The Arm: Latest Update, or, Wearing the Weasel

At last report, in early May, I was waiting to see a different orthopedic surgeon for a second opinion before committing to the Reverse Shoulder Arthroscopy surgery  recommended by my doctor at Mayo.  The second surgery will "probably" reduce my current pain levels, but even if fully successful I'll still have reduced strength and range of motion in my right arm for the rest of my life.

I saw the second doctor on May 8th, then waited for him to send his recommendations to the Workmens Comp office and to my Mayo doctor.  Then waited until the Mayo doctor got back from an out-of-town trip to have a phone consult with him.  Then waited until my Workmens Comp caseworker got back from her out-of-town trip.  Then found out she needed a second recommendation for the surgery from my Mayo doctor, to reflect that he'd received and considered the second doctor's findings.  So had another consult with the Mayo doctor a couple of days ago, rather more in-depth than we'd done over the phone.

The second doctor also recommended surgery, but the RSA surgery was one of several possible paths he suggested.  Another was to re-do the standard joint replacement surgery I'd had in December, with hopefully better results. And of course the option of learning to live with chronic pain was also brought up.

That last one's not really an option, however.  At this point, pain relief is my top priority.  Rebuilding strength and stamina in the arm come second.  Range of motion actually comes in third.  It doesn't really matter how much range the arm has, when it hurts too much to actually do  much of anything with it.

The degradation in usability and increase in pain that started in late March seems to have not only continued, but even worsened somewhat in the last few weeks.  I still usually manage to get through the days by taking lots of Tylenol and Aleve, but there've been a couple of recent days where the pain was sharp enough and persistent enough that I took half a T-4 (Tylenol with codeine) to get some relief.

Besides taking a lot of analgesics, I try to avoid activities that might cause the persistent ache to turn into sharp stabbing pain.  When I move the arm, I try to move it slowly and carefully.  I try to not lift or carry anything weighing more than a few pounds, or for a long period.  In short, the most effective pain-avoidance strategy has been: Don't do jack with that arm.

An extra hassle to all this has been not just the pain, but the fear of pain, the apprehension that trying to do anything with the arm will set it off.  I'm in a near-constant state of hyper-alertness, constantly asking myself: "How far will I need to reach out with that arm?  Can I do it using my other arm?  Will I have to lift, or squeeze, or twist anything?  Will that hurt?  How badly will it hurt?  How long will it take to recover?  Is this worth doing at all?"  This, above and beyond the physical pain, gets tiring.

I do do stuff with the arm, but nothing heavy, and nothing for an extended period of time.  Even very light work like sorting papers will increase the pain after a while.  When the aching gets intense, I've found I can reduce the recovery time by putting the arm back into its post-surgical sling and letting it rest for several hours.  And one of the few things I've found that I can do for a reasonable length of tie is sit at the computer and keyboard; by resting my right arm on the arm of the chair and bringing the keyboard and/or mouse closer, I can even type or browse the Internet for a reasonable stretch.  (One of the main reasons why you're seeing more postings here than prior to the accident.)

Yeah, something like this.
It's sort of like having a bad-tempered weasel strapped to your arm.  Most of the time the little bastard just lays there and growls; but sometimes he'll have a sudden psychotic break and start clawing and biting.
"Don't do jack" is not a viable long-term strategy, however.  Recovery isn't just a matter of being able to return to work; it's being able to do the things that need to be done in my personal life.  That includes being a caregiver to Hilde, and being able to do the household chores and tasks that need doing.  If I wasn't having the chronic pain, I'd be able to cope with a lot more of that even with a partially-disabled arm.

When I talked to my doctor at Mayo on Friday, he went on at some length to impress on me that there are no guarantees that I'll come away from the RSA surgery with any significant improvement.  I will definitely still have an impaired range of motion, and I won't have as much strength and stamina in that arm as before the injury.  There will "probably" be less pain, but there may still be some pain in the arm afterwards, and there's the possibility of no improvement in that area either.

From the medical articles I've read, shoulder surgery in general is a tricky job.  It's even trickier for a traumatic shoulder injury like mine, and trickier still for a revision procedure to a previous surgery like the RSA would be. I came across a discussion forum for shoulder-surgery patients, and one of the participants whose problems also started with a traumatic injury -- thrown from a horse and trampled -- has had six surgeries and still has chronic pain and little use of her arm.

I don't want more surgery.  I don't want more months of an immobilized arm followed by months of physical therapy.  But if the alternative is to try and live with the current status...

Well, even the hope of improvement is something.

In short, I'm scheduled for the RSA surgery on June 28th.

If the results of the surgery are good, I'll probably be able to return to work sometime in the fall.  If the results are less than good, I may have to start thinking in terms of Long Term Disability (and all the paperwork and complications that would entail).

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