By the time that I reached the point that I sought the help of a surgeon, I was far advanced into the deterioration of my shoulder. I think that in order for you to understand my surgical starting point, I need to explain some physiology of the structures of the human shoulder. I will do my best to stay out of the weeds of Real Doctor Speak, and keep the explanations in plain english.
The way that God made us is truly amazing. There are several anatomical structures that need to be defined at this point in my story in order to keep everyone on the same line of thought. At first glance these definitions may seem simplistic and elementary, but humor me, these definitions are important to keep this tale on track.
- Bones: solid parts of the frame thats give the body its structure. There are three bones that form our shoulder. The upper arm bone called the humerus. The shoulder blade known as the scapula, and the collar bone or clavicle.
- Muscles: only two possible functions 1. pull, tense 2. relax, un-tense (they can not push) there are 4 muscles that attach to the rotator cuff. Their names are not relevant at this point. They job is to do two things. 1. Hold the ball part of the humerus against the socket part of the scapula, 2. help the joint move through most of the motions possible.
- Tendons: strong bands that attach muscles to bones. The rotator cuff is made up of the fused tendons of the 4 shoulder muscles mentioned above.
- Nerves: wires that connect the brain to all the parts. They transit control signals from the brain to the muscles and feed back from the muscles to the brain.
My MRI showed a complete tear of the rotator cuff. What we call the rotator cuff is the broad flat tendon that attaches the muscles of the shoulder blade to the ball at the top of the upper arm bone. Its job is very simple; to transfer the pull from those muscles to the arm bone. Since the other end of this tendon was still attached to the muscles, and all they can do is contract, once the tear was complete the end of the rotator cuff had retracted over the head of the upper arm bone (Humerus). One of the unfortunate results that occur when muscles are released at one end is that they get used to their contracted length and are difficult to re-streach if you need to reattach them. This makes the surgical repair of this rotator cuff more complicated especially when, as in my case, this retraction is long standing. Not only does the surgeon need to stretch the tendon back to position, it needs not to be so tight that it will pull through the stitches that attach the tendon to the bone for the months required for healing.
Another unfortunate result to muscles that are detached or are disconnected from their nerve connection, is that when they are not loaded they loose their fitness, get flabby and even can undergo irreversible conversion to fatty tissue. This had occurred in the three muscles on the back of my shoulder blade two to a moderate level and one severely. While this piece of bad news will effect my eventual recovery, it has no bearing on the surgical repair.
My MRI also showed two other complications that would effect and complicate my surgical repair. My Biceps tendon was also involved. and there were boney projections that had grown into the space where the muscles and tendon move snagging the movement and constricting the functional space within the joint. These damaged structures would need to be felt with in the surgery procedure.
All of these issues put together made the surgical process about as high as it gets on the difficulty scale. It took an arthroscopic Rembrandt to pull it off. I am so thankful that God led me to my surgeon!
In the next post I will discuss an supplemental anesthesia procedure that is currently recommended in this type of procedure and its potential side effects.