Reverse Shoulder Replacement TSA to Reverse Replacement

[kjhines]

Hi everyone. I had my TSR w/ a stemless humeral component on October 19, 2022. Post op I was put in an immobilizer and told only passive movements and to not start PT until 6-7 weeks. I have an ice machine with compression and it’s amazing, using it a few times a day.

This was my 8th surgery on this shoulder and I was doing really great up until 3-4 weeks post op. My tricep area began to hurt and my elbow started to ache horribly with numbness and tingling in my last 2-3 fingers (I had paresthesia only prior to the surgery). My AC joint and SC joint ache and have started popping pretty frequently with simple things like relaxing my shoulders after sitting down or moving my neck to the side (my AC joint popped before due to some degenerative changes but not like this). The GH joint feels clunky at times too with what little motion I am doing. Sleep is a total nightmare and it’s impossible to get comfortable enough or to find a position where my hand/fingers don’t go numb.

I have been on heavy narcotics for my shoulder for a couple of years now, wearing a fentanyl patch and taking 10-20mg/day of oxy for breakthrough pain. We weaned down to take the patch off prior to surgery and I have been able to stay off of it. But, I am still having to take about 25-30mg of oxy per day at 6-7 weeks out due to how severe the pain is. I had really hoped to be almost completely off the heavy meds by now.

Due to the holiday and my surgeon being booked I couldn’t get in sooner. But, I see her next Friday and am a little worried about what is going on. I was so excited when the pain was basically gone in those 3-4 weeks and now it’s back with a vengeance in a different way. The arthritis pain is still gone and for that I will be forever grateful.

I am only 41 years old and was really hoping this would give me my life back. Is this normal? Has anyone experienced this? Should I be concerned?

 

[djklaugh]

@kjhines Welcome to BoneSmart! I am so sorry to hear you are having such pain in your new shoulder! Was there anything that happened at the 3-4 week post op time period that seemed to trigger these symptoms? And which shoulder got the TSR? Have you started any PT yet? If so what did the PT person say about these problems?

You mentioned having had 7 other surgeries on that same shoulder -- if you can give us the dates of those and what kind of surgeries they were we can include those in your signature.

While it is not unusual for new joints to make clicking noises it does seem to me (not a doctor or a nurse) that what ever is going on for you is not in the "usual" range. I am glad you have an appointment with your surgeon coming up soon!

As for the sleep problems 00 sigh 000 been there, done that. Do you have a reclining chair? I found that worked pretty well for me after each of my shoulder replacements with a pilloow under the affected arm and one behind the shoulder. You might also try icing the shoulder more frequently.

 

[kjhines]

Nothing out of the ordinary happened that I can think of at that timeframe. Maybe a sudden movement but nothing that jumps out.

It was on my right shoulder. I have not started PT. My doc said wait until 6-7 weeks and with the increased pain I wanted to talk to her first before going.

Oh man, my surgeries were a very long time ago when I was aged 16-20. First one in 1996 and last one in 2000. I had 4 arthroscopic capsular shifts for multidirectional instability and 2 open procedures with a torn subscapularis, multidirectional instability and bankart procedure.

I do have a recliner and a bed with an adjustable base that has been helpful but it’s just impossible to get comfortable.

I don’t wear my immobilizer unless I leave the house because of how bad my elbow hurts and how intense the numbness gets when I wear it, so I keep it propped on pillows while sitting and laying in bed.

I will try icing more. It is a go to and I love it so it can’t hurt.

Thanks!

 

[Jaycey]

@kjhines Welcome to BoneSmart! So sorry you have had rough start with this recovery. I hope things start to ease quickly.

Ice is a natural pain killer. It will help ease any inflammation that is causing the pain.

Please keep us updated!

 

[kjhines]

Just home from my appointment with the surgeon.

New x-rays found that my humerus was slightly raised within the joint compared to the X-rays taken 10 days post op. My shoulder was also torqued anteriorly on physical exam.

Surgeon was concerned about my subscapularis being torn. Luckily, she had another doctor in the practice who utilizes MSK ultrasound and he was able to do one on my shoulder while I was there. Unfortunately, it was confirmed that my subscapularis is fully torn.

The surgeon ordered a CT Arthrogram to formulate a new surgical plan to see if it is repairable and what our options are.

Pretty upset.

 

[Jaycey]

@kjhines So sorry the news is not good. At least you got a quick diagnosis. Please keep us updated. We'll be here for you!

 

[kjhines]

Found out this afternoon that I will be having surgery this Friday to repair the ruptured subscapularis tendon.

I was thankfully able to speak to the surgeon on the phone and she stated the repair needed to be done ASAP. The more time we wait the more the tendon will retract and scar over making it more difficult or impossible to repair.

She still wants the CT Arthrogram scan done and due to the urgency of the issue her assistant was able to call and get me squeezed in on Thursday. Happy for that because I wasn’t able to get in until December 20.

The plan is to repair it by suturing and anchoring it down again. However, if the tendon is irreparable or only partially repairable then a tendon graft would be done using the pec minor or lattisimus.

I’m devastated. Really nervous. The thought of having to go through another open procedure surgery is making me anxious as hell. I understand that it needs to be done in the hopes it will heal properly this time so that I’m not facing a reverse replacement but I’m scared this time and that’s a first for me.

 

[djklaugh]

@kjhines I am so sorry you are having to go through this! But you are fortunate that your surgeon and his assistant are able to make things move forward so quickly for you. Truly it is amazing in this day of long waits for nearly everything medical for them to get the CT scan AND the surgery on the schedules so quickly.

From what I know of shoulders and tendons quick repair is the very best way to help a good outcome!

Very best wishes to you and do let us know how you are getting along.

 

[Layla]

Aww, I am sorry to read this and I sense your anxiety. I am sure you will be in good hands and resting comfortably at home before you know it. Please stay in touch and let us know how you're doing. Wishing you comfort and peace of mind.
@kjhines

 

[kjhines]

Long story short: I had a TSA with bicipital tenodesis done in October 2022 and it failed due to a fully ruptured subscapularis. A revision was done in December 2022 to repair the tendon. I struggled for almost a year with constant pain and not being able to do simple things like plug something into an outlet or reach and open a door. I was completely unable to build any muscle in my deltoid and could not regain my strength or range of motion back. I kept working at PT and it just never came back. The surgeon sent me for a CT arthrogram which revealed another almost fully torn subscapularis along with a minor tears in both the infraspinatus and supraspinatus. So, my options were to live with it or get the reverse done. I chose the reverse because I could not live like that anymore.

I am exactly 4 weeks post op. I have not started PT yet and am doing light pulley and ROM work. I feel pretty okay during the day as long as I take it easy and wear my sling most of the time but the nights are absolutely brutal. Far worse than the previous 2 surgeries were. In fact, this recovery has been way more painful than I mentally prepared myself for. I know it’s my 3rd surgery in 12 months but damn.

I am having severe, deep aching clavicle pain, tricep area pain and pain that even goes down into my forearm and hand. It’s so bad I haven’t slept for more than an hour or two in a couple weeks and I am typing this at 3am out of sheer frustration.

I understand my soft tissues are a mess and ticked off from everything over the last year but this is beyond anything I could have imagined. Wondering if anyone else has experienced this and if it was just temporary or a sign of something more serious. TIA!

 

[Jaycey]

@kjhines What are you taking for your pain and how often? Are you icing your shoulder?

You had two major surgeries in a very short space of time. That whole area is very angry from all the trauma. I know it's very frustrating. But I think you just need to give this time to calm down.

Can you contact your surgeon for alternate pain medication?

You will notice that I merged your newest post with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

Please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we will get it changed for you.

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[CricketHip]

@kjhines I came by your recovery thread, hoping to see an update on how you are doing.
I know you are going through a tough recovery, which can make it difficult to type, but am wondering how things are going for you?
Hopefully the past ten days have given you some improvement!!