you just can't see it!!!).  The third scar is even smaller and it is on the back of my shoulder.  At first you could feel the stitches under the skin, but over time they have gone away and the scars are completely flat.

Now there is very little pain. If I lay on my left side just so it hurts, and so I often wake up in the morning with a little soreness.  If I lift something really heavy it hurts, or if I stretch really far above my head to stretch the tissue, it really hurts.  I have not had any worries or feelings that I am going to dislocate this shoulder since the surgery (before the surgery, I didn't do certain motions because I was afraid it would go out if I did).  Overall, I would call it a success, but I am mostly just glad it is behind me.  And no, I will never go skiing again.