Women’s Health Series

My shoulder surgery

In December 2018 I underwent shoulder surgery after suffering pain for 18 months. At the time I thought it was old age but as the pain got worse and started to affect my sleep, I knew something wasn’t right.

My first point of call was an appointment with my GP who promptly ordered an X-ray and Ultrasound. The X-ray was done first and as is my practice (Hey I’m a journalist what can I say), I took a peek at the screen while the technician was checking my details and saw a large white circle that clearly shouldn’t have been there. It was enormous too.

Diagnosis

During the ultrasound I was lucky enough to get a technician who was normally based at a hospital ER. She took one look and said I had Calcific Tendonitis– essentially a calcium deposit sitting in my rotator cuff. This condition is caused when the tendons are damaged or injured and the body tries to repair them by throwing down huge amounts of calcium. Over time this calcium builds up inside the tendons causing massive inflammation and impinging on the joints – the movement of the shoulder relies on all parts working in harmony.

In my case the calcium was starting to lock my shoulder up when I lifted my arm and causing bursitis in the shoulder capsule as the shoulder tried in vain to function properly. My left shoulder also showed a much smaller deposit of calcium.

An appointment with an Orthopaedic Surgeon confirmed the diagnosis and I was told the only option was surgical repair to remove the calcium deposits via arthroscopy and undertake any tendon repairs whilst in situ. Recovery was six weeks in a sling, no driving for eight weeks and extensive rehabilitation physiotherapy. Total recovery and full range of movement would take six months. SIX MONTHS!  This is a major joint that requires careful and systematic recovery.

By December 2018 the pain was so intense, I couldn’t sleep, use a computer mouse and my shoulder was frequently jamming up. So I informed my employer I would be taking extra leave over the Xmas break to get the surgery done.

Surgery – what to expect 

After surgery

This surgery requires an overnight stay in hospital and a visit from a Physiotherapist before you can leave. I was under a general anaesthetic for an hour and my surgeon had to cut both my Bicep and Rotator Cuff. I had 5 incisions in total and the pain was intense.

Before I left hospital, I was prescribed Endone, Ibuprofen and Tramadol, however this combination didn’t feel right to me. I visited my GP the following day and asked for a drug review and I was prescribed Targin.

** Targin is multi-release pain relief which is perfect for sustained pain from orthopaedic surgery. I ended up taking this for 5 weeks along with ibuprofen for inflammation.

Recovery

The pain combined with effects from the pain relief meant I sat on the couch and watched Netflix for four whole weeks. Yes. FOUR. WHOLE. WEEKS!

I needed assistance to shower for the whole six weeks I was in the sling and was unable to dress myself, put on a bra or even put my hair in a ponytail. The risk of falling whilst recovering from surgery like this is high, with only one arm to support yourself and the strong pain relief making you vulnerable. Make sure you have someone to help you.

• I am now at the 3-month mark and am still unable to do up my bra. I have 90-degree range of movement and it will take another three months to get back to full range of movement.
• Organise a stool for the shower and a hand rail
• Be aware you will need to wear different clothing while you are wearing a sling. I wore dresses the entire time as it was easier to dress and undress
• Buy a front fastening bra as it will be months before you will be able to do up a back-fastening bra
• Investigate a shorter hair style as you will not be able to put your hair up or style it for 3-6 months

Pain relief

** All Opioids (Endone/Tramadol/Targin) have major side effects, so they are not for the faint hearted.

Endone is a short acting opioid oxycodone hydrochloride – it kept me awake at night and I couldn’t keep any food down.

Ibuprofen was tolerated initially but after a couple of weeks it made me feel jittery and would wake me up at night feeling like I was having a panic attack.

Targin is the long acting opioid and is considered the best medication for this kind of surgery and was kinder to the body than the others.

The VERY important fine print on pain relief…

• Make sure you get your medication reviewed by the GP if you have issues before you are due to go back to your post-operative surgeons’ appointment
• Opioids are highly addictive. They are on the national Poisons Standard list of Schedule 8 drugs, drugs of addiction.
• Make sure you research all drugs before surgery and ask your surgeon what he will prescribe for you after surgery

About Calcific Tendonitis

Calcium deposits are very common. They occur either due to age or as a result of injury (tennis/golf).However, my deposit was larger than most.

In most people if there is a tendon injury the body will eventually reabsorb the calcium. In the early stages some surgeons will attempt to flush out or break up the calcium in the joint. Some even suggest steroid shots into the joint for pain relief. But these don’t always work and can actually make the situation worse. Neither my GP or surgeon was willing to go down any of those paths, deeming them to be a waste of time.

Just before I had the surgery, I saw a Rheumatologist who diagnosed me with Enthesitis.

Enthesitis refers to inflammation of entheses, the site where ligaments or tendons insert into the bones. Common locations for Enthesitis include the bottoms of the feet, the Achilles’ tendons, and the places where ligaments attach to the ribs, spine, and pelvis. It is a distinctive feature of psoriatic arthritis and does not occur with other forms of arthritis like rheumatoid arthritis or osteoarthritis. Enthesitis can make the tissues in the affected area become ropey (known as fibrosis) or solid (known as ossification or calcification).

During 2018 I had issues with my knee, elbow, ankle and my shoulders. Every ultrasound report said I had ropey tendons.  Not one single GP in the same medical practice picked it up – but I could clearly see a link and sought a second opinion. Lucky, I did. Unfortunately, there is no cure except knowledge that I need to keep a closer eye on things.

What the doctors don’t tell you (and you need to know)…

• I wore sling for six weeks only taking it off for a shower
• Buy yourself a U-shaped pillow to use if you side sleep on your good shoulder
• Get used to sleeping on your back – side sleeping is painful for 12 weeks
• I couldn’t drive for eight weeks because I couldn’t hold my arm up long enough to hold the wheel
• I couldn’t use a computer keyboard until week four
• Find a good physiotherapist before you have the surgery. They will become your best friend and you will be seeing them for six months
• Physiotherapy commenced after my post-operative surgeon consultation. Expect to go once a week in the initial stages and twice a week once rehabilitation goes up a notch
• Expect to be on pain relief for six weeks minimum. Don’t be a hero because you’ll need to start physio at four weeks, and it will be painful
• At the 12-week mark physiotherapy will go up a notch and it will hurt. The shoulder joint has to be worked on consistently to stretch the ligaments back out again. If the ligaments aren’t stretched there is a danger the shoulder will become frozen and you don’t want that
• Invest in a good massage as you start using back and neck muscles that haven’t been used while you were in a sling. We naturally use our neck muscles when trying to lift our repaired shoulder and this can cause neck pain, a massage will work wonders

Last but not least, take up offers of help and understand this is major surgery. Those 5 little incisions belie the extensive work done by your surgeon and shoulder rest is imperative.

As always consult your family doctor if you have symptoms.